Home Blog Assessments You Might Be Overlooking: Installment 2

Assessments You Might Be Overlooking: Installment 2

Written on August 6, 2013 at 11:08 am, by Eric Cressey

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.

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15 Responses to “Assessments You Might Be Overlooking: Installment 2”

  1. john Power Says:

    Great post Eric. The photo above not only shows a sloping right shoulder/clavicle, the whole right side is depressed-the head tilts to the right as does the thoracic spine evident by the “C” curve of the sternum/midline crease. This is a common postural position for someone who stands on their right leg and leans to the right – a right sided overuse pattern. I see this posture a lot w/knee and hip injuries often the right knee is hyperextended. Would be cool to see a whole body photo Ant/Post

  2. Dr. Roc Byrd Says:

    Often times there are joint adhesions that create compromise the mobility in any of the joints discussed. Those joint fixations will not only create passive joint restriction, but will also either contribute to reflexive inhibition or muscle hypertonicity of the associated musculature. Obviously, long term soft tissue malfunction and/or structural faults also lead to fascial irritation and eventually can create indirect problems one may not even associate with the area hurting. Chiropractic manipulative therapy targeting those joint adhesions and dysfunctions are necessary treatments to relieve those problems. Stretches and exercises targeting these problems are usually not optimal, and occasionally completely ineffective, if the nervous system is reacting to problems like this. So it is important for the excellent trainer who recognizes these problems to establish and utilize his network of sports minded chiropractors. This will only serve to further enhance their athlete’s performance, reduce their risk of injury and increase the trainers’ credibility in the sports community.

  3. nick Says:

    Nice article! Is this something u see (stuck clavicle) with clients that have had a broken clavicle? so foam rolling /lacrosse ball pecs should help right? What about the t-spine also?

  4. Shane Says:

    I am number 2. From now on I am carrying bags on my left.

  5. Christian Says:

    Regarding the clavicle, I’ve got an interesting pattern in mine. I’m a RHP whose right clavicle sticks out farther than the left one, and has a higher angle than the left one as well, while being completely asymptomatic of any pain. Any ideas of why this is?

  6. Eric Cressey Says:


    I wouldn’t say that this is always the case.

  7. Eric Cressey Says:


    Yep. Classic PRI guy…left AIC/right BC pattern.

  8. Eric Cressey Says:


    Have a pic of what you mean?

  9. shams mirza Says:

    Sir, would you mind proposing a corrective exercise for this problem.

  10. Steven Says:

    I have a very similar posture as listed in point 3. Nearly horizontal clavicle on R side only.

    I have been having some neck tightness and shoulder pain that several physio/chiro can not alleviate.

    What can i do to promote clavicular upward rotation? Or a better resting position?

    Should i train upper trapezius on the R side only? Or should i still be focusing on Depressing the scapula, and not activating upper trap.

    Here’s my pic.

  11. Steve Says:


    How are you not a PT? You know a lot more than most PTs I know. Keep up the good work!

  12. Steven Says:

    I have a very similar posture as listed in point 3. Nearly horizontal clavicle on R side only.

    I have been having some neck tightness and shoulder pain that several physio/chiro can not alleviate.

    What can i do to promote clavicular upward rotation? Or a better resting position?

    Should i train upper trapezius on the R side only? Or should i still be focusing on Depressing the scapula, and not activating upper trap.

  13. Eric Cressey Says:


    I certainly wouldn’t be depressing the scapula; that would feed into your problem. Posterior tilt is different than depression, FYI.

    Working on scapular upward rotation and freeing up (soft tissue work) the right subclavius and pec minor is usually a good start. For upward rotation, I like this drill, but only on right side: http://www.youtube.com/watch?v=e5-rB6bYBr8

    May be an element of thoracic rotation that needs to be addressed, as well.  Don’t overlook lat yanking scapula into more depression, too.  Might need less pull-ups, more lat length work, and a break from heavy weights in hands (DLs, lunges).

    Check with a good therapist near you to create a good approach.

  14. Goi Says:

    What would you recommend for people who are nervous? I find myself fidgeting a lot, and sometimes I don’t even catch myself. I don’t necessarily have trouble falling asleep, but I do realize that I seldom feel fully rested when I wake up.

  15. Eric Cressey Says:


    Try getting in a dark room and just breathing deeply for 15 minutes a few times a day. Power naps can be good, too.  I’d also eliminate all electronics an hour before bed; just read instead.

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