Evaluation of the ability of physical therapists to palpate intrapelvic motion with the stork test on the support side.Sacroiliac joint sacroiliac joint (sak´rōil´ēak´), n an irregular synovial joint between the sacrum and ilium on either side of the pelvis. (SIJ SIJ, n sacroiliac joint; the joint located between the ilium and the sacrum. Also called sacroiliac or sacroiliac articulation. ) pain is reported most commonly in the posterior region of the pelvic girdle pelvic girdle n. A bony or cartilaginous structure in vertebrates, attached to and supporting the hind limbs or fins. Also called pelvic arch. (1) and affects people from various backgrounds, such as sporting, postpartum postpartum /post·par·tum/ (post-pahr´tum) occurring after childbirth, with reference to the mother. post·par·tum adj. Of or occurring in the period shortly after childbirth. , and working populations. It is estimated that SIJ pain occurs in over 15% of people classified as having nonspecific nonspecific /non·spe·cif·ic/ (non?spi-sif´ik) 1. not due to any single known cause. 2. not directed against a particular agent, but rather having a general effect. nonspecific 1. chronic low back pain (2); however, at present few reliable diagnostic procedures are available to assist in the clinical evaluation clinical evaluation Medtalk An evaluation of whether a Pt has symptoms of a disease, is responding to treatment, or is having adverse reactions to therapy of impaired pelvic girdle function (3) and resultant pelvic girdle pain Pelvic Girdle Pain During Pregnancy Historical articles show that pregnancy-related pelvic girdle pain has been recognizes for centuries. Mentioned by Hippocrates [1] and later described in medical literature by Snelling. (PGP (Pretty Good Privacy) A data encryption program from PGP Corporation, Palo Alto, CA (www.pgp.com). Published as freeware in 1991 and widely used around the world for encrypting e-mail messages and securing files, PGP is available for commercial use and as freeware for ). The focus of clinical assessment procedures for pelvic girdle function has shifted in the last decade from SIJ mobility testing mobility testing Motion palpation Osteopathy A technique of classic osteopathy, in which the examiner evaluates each spinal segment for proper mobility in all planes of motion, and in relationship to above and below vertebrae. See Classic osteopathy, Osteopathy. to functional assessment procedures that test the ability of the pelvis pelvis, bony, basin-shaped structure that supports the organs of the lower abdomen. It receives the weight of the upper body and distributes it to the legs; it also forms the base for numerous muscle attachments. to maintain stability during load transfer between the spine and the lower limbs. This shift is partially attributable to an increased understanding of the role of the pelvis in load transfer, as well as the poor reliability and validity of many SIJ mobility assessment tests. Assessment tests for SIJ mobility, such as the unsupported hip flexion flexion /flex·ion/ (flek´shun) the act of bending or the condition of being bent. flex·ion n. 1. The act of bending a joint or limb in the body by the action of flexors. 2. component of the Gillet test and the standing forward flexion test A flexion test is a veterinary proceedure performed on a horse, generally during a prepurchase or a lameness exam. The animal's leg is held in a flexed position for 30 seconds to up to 3 minutes (although most veterinarians do not go longer than a minute), and then the horse is , have been shown to have low interrater reliability for therapist palpation palpation /pal·pa·tion/ (pal-pa´shun) the act of feeling with the hand; the application of the fingers with light pressure to the surface of the body for the purpose of determining the condition of the parts beneath in physical diagnosis. . (4,5) Pain provocation tests provocation test Medtalk 1 Any of a number of tests used to deliberately induce a suspected pathologic derangement–eg, provocation of ↑ intraocular pressure by ingestion of excess water 2 Neutralization, see there Orthopedics Any of a number of tests have been shown to have moderate to good reliability (6); however, pain is not always an accurate indicator of altered biomechanical Biomechanical may refer to:
Impairment of SIJ and pelvic function encompasses more than pain produced by the SIJ. The soft tissues surrounding the SIJ and their function in maintaining pelvic stability during weight transfer and movement are equally important to the normal biomechanical function of the pelvis. (8-10) The assessment of pelvic stability during activities that induce load transfer across the pelvic articulations, therefore, is relevant. The Active Straight-Leg-Raise Test is a functional assessment procedure that evaluates the integrity of the pelvis for maintaining stability during load transfer in a supine position The supine position is a position of the body; lying down with the face up, as opposed to the prone position, which is face down. Using terms defined in the anatomical position, the posterior is down and anterior is up. . (11) The Active Straight-Leg-Raise Test has been validated as a reliable means of ranking disease severity for women with posterior pelvic pain following pregnancy (12) while also providing a means of assessing compensatory strategies of the musculo-skeletal system in people with pelvic pain. (13) The articular articular /ar·tic·u·lar/ (ahr-tik´u-ler) pertaining to a joint. ar·tic·u·lar adj. Of or relating to a joint or joints. articular pertaining to a joint. surfaces of the SIJ assist in load transfer from the lumbar spine Lumbar spine The segment of the human spine above the pelvis that is involved in low back pain. There are five vertebrae, or bones, in the lumbar spine. Mentioned in: Low Back Pain through the pelvis to the lower limbs by way of their shape and alignment. (14) Research has shown that small amounts of movement occur at the SIJ and that this movement is controlled during load transfer through engagement of the self-bracing mechanism of the SIJ. (8,15) The self-bracing mechanism is induced through preactivation of the local muscle system of the lumbopelvic region prior to movement, (16) with subsequent tensioning of the pelvic ligaments and thoracolumbar fascia thoracolumbar fascia n. The fascia covering the deep muscles of the back. and compression of the joint surfaces. (8,9) During activities that involve weight transfer through the pelvis (eg, moving from standing to standing on one leg or lying to standing), a concurrent pattern of sacral sacral /sa·cral/ (sa´kral) pertaining to the sacrum. sa·cral adj. In the region of or relating to the sacrum. sacral, adj pertaining to the sacrum. nutation nutation, in astronomy, a slight wobbling motion of the earth's axis. The causes of nutation are similar to those of the precession of the equinoxes, involving the varying attraction of the moon on the earth's equatorial bulge. or relative posterior rotation of the innominate bone innominate bone n. See hipbone. innominate bone, n See hip bone. engages the SIJ into its closed pack position (ie, articular surfaces are fully congruent con·gru·ent adj. 1. Corresponding; congruous. 2. Mathematics a. Coinciding exactly when superimposed: congruent triangles. b. , in maximal max·i·mal adj. 1. Of, relating to, or consisting of a maximum. 2. Being the greatest or highest possible. contact, and tightly compressed so that no further movement is possible). (15,17) A previous investigation of motion between the innominate bone and the sacrum sacrum: see spinal column. on the side of single-leg support during a standing hip flexion movement (Stork stork, common name for members of a family of long-legged wading birds. The storks are related to the herons and ibises and are found in most of the warmer parts of the world. Test support phase) revealed that the innominate bone on the side of single-leg support rotated posteriorly relative to the sacrum in subjects who were healthy (17) (Fig. 1A). This pattern of motion also was shown to be altered reliably in the presence of PGP. The innominate bone rotated anteriorly relative to the sacrum on the side of PGP (Fig. 1B), indicative of a failure of the self-bracing mechanism to maintain the SIJ in its closed pack position. Because the difference in the pattern of bone motion directly reflected the ability (posterior rotation) or inability (anterior rotation) of subjects to maintain pelvic stability for load transfer through the pelvis, (17) Lee (18) suggested that the Stork Test on the support side (Fig. 2) may provide a useful tool for clinical evaluation of a subject's ability to stabilize intrapelvic motion. The reliability of therapists' ability to palpate pal·pate v. To examine by feeling and pressing with the palms of the hands and the fingers. pal·pa  tion n. pelvic bone motion, therefore, requires investigation
in order to determine whether the Stork Test on the support side may be
clinically relevant. The range of palpable motion between the innominate
bone and the sacrum is small, (15,17) and this property may affect the
reliability of clinicians' ability to palpate pelvic bone motion in
vivo in vivo /in vi·vo/ (ve´vo) [L.] within the living body. in vi·vo adj. Within a living organism. in vivo adv. . [FIGURES 1-2 OMITTED] The application of the Stork Test on the support side involves palpation of the posterior superior iliac spine The posterior border of the ala, shorter than the anterior, also presents two projections separated by a notch, the posterior superior iliac spine and the posterior inferior iliac spine. (PSIS) and innominate bone on the side of the pelvis to which weight is to be transferred for single-leg support, and the therapist's other hand palpates the sacrum centrally at $2. The direction of bone motion or lack of bone motion then is palpated as the contralateral contralateral /con·tra·lat·er·al/ (-lat´er-al) pertaining to, situated on, or affecting the opposite side. con·tra·lat·er·al adj. foot is lifted off the ground (Fig. 3). Clinically, the results have been described either by the direction of PSIS movement (cephalad cephalad /ceph·a·lad/ (sef´ah-lad) toward the head. ceph·a·lad adv. Toward the head or anterior section. , caudad caudad /cau·dad/ (kaw´dad) directed toward the tail or distal end; opposite to cephalad. cau·dad adv. Toward the tail or posterior end of the body; caudally. , or no movement relative to S2) occurring with innominate bone motion or as a positive or negative result. In the second description, a negative result is assigned when no relative motion between the innominate bone and the sacrum is palpated (Fig. 3, left), whereas cephalad motion of the PSIS relative to the sacrum (Fig. 3, right) is considered to be a positive result. (18) [FIGURE 3 OMITTED] The aim of this study was to determine whether experienced therapists could reliably detect the pattern of motion occurring between the innominate bone and the sacrum (intrapelvic motion) on the support side in a group of subjects with and without lumbopelvic pain. Method Subjects A total of 33 subjects who were 36.2 [+ or -] 13.4 ([bar.X] [+ or -] SD)years of age and had a body mass of 71.2 [+ or -] 13.6 kg and a height of 170.2 [+ or -] 8.1 cm participated in the study. The subjects were volunteers who responded to notices placed at private physical therapist practices in Sydney, New South Wales New South Wales, state (1991 pop. 5,164,549), 309,443 sq mi (801,457 sq km), SE Australia. It is bounded on the E by the Pacific Ocean. Sydney is the capital. The other principal urban centers are Newcastle, Wagga Wagga, Lismore, Wollongong, and Broken Hill. , Australia. There were no exclusion criteria exclusion criteria AIDS Donor exclusion criteria, see there , except that subjects must have been more than 18 years of age. The subjects varied in sex, history of back or leg pain in the preceding 12 months, and presence of pain at the time of testing (Tab. 1). Eleven women and 4 men had pelvic-girdle pain (visual analog scale [VAS vas (vas) pl. va´ sa [L.] vessel.va´sal vas aber´rans 1. a blind tubule sometimes connected with the epididymis; a vestigial mesonephric tubule. 2. ] score of >0) at the time of testing. No subjects reported that they were pregnant at the interview. Of the subjects who noted the presence of pain at the time of testing, the average scores on the McGill Pain Questionnaire McGill Pain Questionnaire Neurology A 2-part instrument used to evaluate subjective components of pain , the YAS YAS Yet Another Society (nonprofit supporting collaborative efforts in CompSci/IT) YAS You're A Star (TV program from Ireland) YAS Young Adult Smoker YAS Yet Another Standard YAS Young And Sweet , and the Present Pain Index (PPI (1) (Pixels Per Inch) The measurement of the resolution of a monitor or scanner. For example, a monitor that is 16 inches wide and displays 1600 pixels across its width would have a resolution of 100 ppi (1600 divided by 16). ) were 5.0 [+ or -] 5.2, 1.8 [+ or -] 1.9, and 1.7 [+ or -] 1.0, respectively. To reduce the possibility of order effects, a Latin square Noun 1. Latin square - a square matrix of n rows and columns; cells contain n different symbols so arranged that no symbol occurs more than once in any row or column square matrix - a matrix with the same number of rows and columns design was used to produce a series of "order-of-therapist" possibilities. Each subject was randomly assigned an order of therapist prior to undergoing testing. All participants gave informed consent prior to the study. Procedure Three experienced manual therapists (mean of 14.7 years in practice [range=7-21], age range=37-42 years) were included in the study because they regularly used the Stork Test on the side of single-leg support as part of their assessment protocols. The average length of time of their use of the Stork Test on the support side was 4.5 years. The subjects and the therapists were given a set of standard instructions for the performance of the test. First, each subject was instructed to sit with both feet placed equally on the ground prior to starting the examination and between repetitions of the examination for each therapist. Once the therapist entered the room, the subject was instructed to stand, placing equal weight through each leg and allowing the therapist to palpate the innominate bone, PSIS, and sacrum to obtain the testing position. The therapist then performed the test. The hand position for application of the right Stork Test on the support side (Fig. 3, left) was to place the right thumb directly on the right PSIS, allow the rest of the right hand to contact the right innominate bone, and palpate the S2 spinous process spinous process n. 1. See sphenoidal spine. 2. The dorsal projection from the center of a vertebral arch. spinous process of the sacrum with the left thumb. The therapist then instructed the subject to raise the contralateral leg into 90 degrees of hip flexion and 90 degrees of knee flexion while the therapist continued palpating the right PSIS and innominate bone relative to the sacrum. The test movement was repeated 3 times. The hand position for application of the left Stork Test on the support side (Fig. 3, right) was to place the left thumb on the left PSIS, allow the rest of the left hand to contact the left innominate bone, and palpate the $2 spinous process of the sacrum with the right thumb. The subject then was instructed to raise the contralateral leg 3 times and to return to a neutral stance after each movement. The therapists graded the test with 2 scales. In part 1, the therapist was asked to rate the direction of intrapelvic motion with a 3-point scale indicating whether the PSIS moved cephalad relative to the sacrum, the PSIS stayed neutral relative to the sacrum, or the PSIS moved caudad relative to the sacrum. In part 2, the therapist was asked to rate the direction of intrapelvic motion with a 2-point scale indicating a positive result if the PSIS moved cephalad relative to the sacrum or a negative result if the PSIS stayed neutral or moved caudad relative to the sacrum. Data Analysis Data analysis was performed by an assistant who was independent of the testing and unaware of the order of therapist. Interrater reliability was assessed with a Cohen cohen or kohen (Hebrew: “priest”) Jewish priest descended from Zadok (a descendant of Aaron), priest at the First Temple of Jerusalem. The biblical priesthood was hereditary and male. kappa Kappa Used in regression analysis, Kappa represents the ratio of the dollar price change in the price of an option to a 1% change in the expected price volatility. Notes: Remember, the price of the option increases simultaneously with the volatility. reliability coefficient ([kappa]). Manual calculation of K for more than 2 therapists was done as described by Pittenger (19) and interpreted as poor (<.20), fair (.21-.40), moderate (.41-.60), good (.61-.80), and excellent (.81-1.0). When more than 2 therapists are compared, [kappa] calculations may be made by use of rater rat·er n. 1. One that rates, especially one that establishes a rating. 2. One having an indicated rank or rating. Often used in combination: a third-rater; a first-rater. agreement on a category for each subject. (19) Percent close agreement (PCA (tool, programming) PCA - A dynamic analyser from DEC giving information on run-time performance and code use. ) also was calculated to assess agreement among therapists. The Pearson chi-square test chi-square test: see statistics. of association (calculated with SPSS A statistical package from SPSS, Inc., Chicago (www.spss.com) that runs on PCs, most mainframes and minis and is used extensively in marketing research. It provides over 50 statistical processes, including regression analysis, correlation and analysis of variance. version 11.5 * for Windows ([dagger])) with exact 2-sided significance was used to determine whether sex, back pain in the last 12 months, leg pain in the last 12 months, and present pain, as assessed with the McGill Pain Questionnaire, the VAS, and the PPI, showed an association with the therapists' ratings. Results The interrater reliability for part 1, in which the therapist was asked to rate the direction of intrapelvic motion with a 3-point scale (cephalad, neutral, or caudad), was moderate for both the left and the fight sides (left [kappa]=.59, right [kappa]=.59). Table 2 shows each participant's kappa agreement matrix for each side. One hundred percent agreement among raters was seen 82.8% and 79.8% of the time for the left and right sides, respectively. The Pearson chi-square test of association for factors possibly affecting therapists' ratings revealed that sex, back pain in the last 12 months, leg pain in the last 12 months, and present pain, as assessed with the McGill Pain Questionnaire, the VAS, and the PPI, showed no association with therapists' ratings (Tab. 3). The interrater reliability for part 2, in which the therapist was asked to rate the direction of intrapelvic motion as positive or negative (a 2-point scale), was good for both the left and the right sides (left [kappa]=.67, right [kappa]=.77). Table 4 shows each participant's kappa agreement matrix for each side. One hundred percent agreement among raters was seen 91.9% and 89.9% of the time for the left and right sides, respectively. Again, the Pearson chi-square test of association revealed that sex, back pain in the last 12 months, leg pain in the last 12 months, and present pain, as assessed with the McGill Pain Questionnaire, the VAS, and the PPI, showed no association with therapists' ratings (Tab. 5). Discussion and Conclusion The purpose of the present study was to investigate whether experienced manual therapists could reliably detect a pattern of intrapelvic motion during a weight-bearing task. Pittenger's (19) guidelines for the interpretation of [kappa] values showed that the interrater reliability for the Stork Test on the support side varied according to according to prep. 1. As stated or indicated by; on the authority of: according to historians. 2. In keeping with: according to instructions. 3. whether a 2-point or a 3-point scale was used. When a 2-point scale was used to determine a negative or positive result in the Stork Test on the support side, the interrater reliability was good for both sides, and the PCA was high. In comparison, the interrater reliability and agreement were reduced to moderate when a 3-point scale was used. The difference found between the 2 scales may be attributable to probability alone, as an increase in the number of choices would statistically decrease reliability. However, the results do indicate that multiple therapists showed good reliability for determining a positive or negative result in the Stork Test on the support side. The application of the Stork Test on the support side will be more reliable if clinicians describe their palpation findings as either negative results, that is, no relative movement between the innominate bone and the sacrum, or positive results, that is, cephalad motion of the PSIS relative to the sacrum. Increasing the choices by describing the direction of intrapelvic motion is only likely to decrease the interrater reliability of the test. In comparison with many tests previously described as measures of SIJ dysfunction, the Stork Test on the support side is not reliant on a provocation of pain (6) or a clinical comparison of degrees of joint mobility between sides of the body or between subjects. (4,20) Instead, the Stork Test assesses the ability of a subject to maintain a stable alignment of the innominate bone relative to the sacrum during a functional load transfer task. Failure to maintain this alignment, with resultant motion of the PSIS in a cephalad direction or anterior rotation relative to the sacrum (Fig. 3, right), is rated as a positive result. Performance of the Stork Test on the support side challenges the self-bracing mechanism of the SIJ by increasing weight transference TRANSFERENCE, Scotch law. The name of an action by which a suit, which was pending at the time the parties died, is transferred from the deceased to his representatives, in the same condition in which it stood formerly. onto one side of the pelvis. In normal function, minimal intrapelvic motion should occur between the innominate bone and the sacrum during a weight-bearing task, such as standing on one leg, because of compression of the articular surfaces with activation of the self-bracing mechanism. (8,9) With the 2-point scale of the Stork Test on the support side, this normal function would be indicated as a negative test. A positive test would suggest an inability of the SIJ to engage the self-bracing mechanism and maintain alignment of the innominate bone relative to the sacrum in the closed pack position; that is, the innominate bone would tend to rotate anteriorly relative to the sacrum. The ability of the therapists to show good interrater reliability in detecting an altered pattern of intrapelvic motion suggests that the recognition of altered movement patterns is possible. However, it is beyond the scope of this article to suggest how the intrapelvic movement was occurring or at which joint it was occurring. Further research into the validity and specificity of the Stork Test on the support side is needed to determine the relevance of altered pelvic motion patterns to the existence of pelvic pain or dysfunction. The higher [kappa] and PCA values obtained in the present study than in other studies may be indicative of the experience of the therapists, with a mean of 14.7 years of daily performance of SIJ intra-articular motion testing and a mean of 4.5 years of performance of the Stork Test on the support side. Meijne et al (5) reported low intertester reliability of the Gillet test ([kappa] =.00, PCA=76.1%) when performed by 2 final-year students. Meijne et al (5) conducted the study on both the leg swing and the leg stance phases. In total, each subject performed 16 movement patterns for each therapist. It is likely that the performance of the tests by the subjects may have varied over these repeated measures, leading to inconsistent movement patterns. Alterations in performance over time may occur for many reasons, such as learning, fatigue, or pain. The end result would be a loss in reliability among therapists as the movement patterns changed. (4) In the present study, each subject performed the movement patterns a maximum of 9 times with each leg. We expected that less repetition would lead to increased consistency of stabilization strategies during load transfer. The ability of multiple therapists to show good intertherapist reliability when assessing the pattern of intrapelvic motion during transfer of weight from double-leg support to single-leg support was substantiated in the present study. Minimizing the choice of the therapists to a 2-point scale significantly improved interrater reliability. Further research is needed to determine the clinical relevance, validity, and specificity of the Stork Test on the support side for the assessment of functional load transfer through the pelvis. All authors provided concept. Dr Hungerford and Dr Gilleard provided research design. Dr Hungerford, Dr Gilleard, and Mr Moran provided writing. Dr Hungerford, Mr Moran, and Ms Emmerson provided data collection, and Dr Gilleard provided data analysis. Mr Moran provided subjects. Dr Hungerford provided facilities and project management. Dr Gilleard provided institutional liaisons. Dr Gilleard, Mr Moran, and Ms Emmerson provided consultation. The study was approved by the Human Ethics Committee ethics committee A multidisciplinary hospital body composed of a broad spectrum of personnel–eg, physicians, nurses, social workers, priests, and others, which addresses the moral and ethical issues within the hospital. See DNR, Institutional review board. of Southern Cross University. This article was submitted January 11, 2006, and was accepted March 6, 2007. DOI (Digital Object Identifier) A method of applying a persistent name to documents, publications and other resources on the Internet rather than using a URL, which can change over time. : 10.2522/ptj.20060014 Reference (1) Fortin J, Dwyer A, West S, Pier J. Sacroiliac joint referral patterns upon application of a new injection/arthrography technique, I: asymptomatic a·symp·to·mat·ic adj. Exhibiting or producing no symptoms. Asymptomatic Persons who carry a disease and are usually capable of transmitting the disease but, who do not exhibit symptoms of the disease are said to be volunteers. Spine, 1994; 19:1475-1482. (2) Schwarzer A, Aprill C, Bogduk N. The sacroiliac joint in chronic low back pain. Spine. 1995;20:31-37. (3) van der Wurff P, Hagmeijer RH, Meijne W. Clinical tests of the sacroiliac joint: a systematic methodological review, part 1: reliability. Man Ther. 2000;5:30-36. (4) Carmichael JP. Inter- and inter-examiner reliability of palpation for sacroiliac joint dysfunction. J Manipulative Physiol Ther. 1987;10:164-171. (5) Meijne W, van Neerbos K, Aufdemkampe G, van der Wurff P. Intra-examiner and inter-examiner reliability of the Gillet test. J Manipulative Physiol Ther. 1999; 22:4-9. (6) Laslett M, Williams M. The reliability of selected pain provocation tests for sacroiliac joint pathology. Spine. 1994;19: 1243-1248. (7) Bogduk N. Clinical Anatomy of the Lumbar Spine and Sacrum. New York New York, state, United States New York, Middle Atlantic state of the United States. It is bordered by Vermont, Massachusetts, Connecticut, and the Atlantic Ocean (E), New Jersey and Pennsylvania (S), Lakes Erie and Ontario and the Canadian province of , NY: Churchill Livingstone Imprint of a medical publishing company owned by Elsevier Ltd, but previously owned by Harcourt and Pearsons. Originally formed from Livingstone, Edinburgh, Scotland, and J & A Churchill, London, UK, and subsequently with an office in New York, but now integrated with the rest of Inc; 1997. (8) Snijders C, Vleeming A, Stoeckart R. Transfer of lumbosacral load to iliac bones iliac bone n. See ilium. and legs, 1: biomechanics The study of the anatomical principles of movement. Biomechanical applications on the computer employ stick modeling to analyze the movement of athletes as well as racing horses. Biomechanics of self-bracing of the sacroiliac joints and its significance for treatment and exercise. Clin Biomech. 1993;8:285-294. (9) Vleeming A, Pool-Goudzwaard A, Stoeckart R, et al. The posterior layer of the thoraco-lumbar fascia fascia (făsh`ēə), fibrous tissue network located between the skin and the underlying structure of muscle and bone. Fascia is composed of two layers, a superficial layer and a deep layer. : its function in load transfer from spine to legs. Spine. 1995; 20:753-758. (10) van Wingerden JP, Vleeming A, Buyruk HM, Raissadat K. Stabilization of the sacroiliac joint in vivo: verification of muscular contribution to force closure of the pelvis. Eur Spine J. 2004;13:199-205. (11) Mens J, Vleeming A, Snijders C, et al. The active straight leg raising test and mobility of the pelvic joints. Eur Spine J. 1999;8: 468-473. (12) Mens J, Vleeming A, Snijders C et al. Validity of the active straight leg raise The Straight leg raise also, called Lasègue sign or Lasègue test, is a test done during the physical examination to determine whether a patient with low back pain has an underlying herniated disk. test for measuring disease severity in patients with posterior pelvic pain after pregnancy. Spine. 2002;27:196-200. (13) O'Sullivan P, Beales D, Beetham J, et al. Altered motor control strategies in subjects with sacroiliac joint pain during the active straight leg raise test. Spine. 2002; 27:E1-E8. (14) Vleeming A, Volkers A, Snijders C, Stoeckart R. Relation between form and function in the sacroiliac joint, 2: biomechanical aspects. Spine. 1990;15:133-136. (15) Sturesson B, Selvik G, Uden A. Movements of the sacroiliac joints: a roentgen roentgen /roent·gen/ (rent´gen) the international unit of x- or ?-radiation; it is the quantity of x- or ?-radiation such that the associated corpuscular emission per 0. stereo-grammatic analysis. Spine. 1989;14: 162-165. (16) Hungerford B, Gilleard W, Hodges P. Evidence of altered lumbo-pelvic muscle recruitment in the presence of sacroiliac joint pain. Spine. 2003;28:1593-1600. (17) Hungerford B, Gilleard W, Lee D. Altered patterns of pelvic bone motion determined in subjects with posterior pelvic pain using skin markers. Clin Biomech. 2004;19:456-464. (18) Lee D. The Pelvic Girdle: An Approach to the Examination and Treatment of the Lumbopelvic-Hip Region. 3rd ed. Edinburgh, United Kingdom: Churchill Living-stone; 2004. (19) Pittenger D. Behavioral Research Design and Analysis. New York, NY: McGrawHill Inc; 2003. (20) van Deursen L, Patijn A, Ockhuysen A, Vortman B. The value of some clinical tests of the sacroiliac joint. Journal of Manual Medicine. 1990;5:96-99. * SPSS Inc, 233 S Wacker Wacker may refer to:
([dagger]) Microsoft Corp, One Microsoft Way, Redmond, WA 98052-6399. BA Hungerford, PhD, BAppSci (Physio physio Noun 1. short for physiotherapy 2. pl physios short for physiotherapist ), is Consultant Physiotherapist physiotherapist /phys·io·ther·a·pist/ (-ther´ah-pist) physical therapist. physiotherapist physical therapist. , Department of Physiotherapy physiotherapy: see physical therapy. , Sydney Spine and Pelvis Centre, Drummoyne, New South Wales
Drummoyne is a suburb in the inner-west of Sydney, in the state of New South Wales, Australia. , Australia. Address all correspondence to Dr Hungerford at: barbhungerford@aol.com. W Gilleard, PhD, MSc(Hons), is Senior Lecturer senior lecturer n. Chiefly British A university teacher, especially one ranking next below a reader. , School of Exercise Science and Sport Management, Southern Cross University, Lismore, New South Wales Lismore is a sub-tropical city in New South Wales, Australia. It is the main population centre in the City of Lismore local government area. It is a major regional centre in the Northern Rivers region of the state. Geography Lismore is located at latitude 28. , Australia. M Moran, MHIthSc(Sports Physio), BAppSc(Physio)Hons, is Principal Physiotherapist, Carlingford Physiotherapy Centre, Carlingford, New South Wales Carlingford is a suburb of Sydney, in the state of New South Wales, Australia. Carlingford is located 22 kilometres north-west of the Sydney central business district in the local government areas of the Baulkham Hills Shire, Hornsby Shire and the City of Parramatta. , Australia. C Emmerson, MHIthSc(Sports Physio), BAppSc(Physio), is Principal Physiotherapist, Stanmore Physiotherapy and Sports Clinic, Stanmore, New South Wales Stanmore is a suburb in the inner-west of Sydney, in New South Wales, Australia. Stanmore is located 6 km south-west of the Sydney central business district and is part of the local government area of Marrickville Council. The postcode is 2048. , Australia. [Hungerford BA, Gilleard W, Moran M, Emmerson C. Evaluation of the ability of physical therapists to palpate intrapelvic motion with the Stork Test on the support side. Phys Ther. 2007;87:879-887.]
Table 1.
Number of Subjects With Back Pain or Leg Pain in
the Last 12 Months or Pain in the Previous 24 Hours
Factor Men Women
Sex 14 19
Back pain in last 12 mo 7 16
Leg pain in last 12 mo 5 11
Pain reported at time of
testing, as assessed with:
McGill Pain Questionnaire 3 13
Visual analog scale 4 11
Present Pain Index 3 9
Table 2.
Agreement Matrix for Number of Agreements Among 3 Raters for 3
Categories (Cephalad, Neutral, and Caudad) for Each Participant
Participant No. of Raters Who Agreed on the
Indicated Category for Each Participant
Left Side Right Side
Cephalad Neutral Caudad Cephalad Neutral Caudad
A1 0 3 0 0 3 0
A2 0 0 3 2 1 0
A3 0 3 0 3 0 0
B1 0 3 0 3 0 0
B2 0 3 0 3 0 0
B3 1 1 1 1 1 1
C1 1 2 0 0 3 0
C2 0 2 1 0 2 1
C3 0 3 0 0 3 0
D1 0 3 0 3 0 0
D2 0 3 0 0 3 0
D3 0 3 0 0 3 0
E1 0 3 0 1 2 0
E2 0 3 0 3 0 0
E3 0 3 0 0 3 0
F1 0 3 0 2 1 0
F2 0 3 0 0 1 2
F3 0 3 0 3 0 0
G1 1 2 0 0 3 0
G2 3 0 0 0 3 0
G3 3 0 0 0 3 0
Hl 0 2 1 0 3 0
H2 0 3 0 0 3 0
H3 0 3 0 2 1 0
I1 0 1 2 0 2 1
I2 3 0 0 0 3 0
I3 0 3 0 0 3 0
J1 0 3 0 0 3 0
J2 0 3 0 3 0 0
J3 2 1 0 0 3 0
K1 0 3 0 3 0 0
K2 0 3 0 0 2 1
K3 0 3 0 0 2 1
Table 3.
Chi-Square (Observed and Expected) Results for Association of Number
of Agreements Among Raters With Sex, Back Pain in Last 12 Months, Leg
Pain in Last 12 Months, and Presence of Pain in Previous 24 Hours (a)
When a 3-Point Scale Was Used
Factor Observed (Expected) Result [chi P
for the Following Category square]
Cephalad Neutral Caudad
Sex 5.203 .076
Men 24 (19.5) 51 (58.1) 9 (6.4)
Women 22 (26.5) 86 (78.9) 6 (8.6)
Back pain in 4.447 .118
last 12 mo
Yes 31 (32.1) 100 (95.5) 7 (10.5)
No 15 (13.9) 37 (41.5) 8 (4.5)
Leg pain in 2.628 .273
last 12 mo
Yes 26 (22.3) 65 (66.4) 5 (7.3)
No 20 (23.7) 72 (70.6) 10 (7.7)
Pain present in
previous 24 h,
as assessed
with:
MPQ 3.502 .176
Yes 25 (22.3) 67 (66.4) 4 (7.3)
No 21 (23.7) 70 (70.6) 11 (7.7)
VAS 2.328 .323
Yes 22 (20.9) 64 (62.3) 4 (6.8)
No 24 (25.1) 73 (74.7) 11 (8.2)
PPI 4.445 .105
Yes 20 (16.7) 50 (49.98) 2 (5.5)
No 26 (29.3) 87 (87.2) 13 (9.5)
(a) As assessed with the McGill Pain Questionnaire (MPQ, the
visual analog scale (VAS), and the Present Pain Index (PPI).
(b) Significance was determined with the Fisher exact test (2
tailed) because one cell had an expected count of less than 5.
Table 4.
Agreement Matrix for Number of Agreements Among 3 Raters for
2 Categories (Positive and Negative) for Each Participant
Participant No. of Raters Who Agreed on the Indicated
Category for Each Participant
Left Side Right Side
Positive Negative Positive Negative
A1 0 3 0 3
A2 0 3 2 1
A3 0 3 3 0
BI 0 3 3 0
B2 0 3 3 0
B3 1 2 1 2
C1 1 2 0 3
C2 0 3 0 3
C3 0 3 0 3
D1 0 3 3 0
D2 0 3 0 3
D3 0 3 0 3
E1 0 3 1 2
E2 0 3 3 0
E3 0 3 0 3
F1 0 3 2 1
F2 0 3 0 3
F3 0 3 3 0
G1 1 2 0 3
G2 3 0 0 3
G3 3 0 0 3
H1 0 3 0 3
H2 0 3 0 3
H3 0 3 2 1
I1 0 3 0 3
I2 3 0 0 3
I3 0 3 0 3
J1 0 3 0 3
J2 0 3 3 0
J3 2 1 0 3
K1 0 3 3 0
K2 0 3 0 3
K3 0 3 0 3
Table 5.
Chi-Square Test (Observed and Expected) Results for Association of
Number of Agreements Among Raters With Sex, Back Pain in Last 12
Months, Leg Pain in Last 12 Months, and Presence of Pain in Previous
24 Hours (a) When a 2-Point Scale Was Used
Factor Observed (Expected) [chi P
Result for the square]
Following Category
Positive Negative
Sex 2.332 .173
Men 24 (19.5) 60 (64.5)
Women 22 (26.5) 92 (87.5)
Back pain in last 12 mo 0.151 .717
Yes 31 (32.1) 107 (105.0)
No 15 (13.9) 45 (46.1)
Leg pain in last 12 mo 1.550 .241
Yes 26 (22.3) 70 (73.7)
No 20 (23.7) 82 (78.3)
Pain present in previous
24 h, as assessed with:
MPQ 0.825 .402
Yes 25 (22.3) 71 (73.7)
No 21 (23.7) 81 (78.3)
VAS 0.136 .738
Yes 22 (20.9) 68 (69.1)
No 24 (25.1) 84 (82.9)
PPI 1.311 .295
Yes 20 (16.7) 52 (55.3)
No 26 (29.3) 100 (96.7)
(a) As assessed with the McGill Pain Questionnaire (MPQ),
the visual analog scale (VAS), and the Present Pain Index
(PPI).
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