Athletic Shoulder Test

Background[edit | edit source]

shoulder overhead sport

Upper extremity injuries are common in overhead sports, however objective criteria to support back to sport decisions remains limited[1].In overhead, the shoulder and elbow are at higher risk of injury due to the high forces required to perform sport specific tasks[2][3][4]. Overhead sports include but are not limited to basketball, water-polo, Javelin and volleyball. This is because overhead is an extremely skilful movement that demands extraordinary forces on the shoulder complex[3]. Additionally, the majority of shoulder injuries occur in the latter stages of training and matches as a consequence of repeated exposure to tackling[5], fatigue may contribute to risk [6] Other risk factors have been defined as basic recommendations for the prevention of recurrent injury and return to play [7]after injury: glenohumeral internal-rotation deficit (GIRD); rotator cuff strength, mainly the strength of the external rotators; and scapular dyskinesis, in particular scapular position and strength[8].

Since scapular muscles are highly activated to protract, upwardly rotate and stabilise scapula in early pull through of freestyle swimming or at ball impact in volleyball and tennis [9], their activity will be explored during the Modified- Athletic test[10].

Purpose[edit | edit source]

The athletic shoulder (ASH) test is used to assess and monitor the shoulder isometric strength of athletes during recovery[11]. It is a novel test developed by Ashworth et al. (2018) to evaluate the neuromuscular activity of the shoulder girdle in contact sports and those that includes overhead actions[11].

Technique[edit | edit source]

Both upper extremities were tested to ensure accurate data between dominant and non dominant limbs.[1][11].

Starting Position : Prone on the floor with the forehead resting on a 4cm foam block and the hand placed on a vertical axis platform[11].

Procedure:[edit | edit source]

The subject will push down from the shoulder in three consecutive test positions maximally for 3 seconds:

  1. I-test: Shoulder positioned in full abduction (180°), forearm in pronation and elbow in full extension. Contralateral arm at the side.
  2. Y-test: Shoulder positioned at 135°, forearm in pronation and elbow in full extension. The contralateral arm placed behind the back
  3. T-test: Shoulder positioned at 90°, forearm in pronation and elbow in full extension. The contralateral arm is placed behind the back.


Evidence[edit | edit source]

Shoulder advanced training device
[13] Shoulder training device

Some data supports the isometric-based strength training device Active5™ as a reliable and valid tool for ASH test performance[13].

The test demonstrates excellent reliability, but further studies are needed to assess its sensitivity[11].

  • Absolute reliability (SEM 4.8–10.8)[11].
  • Interday measurement error was below 10% in all test positions (CV 5.0–9.9) except for non-dominant arm I-position (CV 11.3%)"[14].

New findings found results that focus on rugby players at risk of shoulder injuries when performing long lever arm tackles[11].

Functional Shoulder Test[edit | edit source]

Karlen-Jobe Functional Shoulder Test:

It's clinically relevant to aid in clearance of an athlete for return to overhead sports[1].

Hypothesis:previous tests evaluated the reliability of a series of tests using portable force plates in various positions (I, Y, T) which made to mimic motions in rugby and found excellent reliability, However, these tests were made as a return to tackling test in rugby, which has different demands in comparison to overhead sports.[1] This is due to the higher demand of the Dynamic Stabilisers of the Shoulder Complex through throwing activities[15]

Shoulder testing positions included: I, Y, Internal rotation (IR), & External Rotation (ER) of the shoulder. It consists of 4 positions, 3 prone and 1 supine position.[1]

Testing protocol: Subject performs 3 trials in each position. In the prone testing positions (I, Y, IR), subjects were directed to maintain their scapula in a neutral position relative to the upper extremity being tested (no winging, anterior tilt, or excessive upward rotation).

Each subject has to press down with maximal effort and verbal encouragement is provided at the start of the test. Each attempt consisted of 3 seconds of exertion, alternating with 5 seconds of rest. A 20 second recovery was used between test positions.

The entire testing protocol took less than 10 minutes per subject, including warm-up and recovery periods.

Result: The high reliability of this test shows a positive trend that the 4 testing positions may have clinical utility when making a return to sport decision with overhead athletes.[1]

Modified - Athletic Shoulder Test[edit | edit source]

Using a force platform is considered the gold standard in assessing isometric force[16]. However, due to their cost and impracticality, other devices are studied as potential alternatives[13][10].

The Modified-Athletic Shoulder Test (M-AST) is a promising alternative, utilising a handheld dynamometer for the easier test implementation. The use of a handheld dynamometer to appreciate muscle function has become more popular in the last years for its accessibility and its cost[17][18] [10]

A strong concordance was found between ASH Test and M-AST values (ICC = 0.86–0.97; p > 0.05) in all the positions[10].Therefore, the Modified-Athletic Shoulder Test (M-AST) constitutes a reliable, quick and easy to implement test to measure performance and return to play capacity in a non-rotational plane of movements in overhead athletes. The recovery status after training sessions/matches could also be monitored with this test[10]. However there was a raised concern on its reliability due to the lack of consensus regarding the test protocols and sources of measurement errors[19].

Summary[edit | edit source]

Existing upper limb strength assessments are typically short lever tests that do not mimic sports specific actions or adequately assess higher shear forces experienced during competition[5].

The M-AST can be a useful tool for sports medicine professionals, coaches, and athletes to evaluate shoulder joint function and to monitor progress during rehabilitation[10].

Multiphasic approach is required to return an individual to prior level of play[2][20][15].

Resources[edit | edit source]

  1. ForceDecks Test: Athletic Shoulder (ASH) Test Protocol

References[edit | edit source]

  1. 1.0 1.1 1.2 1.3 1.4 1.5 Z, Cady A, Serrano B, Banffy M. Research Article Advances in Orthopedics and Sports Medicine AOASM-172 ISSN 2641-6859.
  2. 2.0 2.1 Wilk KE, Meister K, Andrews JR. Current concepts in the rehabilitation of the overhead throwing athlete. The American journal of sports medicine. 2002 Jan;30(1):136-51.
  3. 3.0 3.1 Wilk KE, Obma P, Simpson CD, Cain EL, Dugas J, Andrews JR. Shoulder injuries in the overhead athlete. Journal of orthopaedic & sports physical therapy. 2009 Feb;39(2):38-54.
  4. Cain Jr EL, Dugas JR, Wolf RS, Andrews JR. Elbow injuries in throwing athletes: a current concepts review. The American journal of sports medicine. 2003 Jul;31(4):621-35.
  5. 5.0 5.1 Gabbett TJ. Influence of fatigue on tackling ability in rugby league players: role of muscular strength, endurance, and aerobic qualities. PLoS One. 2016 Oct 31;11(10):e0163161.
  6. Hendricks S, Matthews B, Roode B, Lambert M. Tackler characteristics associated with tackle performance in rugby union. European Journal of Sport Science. 2014 Nov 17;14(8):753-62.
  7. Tooth C, Gofflot A, Schwartz C, Croisier JL, Beaudart C, Bruyère O, Forthomme B. Risk factors of overuse shoulder injuries in overhead athletes: a systematic review. Sports health. 2020 Sep;12(5):478-87.
  8. Cools AM, Johansson FR, Borms D, Maenhout A. Prevention of shoulder injuries in overhead athletes: a science-based approach. Brazilian journal of physical therapy. 2015 Sep 1;19:331-9.
  9. 5. Miura K, Tsuda E, Kogawa M, Ishibashi Y. The effects of ball impact position on shoulder muscle activation during spiking in male volleyball players. JSES Int [Internet]. 2020;4(2):302–9. Available from:
  10. 10.0 10.1 10.2 10.3 10.4 10.5 Tooth C, Forthomme B, Croisier JL, Gofflot A, Bornheim S, Schwartz C. The Modified-Athletic Shoulder Test: Reliability and validity of a new on-field assessment tool. Physical therapy in sport. 2022 Nov 1;58:8-15.
  11. 11.0 11.1 11.2 11.3 11.4 11.5 11.6 Ashworth B, Hogben P, Singh N, Tulloch L, Cohen DD. The Athletic Shoulder (ASH) test: reliability of a novel upper body isometric strength test in elite rugby players. BMJ open sport & exercise medicine. 2018 Jul 1;4(1):e000365.
  12. Physio Network. Athletic Shoulder Testing. Available from: [last accessed 18/9/2018]
  13. 13.0 13.1 13.2 Królikowska A, Mika A, Plaskota B, Daszkiewicz M, Kentel M, Kołcz A, Kentel M, Prill R, Diakowska D, Reichert P, Stolarczyk A. Reliability and Validity of the Athletic Shoulder (ASH) Test Performed Using Portable Isometric-Based Strength Training Device. Biology. 2022 Apr 11;11(4):577.
  14. Cormack SJ, Newton RU, McGuigan MR, Doyle TL. Reliability of measures obtained during single and repeated countermovement jumps. International journal of sports physiology and performance. 2008 Jun 1;3(2):131-44.
  15. 15.0 15.1 Wilk KE, Arrigo CA, Hooks TR, Andrews JR. Rehabilitation of the overhead throwing athlete: there is more to it than just external rotation/internal rotation strengthening. Pm&r. 2016 Mar 1;8(3):S78-90.
  16. Stark T, Walker B, Phillips JK, Fejer R, Beck R. Hand-held dynamometry correlation with the gold standard isokinetic dynamometry: a systematic review. PM&R. 2011 May 1;3(5):472-9.
  17. 6. Cools AM, Johansson FR, Borms D, Maenhout A. Prevention of shoulder injuries in overhead athletes: a science-based approach. Braz J Phys Ther [Internet]. 2015;19(5):331–9. Available from:
  18. Cools AM, Vanderstukken F, Vereecken F, Duprez M, Heyman K, Goethals N, Johansson F. Eccentric and isometric shoulder rotator cuff strength testing using a hand-held dynamometer: reference values for overhead athletes. Knee Surgery, Sports Traumatology, Arthroscopy. 2016 Dec;24:3838-47.
  19. Cools AM, De Wilde L, Van Tongel A, Ceyssens C, Ryckewaert R, Cambier DC. Measuring shoulder external and internal rotation strength and range of motion: comprehensive intra-rater and inter-rater reliability study of several testing protocols. Journal of shoulder and elbow surgery. 2014 Oct 1;23(10):1454-61.
  20. Wilk KE, Lupowitz LG, Arrigo CA. The Youth Throwers Ten Exercise Program: A variation of an exercise series for enhanced dynamic shoulder control in the youth overhead throwing athlete. International Journal of Sports Physical Therapy. 2021;16(6):1387.