0:05 This is Brent of the Brookbush Institute, 0:06 and in this video we're going to do 0:07 shoulder external rotator manual muscle 0:10 testing for an active population. So, 0:12 since we're going to go ahead and test a 0:14 more active population, we're going to 0:15 get rid of that Kendall scale of the one 0:17 through five of the pluses and minuses and 0:19 replace it with a simpler scale of 0:21 strong, weak, with compensation, or with 0:25 pain. But, we're going to pay a little 0:26 closer attention to the details, because 0:30 we know in that more active population, who 0:31 is putting a little bit more stress on 0:33 their musculoskeletal system, it often 0:35 doesn't take a very large change in 0:38 muscle activity, length, or we'll say joint 0:41 alignment to start showing signs of pain 0:44 and dysfunction. I'm going to have my 0:45 friend, Melissa, come out. She's going to 0:47 help me demonstrate these tests. Now, the 0:49 first test we're going to use for the 0:51 infraspinatus and teres minor, which we 0:53 know have a propensity to get long and 0:55 underactive, is the very traditional 0:58 Kendall style test. It is prone, facing 1:03 away, with their humorous supported by a table, and you 1:07 guys can use a little towel under their 1:09 humorous so that they they keep in good 1:12 alignment throughout their shoulder. 1:14 Since their chest tissue 1:17 will lift them up a little bit, we want 1:18 them in neutral position. Now, in this 1:21 position, I have a lot of control over her 1:23 shoulder girdle, so I can help stabilize 1:25 it. Or, I can put it back into good 1:28 position and just have her hold that. I 1:30 can also palpate her infraspinatus, just 1:33 under the spine of her scapula, or I can 1:36 use my thumb to palpate her teres 1:39 minor. Now, the first thing I'm going to 1:42 do with this test is I'm actually going 1:43 to check her range of 1:45 motion. We can see Melissa actually 1:49 has pretty close to optimal range at 90 or 1:52 95 degrees of external rotation. If I 1:55 have her do the same thing actively- now 1:57 go ahead and do that for me- you guys will 1:59 start to notice that she actually doesn't 2:01 have the same range of motion actively. 2:03 That's something I want to take note of. 2:04 She has good passive range of motion, but 2:07 her active range of motion is lacking. 2:09 Now, if I have her go ahead and do that 2:12 again and then I add some external 2:15 resistance, 2:17 what we notice with Melissa is she 2:19 has a weak spot through here. 2:22 and then she catches about here, at about 2:24 75 to 80 degrees of external 2:27 rotation. Now, if you're asking me, I'm 2:31 actually going to make a note of that. 2:33 That's a week test to me. Although, she 2:37 may test a five in this position, if she 2:41 doesn't have optimal strength all the 2:44 way to 90 degrees, the question I start 2:47 asking myself are will she keep that 90 2:50 degrees of external rotation. If she's 2:52 not stable and strong in a range of 2:54 motion, there is a chance that she could 2:56 lose that range of motion. So note: weak 3:00 maybe week last 15 degrees and whatever you 3:04 guys want to add as far as detail, but 3:05 this would be a weak test to me. I'm 3:07 going to go ahead and have Melissa sit 3:09 up. Now, the test I use more commonly is 3:13 not the traditional Kendall test, but 3:16 it's the one I see a lot of people use 3:18 in clinic, because it's 3:20 convenient and has some advantages. It's 3:23 not quite as strict as that test, but if 3:26 I have Melissa just sit up here, put both 3:29 her arms out, and I'm going to go ahead and make 3:31 sure she's in a slightly flexed position, 3:33 so maybe elbows lined up with the 3:36 anterior side of a rib cage here. Once 3:40 she's lined up this way, I have posterior 3:42 delt a little bit inhibited, I'm making 3:47 sure I get as much infraspinatus and 3:48 teres minor as I can, and I can go ahead 3:51 and push both arms at once. The 3:55 advantage to pushing both arms at once 3:58 is I can compare her two sides. With all 4:03 manual muscle testing, there's a little 4:04 bit of practice that you guys need to do. 4:07 You have to start comparing 4:08 individuals. It takes a little bit of 4:10 time to kind of determine what is strong 4:12 versus what is weak. I can't just tell 4:15 you guys on camera that a strong result 4:17 would give you X percentage, or X pounds, 4:20 or she should be able to hold, because I 4:22 can tell you right now that Melissa's 4:23 infraspinatus and teres minor are not as 4:27 strong as my pecs. Right? Those are much 4:29 smaller muscles. But, I don't have to 4:32 necessarily be able to rate her 4:35 infraspinatus and teres minor versus my 4:37 pecs if I can compare sides, especially 4:40 she's coming to see somebody like me to 4:42 correct some shoulder pain on 4:44 her right side. I can do that test and 4:47 immediately compare her left side to the 4:50 right side, and now I have presumably a good 4:54 side and a symptomatic side to compare 4:57 to. The other thing that this position is 4:59 really nice for is I can easily address 5:02 or see compensation. Remember, that's that 5:05 test result with compensation that we 5:07 talk about a lot when it comes to 5:09 using these tests for helping us 5:11 determine postural dysfunction and 5:12 intervention. If I come behind her, which 5:16 isn't how I would do this test, 5:17 but just so you guys can see on camera, 5:19 if I push her into internal rotation, 5:23 you can see her start to abduct at the 5:27 shoulder and her elbows are actually 5:29 starting to flare out a little bit. 5:34 Her infraspinatus and teres minor 5:35 definitely don't do abduction, so she's 5:38 starting to try to use her overactive 5:40 synergists, which in the case 5:42 of the external rotators is posterior 5:44 delt and supraspinatus, to try to 5:47 abduct her shoulders to resist me rather 5:50 than do pure external rotation. That's 5:53 with compensation. If I know her 5:56 compensation's abduction, maybe I'm 5:58 thinking in the back of my head already that 6:00 maybe one of the interventions I 6:03 want to give her is supraspinatus 6:05 release, or posterior deltoid release 6:08 along with her external rotator 6:10 activation. Now, I do want to show you 6:12 guys one more view from the side. I would 6:16 make sure Melissa's sitting up nice and 6:18 tall so that I don't have her starting 6:20 in a compensated position. I'm once again 6:23 going to line her arms up so that her 6:25 elbows are at her anterior rib cage, just 6:28 to try to inhibit her posterior delt a 6:31 little bit. We don't 6:32 want that taking over from the get-go. 6:33 And then, all I'm going to do is use my 6:36 pecs to go ahead and push in and see if 6:42 she can maintain that perfect posture. 6:48 Melissa, as we could tell from the other test, does have, in my 6:49 opinion, fairly weak external rotators. 6:53 From this view, they're even and 6:55 unless I'm cueing her to do so, she 6:58 actually doesn't compensate. So, maybe in 7:01 Melissa's case, since she doesn't 7:03 compensate, I could get away with not 7:05 doing supraspinatus release, not doing 7:08 posterior delt release, which is two less 7:10 releases I have to do. Maybe I don't 7:13 have to do any posterior capsule 7:14 stretching, which is one less stretch I 7:16 have to do. But, I am going to go ahead 7:18 and do some external rotator isolated 7:22 activation and integration to try to get 7:25 her shoulders a little stronger. I hope 7:28 you guys enjoyed this video. I hope you 7:30 guys enjoyed seeing my take on the 7:33 external rotators, or infraspinatus and 7:35 teres minor manual muscle test for an 7:38 active population. 7:47 you
