Ok, I am finally getting around to posting my thoughts on the shoulder and the movements that are associated with it. I originally did not discuss the shoulder in the foundational movement patterns, as the shoulder is more involved than these combined shoulder movement assessments…but this method still has merit. The complexity of the shoulder is the primary reason that I did not initially include them in the prior movement pattern descriptions. I will first show you the self-screening movement patterns, then the basics of the “pain provocation tests.” I will also attempt to touch on what makes the shoulder so amazing and challenging in the next set of posts. So, when looking back at the original Movement Patterns post, you should make sure to check your shoulder girdle mobility as described below.
On to the self screening:
First, reach one arm up and over your head and try to touch the upper part of the opposite shoulder blade (image 1 – LEFT). Repeat for the other side. Second, reach one arm behind your back and try to touch the lower part of the opposite shoulder blade (image 2 – RIGHT). Repeat for the other side. These are combined motions that incorporate elements of elevation, rotation, and movements away from or across your body. Note any differences side to side – even if you reach to these landmarks or beyond the minimum described goals. These reason to note where each hand could reach is that you are checking for symmetry (how your Right arm compares to your Left) along with these baseline movements.
Next, you are going to perform “provocation patterns”. The objective here is to identify combined movements that are designed to somewhat replicate special tests that we routinely perform in the physical therapy clinic – this is in attempt to determine any pain that may indicate underlying pathology (like rotator cuff or joint involvement, for example).
Provocation Test 1: Take the palm of the RIGHT hand and place it on the LEFT shoulder. Slowly lift the elbow towards the ceiling. Repeat with the opposite side.
Provocation Test 2: Take your LEFT hand and help pull the RIGHT arm across your chest as far as possible. Repeat with the opposite side.
If either of these movements created pain, please note where it hurt (front, top, back). If you experience pain, as always, it may be worth a visit to a medical professional to help rule o
ut any underlying pathology. When simply moving your body in these ways, you should never experience pain. When pain is present, something more may be involved. Again, you are not seeking to push into any painful ranges.
So, if you reached those baseline landmarks, as described above, your shoulder/shoulder blade/thoracic/cervical structures all are appropriately moving. If not, we need to attempt to better understand these combined movements and need you to move into a lying on your stomach position. The reason for this position is to limit the role of thoracic, cervical and shoulder girdle stability requirements. Now, try the original 2 combined movements from your stomach and see if your range has improved – are you able to reach your shoulder blade in both directions now? If not, are you closer? Is it easier or less painful? If any aspect is better, your shoulder joint itself may move well, but you possibly have postural or positional or stabilization deficits. If nothing improved from this position, you may truly have a mobility issue that needs to be addressed. Where the mobility or stability deficits lie may take more assessment, though…
I will leave you with the understanding that there are hundreds of published articles about the shoulder and many are conflicting, controversial and even unclear oftentimes. They seek to address things from rotator cuff tears, to tendonitis, to bursitis, to labral tears, to sprains, to spurs, to arthritis to many other conditions. As always, pain is a game-changer. Never push into it or try to determine it’s source by something this simplistic (or via any other internet info) and consult a qualified medical professional. Again, this post is meant to serve as a quick and simple way to self-assess your shoulder complex and is by no means specific to any pathology or injuries you may have. With that, good luck trying the first step of checking out your own shoulder!