It’s time for round 2 of my series on things you might overlook when assessing a new client or athlete. Here are three news things to which you should pay attention:

1. Nervous Tick/Anxiety

When I see someone who is constantly “on” – foot tapping, cracking knuckles, fidgeting while standing/sitting, or any of a number of other displays of nervous energy – I’m obviously wondering if this is someone who is so wired that stress outside of training could be a serious problem. These folks often have poor sleep quality and don’t recover well.

However, it may extend beyond that. If you check out Clinical Applications of Neuromuscular Techniques, Lean Chaitow and Judith DeLany reflect on how congenital laxity (loose joints) is correlated with anxiety disorders and panic attacks. So, even in my first dealings with people, if they’re really on edge, I’m wondering we’re going to need to do a lot more stabilization work, as opposed to actually created new range of motion.

2. How They Carry Their Bags

A lot of people really don’t understand how their daily habits impact their long-term movement quality or the presence or absence of pain. Along these lines, it always surprises me to see people with low right shoulders who always carry their backpacks or purses over the right shoulder, just feeding into this excessive asymmetry with constant scapular depression. An initial evaluation is the perfect time to pick up on these things and counsel clients and athletes on how to prevent activities of daily living from interfering with fitness progress.

3. Clavicular Angle

The clavicle is like the bastard child of the upper body; it never gets any love. In fact, there are a lot of people who don’t even know what a clavicle is unless you call it by its common name, the collarbone. It’s actually a tremendously important bone, as it is the link between two very important joints of the shoulder girdle: the acromioclavicular (scapula with clavicle) and sternoclavicular (sterum with clavicle) joints.

A normal resting posture of the clavicle is about a 6-20° upslope (medial to lateral). What you’ll often see with folks with faulty upper extremity posture is a horizontal or even downsloped collarbone. Check out this right-handed pitcher (left side is more normal, right is really “stuck down”):

Just like a scapula needs to upwardly rotate for optimal function in overhead activies, a clavicle needs to upwardly rotate, too. From 0-90° abduction, you only need 5-10° of clavicular upward rotation. From 90-180° of abduction, you need 20-25° of clavicular upward rotation. This clavicular movement can be affected by the muscles that attach directly to it (pectoralis major) or by those that indirectly impact it (muscles attaching to the scapula and/or humerus), as well as the positioning of the thoracic spine.

Keep in mind that where most people with acromioclavicular joint pain wind up with symptoms during abduction: the final 30° of overhead reaching. Any surprise that the symptoms occur at the point where the most amount of clavicular upward rotation is needed? Nope!

If that clavicle starts as too horizontal (downwardly rotated), it’s like starting a race from a few yards behind the starting line. Getting resting posture where it needs to be helps to ensure that the subsequent movements that take place will be free, easy, and pain-free.

I’ll be back soon with more commonly overlooked assessments. In the meantime, if you’re looking for an additional resource on this front, I’d encourage you to check out Assess and Correct: Breaking Barriers to Unlock Performance.