0:05 This is Brent of the Brookbush Institute, and in this video we're going to 0:07 go over the Apley's scratch test. A great quick test for assessing shoulder 0:12 mobility. These are combined movement tests, so I think you'll find they're very 0:16 useful as pre to post tests, especially in those individuals who have just a 0:22 little bit of dysfunction, but are already starting to have symptoms of 0:26 pain. I'm going to have my friend Melissa come out, she's going to help me 0:29 demonstrate this test. I'm going to start with you having facing your back to the 0:32 camera. Now what Melissa is going to do is we're going to use combined motions 0:36 at the shoulder, to see if she actually has all the mobility she's supposed to 0:42 have. We're going to start with flexion abduction, and of course external 0:48 rotation here, as I asked her to place her hand on the opposite superior angle 0:54 of her scapula or reach down her back, optimal range of motion would be at 0:59 about T7, or able to touch that superior angle without any compensation. So I'm 1:06 going to have you turn sideways. What you guys will notice is her thoracic spine 1:10 is still nice and straight. We have no scapular elevation or scapular anterior 1:16 tipping. So that's the first test. I'm gonna have you go ahead and turn your 1:20 back to the camera, again I can then have her, let's go ahead and combine the rest 1:24 of the joint actions which would be extension adduction, and of course now 1:30 she's in maximal internal rotation as she reaches up back towards T7, or the 1:36 inferior angle of the opposite scapula is a good cue, and again if you guys look 1:43 at it from the side, I want no anterior tipping, or at least very little anterior 1:48 tipping. No elevation of the scapula and then if you guys look this way, I'm also 1:54 going to look at this scapular winging, and you can tell 2:00 Melissa here has a bit of scapular winging, so I might write that down in my 2:04 notes. Her over hand looked pretty good, her under hand she had some scapular 2:11 winging, which might be a sign that she's lacking some internal rotation or 2:15 lacking some extension that we're going to then need to work on. As well as 2:19 helping her to stabilize her scapula with maybe something like serratus 2:22 anterior activation. Now there is many combinations to this test, many different 2:28 ways to do this test. I've seen individuals do okay. So let's try to get 2:33 you to go one under and one over, and touch your fingertips, and you can see 2:39 Melissa can actually touch way more than our fingertips, which is actually not a 2:42 good thing. This is this is hypermobility with this is the cow face pose in yoga. 2:48 Alright so the cow face pose where you trying to hold wrist to wrist, realize 2:53 that's going to come at a price. If you try to get wrist to wrist and get 2:58 hypermobility that's going to lead to dysfunction and pathology, and 3:03 eventually pain, which might lead you back into here. I have to say yoga 3:09 actually gets me as many clients as a physical therapist as any of the 3:13 high-intensity training modalities out there right now. Alright so we can go 3:18 this way, can you do the other way, maybe we just want to test if it's even. We can 3:22 see she's hypermobile on both sides that's that's good, a little bit of 3:25 stability work on maybe. I could compare sides by maybe going both over right, so 3:33 can she touch her the superior angles on opposite sides this way. Can she go both 3:39 under 3:43 and we can see actually she has scapular winging on both sides. So she's very 3:48 symmetrical which is nice, but we do have some stability issues that I would want 3:54 to look into, where she's hypermobile when we do this way we see way too much 3:58 mobility. We see some scapular winging when she goes underneath which I'm going 4:02 to want to check into further as well. Now as a trick to help you differentiate 4:10 whether somebody truly has enough mobility to touch the opposing superior 4:15 angle or opposing inferior angle, without going into anterior tipping and thoracic 4:20 flexion, a little mean trick you can play on people. ls have them go toes to 4:27 the wall, and nose up to the wall. Well not quite that, just toes to the wall 4:32 alright, and now can they reach over and back, good, and she can, she can reach down 4:39 to t7 pretty good. So when it comes to the combined motion of once again 4:45 flexion, abduction and external rotation Melissa has good mobility. And if I'm 4:51 thinking through all of my muscles and arthrokinematics, and Melissa here I know 4:57 that she has plenty of extensibility through those structures. Now if I have 5:01 her do the same thing the other way she's not gaining that mobility through 5:07 her thoracic spine, or through anterior tipping of her scapula. Although she is 5:11 getting, i take that back, she is getting scapular winging which would be a sign 5:15 of anterior tipping, we know it's not coming from her thoracic spine because 5:19 she's not bouncing her head off the wall. So this is a way to make the Apley's 5:23 scratch test a little stricter. Now as part of a physical therapy examination 5:30 for shoulder pain, especially with an athletic population who doesn't need 5:34 very much dysfunction to become painful, you guys can add overpressure to these 5:41 tests. So if I have, go ahead and stand back from the wall, if I have Melissa go 5:47 ahead and let's say reach up with this hand, and touch the opposite, and then what i 5:52 can do is i can stabilize her scapula, take her other elbow, 5:56 and I'm going to push her further back into flexion, abduction, and external 6:00 rotation. Is that painful? If it's not painful i can add overpressure for this 6:06 range of motion that I know she's clear. I had the same thing if I have a reach 6:11 under. I'm going to now take this hand and I'm going to reach underneath her 6:16 forearm as I stabilize this scapula here, and I'm going to pull her into adduction, 6:22 extension, and external rotation. Is that painful? Okay so she's clear through her 6:28 shoulder joint. So I know I just showed you a lot of variations of this supposed 6:35 quick test, or suppose to be quick test, didn't become a very quick video. So she 6:40 has reach over, reach under, those are the basics. You can then combine the two 6:46 shoulders however you want to look at them. You might have a reason to do 6:50 opposites, looking specifically it may be thoracic spine mobility, or maybe this is 6:55 a pose that they're trying to get back to in yoga, but try to keep in mind of 6:59 what I said hypermobility can be very problematic too. You might have a 7:04 reason to do both the same way, maybe this is painful for them on both 7:09 shoulders, so this is the easier quick test. Or this is painful for both 7:12 shoulders like an impingement syndrome, Maybe this is painful on both shoulders 7:16 and this is your better quick test, and of course if somebody has pathology and 7:20 shoulder pain, you can use this as a combined motion joint exam. In which case 7:26 that have you do either reach up or reach under, and then I neither add 7:32 overpressure this way, go ahead and switch. 7:36 Or I might add overpressure this way. You guys need to work out the math on these two. 7:42 As far as what is short, if you can't get into flexion, abduction, and external 7:51 rotation; or adduction, extension and internal rotation, make sure you had that 7:55 worked out at some point so that you can go back and write a corrective exercise 7:59 program. I'll talk with you guys soon. 8:08
