Today we're going to be looking at shoulder mobility screening. While it might seem intimidating or even tedious to do these assessments with your clients, they can provide valuable information about where they might be tight or weak, and you can address that with your program. It is important to understand the objective or purpose of the assessment and that you can explain that to your client. This is not only to help your clients understand how to perform the assessment, but how the results of the assessment will allow you to cater the program to their unique needs.
Adding educational moments like this into your client's program is a fantastic way to increase their health literacy and help them develop autonomy within their program. The Apli Scratch Test is the first assessment we will look at. To understand this better, let's take a look at our shoulder.
Our shoulder is made up of two joints. One, the glenohumeral joint, and two, the scapulothoracic joint. Keep in mind that whenever there is an O in between a word, O means and. So the glen-O humeral joint is where the head of the humerus and the glenoid vasa, a depression in the side of the scapula, come together or articulate.
The scapula-O thoracic joint is where the scapula and the thorax articulate. This assessment looks at the simultaneous movements of the shoulder and shoulder girdle, including flexion, extension, abduction, adduction. and internal and external rotation.
The motion of this assessment is made up of two movements completed one arm at a time. For the first movement, raise the arm up and bending at the elbow, reach posteriorly for the opposite shoulder blade. Then, for the second movement, you will extend the arm posteriorly and bending at the elbow, try to touch the opposite shoulder blade. For this one, the back of the hand will be against the back.
If they can do that on both sides, the ability to touch specific landmarks indicates good shoulder mobility. If they are unable to reach the opposite shoulder blade or perform differently on either side, then we can perform further assessments to see where those limitations might be stemming from. If further assessments are needed, you can perform the shoulder flexion and extension and internal and external rotation assessments. During the flexion portion of the assessment, The client lies on their back or in a supine position with knees bent. They should be able to reach their arms overhead until their thumbs contact the ground and they should be able to do this without arching their back or straining into the shoulders.
During the extension portion, they would lie on their belly in a prone position and while keeping their forehead on the ground, lift their arms behind them with thumbs facing the ground as high as they can. If they can achieve 50 to 60 degree angle with their arms, that is considered good shoulder extension mobility. A limitation in either direction will likely mean that there is tightness in the antagonist muscles and a weakness in the agonist muscle, so we can select exercises to address this. For example, if someone had a lack of range of motion in shoulder extension, we could assume that the shoulder flexors and surrounding muscles are tight and the shoulder extensor muscles are weak.
Then we could select stretches for the tight muscles such as the anterior, inferior, and superior capsule stretches, as well as a strengthening exercise for the periscapular muscles such as prone arm lifts. Finally, the internal and external rotation test assessed the medial and lateral rotation of the humerus at the shoulder joint. During this assessment, the client starts lying on their back with knees bent, elbows level with the shoulders, and fingertips towards the sky.
To assess internal rotation, you try and move the palm towards the floor while keeping your elbow against the floor at shoulder height. If they can achieve 70 degrees of rotation, that is considered good mobility. And if they can't, that is an indicator that the external rotators are tight, which are preventing them from moving into internal rotation.
To assess external rotation from the starting position, The client would want to try and get the back of their hand to touch the ground. If they cannot, then this is an indication that their internal rotators are tight and preventing them from moving to external rotation. If a client exhibits a limitation in either direction, then you would want to select appropriate exercises to strengthen and stretch the shoulder internal and external rotators to promote muscular balance and good range of motion. There's no one program that fits all.
So use these assessments to create a unique and complete program for your client's needs.