Evaluation of the Ability of Physical Therapists to Palpate Intrapelvic Motion With the Stork Test on the Support Side

Background and Purpose Clinical indicators of pelvic girdle dysfunction are limited. However, research has shown that the pattern of intrapelvic motion is altered during single-leg support in subjects with pelvic girdle pain (PGP). Functionally, no relative motion should occur within the pelvis during load transfer, whereas anterior rotation of the innominate bone relative to the sacrum occurs during weight bearing in the presence of PGP. The aim of this study was to investigate whether the pattern of intrapelvic motion could be detected reliably during a new clinical assessment test for functional load transfer: the Stork Test on the support side. Subjects and Methods Three physical therapists were randomly assigned to palpate the motion of the innominate bones and sacrum in 33 subjects during the Stork Test on the support side. The direction of bone motion was indicated on 2-point and 3-point scales. Results When a 2-point scale was used, intertherapist agreement on the pattern of intrapelvic motion occurring during load transfer showed good reliability (left κ=.67, right κ=.77), and the percentage of agreement was high (left=91.9%, right=89.9%). A 3-point scale resulted in moderate reliability for both the left and the right sides (left κ=.59, right κ=.59), and the percentage of agreement decreased to 82.8% (left) and 79.8% (right). Discussion and Conclusion The ability of the physical therapists to reliably palpate and recognize an altered pattern of intrapelvic motion during the Stork Test on the support side was substantiated. The ability to distinguish between no relative movement and anterior rotation of the innominate bone during a load-bearing task was good. Further research is needed to determine the validity of this test for detecting pelvic girdle dysfunction.

[1]  P. Hodges,et al.  Evidence of altered lumbopelvic muscle recruitment in the presence of sacroiliac joint pain. , 2003, Spine.

[2]  N. Bogduk,et al.  The Sacroiliac Joint in Chronic Low Back Pain , 1995, Spine.

[3]  D. Beales,et al.  Altered Motor Control Strategies in Subjects With Sacroiliac Joint Pain During the Active Straight-Leg-Raise Test , 2002, Spine.

[4]  W. Gilleard,et al.  Altered patterns of pelvic bone motion determined in subjects with posterior pelvic pain using skin markers. , 2004, Clinical biomechanics.

[5]  P. van der Wurff,et al.  Clinical tests of the sacroiliac joint. , 2000, Manual therapy.

[6]  C. Snijders,et al.  The Posterior Layer of the Thoracolumbar Fascia|Its Function in Load Transfer From Spine to Legs , 1995, Spine.

[7]  J. Carmichael Inter- and intra-examiner reliability of palpation for sacroiliac joint dysfunction. , 1987, Journal of manipulative and physiological therapeutics.

[8]  J. Hodder The Pelvic Girdle: An approach to the examination and treatment of the lumbo-pelvic-hip region , 1990 .

[9]  G. Aufdemkampe,et al.  Intraexaminer and interexaminer reliability of the Gillet test. , 1999, Journal of manipulative and physiological therapeutics.

[10]  C. Snijders,et al.  Relation Between Form and Function in the Sacroiliac Joint: Part II: Biomechanical Aspects , 1990, Spine.

[11]  M. Laslett,et al.  The Reliability of Selected Pain Provocation Tests for Sacroiliac Joint Pathology , 1994, Spine.

[12]  G. Selvik,et al.  Movements of the Sacroiliac Joints: A Roentgen Stereophotogrammetric Analysis , 1989, Spine.

[13]  H. Stam,et al.  The active straight leg raising test and mobility of the pelvic joints , 1999, European Spine Journal.

[14]  N. Bogduk Clinical Anatomy of the Lumbar Spine and Sacrum , 1997 .

[15]  H. Stam,et al.  Validity of the Active Straight Leg Raise Test for Measuring Disease Severity in Patients With Posterior Pelvic Pain After Pregnancy , 2002, Spine.

[16]  C. Snijders,et al.  Transfer of lumbosacral load to iliac bones and legs Part 1: Biomechanics of self-bracing of the sacroiliac joints and its significance for treatment and exercise. , 1993, Clinical biomechanics.

[17]  C. Aprill,et al.  Sacroiliac Joint: Pain Referral Maps Upon Applying a New Injection/Arthrography Technique Part I Asymptomatic Volunteers , 1994, Spine.

[18]  H. Buyruk,et al.  Stabilization of the sacroiliac joint in vivo: verification of muscular contribution to force closure of the pelvis , 2004, European Spine Journal.

[19]  P. van der Wurff,et al.  Clinical tests of the sacroiliac joint. A systematic methodological review. Part 1: Reliability. , 2000, Manual therapy.

[20]  Diane G. Lee The Pelvic Girdle: An Approach to the Examination and Treatment of the Lumbo-Pelvic-Hip Region , 1989 .