Abstract

BackgroundThe cross-body and the modified sleeper stretch have been used to improve posterior shoulder soft tissue flexibility and to increase glenohumeral joint internal rotation (GHJ IR) in overhead athletes. However, due to the inability to stabilize patient’s scapula and control GHJ rotation with the cross-body stretch and the potential for subacromial impingement or symptoms’ aggravation with the modified sleeper stretch, a new stretching technique (Passive Glenohumeral Internal Rotation with Clam Shell Bridging) was developed as an alternative to these commonly used stretches that may allow for greater stability of the scapula without reproducing symptoms. Thus, the current study aimed to examine and compare a novel stretching technique to the traditional modified sleeper stretch to determine the effect on glenohumeral IR range of motion (ROM) and self-reported pain in overhead athletes with glenohumeral internal rotation deficits (GIRD).MethodsForty-two overhead athletes with GIRD [mean age 25.9 ± 2.6 years, 20 males and 22 females] participated in this study. Participants were randomly assigned into either novel stretching group or modified sleeper stretching group. IR ROM was measured with a digital inclinometer before, immediately, and at week 4 post intervention, while pain was measured with Numeric Pain Rating Scale before and at week 4 post intervention.ResultsThere was no significant group by time interaction effect for IR ROM (p = 0.27); however, there was a significant change over time (p < 0.001, η2 = 0.77). Both groups demonstrated a significant increase in IR from baseline to immediate and week 4, and from immediate to week 4 (p < 0.001). There was a significant group by time interaction for pain intensity (p < 0.001, η2 = 0.72). Results showed a significant reduction in pain intensity over time in the novel group (p = 0.001, d = 2.18), but not in the traditional group (p = 0.231, d = 0.46).ConclusionBoth stretches appear to be effective at improving IR ROM in overhead athletes with GIRD. However, the novel stretching might be more effective at reducing shoulder pain and thus may be more appropriate for symptomatic patients.Trial registrationProspectively registered in February 6, 2017 under Clinical Trial Registry # NCT03044236.

Highlights

  • The cross-body and the modified sleeper stretch have been used to improve posterior shoulder soft tissue flexibility and to increase glenohumeral joint internal rotation (GHJ IR) in overhead athletes

  • Gharisia et al BMC Musculoskeletal Disorders (2021) 22:402 (Continued from previous page). Both stretches appear to be effective at improving IR range of motion (ROM) in overhead athletes with glenohumeral internal rotation deficits (GIRD)

  • There was no significant group by time interaction effect for GH IR ROM (p = 0.27); there was a significant change over time (p < 0.001, η2 = 0.77) for the combined groups

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Summary

Introduction

The cross-body and the modified sleeper stretch have been used to improve posterior shoulder soft tissue flexibility and to increase glenohumeral joint internal rotation (GHJ IR) in overhead athletes. It has been reported that individuals who frequently participate in overhead throwing sports demonstrate an altered mobility patterns in the throwing shoulder as compared to the non-throwing shoulder [8] These adaptive mobility patterns usually present as excessive external rotation (ER) and decreased internal rotation (IR) of the throwing shoulder [9]. This loss of IR range (15°-25°) has been defined as Glenohumeral Internal Rotation Deficit (GIRD) [9,10,11] and has been linked to adaptive structural changes in the soft tissue (i.e. capsuloligamentous or muscular tightness) and/or osseous tissue (i.e. humeral retroversion) of the glenohumeral (GH) joint as result of the extreme demands and the excessive overload of repetitive overhead activities [8]

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