Range of Motion: Combined Elevation Test

A client may report difficulty reaching overhead, reduced streamline position in swimming, stiffness during overhead lifting, discomfort with shoulder flexion, or a feeling that both shoulders do not move evenly.

The Combined Elevation Test gives a simple way to assess overhead movement as an integrated shoulder, scapular and thoracic task. It does not explain the cause of reduced overhead movement on its own, but it provides useful baseline information when interpreted alongside pain, symptoms, shoulder flexion, shoulder external rotation, thoracic extension, scapular control, strength and functional overhead tasks.

Quick Summary

Test name: Combined Elevation Test
Purpose: Assess bilateral combined overhead elevation capacity
Movement: Raising both arms overhead together in a standardised position
Joint/body region: Shoulders, scapulothoracic region and thoracic spine
Plane: Primarily sagittal/scapular plane, depending on setup
ROM type: Active movement and movement-quality assessment
Score: Distance from hand/thumb to floor, arm angle, side-to-side comparison, combined movement quality or symptom response
Equipment: Floor or treatment table, tape measure, inclinometer, goniometer, video or Measurz recording workflow
Best used with: Shoulder flexion, shoulder abduction, shoulder external rotation, thoracic extension, scapular control, overhead squat, push-up, chin-up, swimming streamline assessment and overhead sport assessment
Key limitation: Results vary by protocol, arm path, thoracic extension, scapular movement, symptoms, body size, measurement method and client effort

What Is the Combined Elevation Test?

The Combined Elevation Test is a practical bilateral overhead movement assessment.

It is commonly described as a combined movement involving:

• glenohumeral flexion
• scapular retraction
• scapular upward rotation
• thoracic extension
• trunk control
• shoulder and latissimus dorsi tissue tolerance
• symptom response

In swimming-related settings, it has been used to assess the ability to achieve an efficient streamline position.

The result may be recorded as a distance, angle, side-to-side comparison or movement-quality finding.

Why It Is Used

The test is used to establish a baseline and monitor change in bilateral overhead movement capacity.

It may help inform:

• overhead mobility monitoring
• shoulder flexion assessment
• thoracic extension contribution
• scapular movement quality
• swimming streamline position assessment
• throwing and overhead sport assessment
• gym overhead movement screening
• progress tracking after changes in symptoms or loading
• exercise selection for shoulder, thoracic and scapular programmes

What It Measures

The test measures bilateral combined overhead elevation capacity under the selected setup.

It may be influenced by:

• shoulder flexion range
• shoulder abduction/scapular plane movement
• scapular upward rotation
• scapular posterior tilt
• scapular retraction
• thoracic extension
• latissimus dorsi and posterior shoulder tissue tolerance
• pectoral and anterior shoulder tissue tolerance
• pain or symptoms
• trunk position
• breathing and rib position
• client effort and motor control
• measurement method
• previous activity or loading history

Reduced combined elevation provides movement information, but it does not explain the cause on its own.

Active vs Passive Range of Motion

The Combined Elevation Test is usually performed actively, because the client raises both arms themselves.

Passive shoulder flexion, passive shoulder abduction or passive shoulder elevation should be assessed separately if required.

Comparing active combined elevation with passive shoulder flexion may help separate available movement from strength, control, pain inhibition or confidence.

Passive movement should be applied gently and should not force symptoms.

Who It Is Useful For

This test may be useful for:

• swimmers
• throwers
• overhead athletes
• gym clients
• CrossFit and Olympic lifting athletes
• climbers
• general fitness clients
• clients monitoring shoulder movement
• people returning to overhead training or sport
• clients with bilateral overhead stiffness or symptoms

It is also useful when comparing overhead movement across sessions.

Equipment Required

• Floor, mat or treatment table
• Tape measure if recording hand or thumb distance
• Goniometer or inclinometer if recording arm angle
• Optional Measurz inclinometer
• Optional Measurz AR measurement or video for setup consistency
• Pain scale
• Measurz for recording ROM, pain, symptoms and progress
• Optional towel roll or support depending on protocol
• Optional comparison notes

Step-by-Step Protocol or How to Apply This in Practice

Starting position

Position the client according to the chosen protocol. A common approach is prone lying with both arms overhead, although some settings may use a wall, floor or standing overhead setup.

Use the same position for every retest.

Client position

The client keeps the trunk and pelvis as still as possible. The head and neck remain comfortable.

If prone, the client lies face down with both arms positioned overhead and elbows straight unless another protocol is selected.

Professional position

Stand or sit where both arms, shoulder blades, trunk and pelvis can be observed.

Body/joint setup

Start with both arms in the selected overhead starting position. Keep elbows straight if the protocol requires it.

Stabilisation

Monitor the trunk and pelvis. Avoid allowing excessive lumbar extension, rib flare or pelvic movement unless the chosen protocol specifically includes whole-body contribution.

Movement instruction

Ask the client to lift or reach both arms as high as comfortably possible while keeping the elbows straight and body position controlled.

If measuring from the floor, ask the client to raise both arms away from the floor while maintaining the selected setup.

Measurement method

Choose one consistent method:

• measure distance from thumb or hand to floor
• measure humeral angle with an inclinometer
• measure arm elevation angle from a video still
• record whether movement is symmetrical
• record movement quality and symptoms

Measurement landmarks

If measuring distance, use the same point on the hand or thumb each time.

If measuring angle, use consistent device placement and arm landmarks each time.

What to ask

Ask about pain, stretch, stiffness, pinching, shoulder symptoms, neck symptoms, thoracic stiffness and whether the movement feels familiar.

Stopping rules

Stop if pain increases sharply, symptoms spread, the client guards strongly, neurological symptoms occur, or movement is not tolerated.

What to record

Record distance or angle, pain score, symptom location, trunk compensation, scapular movement, elbow position, device used and endpoint definition.

Number of trials

One to three trials may be used. Record the best, average or selected trial consistently.

Retest consistency

Use the same position, arm path, device, landmarks, warm-up, endpoint and scoring method each time.

Scoring and Interpretation

The result may be recorded as:

• distance from hand/thumb to floor
• arm elevation angle
• side-to-side difference
• symptom response
• movement-quality score
• qualitative pass/monitor finding

A greater elevation angle or higher lift distance generally indicates more combined shoulder, scapular and thoracic elevation capacity under the tested setup.

Interpretation is stronger when combined with:

• pain score
• symptom location
• shoulder flexion ROM
• shoulder abduction ROM
• shoulder external rotation
• thoracic extension
• scapular movement
• overhead strength
• single-arm comparison
• overhead sport or gym tasks

The result does not explain the cause of reduced movement by itself. It helps guide exercise selection, monitoring and further assessment decisions.

Normative Data, Benchmarks or Reference Values

Evidence level: Level 2–3 — specific combined elevation research exists, especially in swimming-related contexts, but values are protocol-specific.

A commonly cited practical reference for the Combined Elevation Test describes an appropriate range of approximately 5–15 degrees, where the angle is measured between the line of the humerus and the horizontal.

Some protocols also measure the perpendicular distance from the base of the thumb metacarpal to the floor during prone arm lift. Distance values will vary by body size, arm length, setup and protocol.

Practical benchmarks:

• compare baseline to retest
• compare movement symmetry
• track pain at end range
• track movement quality and compensation
• record distance or angle consistently
• compare with single-arm combined elevation
• compare with shoulder flexion and thoracic extension findings

A meaningful change from baseline, painful end range, clear movement compensation or obvious side-to-side contribution is usually more useful than a universal cut-off.

Reliability and Validity

The Combined Elevation Test has been used in sport and swimming-related assessment contexts and reflects a combined movement of thoracic extension, glenohumeral elevation, scapular motion and trunk control.

Reliability improves when the same testing position, measurement method, device, endpoint and instructions are used.

Shoulder ROM measurement can be influenced by device choice, examiner landmarking, client effort, scapular movement and trunk compensation. Consistent protocols are more useful than casual visual estimation when tracking progress.

Reliability improves when:

• the same setup is used
• the same arm path is used
• the same measurement point is used
• the same device is used
• elbow position is standardised
• trunk and pelvis position are monitored
• symptoms and compensations are recorded
• the same endpoint definition is used

Validity depends on the purpose. The test reflects combined overhead movement capacity under the chosen protocol, but it does not isolate one structure or explain why movement is limited.

Common Errors and Testing Limitations

Common errors include:

• changing the test position between sessions
• allowing excessive lumbar extension
• allowing rib flare
• allowing elbow bend
• measuring from inconsistent landmarks
• not recording pain or symptoms
• ignoring scapular movement
• comparing distance and angle scores directly
• using the result as a diagnosis

Limitations include:

• values are protocol-specific
• affected by thoracic extension
• affected by scapular movement
• affected by body size and arm length
• symptoms may limit movement
• active control may differ from passive capacity
• distance values are not universal
• the test does not identify tissue source
• the test does not determine sport or work readiness on its own

Practical Applications

Use the Combined Elevation Test to:

• establish baseline overhead mobility
• monitor shoulder and thoracic movement progress
• guide overhead exercise selection
• support swimming streamline assessment
• support throwing and gym overhead assessment
• identify whether related tests would add context
• compare bilateral and single-arm overhead elevation
• monitor symptoms during overhead movement

It is most useful with:

• shoulder flexion ROM
• shoulder abduction ROM
• shoulder external rotation
• thoracic extension
• scapular control assessment
• single-arm combined elevation test
• wall slide test
• push-up test
• chin-up test
• dead hang

How to Record This in Measurz

In Measurz, record the baseline result using the chosen method.

Record:

• distance or angle
• test position
• arm path
• elbow position
• device used
• pain score
• symptom location
• scapular movement
• trunk compensation
• rib flare or lumbar extension
• endpoint definition
• retest date

Use the Measurz inclinometer if recording arm angle. Use Measurz AR measurement or video if recording distance, arm position or setup consistency.

Track progress across sessions and compare with single-arm combined elevation, shoulder ROM, thoracic mobility, strength, overhead task and symptom findings when relevant.

Related Tests or Internal Linking Suggestions

• Single Arm Combined Elevation Test
• Shoulder Flexion Test
• Shoulder Abduction Test
• Shoulder External Rotation Test
• Shoulder Internal Rotation Test
• Thoracic Extension Test
• Wall Slide Test
• Push Up Test
• Chin Up Test
• Dead Hang

FAQs

What does the Combined Elevation Test measure?

It measures combined overhead movement involving the shoulders, scapulae and thoracic spine.

Is it the same as shoulder flexion ROM?

No. Shoulder flexion ROM is more isolated. Combined elevation includes shoulder, scapular and thoracic movement together.

What is a normal result?

A practical reference describes approximately 5–15 degrees when measuring humeral angle relative to horizontal, but results depend heavily on protocol.

Should the test be done single-arm or both arms?

Both can be useful. Bilateral testing shows combined overhead movement, while single-arm testing helps compare sides.

What does reduced combined elevation mean?

It means reduced overhead elevation under the tested setup. It does not explain the cause by itself.

Can this test diagnose shoulder pain?

No. It provides movement information but does not diagnose the cause of shoulder pain.

Why does thoracic extension matter?

Thoracic extension contributes to overhead reach. Limited thoracic contribution may reduce the combined elevation result.

How should progress be tracked?

Use the same position, arm path, device, landmark, endpoint and recording method across sessions.

Key Takeaways

• Combined Elevation assesses bilateral overhead movement capacity.
• It includes shoulder, scapular and thoracic contribution.
• It is commonly used in overhead and swimming-related movement assessment.
• Test position and measurement method must be standardised.
• Reduced elevation does not explain the cause by itself.
• Measurz should capture distance or angle, symptoms, device, position and progress.

References

Blanch, P. (2004). Conservative management of shoulder pain in swimming. Physical Therapy in Sport, 5(3), 109–124. https://doi.org/10.1016/j.ptsp.2004.05.002

Hill, L., Collins, M., Posthumus, M., & Botha, A. (2018). The Combined Elevation Test in adolescent school children: A reliability study. South African Journal of Sports Medicine, 30(1), 1–5. https://doi.org/10.17159/2078-516X/2018/v30i1a4914

Hibberd, E. E., Laudner, K. G., Kucera, K. L., & Berkoff, D. J. (2016). Effect of swim training on the physical characteristics of competitive adolescent swimmers. American Journal of Sports Medicine, 44(11), 2813–2819. https://doi.org/10.1177/0363546516662326

Kolber, M. J., Vega, F., Widmayer, K., & Cheng, M.-S. S. (2011). The reliability and minimal detectable change of shoulder mobility measurements using a digital inclinometer. Physiotherapy Theory and Practice, 27(2), 176–184. https://doi.org/10.3109/09593985.2010.481011