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.
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
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.
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
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.
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.
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.
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
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.
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.
Stand or sit where both arms, shoulder blades, trunk and pelvis can be observed.
Start with both arms in the selected overhead starting position. Keep elbows straight if the protocol requires it.
Monitor the trunk and pelvis. Avoid allowing excessive lumbar extension, rib flare or pelvic movement unless the chosen protocol specifically includes whole-body contribution.
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.
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
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.
Ask about pain, stretch, stiffness, pinching, shoulder symptoms, neck symptoms, thoracic stiffness and whether the movement feels familiar.
Stop if pain increases sharply, symptoms spread, the client guards strongly, neurological symptoms occur, or movement is not tolerated.
Record distance or angle, pain score, symptom location, trunk compensation, scapular movement, elbow position, device used and endpoint definition.
One to three trials may be used. Record the best, average or selected trial consistently.
Use the same position, arm path, device, landmarks, warm-up, endpoint and scoring method each time.
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.
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.
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 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
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
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.
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
It measures combined overhead movement involving the shoulders, scapulae and thoracic spine.
No. Shoulder flexion ROM is more isolated. Combined elevation includes shoulder, scapular and thoracic movement together.
A practical reference describes approximately 5–15 degrees when measuring humeral angle relative to horizontal, but results depend heavily on protocol.
Both can be useful. Bilateral testing shows combined overhead movement, while single-arm testing helps compare sides.
It means reduced overhead elevation under the tested setup. It does not explain the cause by itself.
No. It provides movement information but does not diagnose the cause of shoulder pain.
Thoracic extension contributes to overhead reach. Limited thoracic contribution may reduce the combined elevation result.
Use the same position, arm path, device, landmark, endpoint and recording method across sessions.
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.
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
