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