Hara Test

The Hara Test was developed to evaluate kinetic chain abnormalities in the upper extremity that may contribute to shoulder pain in throwing athletes¹². Many baseball players are unaware of the physical limitations that restrict their throwing ability, and subtle biomechanical deficits can go undetected without systematic evaluation. The Hara Test consists of 11 specific clinical assessments of scapular and humeral motion, supplemented by imaging (X-ray and ultrasound) for enhanced diagnostic accuracy³.

Unlike imaging alone, this structured combination of physical and imaging assessments provides a more comprehensive picture of shoulder health in overhead athletes.

Test components

1. Scapula Spine Distance (SSD)

• Measures the distance between the medial border of the scapular spine and the thoracic spinous process.

• Abnormal finding: >1.0 cm difference between dominant and non-dominant side

2. Combined Abduction Test (CAT)

• Assesses posterior shoulder tightness.

• With scapula stabilized, the humerus is passively abducted.

• Abnormal finding: The upper arm does not reach the head during abduction.

3. Horizontal Flexion Test (HFT)

• Evaluates posterior shoulder capsule tightness.

• With scapula stabilized, the humerus is passively moved into horizontal flexion.

• Abnormal finding: Inability to reach the opposite shoulder or touch the surface.

4. Rotator cuff muscle strength testing (ISP, SSP, SSC)

• Manual muscle testing (0–5 scale) for infraspinatus, supraspinatus, subscapularis.

• Abnormal finding: Reduced strength on the throwing arm compared to the non-dominant side.

5. Elbow Push Test (EPT)

• Assesses scapular stabilizers.

• Patient grasps the opposite elbow and pushes forward with maximal force.

• Abnormal finding: Weakness or asymmetry.

6. Elbow Extension Test (EET)

• Tests triceps function with auto-extension from 100° elbow flexion.

• Abnormal finding: Weakness or pain in the throwing arm.

7. Capsular Laxity Test

• Includes load-and-shift (anterior, posterior, inferior) and apprehension-relocation maneuvers.

• Abnormal finding: Excessive laxity or sense of instability in the throwing arm.

8. Subacromial Impingement Test

• Uses Neer, Hawkins-Kennedy, and Yocum tests.

• Abnormal finding: Pain provoked during testing.

9. Hyper External Rotation Test (HERT)

• Performed at 90° abduction, 90° elbow flexion.

• Evaluates peel-back mechanism of the superior labrum and internal impingement.

• Abnormal finding: Pain during forced external rotation.

Scoring system

• Maximum score: 11 points (no abnormalities).

• Lower scores: Indicate a higher likelihood of shoulder pathology or kinetic chain dysfunction in throwers.

Diagnostic accuracy and limitations

• The Hara Test is relatively new, and large validation studies are still lacking².

• Early evidence suggests clinical utility in detecting subtle biomechanical issues in overhead athletes.

• Should be used as part of a comprehensive shoulder assessment, not as a stand-alone diagnostic tool.

Clinical relevance

• Detects posterior capsule tightness, rotator cuff weakness, scapular dyskinesis, and labral pathology in overhead athletes.

• Helps clinicians identify at-risk throwers before structural damage occurs.

• May guide rehabilitation strategies, particularly scapular stabilization and posterior capsule mobility programs.

• Serves as a bridge between clinical examination and advanced imaging.

Conclusion

The Hara Test provides a systematic approach to identifying kinetic chain deficits in throwing athletes. By combining 11 targeted physical assessments with imaging, it offers valuable insight into potential shoulder pathology, even in the absence of overt structural findings. While evidence is limited, it shows promise as a screening and diagnostic tool for overhead athletes with shoulder dysfunction.

References

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2. Teruhisa M. Current concepts: arthroscopic treatment of articular-sided partial-thickness rotator cuff tears. In: Sports Injuries to the Shoulder and Elbow. Springer, Berlin, Heidelberg, 2015. p. 85-97.

3. Somu K, Noriaki M, Yukio U, Junpei S, Kei A, Ryohei S, Kazutaka Y, Masafumi H. Effect of short-term intervention on infraspinatus muscle activity during throwing motion and physical examination in baseball players with throwing disorder. Isokinetics and Exercise Science, 2020, Preprint: 1-9.

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