Shoulder Series Part 2: Shoulder Assessment for the Fitness Professional

Shoulder Series Part 2: Shoulder Assessment for the Fitness Professional

Undoubtedly we have all had a client come in for their initial assessment with either complaints of, or a history of, shoulder pain. From post-surgery to just a chronic “naggy” shoulder, as fitness professionals, we will see a broad spectrum of shoulder health from our clients. While it is imperative to obtain a good and thorough health history and make sure to identify any restrictions that are set forth from their physician or other medical providers, performing a quick and easy physical assessment can offer a lot of insight for establishing a proper starting point for programming. Looking at the shoulder specifically, there are 2 aspects that need to be evaluated - stability and mobility. To put it plainly, you need to have both in order to have a properly functioning shoulder. So, we are going to look at a few different things that you can do in your assessment to identify whether your client has adequate mobility and stability of their shoulder complex. Additionally, these methods can possibly identify some compensations that they have put in action to be able to operate.

To preface, while I will discuss mobility and stability separately, it is important to note that they are not independent of each other. There is a requisite amount of mobility and stability that must be present at the shoulder to perform functional tasks.

Mobility

When assessing the shoulder for mobility, we are typically going to look at the range-of-motion that is available at the glenohumeral joint of the shoulder. As it pertains to strength and conditioning, I am primarily concerned with shoulder flexion, internal rotation, and external rotation. While these motions are technically evaluated at the ball-and-socket (glenohumeral) joint of the shoulder, the range-of-motion comes from both the glenohumeral joint and the scapulothoracic joints. So, the goal of this assessment is to identify whether or not a mobility restriction exists, but finding where that restriction is may take some more evaluating.

Shoulder Flexion

Assessment: Standing PVC Pipe Shoulder Flexion

How to Perform:

  • Standing, feet shoulder-width apart
  • Hold PVC pipe slightly wider than shoulder-width apart, palms facing body
  • Lock the elbows out
  • Instruct the client to raise arms forward until they cannot go any farther

What to Look For:

  • Does the PVC pipe extend past their ears?
  • Is it symmetrical? (Right vs. Left)
  • Compensations
    • Forward head posture
    • Arching at the lumbar spine
    • Excessive Shrugging of the shoulders (scapular elevation)
    • Not keeping the elbows locked out

Why: I like to start people in a standing position and give them no coaching cues (other than what is outlined above) because it will demonstrate how the client has been getting to an overhead position. We are task completion oriented machines, so understanding how someone has been getting to a certain position can tell you a lot about what could be going on at the shoulder, or even explain a piece of why they are having problems elsewhere.

If you observe some compensations, my first go-to is to coach them on the movement to see if they can still achieve adequate mobility. A few target areas to point out (and some coaching cues for them) include some of the following:

  • Anterior Core Control - “Tack the rib cage down”
  • Arching at the Lumbar Spine - “Squeeze the glutes and brace abs"

Other Possibilities: If your client does not respond well to the coaching cues that you give them, you can put them in a supine position and repeat the assessment. Instruct them to keep their butt, low back, and shoulder blades on the ground and then perform the movement. You are stripping away things for the client to have to pay attention to, so it gives a more regressed version of the assessment.

If they are able to exhibit full ROM with these static assessments, you can progress them to a more full-body assessment to see if it changes when you include multiple joints. My 2 favorites are either an overhead squat or an overhead walking lunge.

Shoulder Internal and External Rotation

Assessment: Apley’s Scratch Test (also known as the shoulder mobility test of the Functional Movement Screen)

How to Perform:

  • Standing, feet shoulder width-apart
  • Reach one hand behind the head and reach the other hand behind the back
  • Try to touch the hands together

What to Look For:

  • How close can the client get their hands together?
    • The goal is to be within 6 inches of each other
  • Is it symmetrical? (Right vs. left)

Why: In order for you to be able to reach your hands close together, an adequate amount of shoulder flexion/extension and internal rotation/external rotation must be present. While there can still be some limitations present, if the client is able to achieve adequate mobility, this can establish a good baseline to determine if strategies to improve shoulder mobility should be implemented in your client’s programming.

Stability

Assessment: Rotator Cuff (External Rotators) Manual Muscle Test

How to Perform:

  • Standing, feet shoulder-width apart
  • The client has their arms at their side, elbows flexed to 90 degrees, palms facing each other
  • Instruct the client that you are going to try and push their hands in and their goal is to resist that movement and not let any movement occur
  • You provide an inward push against the outside of their hands, trying to “break” their position

What to Look For:

  • Can they resist the movement?
  • Is it painful?
  • Compensations
    • Shoulders round forward
    • Elbows flare out
    • Shoulders shrug

Why: This is a low-level and easy way to assess whether or not the rotator cuff is able to function in a controlled setting. By no means are you trying to assess for injury to the rotator cuff, but to simply look at the rotator cuff’s ability to function. If the client is unable to maintain that position, the likelihood of them being able to control movement and have a stable shoulder is minimal. Furthermore, this can uncover a lot of potential compensations of the client. Essentially, these compensations are the brain’s way of trying to add stability to the joint by making other muscles do the work that otherwise shouldn’t be.

Wrapping It Up

By no means is this an exhaustive list of things that you should look for or even a complete list of ways to evaluate shoulder function. However, these simple and easy assessments can give you a good baseline as to how your client’s shoulders are functioning. A good assessment should start as soon as you see them and continue until you are done working with them. It is important that you are evaluating their movement while they are training and continue to make adjustments and progressions. The hope is that you can perform some of these assessments to gather data to guide your programming and be able to monitor progress. It is hard to evaluate progress if you don’t have a baseline to compare it to. The goal for my initial assessment is to establish what movements or exercises my client is able to perform and provide me with a list of things that should be addressed. Whether it be to improve mobility in some specific areas or increase their motor control, without gathering information it is impossible to know what they need and where you should start.

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Jordan is an Athletic Trainer and strength coach based out of Richmond, VA. He earned a Master of Science degree in Kinesiology with an emphasis in Sports Medicine from Indiana University and a Bachelor of Arts degree in Athletic Training from Franklin College. Jordan holds certifications from the BOC and NATA as a Certified Athletic Trainer (ATC) and the NSCA as a Certified Strength and Conditioning Specialist (CSCS). Jordan’s goal is to bridge the gap between rehabilitation and performance by combining both rehabilitative and strength and conditioning principles. Contact: jordansmuts@gmail.com or at jordansmuts.wordpress.com/about

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