Stability vs Mobility, Round 1: Fight! | Modern Manual Therapy Blog

Stability vs Mobility, Round 1: Fight!

A current intern of mine said he had difficulty washing his back a certain way because his right shoulder was so tight. Was it really tight? Read on to find out!

The SFMA borrows from Cyriax's assessments checking motions passively and actively. The motion that this individual could not do was left shoulder LRF and right shoulder MRE simultaneously (that's functional ER and IR, respectively). He could do right LRF and left MRE, which is how he washed his back. However, he felt asymmetrical in motion, and possibly in cleanliness. I just happened to be teaching some SFMA principles that day, and this was a perfect example.
Thanks to the lovely Dr. Nicole Religioso for her generous contributions of  her upper body

It was his right shoulder that he insisted was "so tight." The above picture is an example of how much motion he had checking MRE (medial rotation and extension). That motion was active. To get a FN on this movement, you have to easily be able to touch your opposite inferior angle of the scapula without excessive compensatory motions. If he was actually limited in mobility, I should not have been able to passively increase his motion significantly. Normally, passive motion should be greater than active, that is joint play and necessary in all joints. However, when I tested him passively, his hand easily reached his scapula. When passive motion is significantly greater than active, and we tested three times, it indicates a stability issue.

He was flabbergasted that his hand easily touched his scapula without even a hint of perceptible "tightness." I placed my right hand on the inferior angle of his scapula and gently cued him to meet my resistance to get his scapular stabilizers working.

PNF to cue scapula stabilizers
Don't forget about your PNF! It is mistakenly thought of as a neuro-rehab treatment, but it is a extremely effective method to cue movement through touch. With just a light scapula depression into set position, he was able to reach above 2 inches higher, but immediately got a very painful lower trap spasm.

I then instructed him to carry a kettlebell overhead intermittently for 3-4 minutes. We chose a 25# bell, and he felt comfortable with this, and took 1 break. Immediately upon retest, automagically, the perception of "tightness" was now gone and he easily touched his left scapula. He has been keeping up with his kettlebell carries and rotations and is now symmetrical with the MRE testing bilaterally just a few weeks later after having years of "tightness."

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