**3.2. The humeral glenoid internal rotation test (HGIR)**

This positional test assesses ribcage alignment. The posterior ribcage, as the foundation for the scapulae, determines scapular position and glenoid orientation, and therefore, humeral-glenoid mechanics. In the supine, bent knees test position, the humeral head is abducted to 90°, the elbow is flexed to 90°, and the forearm is pronated. Neutral alignment of the hemiribcage will allow full passive humeral internal rotation within the glenoid fossa. If the ribs of the anterior ribcage are internally rotated and the intercostals adaptively shortened, the apical chest wall will exhibit restriction and limited expansion with inhalation. The scapula is pulled forward by pectoralis minor and positioned in a state of upward rotation, abduction, internal rotation, and protraction. Consequently, the humeral head is now in external rotation relative to the glenoid fossa. Passive internal rotation of the humerus will result in impingement on the glenoid fossa and the range of motion will be limited (see **Figure 13**).

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**Figure 13.** Humeral glenoid internal rotation test used with permission from the Postural Restoration Institute®. Copyright 2017, www.posturalrestoration.com

#### **3.3. Trunk rotation test (TRT)**

Over 25 PRI tests are available for initial assessment and to guide exercise progression as the patient progresses toward functional strength, respiratory competence, and upright alternating reciprocal activity. During treatment, the PRI tests are often applied before and after therapeutic exercise to determine its effectiveness, to reveal weakness or improvements in strength, and to further guide appropriate exercise progression. Three basic tests are

This is an example of a positional test for hemipelvic position in the sagittal plane. This sidelying test position facilitates a neutral hemipelvic position by flexing the hips and knees, thereby taking potential overstretch off the hamstring muscles. If the hemipelvis is in its neutral range, the ipsilateral femoral head will align with the acetabular groove allowing the femur to achieve full passive adduction as it is lowered by the clinician. If the hemipelvis is anteriorly rotated despite the test position of bent hips and knees, the femoral neck will impinge on the

This positional test assesses ribcage alignment. The posterior ribcage, as the foundation for the scapulae, determines scapular position and glenoid orientation, and therefore, humeral-glenoid mechanics. In the supine, bent knees test position, the humeral head is abducted to 90°, the elbow is flexed to 90°, and the forearm is pronated. Neutral alignment of the hemiribcage will allow full passive humeral internal rotation within the glenoid fossa. If the ribs of the anterior ribcage are internally rotated and the intercostals adaptively shortened, the apical chest wall will exhibit restriction and limited expansion with inhalation. The scapula is pulled forward by pectoralis minor and positioned in a state of upward rotation, abduction, internal rotation, and protraction. Consequently, the humeral head is now in external rotation relative to the glenoid fossa. Passive internal rotation of the humerus will result in impingement on the glenoid fossa and the range of motion will

**Figure 12.** Adduction drop test used with permission from the Postural Restoration Institute®. Copyright 2017, www.

acetabular rim. The femur will not achieve full passive adduction (see **Figure 12**).

**3.2. The humeral glenoid internal rotation test (HGIR)**

be limited (see **Figure 13**).

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described below.

**3.1. The adduction drop test (ADT)**

150 Innovations in Spinal Deformities and Postural Disorders

This test assesses the integrity of the right iliolumbar ligament and the stability of the lumbopelvic junction. In patients with scoliosis, it is used to classify curve patterns. A "nonpathological" curve indicates this ligament is intact and the pelvis moves with the lumbar spine. A "pathological-compensatory" curve refers to an overstretching of the ligament, allowing the pelvis to move opposite to the lumbar spine and indicating laxity of this lumbopelvic stabilizing ligament. The nonpathological curvature is similar to the Schroth Barcelona<sup>1</sup> 3 curve or non 3-non 4; the pathological-compensatory curve is similar to the 4 curve or thoracolumbar curve. A positive TRT corresponds to countertilts identified by X-ray.

The test position is supine with knees bent and with ankles together. As the bent legs are passively rotated to one side, the clinician monitors the contralateral lower ribcage feeling for a movement of the ribcage away from the supporting surface. The beginning of ribcage movement indicates that the pelvis has reached its end of range and the spine is beginning to assist the rotation. Because the ribs articulate with the spine, the initiation of spinal rotation can be palpated. The range of motion is recorded and compared with motion to the other side (see **Figure 14**).

**Figure 14.** Trunk rotation test used with permission from the Postural Restoration Institute®. Copyright 2017, www. posturalrestoration.com

1 C2 certified. Findings from this test must be correlated with the ADT for accurate assessment. If the ADT demonstrates a bilaterally neutral pelvic position, the rotational range to right and left should be equal. If the ADT reveals left or bilateral anterior pelvic rotation, the legs should have a greater range of motion to the right. The rationale for this test assumes a right-side dominant pattern unless the ADT demonstrates neutral balance. In a right-side dominant person, the lumbar spine will be right-oriented; therefore, the legs will appear to turn further to the right. If the legs move farther to the left, it indicates that the right iliolumbar ligament is compromised and does not maintain lumbopelvic stability.

These few examples give an idea of how the findings from PRI clinical tests correlate with one another to give an understanding of the patient's position and biomechanical function. These physiological details are otherwise hard to assess and factor into treatment protocols.
