Assessing Our Assessments: Shoulder Flexion
It’s a powerful word. A daunting word. A ten letter word. A word that means different things to different people.
But the word itself implies you’re assessing something.
So, what is it?
Well, given this is a fitness website it stands to reason that when I say the word “assessment” I’m not referring to one’s ability to color between the lines, write sick computer codes, or, I don’t know, how to say “excuse me, but can you tell me where the library is?” in Spanish1
No, in this context, when referring to the word assessment…I’m alluding to one’s ability to do “stuff.”
Particularly with their body. Most often in the weight room and/or within the confines of their respective sport(s).
But also their ability to perform every day life tasks – bending over to pick something up off the floor, reaching for something, carrying things, fighting crime, walking down a flight of stairs without snapping their hip in half – pain free.
The other day I said something halfway smart on Twitter:
Too many people think of their “point B” (where they want to be) before vetting their “point A” (where they are..NOW). That’s assessment.
— Tony Gentilcore (@tonygentilcore1) June 19, 2015
I approach assessment with every person with a blank slate. While I’d be remiss not to mention we do have a “protocol” we prefer to follow at Cressey Sports Performance – namely because of the unique population we overwhelming work with on a daily basis, overhead athletes – it’s not uncommon for me to go off the beaten track when it’s called for.
Put another way…..
No two assessments are the same.
It’s outside the scope of this article to discuss the entire assessment process. Rest assured I’m asking all the pertinent questions: training history, injury history, goals, favorite Mighty Morphin Power Ranger, you know, the important stuff.
While every assessment is different, there is a go to “algorithm” that exists which helps guide the process and keeps this succinct and organized.
We generally start static to dynamic; proximal to distal; and seated/lying/ground-based to moving.
All that said, under the umbrella of assessment, there are certain protocols or screens I use with just about every client or athlete I work with – no matter what sport he or she plays or what their background is. There are some screens too valuable to omit.
Not only that, we have to be able to look at what the assessment is looking at, whether it’s looking at what we think it’s looking at, and whether or not it’s telling us as much information as we think we’re getting from it.
I don’t even know if that makes any sense, but I’m going with it.
Basically all I’m saying is that, while assessment is cool and all, a lot of fitness professionals really suck at it and have no clue what they’re looking for.
Lets take a look at the standing shoulder flexion screen.
To the casual fitness professional this screen tests one’s ability to get their arms over their head.
It goes like this:
Trainer to Client: “So, like, stand there and lift your arms over your head.”
Client to Trainer: “Like this?” [Cue picture pictured below, the one on the left].
Trainer to Client: “Yes! You did it! Well done. Lets go kip.”
Client to Trainer: “Right on. Weeeeeeeeeeee”
To the untrained eye (again, looking at the picture to the left), and to someone who doesn’t know what to look for, things look a-okay.
Arms + Overhead = Able to train.
But to me it looks like a nightmare. There’s significant forward head posture in conjunction with a massive rib flair and hyperextension through the lumbar spine.
[Not coincidentally, lack of shoulder flexion could easily explain why someone has chronic lower back issues. Look at what happens every time they do anything overhead. They crank through their lumbar spine. Just sayin…..]
When corrected – picture to the right – total ROM (shoulder flexion) is reduced because compensation patterns are corrected (no head protraction, rib flair, and pelvis is more posteriorly tilted). And this isn’t even half bad. I’ve seen way worse. Some people I’ve worked with couldn’t get their shoulders past 75 degrees of shoulder flexion when I made sure they weren’t allowed to compensate!
Candidly: if someone can’t pass this simple screen they really have no business doing anything over their head in the weight room, kipping pull-ups included.
So this begs the question: What prevents someone from getting full shoulder flexion in the first place?
It could be any number of things:
1. Shoulder Capsule, osseous changes (which, admittedly, aren’t very common).
2. Soft tissue restrictions – subscapularis, lats, teres minor, traps, etc. (much more common).
3 Lack of scapular upward rotation (instead of upwardly rotating scapulae, they shrug).
4. Thoracic spine mobility.
5. And lastly, and something Mike Reinold speaks to quite often, lack of lumbo-pelvic hip control.
I’m not going to hit on every point above today. I’d encourage you to check out Mike Reinold’s site and/or look into his and Eric Cressey’s Functional Stability Training series (which goes into the geeky stuff in MUCH more detail).
What I will delve into is how, when someone does present with a lack of shoulder flexion, you can differentiate between whether you’re dealing with a lat length/soft tissue restriction or if it’s a anterior core/pelvic control issue.
Easy – test their PASSIVE range of motion.
Have them lie on their back (making sure to bend their knees to flatten out the lumbar spine and to account for any excessive rib flair). If their upper arms don’t touch the table….you’re most likely dealing with a soft-tissue restriction (lats, teres minor, traps, rhomboids, etc).
Hammer the lats with some t-spine mobility drills like this one:
And you can hit the rhomboids and traps using this drill:
And you can get the teres minor using this drill (thank you Mike Reinold).
If you test someone on their back and they pass with flying colors (I.e., their arms touch the table), then it stands to reason you’re probably dealing with a lumbo-pelvic control issue and a weak anterior core.
In that case my go to is coaching someone through deadbug variations.
Standard Deadbug – with emphasis on exhale
Note: these can be regressed to include arms only or legs only (or even legs bent so ROM is decreased).
Stability Ball Deadbug
Note: placing the stability ball between contralateral elbow and knee forces the trainee to squeeze the ball, thus activating the anterior core to a more effective degree.
Core Activated Deadbug w/ KB
People will often roll their eyes at deadbugs – deeming them too easy. That is until they do them correctly.
As well we can’t discount other exercises and drills that challenge the anterior core and pelvic control. Push-ups (and their infinite variations), birddogs, bear crawls, chops, lifts, Farmer carries, Pallof Presses, asymmetrical loaded lifts….all are fair game in my book.
The bigger picture, however, is to pay closer attention to what you’re actually assessing. Does the assessment itself assess what you think it’s assessing? Moreover, are you able to interpret what it’s telling you correctly?
If yes, awesome. You win the internet today.
If no, WTF are you doing???