Howdy,
Practice has showed that shoulder joint is very vulnerable among both general and athletic population. That’s not weird according to the fact that it’s the most mobile joint of the human body (a very shallow ball and socket joint). This joint needs to be stable during those multidirectional moves. Yes, this joint needs to be both mobile and stable properly. If it’s not so, injury risk increases.
When I say stable, I mean on glenohumeral joint stability/congruency. Rotator cuff muscles need to do their job – stabilizing humeral head inside the socket. If they are weak, some upper arm single/multi joint muscle(s) (lats, teres major, pecs, triceps br., biceps br…) are trying to stabilize shoulder joint very often by forming protective tension (and decreasing shoulder mobility consequently) and we have a lot of “confused” muscles at the one spot – nobody is doing their primary job which produce upper body mechanical alternations and potential injury over time if body is not able to adapt on those alternations/compensations.
Today, I chose 3 tests you need to have in your toolbox at least when it comes to shoulder joint. By doing them with your clients regularly, you can notice some important details and make an exercise program according to it. Let’s do it!
Test 1: Supine 90/90 ER test. Take a look at the video below and let’s discuss…
Supine 90/90 ER test
The goal here is to figure out if person lacks shoulder external rotation. Your client should be able to touch the ground with forearm/hand (wrists in neutral position) – 90 degrees of shoulder external rotation is the norm you should reach. You don’t need a protractor for external rotation but you will need it for shoulder internal rotation (70 degrees is good) which is not shown in the video – you can do it of course because both external and internal shoulder rotations are important and they need to be properly mobile (especially for throwing athletic population: baseball, water polo, handball, tennis, volleyball…). Of course, rear shoulder rotator cuff muscles should be strong enough to stabilize shoulder joint through the whole throwing movement and to stop movement safely (along with another muscles) after the ball leaves thrower’s hand as well (in opposite, some tendinitis could show up at least…).
Try to put your client at the exact same position on the floor as video shows. Knees should be flexed because the goal here is to stick or almost stick low back to the floor. By sticking it can be tougher to successfully perform the test because of the posterior pelvic tilt (lats are even more extended and shoulder external rot. is a little bit tougher because lats are shoulder internal rotator among the other functions) and if you reach 90 degrees in this position it’s an ideal. That’s why baseball players compensate throwing very often by arching low back – but low back shouldn’t suffer acutely (maybe in the future after the career). Hmmm if you think twice, we are utilizing elastic energy maybe better by using this compensation and throw could be more powerful – maybe our body is doing that with intention. Theoretically, back should stay in “neutral” position. Hmmm, food for thought for sure…
If the shoulder external rot. isn’t proper, see below what could happen and tell me does it make sense?
If you think about the right photo, you know what I am talking about. The mechanisms are similar in other “throwing sports”
But from the functional standpoint, maybe it’s better to perform the test with fully extended legs or from the standing position – back against the wall (3 back points sticked to the wall). It’s more specific/natural position.
Last but not least, if you are not able to reach 90 degrees without compensation, maybe you have kyphosis – and shortened/tight pec major (as well as lacking of T spine mobility) will not let you to externally rotate arm too much (pec major is internal rotator as well). If you feel top or front shoulder pain by doing test it could mean that you suffer from the shoulder impingement syndrome (m. supraspinatus or m. biceps brachii – long head tendon). Therefore, you see how many important things you can notice by utilizing this test? The story could go on…
Test 2: Standing shoulder flexion test. Take a look at the video below and let’s discuss…
Standing shoulder flexion test
In the 1st test we had shoulder external rot. assessment, but now shoulder flexion assessment. It’s important that the test is in standing position which is more natural pos. (we don’t make a pelvic tilt modifications). In the video above you can see an ideal test performing (negative mark of course). If you want to perform vertical pushing and pulling exercises SAFELY, this one should look exactly like that. So, if you can “touch” your ears with biceps while maintaining “neutral” spine/posture, it means you are pretty safe to do overhead press or any other type of overhead reaching exercise.
So many people (both general and athletic population) can’t do the test correctly. Similar to 1st test, lack of T spine mobility (kyphosis mainly); short/tight lats/teres major/pecs… could be the reasons. On the video below (it’s named “HERE”) you can see on which way you can utilize the same test – maybe it’s even better because you can “fix” your back (3 points) better on this way and have a good feedback from your spine so you can make small adjustments while performing – and make more reliable testing result consequently. Listen carefully what Eric says additionally!
HERE you can watch the video (wasn’t able to edit it for some reason…).
Pay attention on your palms – they should stay in neutral position (thumbs back) all the time and instead of explanation, I will put one more video on why is it important and how actually you can figure out if there is some structural limitations inside/around the joint or a soft tissue issue 🙂 . Watch the video below and remember that your legs should be in the shown position because the test will be more reliable (the same reason like the 1st test).
Test 3: FMS shoulder clearing test. Take a look at the video below and let’s discuss…
FMS shoulder clearing test
We mentioned the shoulder impingement syndrome above (m. supraspinatus or m. biceps brachii – long head tendon). Yes, this test is for revealing potential pain on the top or front shoulder side. Even if you don’t feel any pain you will probably feel some dose of discomfort which is normal because the test is decreasing a subacromial space. Just take a look at the picture below and you will realize what could be pinched during the test when an elbow is going up (more up – less subacromial space). Pain happens really often because the shoulder blade is not moving around the rib cage properly (lack of the proper upward scapular rotation causes reaching the “roof” earlier and potential irritation of not only the 2 listed muscles but the bursa as well).
When you look the photo, it maybe makes sense that you perform 2 additional modified tests as well. If you don’t feel pain during the test, try lifting arm aside (fully extended arm) palms facing up (arm external rotation) – on this way we are provoking the long biceps tendon potential impingement (lifting up to almost overhead position is more than fine); the second one is the same movement while palm is facing between down and back (arm internal rotation) – you are checking m. supraspinatus tendon potential impingement on this way. The original test is good but I would add these too as well just to be sure – get more reliable results. But this is just an assumption. Sometimes, I meet patients who feel identical consistent pain in all 3 movements – and they maybe need some deeper insight… Any pinching could be felt whatever way you lift your arm is, very often.
If pain occurs, it means you need to pay attention on proper exercise technique while strengthening and mobilizing the proper areas (also proper exercises, sets, reps, load, rest…) – but that’s for some another topic… Short reminder, scapular stability plays a role with your shoulder mobility, overhead stability, rotator cuff coordination, and prevention of impingement (very often) – so give it some love by doing a bunch of useful exercises during warm up or main part (depends on the case).
Ok guys, among the numerous good tests I chose these 3 because I believe they are pretty valuable for revealing some important things, potential limitations. If you want your shoulders stay healthy, pay attention to maintaining good stability/strength (upper back and rot. cuff especially) and mobility of proper areas.
For the love of movement,
Luka