Upper Extremity Closed Chain Testing Part 1

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In the last post, I discussed the importance of having a patient or athlete demonstrate that he has basic motor control competency and capacity in the closed kinetic chain. That way there are more data points to indicate that there is a solid foundation for sport specific skills. Now I will focus on selecting tests that can be used for the upper quarter. Please note, I used upper quarter versus upper extremity intentionally given the vital connection of the upper limb to the thorax.

Before listing specific tests, it is important to consider the testing order. Prior to higher level closed chain testing, there must be basic range of motion and strength. I do want to make special note of the importance of testing grip strength with hand at side, out front and full flexion and comparing bilaterally. Symmetrical grip strength in these positions indicates that the shoulder has enough stability to generate force through the hand. Try this and you might find some interesting results.

Once that is present, I feel comfortable progressing through an upper quarter testing hierarchy.

Functional Movement Screen Trunk Stability Push Up

Trunk Stability Push Up

While I don’t perform the Trunk Stability Push Up in isolation (I use all seven tests), I do feel it is important to mention it in the hierarchy of upper quarter tests. The TSPU requires symmetrical trunk stability, scapular stability, and upper extremity strength. Before advancing to higher level tests, I want to see the person score a 2. That means that from the bottom part of a push up position, the trunk comes off floor as one unit with no sag in lumbar spine (able to perform with thumbs in-line with chin (men) or with thumbs in-line with clavicle (women)).

Once this is normal, I want see that he has bilateral static stability through prone plank position for at least 10 seconds. Then I look at unilateral stability through holding the side plank for 10 seconds. Remember, I am not trying to test endurance with these tests at this point. Endurance, power, and agility come later in the testing hierarchy.

Y Balance Test – Upper Quarter

Of course, I have a bias here. I was actually resistant to creating an upper quarter test similar to the Y Balance Test for the Lower Quarter. But now, I actually appreciate the harmony of the Upper and Lower Quarter Y Balance test and I get a ton of information from both.

Y-Balance Test - Infero Lat

There are 2 published research studies (Gorman et al 2012, Westrick et al 2012) that specifically examine Y Balance Test – Upper Quarter. Both studies found the Y Balance Test – Upper Quarter to be reliable. In addition, both studies found there was no difference in YBT-UQ performance between dominant and non-dominant limbs. This indicates that YBT-UQ performance may serve as a good measure in return to sport testing when rehabilitating shoulder, upper limb, and spine injuries. Westrick et al stated:

 

“Similarity on the UQYBT between dominant and non-dominant limbs indicates that performance on this test using a non-injured UE may serve as a reasonable measure for “normal” when testing an injured UE.”

In our current research, we are also finding right/left symmetry on the YBT-UQ in professional and collegiate baseball players (including pitchers). So, I think if overhead athletes and healthy adults demonstrate symmetry on the YBT-UQ, patients should demonstrate symmetry before returning to sport/activity (or at least before discharge).

In the next post, I will go through higher level upper quarter testing.  This will cover testing for endurance, power, and agility including the 4 plank positions, one arm hop testing, and the Closed Kinetic Chain Upper Extremity Stability Test.

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2 Comments:

  • By Greg Dea 19 Oct 2013

    Hi Phil,
    You know I’m a fan of your work, especially M2P and the YBT’s. So this is a slightly different question.
    I’m not entirely clear how to talk about the prone plank. I have conflicting thoughts on it.
    I get it as a test of bilateral static stability. And I get that there appear to be “studied opinions” about how long one “should” be able to prone plank. But I also understand it’s a task that is often used as a training tool. Let’s assume everything and nothing about person “X”. All things being great and/or all things being dysfunctional… we know it depends… but I’ve got S&C coaches who like to use it as a training tool. They have heard the line that training can be testing and vice versa, which I agree with IF they mean training should be “assessment” (for disability), not “testing” (for ability), as we should be looking for quality issues when training. I am not convinced training high threshold strategies for time under tension is always a good idea. I know time under tension training has great benefits for strength, but I also default to the question of “why” we would be training that way. Strength is required for power development, but not necessarily for movement or “function” – which I’m currently defining as “the ability to adapt to internal and external stimuli”. I know when it should be a good idea – when you have to stop an opposition player charging at you – y’know – the imposing force meets the immoveable object – so you need to develop an ability to prepare for impact by using a high threshold strategy. And I know when it’s not a good idea – when high threshold strategies are imposed upon dysfunction (teased out via specific skilled assessment). So, perhaps I’ve answered my own questions about when planking is a good idea – it depends. On the why. And the who.

  • By Phil Plisky 21 Oct 2013

    Thanks Greg! You are right! There are certain times that someone should not plank. But, if they pass the Functional Movement Screen and Upper and Lower Quarter Y Balance Test, I think planking can be indicated particularly if testing indicates a deficit in that area.

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