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Writer's pictureJo Clubb

Practitioner's Guide to Shoulders

The following excerpt is taken from the VALD eBook 'Practitioner's Guide to Shoulders'. The guide, co-authored by myself and Ben Ashworth, aims to help practitioners better understand and improve their shoulder assessment and treatment strategies.



Advancements in technology have significantly enhanced the precision and scope of shoulder assessments. Technology adds value by:


• Quantifying shoulder function through objective data

• Calculating asymmetries between left and right sides and imbalances within the shoulder joint

• Providing biofeedback to improve exercise application during training

• Allowing training to be used as testing in an ongoing monitoring process

• Enhancing criteria-based progression

• Benchmarking – enabling greater insights by comparison to normative data.



Range of Motion Testing


Testing ROM provides crucial information about the mobility of the shoulder joint. Given the shoulder’s complex structure (outlined earlier), it is important to assess the movement in multiple planes: flexion, extension, abduction, horizontal adduction and abduction, and IR and ER. In each of these movements, multiple positions exist.


A table showing the different planes to test shoulder range of motion: internal rotation, external rotation, flexion, extension, abduction and horizontal abduction. For each column listed below are different positions in which they can be tested. Overlaid is an image of a ROM test measured by VALD's HumanTrak.

For more information on testing protocols for each of these positions, head to VALD’s Knowledge Base for DynaMo setup and testing protocols.



Shoulder Strength Testing


Shoulder strength testing is particularly important for athletes involved in high-demand, overhead activities such as throwing, tackling or catching. Traditional strength assessments often involve manual muscle testing, which, while useful, can be limited by their subjective nature and variability between testers. To overcome these limitations, more objective methods have been developed.


Strength testing focuses on evaluating the force-generating capacity of the shoulder muscles, particularly the rotator cuff and scapular stabilizers. Isometric strength tests are commonly used, as they provide reliable data without inducing significant fatigue. Devices like handheld dyanmometers (HHDs) and fixed frame dynamometers (FFDs), such as VALD’s DynaMo and ForceFrame, are frequently employed for this purpose.




For throwing athletes and others involved in overhead sports, it is particularly important to assess the strength of internal and external rotators, given their role in stabilizing the GH joint during high-velocity movements.



Examples of Shoulder Strength Testing Options


Four key examples of shoulder strength testing are shown with an orange silhouette representing the testing position. These tests are prone IR in 90 degrees abduction, shoulder ISO-Y, Standing ER, and supine ER in 90 degrees abduction.

The ratio of ER to IR strength is a critical metric (ER:IR), as significant imbalances can increase the risk of injury, and we will explore how to interpret this ratio in the data interpretation and analysis section.



Isometric Strength


Isometric training is a strength method where the joint angle remains unchanged during contraction. Its popularity has grown due to its safety, simplicity and effectiveness. A major benefit of isometric training is the ability to assess and train force in nearly any position. It allows for greater force production than traditional weights, as it removes technical demands, enabling more intensive muscle training. For more on the science and application of isometric training, download VALD’s Practitioner’s Guide to Isometrics.




Don’t Forget the Lower Body!


Even though this is a guide to the shoulder, it is crucial to consider the body as a kinetic chain, where lower-body strength impacts shoulder performance and injury risk. The lower body generates around 50% of the force in upper-body actions like throwing.


When lower-limb strength is lacking, athletes may overcompensate with their shoulders, leading to altered mechanics and increased injury risk. Assessing lower limb force through tests like the isometric mid-thigh pull (IMTP) or countermovement jump (CMJ) and comparing it with upper body strength helps identify imbalances. Athletes who focus on building lower body strength and power but neglect upper body development may face an imbalance.


A baseball pitcher mid-pitch. Cut-out boxes provide examples of his testing data across a mixture of upper and lower body strength tests.

Such imbalance between lower and upper body strength can cause shoulder overload, contributing to overuse injuries like rotator cuff tendinopathy or degenerative labral pathology. Equally, this is especially evident in fatigued athletes, who may struggle to generate force from their legs, relying excessively on the shoulder, thus exacerbating injury risk. Combining upper and lower body testing can provide invaluable insights to drive effective long-term athlete development programs



Boxes that show the content of VALD's ebook, including how should I start my multidisciplinary postseason review? How to design testing protocols? Who do radar plots work so well for comparisons? How do you calculate z-scores?

This content continues in the free eBook: Practitioner's Guide to Shoulders.


The guide covers a wide range of topics and answers some common questions, including those shown right.


Visit VALD Performance to download your free guide, here:



 

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The sports technology company VALD Performance's logo in orange on a white background.

This article is support by VALD Performance. For more information, about their technology, visit their website.

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