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Chiropractic Journal of Australia : CJA March 2012
2 Chiropractic Journal of Australia Volume 42 Number 1 March 2012 INTRODUCTION Jacob and Kissling1 have established that a small amount of movement occurs at the sacroiliac joint and that the relative direction of the movement between the two joint surfaces can be nutation (anterior rotation of the sacral base) together with posterior rotation of the innominate (os coxa or pelvic bone); or counternutation (a posterior rotation of the sacral base) Observation Methods relating to the Stork Test: Are they Important? DOROTHY CURNOW, DEIRDRE COBBIN and JENNIFER WYNDHAM ABSTRACT: Objectives: The stork test is a palpation test to detect movement in the sacroiliac joint (SIJ). It is used to assess the self-bracing mechanism of the SIJ when weight is transferred from two feet to one foot, as in gait. Nutation (anterior rotation of the sacral base) together with posterior rotation of the innominate (os coxa or pelvic bone) places the joint in a locked or 'self braced' position, which is better able to withstand the shear forces of vertical loading. In the stork test, thumbs are placed on the posterior superior iliac spine (PSIS) on the side of the weight bearing leg and the second sacral spinal process (S2) on the side of the lifting leg. The aims of the present study were to: 1. examine movement of the innominate, by observing movement of the PSIS thumb across two stances, as in the stork test and 2. to examine the spatial relationship between the innominate and sacrum, by observing the change in distance between the PSIS thumb and S2 thumb across two stances, as in the stork test Design: The design was a within subjects experimental design with repeated measures. The two independent variables were the starting stances and observation methods and the dependent variable was the stork test outcome. There were 74 adult volunteers and the methods of volunteer recruitment, inclusion and exclusion criteria have been detailed previously.1 All 148 tests were videoed and reviewed on a computer screen using horizontal lines to determine vertical direction of change relative to the baseline thumb positions. Videoing was carried out in an appropriately equipped studio in southern NSW. Outcome Measures: The outcome measures for observation method 1 (OM1) were a positive result if the thumb on PSIS on the weight bearing side moved cephalad on the lift and a negative result if it did not. The outcome measures for observation Method 2 (OM2) were a positive result if there was an increase in distance between the PSIS and S2 thumbs on the lift and a negative result if there was a decrease or no change. Results: Starting stance and observation method infuenced stork test outcomes, as κ < 0.8 for the two stances and two observation methods. Conclusion: No conclusions could be made about sacral and innominate movement in the stork test between the stances, except that further investigation of sacral/innominate movement, weight displacement and stance is warranted. INDEX TERMS: (MeSH): SACROILIAC JOINT; SACRUM. (Other): ONE LEGGED STANDING TEST; STORK TEST. Chiropr J Aust 2012; 42: 2-7. Dorothy Curnow MA, MSc Honorary Research Associate, Dept of Medical and Molecular Bioscience, University of Technology Sydney Deirdre Cobbin PhD, PhD Senior Lecturer Dept of Medical and Molecular Bioscience University of Technology Sydney Jennifer Wyndham BSc, MSc, MPH, GCHE Honorary Senior Lecturer, Dept of Medical and Molecular Bioscience, University of Technology Sydney Received: 23 September 2011, accepted with revisions: 21 October 2011. CONFLICT OFINTERESTNOTIFICATION:Thereisnoconfictofinterestor potential for a confict of interest for the authors. together with anterior rotation of the innominate. In addition, they have shown that rotation is inconsistent and nutation or counternutation may occur for a given movement, for example, forward fexion. Snijders et al2 have demonstrated that nutation places the joint in a ‘self-braced’ or locked position able to distribute vertical shear forces, as occurs in gait, effectively; and counternutation places the joint in a position vulnerable to those forces. Hungerford et al4-6 used an Expert Vision Advanced Motion Analysis SystemTM to flm skin markers on bony landmarks to provide three-dimensional motion tracking of the innominate. Hungerford and Gilleard4 found posterior rotation of the innominate in healthy individuals and anterior rotation of the innominate5,6 in subjects with posterior pelvic pain. They also noted delayed activation of internal oblique and multifdus muscles in posterior pain subjects compared with controls. Clinically, the stork or one-legged standing test is a palpation test used to detect SIJ movement. It detects movement of the posterior superior iliac spine (PSIS) relative to the second sacral spinous process (S2) on the weight bearing side as the opposite foot is lifted from the foor. The test is used to assess the self-bracing mechanism
CJA June 2012