00:00:0500:00:06
This is Brent of the Brookbush Institute,
00:00:0600:00:07
and in this video we're going to do
00:00:0700:00:10
shoulder external rotator manual muscle
00:00:1000:00:12
testing for an active population. So,
00:00:1200:00:14
since we're going to go ahead and test a
00:00:1400:00:15
more active population, we're going to
00:00:1500:00:17
get rid of that Kendall scale of the one
00:00:1700:00:19
through five of the pluses and minuses and
00:00:1900:00:21
replace it with a simpler scale of
00:00:2100:00:25
strong, weak, with compensation, or with
00:00:2500:00:26
pain. But, we're going to pay a little
00:00:2600:00:30
closer attention to the details, because
00:00:3000:00:31
we know in that more active population, who
00:00:3100:00:33
is putting a little bit more stress on
00:00:3300:00:35
their musculoskeletal system, it often
00:00:3500:00:38
doesn't take a very large change in
00:00:3800:00:41
muscle activity, length, or we'll say joint
00:00:4100:00:44
alignment to start showing signs of pain
00:00:4400:00:45
and dysfunction. I'm going to have my
00:00:4500:00:47
friend, Melissa, come out. She's going to
00:00:4700:00:49
help me demonstrate these tests. Now, the
00:00:4900:00:51
first test we're going to use for the
00:00:5100:00:53
infraspinatus and teres minor, which we
00:00:5300:00:55
know have a propensity to get long and
00:00:5500:00:58
underactive, is the very traditional
00:00:5800:01:03
Kendall style test. It is prone, facing
00:01:0300:01:07
away, with their humorous supported by a table, and you
00:01:0700:01:09
guys can use a little towel under their
00:01:0900:01:12
humorous so that they they keep in good
00:01:1200:01:14
alignment throughout their shoulder.
00:01:1400:01:17
Since their chest tissue
00:01:1700:01:18
will lift them up a little bit, we want
00:01:1800:01:21
them in neutral position. Now, in this
00:01:2100:01:23
position, I have a lot of control over her
00:01:2300:01:25
shoulder girdle, so I can help stabilize
00:01:2500:01:28
it. Or, I can put it back into good
00:01:2800:01:30
position and just have her hold that. I
00:01:3000:01:33
can also palpate her infraspinatus, just
00:01:3300:01:36
under the spine of her scapula, or I can
00:01:3600:01:39
use my thumb to palpate her teres
00:01:3900:01:42
minor. Now, the first thing I'm going to
00:01:4200:01:43
do with this test is I'm actually going
00:01:4300:01:45
to check her range of
00:01:4500:01:49
motion. We can see Melissa actually
00:01:4900:01:52
has pretty close to optimal range at 90 or
00:01:5200:01:55
95 degrees of external rotation. If I
00:01:5500:01:57
have her do the same thing actively- now
00:01:5700:01:59
go ahead and do that for me- you guys will
00:01:5900:02:01
start to notice that she actually doesn't
00:02:0100:02:03
have the same range of motion actively.
00:02:0300:02:04
That's something I want to take note of.
00:02:0400:02:07
She has good passive range of motion, but
00:02:0700:02:09
her active range of motion is lacking.
00:02:0900:02:12
Now, if I have her go ahead and do that
00:02:1200:02:15
again and then I add some external
00:02:1500:02:17
resistance,
00:02:1700:02:19
what we notice with Melissa is she
00:02:1900:02:22
has a weak spot through here.
00:02:2200:02:24
and then she catches about here, at about
00:02:2400:02:27
75 to 80 degrees of external
00:02:2700:02:31
rotation. Now, if you're asking me, I'm
00:02:3100:02:33
actually going to make a note of that.
00:02:3300:02:37
That's a week test to me. Although, she
00:02:3700:02:41
may test a five in this position, if she
00:02:4100:02:44
doesn't have optimal strength all the
00:02:4400:02:47
way to 90 degrees, the question I start
00:02:4700:02:50
asking myself are will she keep that 90
00:02:5000:02:52
degrees of external rotation. If she's
00:02:5200:02:54
not stable and strong in a range of
00:02:5400:02:56
motion, there is a chance that she could
00:02:5600:03:00
lose that range of motion. So note: weak
00:03:0000:03:04
maybe week last 15 degrees and whatever you
00:03:0400:03:05
guys want to add as far as detail, but
00:03:0500:03:07
this would be a weak test to me. I'm
00:03:0700:03:09
going to go ahead and have Melissa sit
00:03:0900:03:13
up. Now, the test I use more commonly is
00:03:1300:03:16
not the traditional Kendall test, but
00:03:1600:03:18
it's the one I see a lot of people use
00:03:1800:03:20
in clinic, because it's
00:03:2000:03:23
convenient and has some advantages. It's
00:03:2300:03:26
not quite as strict as that test, but if
00:03:2600:03:29
I have Melissa just sit up here, put both
00:03:2900:03:31
her arms out, and I'm going to go ahead and make
00:03:3100:03:33
sure she's in a slightly flexed position,
00:03:3300:03:36
so maybe elbows lined up with the
00:03:3600:03:40
anterior side of a rib cage here. Once
00:03:4000:03:42
she's lined up this way, I have posterior
00:03:4200:03:47
delt a little bit inhibited, I'm making
00:03:4700:03:48
sure I get as much infraspinatus and
00:03:4800:03:51
teres minor as I can, and I can go ahead
00:03:5100:03:55
and push both arms at once. The
00:03:5500:03:58
advantage to pushing both arms at once
00:03:5800:04:03
is I can compare her two sides. With all
00:04:0300:04:04
manual muscle testing, there's a little
00:04:0400:04:07
bit of practice that you guys need to do.
00:04:0700:04:08
You have to start comparing
00:04:0800:04:10
individuals. It takes a little bit of
00:04:1000:04:12
time to kind of determine what is strong
00:04:1200:04:15
versus what is weak. I can't just tell
00:04:1500:04:17
you guys on camera that a strong result
00:04:1700:04:20
would give you X percentage, or X pounds,
00:04:2000:04:22
or she should be able to hold, because I
00:04:2200:04:23
can tell you right now that Melissa's
00:04:2300:04:27
infraspinatus and teres minor are not as
00:04:2700:04:29
strong as my pecs. Right? Those are much
00:04:2900:04:32
smaller muscles. But, I don't have to
00:04:3200:04:35
necessarily be able to rate her
00:04:3500:04:37
infraspinatus and teres minor versus my
00:04:3700:04:40
pecs if I can compare sides, especially
00:04:4000:04:42
she's coming to see somebody like me to
00:04:4200:04:44
correct some shoulder pain on
00:04:4400:04:47
her right side. I can do that test and
00:04:4700:04:50
immediately compare her left side to the
00:04:5000:04:54
right side, and now I have presumably a good
00:04:5400:04:57
side and a symptomatic side to compare
00:04:5700:04:59
to. The other thing that this position is
00:04:5900:05:02
really nice for is I can easily address
00:05:0200:05:05
or see compensation. Remember, that's that
00:05:0500:05:07
test result with compensation that we
00:05:0700:05:09
talk about a lot when it comes to
00:05:0900:05:11
using these tests for helping us
00:05:1100:05:12
determine postural dysfunction and
00:05:1200:05:16
intervention. If I come behind her, which
00:05:1600:05:17
isn't how I would do this test,
00:05:1700:05:19
but just so you guys can see on camera,
00:05:1900:05:23
if I push her into internal rotation,
00:05:2300:05:27
you can see her start to abduct at the
00:05:2700:05:29
shoulder and her elbows are actually
00:05:2900:05:34
starting to flare out a little bit.
00:05:3400:05:35
Her infraspinatus and teres minor
00:05:3500:05:38
definitely don't do abduction, so she's
00:05:3800:05:40
starting to try to use her overactive
00:05:4000:05:42
synergists, which in the case
00:05:4200:05:44
of the external rotators is posterior
00:05:4400:05:47
delt and supraspinatus, to try to
00:05:4700:05:50
abduct her shoulders to resist me rather
00:05:5000:05:53
than do pure external rotation. That's
00:05:5300:05:56
with compensation. If I know her
00:05:5600:05:58
compensation's abduction, maybe I'm
00:05:5800:06:00
thinking in the back of my head already that
00:06:0000:06:03
maybe one of the interventions I
00:06:0300:06:05
want to give her is supraspinatus
00:06:0500:06:08
release, or posterior deltoid release
00:06:0800:06:10
along with her external rotator
00:06:1000:06:12
activation. Now, I do want to show you
00:06:1200:06:16
guys one more view from the side. I would
00:06:1600:06:18
make sure Melissa's sitting up nice and
00:06:1800:06:20
tall so that I don't have her starting
00:06:2000:06:23
in a compensated position. I'm once again
00:06:2300:06:25
going to line her arms up so that her
00:06:2500:06:28
elbows are at her anterior rib cage, just
00:06:2800:06:31
to try to inhibit her posterior delt a
00:06:3100:06:32
little bit. We don't
00:06:3200:06:33
want that taking over from the get-go.
00:06:3300:06:36
And then, all I'm going to do is use my
00:06:3600:06:42
pecs to go ahead and push in and see if
00:06:4200:06:48
she can maintain that perfect posture.
00:06:4800:06:49
Melissa, as we could tell from the other test, does have, in my
00:06:4900:06:53
opinion, fairly weak external rotators.
00:06:5300:06:55
From this view, they're even and
00:06:5500:06:58
unless I'm cueing her to do so, she
00:06:5800:07:01
actually doesn't compensate. So, maybe in
00:07:0100:07:03
Melissa's case, since she doesn't
00:07:0300:07:05
compensate, I could get away with not
00:07:0500:07:08
doing supraspinatus release, not doing
00:07:0800:07:10
posterior delt release, which is two less
00:07:1000:07:13
releases I have to do. Maybe I don't
00:07:1300:07:14
have to do any posterior capsule
00:07:1400:07:16
stretching, which is one less stretch I
00:07:1600:07:18
have to do. But, I am going to go ahead
00:07:1800:07:22
and do some external rotator isolated
00:07:2200:07:25
activation and integration to try to get
00:07:2500:07:28
her shoulders a little stronger. I hope
00:07:2800:07:30
you guys enjoyed this video. I hope you
00:07:3000:07:33
guys enjoyed seeing my take on the
00:07:3300:07:35
external rotators, or infraspinatus and
00:07:3500:07:38
teres minor manual muscle test for an
00:07:3800:07:41
active population.