00:05 - 00:06This is Brent of the Brookbush Institute,
00:06 - 00:07and in this video we're going to do
00:07 - 00:10shoulder external rotator manual muscle
00:10 - 00:12testing for an active population. So,
00:12 - 00:14since we're going to go ahead and test a
00:14 - 00:15more active population, we're going to
00:15 - 00:17get rid of that Kendall scale of the one
00:17 - 00:19through five of the pluses and minuses and
00:19 - 00:21replace it with a simpler scale of
00:21 - 00:25strong, weak, with compensation, or with
00:25 - 00:26pain. But, we're going to pay a little
00:26 - 00:30closer attention to the details, because
00:30 - 00:31we know in that more active population, who
00:31 - 00:33is putting a little bit more stress on
00:33 - 00:35their musculoskeletal system, it often
00:35 - 00:38doesn't take a very large change in
00:38 - 00:41muscle activity, length, or we'll say joint
00:41 - 00:44alignment to start showing signs of pain
00:44 - 00:45and dysfunction. I'm going to have my
00:45 - 00:47friend, Melissa, come out. She's going to
00:47 - 00:49help me demonstrate these tests. Now, the
00:49 - 00:51first test we're going to use for the
00:51 - 00:53infraspinatus and teres minor, which we
00:53 - 00:55know have a propensity to get long and
00:55 - 00:58underactive, is the very traditional
00:58 - 01:03Kendall style test. It is prone, facing
01:03 - 01:07away, with their humorous supported by a table, and you
01:07 - 01:09guys can use a little towel under their
01:09 - 01:12humorous so that they they keep in good
01:12 - 01:14alignment throughout their shoulder.
01:14 - 01:17Since their chest tissue
01:17 - 01:18will lift them up a little bit, we want
01:18 - 01:21them in neutral position. Now, in this
01:21 - 01:23position, I have a lot of control over her
01:23 - 01:25shoulder girdle, so I can help stabilize
01:25 - 01:28it. Or, I can put it back into good
01:28 - 01:30position and just have her hold that. I
01:30 - 01:33can also palpate her infraspinatus, just
01:33 - 01:36under the spine of her scapula, or I can
01:36 - 01:39use my thumb to palpate her teres
01:39 - 01:42minor. Now, the first thing I'm going to
01:42 - 01:43do with this test is I'm actually going
01:43 - 01:45to check her range of
01:45 - 01:49motion. We can see Melissa actually
01:49 - 01:52has pretty close to optimal range at 90 or
01:52 - 01:5595 degrees of external rotation. If I
01:55 - 01:57have her do the same thing actively- now
01:57 - 01:59go ahead and do that for me- you guys will
01:59 - 02:01start to notice that she actually doesn't
02:01 - 02:03have the same range of motion actively.
02:03 - 02:04That's something I want to take note of.
02:04 - 02:07She has good passive range of motion, but
02:07 - 02:09her active range of motion is lacking.
02:09 - 02:12Now, if I have her go ahead and do that
02:12 - 02:15again and then I add some external
02:15 - 02:17resistance,
02:17 - 02:19what we notice with Melissa is she
02:19 - 02:22has a weak spot through here.
02:22 - 02:24and then she catches about here, at about
02:24 - 02:2775 to 80 degrees of external
02:27 - 02:31rotation. Now, if you're asking me, I'm
02:31 - 02:33actually going to make a note of that.
02:33 - 02:37That's a week test to me. Although, she
02:37 - 02:41may test a five in this position, if she
02:41 - 02:44doesn't have optimal strength all the
02:44 - 02:47way to 90 degrees, the question I start
02:47 - 02:50asking myself are will she keep that 90
02:50 - 02:52degrees of external rotation. If she's
02:52 - 02:54not stable and strong in a range of
02:54 - 02:56motion, there is a chance that she could
02:56 - 03:00lose that range of motion. So note: weak
03:00 - 03:04maybe week last 15 degrees and whatever you
03:04 - 03:05guys want to add as far as detail, but
03:05 - 03:07this would be a weak test to me. I'm
03:07 - 03:09going to go ahead and have Melissa sit
03:09 - 03:13up. Now, the test I use more commonly is
03:13 - 03:16not the traditional Kendall test, but
03:16 - 03:18it's the one I see a lot of people use
03:18 - 03:20in clinic, because it's
03:20 - 03:23convenient and has some advantages. It's
03:23 - 03:26not quite as strict as that test, but if
03:26 - 03:29I have Melissa just sit up here, put both
03:29 - 03:31her arms out, and I'm going to go ahead and make
03:31 - 03:33sure she's in a slightly flexed position,
03:33 - 03:36so maybe elbows lined up with the
03:36 - 03:40anterior side of a rib cage here. Once
03:40 - 03:42she's lined up this way, I have posterior
03:42 - 03:47delt a little bit inhibited, I'm making
03:47 - 03:48sure I get as much infraspinatus and
03:48 - 03:51teres minor as I can, and I can go ahead
03:51 - 03:55and push both arms at once. The
03:55 - 03:58advantage to pushing both arms at once
03:58 - 04:03is I can compare her two sides. With all
04:03 - 04:04manual muscle testing, there's a little
04:04 - 04:07bit of practice that you guys need to do.
04:07 - 04:08You have to start comparing
04:08 - 04:10individuals. It takes a little bit of
04:10 - 04:12time to kind of determine what is strong
04:12 - 04:15versus what is weak. I can't just tell
04:15 - 04:17you guys on camera that a strong result
04:17 - 04:20would give you X percentage, or X pounds,
04:20 - 04:22or she should be able to hold, because I
04:22 - 04:23can tell you right now that Melissa's
04:23 - 04:27infraspinatus and teres minor are not as
04:27 - 04:29strong as my pecs. Right? Those are much
04:29 - 04:32smaller muscles. But, I don't have to
04:32 - 04:35necessarily be able to rate her
04:35 - 04:37infraspinatus and teres minor versus my
04:37 - 04:40pecs if I can compare sides, especially
04:40 - 04:42she's coming to see somebody like me to
04:42 - 04:44correct some shoulder pain on
04:44 - 04:47her right side. I can do that test and
04:47 - 04:50immediately compare her left side to the
04:50 - 04:54right side, and now I have presumably a good
04:54 - 04:57side and a symptomatic side to compare
04:57 - 04:59to. The other thing that this position is
04:59 - 05:02really nice for is I can easily address
05:02 - 05:05or see compensation. Remember, that's that
05:05 - 05:07test result with compensation that we
05:07 - 05:09talk about a lot when it comes to
05:09 - 05:11using these tests for helping us
05:11 - 05:12determine postural dysfunction and
05:12 - 05:16intervention. If I come behind her, which
05:16 - 05:17isn't how I would do this test,
05:17 - 05:19but just so you guys can see on camera,
05:19 - 05:23if I push her into internal rotation,
05:23 - 05:27you can see her start to abduct at the
05:27 - 05:29shoulder and her elbows are actually
05:29 - 05:34starting to flare out a little bit.
05:34 - 05:35Her infraspinatus and teres minor
05:35 - 05:38definitely don't do abduction, so she's
05:38 - 05:40starting to try to use her overactive
05:40 - 05:42synergists, which in the case
05:42 - 05:44of the external rotators is posterior
05:44 - 05:47delt and supraspinatus, to try to
05:47 - 05:50abduct her shoulders to resist me rather
05:50 - 05:53than do pure external rotation. That's
05:53 - 05:56with compensation. If I know her
05:56 - 05:58compensation's abduction, maybe I'm
05:58 - 06:00thinking in the back of my head already that
06:00 - 06:03maybe one of the interventions I
06:03 - 06:05want to give her is supraspinatus
06:05 - 06:08release, or posterior deltoid release
06:08 - 06:10along with her external rotator
06:10 - 06:12activation. Now, I do want to show you
06:12 - 06:16guys one more view from the side. I would
06:16 - 06:18make sure Melissa's sitting up nice and
06:18 - 06:20tall so that I don't have her starting
06:20 - 06:23in a compensated position. I'm once again
06:23 - 06:25going to line her arms up so that her
06:25 - 06:28elbows are at her anterior rib cage, just
06:28 - 06:31to try to inhibit her posterior delt a
06:31 - 06:32little bit. We don't
06:32 - 06:33want that taking over from the get-go.
06:33 - 06:36And then, all I'm going to do is use my
06:36 - 06:42pecs to go ahead and push in and see if
06:42 - 06:48she can maintain that perfect posture.
06:48 - 06:49Melissa, as we could tell from the other test, does have, in my
06:49 - 06:53opinion, fairly weak external rotators.
06:53 - 06:55From this view, they're even and
06:55 - 06:58unless I'm cueing her to do so, she
06:58 - 07:01actually doesn't compensate. So, maybe in
07:01 - 07:03Melissa's case, since she doesn't
07:03 - 07:05compensate, I could get away with not
07:05 - 07:08doing supraspinatus release, not doing
07:08 - 07:10posterior delt release, which is two less
07:10 - 07:13releases I have to do. Maybe I don't
07:13 - 07:14have to do any posterior capsule
07:14 - 07:16stretching, which is one less stretch I
07:16 - 07:18have to do. But, I am going to go ahead
07:18 - 07:22and do some external rotator isolated
07:22 - 07:25activation and integration to try to get
07:25 - 07:28her shoulders a little stronger. I hope
07:28 - 07:30you guys enjoyed this video. I hope you
07:30 - 07:33guys enjoyed seeing my take on the
07:33 - 07:35external rotators, or infraspinatus and
07:35 - 07:38teres minor manual muscle test for an
07:38 - 07:41active population.
07:47 - 07:49you