Kinesiology THURSDAY – Fix the FABER (Hand to Head)

Can you touch the back of your head? Can you reach behind your head and touch your opposite ear? You SHOULD be able to do this without feeling any shoulder pain and without moving your head.

This FABER test (Flexion/Abduction/External Rotation) is one I use often for my shoulder patients to determine functional arm elevation. I currently have several patients who have had reverse total shoulder arthroplasty (RTSA). This advancement in shoulder replacement surgery has added to the stability of the post-surgical shoulder. However, weakness or limitation in external rotation is often seen due to altered mechanics of the shoulder. (More on this next week).

The FABER test isn’t just about the shoulder joint. Here is a list of things that must occur in order for you to touch the back of your head (or even better, your opposite ear) without pain or restriction:

Thoracic spine extension and rotation towards the lifting arm
Thoracic spine side bending away from the lifting arm
Scapular retraction and upward rotation
Clavicular upward rotation (at the SC joint) and posterior rotation (at the AC joint)
And FINALLY, glenohumeral flexion and external rotation

Check those things. Fix what you find. And then recheck the FABER.

To normalize thoracic motion, try the thoracic sequence or seated thoracic rotation
To normalize scapular retraction, try the foam roll angels
Release trigger points in the upper trapezius and infraspinatus as these muscles will position the scapula in upward rotation at rest, causing a “bottoming out” or jamming feeling at the top of the shoulder with end range elevation
Check and correct medial clavicle subluxations posterior or anterior

Why does this matter?

Limitations in arm elevation often exhibit as pain in the shoulder. In some cases, like reverse total shoulder replacement, altered mechanics may limit this motion at the shoulder. But all is not lost. Addressing the associated contributions of the thoracic spine, scapula and clavicle can help patients achieve pain-free and very functional arm elevation.

Remember, we are all connected. Lots of moving parts. That’s a good thing.

Because nobody has time to be in pain.

Until next time…