These assessment and treatment recommendations represent a synthesis of information derived from personal clinical experience and from the numerous sources which are cited, or are based on the work of researchers, clinicians and therapists who are named (Basmajian 1974, Cailliet 1962, Dvorak & Dvorak 1984, Fryette 1954, Greenman 1989, 1996, Janda 1983, Lewit 1992, 1999, Mennell 1964, Rolf 1977, Williams 1965).
Infraspinatus shortness test (a) The patient is asked to reach upwards, backwards and across to touch the upper border of the opposite scapula, so producing external rotation of the humeral head. If this effort is painful infraspinatus shortness should be suspected.
Infraspinatus shortness test (b) (see Fig. 4.37 below) Visual evidence of shortness is obtained by having the patient supine, upper arm at right angles to the trunk, elbow flexed so that lower arm is parallel with the trunk, pointing caudad with the palm downwards. This brings the arm into internal rotation and places infraspinatus at stretch. The practitioner ensures that the shoulder remains in contact with the table during this assessment by means of light compression.
Figure 4.37 Assessment and self-treatment position for infraspinatus. If the upper arm cannot rest parallel to the floor, possible shortness of infraspinatus is indicated. If infraspinatus is short, the lower arm will not be capable of resting parallel with the floor, obliging it to point somewhat towards the ceiling.
The patient is seated. The practitioner stands behind. The patient’s arms are flexed at the elbows and held to the side, and the practitioner provides isometric resistance to external rotation of the lower arms (externally rotating them and also the humerus at the shoulder). If this effort is painful, an indication of probable infraspinatus shortening exists.
The relative strength is also judged. If weak, the method discussed by Norris (1999) should be used to increase strength (isotonic eccentric contraction performed slowly).
NOTE: In this as in other tests for weakness there may be a better degree of cooperation if the practitioner applies the force, and the patient is asked to resist as much as possible. Force should always be built slowly and not suddenly.
Figure 4.38 MET treatment of infraspinatus. Note that the practitioner’s left hand maintains a downward pressure to stabilise the shoulder to the table during this procedure.
The patient is supine, upper arm at right angles to the trunk, elbow flexed so that lower arm is parallel with the trunk, pointing caudad with the palm downwards. This brings the arm into internal rotation and places infraspinatus at stretch.
The practitioner ensures that the posterior shoulder remains in contact with the table by means of light compression. The patient slowly and gently lifts the dorsum of the wrist towards the ceiling, against resistance from the practitioner, for 7–10 seconds.
After this isometric contraction, on relaxation, the forearm is taken towards the floor (combined patient and practitioner action), so increasing internal rotation at the shoulder and stretching infraspinatus (mainly at its shoulder attachment).
Care needs to be taken to prevent the shoulder from rising from the table as rotation is introduced, so giving a false appearance of stretch in the muscle. In order to initiate stretch of infraspinatus at the scapular attachment, the patient is seated with the arm (flexed at the elbow) fully internally rotated and taken into full adduction across the chest. The practitioner holds the upper arm and applies sustained traction from the shoulder in order to prevent subacromial impingement.
The patient is asked to use a light (20% of strength) effort to attempt to externally rotate and abduct the arm, against resistance offered by the practitioner, for 7–10 seconds.
After this isometric contraction, and with the traction from the shoulder maintained, the arm is taken into increased internal rotation and adduction (patient and practitioner acting together) where the stretch is held for at least 20 seconds.
Dr. Alex Jimenez offers an additional assessment and treatment of the hip flexors as a part of a referenced clinical application of neuromuscular techniques by Leon Chaitow and Judith Walker DeLany. The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
By Dr. Alex Jimenez
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