Download Pectoralis Major/ Latissimus Dorsi

BASIC ORTHOPEDIC ASSESSMENT
Muscle and Joint Testing
The following tests are for the purpose of determining relative shortening,
restriction or bind of muscle tissues. In this context the term bind in a muscle
is synonymous with the feeling of restriction felt when a shortened hypertonic
muscle reaches its end range of motion (ROM). The term ease is used as the
opposite of bind.
One tool for determining this is to use a “listening hand” palpating the
muscle(s) being tested. As the muscle/joint is tested this hand lightly palpates
to feel or “listen” for the muscles end range ROM.
The following directions are used describing the following:
Client Position = The clients position on or off the table as well as any
directions needed subsequent to beginning the test
Test Protocol = Description of the test to be performed
Results = Explanations of the possible test results
The results are listed as:
1. A positive (+) test meaning there is a sensation of bind prior to the
muscle reaching normal ROM
2. A negative (-) test meaning full ROM is obtained w/o bind.
3. In some cases a positive test requires further isolated muscle tests to
narrow the evaluation to a muscle or muscle group.
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Pectoralis Major/ Latissimus Dorsi
Client Position: Supine
Test Protocol: Place client’s arms in a flexed medially rotated position (as shown).
Results:
- upper arm lays flat on table
+ Raised arm indicates Pect. Or Lat. bind
- Left arm position
+ right arm position indicates
Latissimus Dorsi bind
You may utilize a “spring test” as with the Rectus Femoris on page 6
Push medially to test Latissimus Dorsi
Push posteriorly for Pectoralis test
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Upper Trapezius/Levator Scapula
Functional Assessment
Client Position: seated
Test Protocol: Abduct arm then have client abduct
arm past horizontal (90). Visually note degree of
“hinging” at area marked by
and “bunching” of
the muscles just medial to this point.
Results:
- upon action noted “hinging” at the shoulder joint
with minimal “bunching” of the Upper Trapezius and
Levator Scapula
+ action “hinges” over upper trapezius with excessive
“bunching” of muscles and marked upward rotation of
the scapula indicating overactivity in the two muscles
Test Protocol: Palpate just medial to the
observation point in the previous test
Instruct client to bend their arm bringing
their elbow straight back.
Results:
- no contraction of Trapezius or Levator Scapula felt during movement
+ contraction of these muscles felt during movement indicating relative shortness and overactivity
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Upper Trapezius
Client Position: Supine
Test Protocol: Side bend neck and rotate head
from side being assessed.
Cup shoulder and perform “spring test away
by depressing shoulder and releasing.
Results:
- soft, bounce return into elevation
+ hard, tight elastic return indicates Upper Trapezius bind
Levator Scapula
Test Protocol:
Flex then side bend neck and rotate head away from
side being assessed. Cup shoulder and perform
“spring test” by depressing shoulder and releasing.
Results:
- soft, bounce return into elevation
+ hard, tight elastic return indicates Levator Scapula bind
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Range of Motion of Neck On Rotation
Client Position; supine
Test Protocol: Gently take clients head into rotation. Be sure chin stays level. Proper rotation
should be 90° or flat on table. Test both sides. This test may also be done actively by client, with
proper movement allowing client to hear hair rubbing on table.
Results;
- Head lays flat on table
+ Any position where head does not rest on table indicates tightness in muscles on opposite side
including Sternocleidomastoid.
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Sternocleidomastoid
Client Position: Supine
Test Protocol: Instruct client to lift head from table bringing their chin to their chest. Observe
looking for proper movement. Chin should tuck with initiation of movement as forehead leads
capital and neck flexion.
Results:
- smooth flexion with forehead leading
+ chin “just out” and leads movement indicating
Scalenes
Client position: Seated
Test Protocol: Observe client’s shoulders while they breathe normally. Watch for breath but try
not to be obvious.
Results:
- shoulders do not move with breath
+ Shoulders rise with breath, indicating possible scalenes shortness
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Medial Rotators of the Gleno/humeral joint
Client position: Supine, close to edge of table.
Test Protocol: Have client bring arm into abduction with elbow in flexion. Passively or actively
move client’s arm so that lower arm faces upward and hand lies level to or above head. You may
choose to palpate client shoulder to feel for restrictions in ROM. Do not force, although a “spring
test” is possible.
Results:
- forearm rest comfortably on or level with table
+ Forearm is elevated and does not lie flat on table, indicating shortness of medial rotators,
especially
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Lateral Rotators of the Gleno/humeral joint
Client position: Supine, close to edge of table.
Test Protocol: Have client bring arm into abduction with elbow in flexion. Passively or actively
move client’s arm so that lower arm faces downward toward floor (and feet) and hand lies level to
table. You may choose to palpate client shoulder to feel for restrictions in ROM. Do not force,
although a “spring test” is possible.
Results:
- forearm rest comfortably on or level with table
+ forearm is elevated and does not lie flat on table, indicating shortness of lateral rotators,
especially Infraspinatus.
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Restrictions in rotator cuff muscles
The following movements check for restrictions in the rotator cuff muscles. Observe client for
difficultly or limitation in ROM and difference between one side and the other. Normally, the
dominate side will have more restriction in ROM than the non dominate side.
Client’s position: standing or seated, facing myomassologist
Test Protocol: have client move into positions indicated, watch for pain or limitation of movement
Test One: Have client slowly abduct arm, palms facing forward until arms are over head. Have
client hold this position for 10 seconds and then slowly return arms to side.
Results:
- Client has no trouble and movement is free and unrestricted
+ Client has difficultly either in raising arms, or lowering arms smoothly, indicating restrictions in
rotator cuff muscles, especially Supraspinatus.
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Test Two: have client slowly place hands together behind head, interlocking fingers. (This tests
ROM of external rotators.)
Results:
- Client has no trouble and movement is free and unrestricted. Fingers interlock comfortably
behind head, arms stay in coronal plane.
+ Client has difficulty bringing fingertips together, and/or elbows point forward instead of staying on
coronal plane, indicating medial rotators restrict movement, especially subscapularis.
Test Three: have client bring hands behind back, palms facing posterior. (This tests quality of
ROM of medial rotators.)
Results:
- Client has no problem bring hands behind back, arms stay in coronal plane.
+ Client cannot place hands behind back, elbows face posteriorly, indicating restriction in
Infraspinatus and Teres minor.
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Pectoralis Minor:
Client’s position: supine
Test protocol: Observe client’s shoulders from head of table. Shoulders should lay even with
table.
Results:
- Shoulders lay even with table.
+ One or both shoulders project upwards from table, indicating tightness in Pectoralis minor.
Wrist Extensors
Client position: Seated on chair, elbow on table (or other flat surface) , palm facing client.
Test protocol: Passive take wrist into flexion (bend towards client) to its easy limit. (No strain)
Results:
- Hand is at 90° with forearm
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+ Hand does not reach a 90° angle with forearm indicates tight extensors of the wrist
Wrist Flexors:
Client position: Seated on chair, elbow on table (or other flat surface) , palm facing away from
client.
Test protocol: Passive take wrist into extension (bend towards client) to its easy limit. (No strain)
Results:
- Wrist easily bends to 90° between hand and forearm
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+ Wrist cannot bend to 90° between hand and forearm indicating tight wrist flexors
This has been just a sampling of the different types of tests we can perform to help better evaluate
our client’s therapeutic massage needs. As I have stated before, choose a few, use them and
learn to become more experienced, both with palpating skills and your eyes. Just as the more you
feel , the more you feel –the more you see, the more you see!
All joints in the body can be complex and as with all massage, nothing should be determined as
concrete, especially with a joint designed for movement, like the gleno/humeral joint. Learning
“Actions” as well as “ Muscles” will help immensely with evaluation and treatment planning. As
long as pain is not the cause of restriction, remember, if it won’t go where you want it, resist it back
to where it came from (as well as make sure that is where it is suppose to go! :-) )
There are many more possibilities for testing of muscle shortness and/ or ROM restrictions. There
are also tests that can indicate muscle weakness. It would be impossible to show them all in such
a limited class time. Even if it seems like something you won’t use today, it could very easily be
what keeps you in demand further on in your career as a Myomassologist. My suggestion would
be to use what you can, and continue always to learn!
The following may prove usefully, either as elective classes, continuing education, or reference
materials as you continue to strive for excellence in our chosen career.
Any Sports Massage class
Orthopedic Massage Training with Whitney Lowe (taught as seminars throughout the country,
check www.omeri.com for listings of a class near you)
Massage for Orthopedic Conditions, Thomas Hendrickson LWW, © 2003
Maintaining Body Balance Flexibility and Stability, Leon Chaitow Churchill Livingstone, ©2004
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One more thing before we go – a little self help for rounded shoulders/FHP
Stand against a flat wall. Feet should be out @ 6 inches from wall, feet flat on floor,
back pressed against wall. Tilt pelvis backward so shoulders and head are also
pressed against the wall. Tuck chin towards chest (not all the way) to help lengthen
posterior neck muscles. Arms are abducted outward, elbow in 90° flexion. Ideally all
of your forearm, wrist and hand should be against the wall.
Repeat the following movements for up to 20 repetitions at a time (up to 100 reps in
the course of a day) to start with:
1. Raise arms upward, keeping wrists and elbows against the wall. Inhale as you
stretch upward.
2. Pause
3. Exhale and lower elbows to your side (about level to waist line). This is the
therapeutic aspect, so utilize muscle contraction to get you there. Pull elbows
into waist line, KEEPING elbows as well as wrists as near to wall as possible.
Concentrate on contracting the external rotators, scapular adductors and
posterior scapular depressors.
As always, avoid movements that cause pain.
This technique can be very valuable to help retrain lazy muscles, reinforcing
retraction of the shoulder and neck muscles, and aids in stabilization of the shoulder.
Great to help ease the strain of rounded shoulders /FHP we so often see associated
with upper crossed syndrome. Practice makes perfect and daily and focused
practice may show noticeable improvements in just two weeks, and continue to
accumulate benefits thereafter. Once the exercise becomes easy try adding very
light weights for added resistance (a soup can works nicely).
My most grateful thanks to Bob King, Chicago School of Massage Therapy, for teaching me this
incredible exercise.
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