Horizontal Adduction Range Of Motion Research Articles

Factors Associated with Medial Elbow Torque Measured Using a Wearable Sensor in Junior High School Baseball Pitchers

There are no reports investigating the relationship between shoulder range of motion (ROM) and pitching elbow torque in junior high school pitchers. Therefore, we aimed to evaluate the factors associated with medial elbow torque in this population. Sixty-three junior high school baseball pitchers were recruited for this study. The participants completed a questionnaire and passive ROM measurements of shoulder abduction and horizontal adduction. All pitchers pitched three fastballs at maximum effort while wearing a wireless sensor recording pitching mechanics and elbow valgus torque for each pitch. Age (r = 0.65, p < 0.001), height (r = 0.83, p < 0.001), body weight (r = 0.82, p < 0.001), BMI (r = 0.60, p < 0.001), and ball velocity (r = 0.80, p < 0.001) were significantly positively correlated with elbow valgus torque. Participants were divided into two groups based on elbow valgus torque, >30 (high torque [HT]) and <30 N·m (low torque [LT]). Age, height, body weight, BMI, and ball velocity were significantly higher in the HT group than in the LT group. The difference between dominant and non-dominant shoulder horizontal adduction ROM was 5.3 ± 9.3° and 1.0 ± 6.4° in the HT and LT groups, respectively, which was also significantly different. Ball velocity, age, larger physique, and increased restriction of the dominant shoulder’s horizontal adduction ROM were associated with higher medial elbow torque in junior high school pitchers. This suggests that improving the dominant shoulder’s horizontal adduction ROM contributes to preventing elbow injuries.

Throwing Shoulder Adaptations Are Not Related to Shoulder Injury or Pain: A Preliminary Report.

Overhead throwing in baseball and softball athletes induces shoulder adaptations theorized to increase risk of shoulder musculoskeletal injury (MSI) and/or pain due to range of motion (ROM) deficits. Shoulder ROM adaptations are associated with a higher risk for developing shoulder MSI and pain. Prospective cohort study. Level 3. A total of 60 National Collegiate Athletic Association Division I athletes cleared for full athletic participation and free from upper extremity MSI in the last 4 weeks (age, 19.0 ± 1.2 years; weight, 82.1 ± 13.7 kg; height, 178.6 ± 11.2 cm; softball, n = 23; baseball, n = 37). Passive glenohumeral internal rotation (IR), external rotation (ER), and horizontal adduction (HA) ROM were measured with the scapula stabilized and used to categorize participants with/without external rotation gain (ERG), external rotation insufficiency (ERI), glenohumeral internal rotation deficit (GIRD), pathological GIRD, and posterior shoulder tightness (PST) before the competitive season. Groups were then compared to assess the incidence of shoulder MSI prospectively and prevalence of shoulder pain at the initial evaluation. Baseball and softball athletes demonstrated significantly less IR ROM in the dominant shoulder (50.6° ± 9.4°) compared with the nondominant shoulder (59.1° ± 8.6°; P < 0.01) and significantly more ER ROM (dominant, 104.6° ± 12.1°; nondominant, 97.7° ± 12.0°; P < 0.01). Incidence of shoulder MSI was 15% but was not significantly related to any shoulder adaptations. No significant relationship was found between prevalence of pain and any shoulder adaptations in the 27% of athletes with pain. Increased ER and decreased IR ROM adaptations in intercollegiate overhead throwing athletes do not appear to be correlated to risk of shoulder MSI or pain. The findings of this level 3 prospective study provide clinicians working with overhead athletes information regarding shoulder MSI risk and pain. It is recommended that clinicians should not use ROM adaptations exclusively to determine increased risk of shoulder MSI.

Effectiveness of a Shoulder Exercise Program in Division I Collegiate Baseball Players During the Fall Season.

BackgroundDeficits in shoulder range of motion (ROM) and strength are associated with risk of arm injury in baseball players.PurposeThe purpose of this study was to assess the effectiveness of a standardized exercise program, during the fall season, on shoulder ROM and rotational strength in collegiate baseball players.Study DesignProspective cohort studyMethodsPassive shoulder internal rotation (IR), external rotation (ER), and horizontal adduction ROM were measured with an inclinometer. Shoulder IR and ER strength was assessed using a hand-held dynamometer and normalized to body weight. Players performed a program of shoulder stretching and strengthening exercises, three times/week for one month and then one time/week for two months. Paired sample t-tests compared pre-intervention to post-intervention outcome measures.ResultsDivision I baseball players (n=43; 19.6±1.2years, 185.8±5.5cm, 90.5±7.0kg) volunteered. From pre- to post-intervention, there were increases in horizontal adduction ROM in the throwing (Mean Difference (MD)=6.1°, 95%CI=3.7,8.5; p<0.001) and non-throwing arm (MD=8.0°, 95%CI=5.6,10.3; p<0.001), and a decrease in non-throwing arm ER ROM (MD=2.8°, 95%CI= 0.2,5.5; p=0.039). The ER ROM surplus (throwing – non-throwing) increased (MD=5.6°, 95%CI= 1.1,10.2; p=0.016). Throwing arm (MD=1.3%BW, 95%CI=0.5-2.1, p=0.003) and non-throwing arm (MD=1.2%BW, 95%CI=0.4,2.0; p=0.004) ER strength decreased. A notable, but non-significant increase in IR strength on the throwing arm (MD=1.6%BW, 95%CI=0.1,3.0; p=0.055) and decrease on the non-throwing arm (MD=1.2%BW, 95%CI=0.0,2.4; p=0.055) occurred. Additionally, throwing arm ER:IR strength ratio (MD=0.16, 95%CI=0.08,0.25; p<0.001) also decreased.ConclusionChanges in shoulder horizontal adduction ROM, IR strength and relative ER surplus on the throwing arm were noted at the end of the season. The lack of change in IR and ER ROM and may be related to the lack of deficits at the start of the fall season.Level of Evidence2.

Relationship Differences in Pre-season Isometric Shoulder Strength, Humeral Torsion and Shoulder Range of Motion in Collegiate Baseball Players (218)

Objectives:Muscle strength, humeral torsion (HT) and shoulder range of motion (ROM) have been linked to throwing performance and injury risk in baseball players. Research suggests that players who demonstrate an isometric shoulder external rotation (ER)/internal rotation (IR) strength ratio of <0.75 are at a higher risk for developing a throwing-related upper extremity injury. While the relationships between HT and shoulder ROM have been examined in the literature, few studies have examined the potential relationships between these variables and isometric shoulder strength. The purpose of this study was to examine the relationships between isometric shoulder strength, HT and shoulder ROM at the start of each baseball season in a cohort of healthy junior college baseball players.Methods:Ninety-two healthy junior college baseball players (mean age=19.9±0.8 years) were prospectively assessed at the start of 2 consecutive spring seasons. Variables measured included HT, shoulder ROM and isometric shoulder strength. Both the dominant (D) and non-dominant (ND) shoulders of each player were assessed throughout the study. Chi square tests and bivariate Pearson correlation coefficients were calculated to examine between group differences and the relationships between variables. Statistical significance was set a priori at α=0.05.Results:33.7% of junior college players demonstrated a D shoulder ER/IR strength ratio of <0.75 at the start of baseball season. Pitchers and position players demonstrated no significant differences in D shoulder ER/IR strength ratios at the start of the season (P=.40). Additionally, moderate positive relationships were observed between D HT and D IR ROM (r=0.35; P=.001) as well as D horizontal adduction (HA) ROM (r=0.43; P<.001). A moderate relationship was also observed between ND HT and ND IR ROM (r=0.56, P<.001), however ND ER and HA ROM demonstrated weaker relationships respectively (ER: r=-0.27; P=.01; HA: r=0.26; P=.01). Inverse relationships were observed between HT and ER strength in both the D and ND shoulders (D: r=-0.27, P=.01; ND: r=-0.28, P=.007). Internal rotation ROM was also inversely correlated with ER strength (r=-0.29, P=0.005) and ER/IR strength ratios (r=-0.31, P=.003), but only in the D shoulder. No significant correlations were observed between ROM and strength in the ND shoulder.Conclusions:One third of the junior college baseball players in this study began the season with marked deficits in D shoulder strength, irrespective of their position. We then examined the relationships between HT, shoulder ROM and isometric shoulder strength and confirmed the previously established correlation between HT and shoulder ROM. Moreover, there appeared to be inverse relationships between HT and ER strength in both the D and ND shoulders as well as IR ROM and ER strength in the D shoulder. This study emphasizes the importance of pre-season rotator cuff strength training, with an emphasis on improving ER strength, to potentially aid in the prevention of throwing-related upper extremity injuries in collegiate baseball players. Humeral torsion and shoulder ROM may influence isometric shoulder strength, however more research is needed to better understand these relationships in the throwing shoulder.

Trunk stabilization, body balance, body perception, and quality of life in professional physically disabled and able-bodied archers

Archery is defined as a static sport that requires postural control, upper body strength and balance ability to achieve high scores. The aim of this study was to compare the trunk stabilization, body perception, and quality of life of professional physically disabled and able-bodied archers. Twenty professional archers aged between 18 and 55 years were included in the study. The individuals were divided into two groups as physically disabled archers (n = 10) and able-bodied archers (n = 10). All athletes were evaluated with anthropometric measurements of upper extremity, normal range of motion (ROM) of shoulder, manual muscle strength of upper extremity, and endurance of trunk flexion and extension for trunk stabilization, with modified functional reach, lateral reach and bilateral reach tests for body balance, with Body Perception Scale (BPS) for body perception, and with Short Form 36 (SF-36) for quality of life. Statistically significant differences were found in all reach tests, physical role difficulties and physical function sub-scores of SF-36, and left horizontal adduction and right internal rotation ROM in favor of the able-bodied group. There was a statistically significant difference in arm circumference measurements in favor of the disabled group. No significant difference was there between the groups in endurance of trunk flexion and extension, and BPS. In conclusion, it has been observed that the able-bodied archers have better body balance and quality of life than disabled archers and there is no difference between disabled and able-bodied athletes in terms of trunk stabilization and body perception.

Shoulder impairment and pain of individuals with newly acquired spinal cord injury compared to uninjured peers.

Cohort study. Shoulder pain prevalence is high in those with spinal cord injury (SCI) and is associated with decreased function, participation restrictions and decreased quality of life. Limited evidence exists regarding physical impairments of newly acquired SCI. The current study compared musculoskeletal factors at rehabilitation initiation in individuals with newly acquired SCI to uninjured individuals. We hypothesized no impairment differences of shoulder pain, strength, mobility, muscle extensibility, or rotator cuff integrity would exist between groups. Multi-site laboratory setting. Thirty-five individuals with newly acquired SCI and age and gender-matched controls without SCI (n = 34) participated. Musculoskeletal Pain Survey, shoulder range of motion (ROM), strength, pectoralis minor muscle extensibility (PM) and tissue integrity [Ultrasound Pathology Rating Scale (USPRS)] were obtained. Higher pain was reported by individuals experiencing new SCI along with lower strength across all bilateral measures, reduced elevation, external rotation, and horizontal adduction ROM, with large effect sizes. PM bilateral extensibility was reduced compared to controls, with moderate between group effect size; however, no USPRS score difference existed. This study provided the first comprehensive clinical description for individuals with newly acquired SCI. In comparison to matched uninjured controls, participants with new SCI reported greater shoulder pain with impairments in mobility, strength, and extensibility. The identified early clinical impairments aligned with progressive impairment including further pain development and persistence. Awareness and modification of these early clinical impairments may lead to improved long-term outcomes, improving the overall health and well-being of individuals with newly acquired SCI. Spinal Cord Injury Research Program Investigator-Initiated Research Award under Award No. W81XWH-17-1-0476.

The effects of restricted glenohumeral horizontal adduction motion on shoulder and elbow forces in collegiate baseball pitchers

Decreased glenohumeral (GH) horizontal adduction range of motion (ROM) among baseball pitchers has been associated with the development of various shoulder and elbow pathologies. No research has examined how this tightness may affect the forces placed on the shoulder and elbow during the pitching motion. Fifty-five asymptomatic National Collegiate Athletic Association Division I baseball pitchers participated. Twenty-five participants had -10° or less horizontal adduction ROM in their throwing shoulder. The remaining 30 participants had greater than -10° of horizontal adduction. A digital inclinometer was used to measure GH horizontal adduction, internal rotation, and external rotation ROM while in 90° of shoulder abduction. Forces produced in the throwing shoulder and elbow were assessed with a 3-dimension, high-speed video capture system and based on the sum of angular momenta of the kinetic chain segments around the center of gravity. Separate 2-tailed t tests were run to determine significant differences between groups (P < .05). Both groups presented with significant bilateral differences in their total arcs of motion (P < .04). This suggests that the loss of horizontal adduction in these groups was at least partially due to soft tissue tightness. There were no significant between-group differences for shoulder external rotation torque or shoulder and elbow distraction (P > .10). The restricted ROM group had significantly more shoulder abduction torque (P = .04), shoulder horizontal abduction torque (P = .004), elbow flexion torque (P = .002), and elbow valgus torque (P = .02) compared with the control group. These results demonstrate that collegiate pitchers with -10° or less of horizontal adduction ROM in their throwing shoulder create significantly more shoulder abduction and horizontal abduction torque, as well as more elbow flexion and valgus torque, during the pitching motion than those with more ROM.

Changes in clinical measures and tissue adaptations in collegiate swimmers across a competitive season

Competitive swimmers incur shoulder pain and injury. Physical characteristics such as shoulder range of motion (ROM) and endurance and tissue adaptations such as posterior capsule thickness (PCT) may be risk factors in addition to high training volume. 1) To identify the most provocative special test and prevalence of positive special tests for shoulder impingement tests in a group of collegiate swimmers, (2) to assess shoulder pain and disability, internal rotation (IR) and external rotation, and horizontal adduction (HADD) ROM and posterior shoulder endurance longitudinally over a competitive collegiate season, and (3) determine if there is a relationship between swimming yardage, supraspinatus tendon organization, and PCT. Thirty Division III swimmers were tested poolside at the beginning (T1), middle (T2), and end (T3) of their season. Dependent variables included pain and disability, shoulder ROM, Posterior Shoulder Endurance Test (PSET) value, and PCT. Analyses of variance with follow-up t tests compared measures over time, and Pearson correlation coefficients were performed. Despite increased swimming yardage, disability was reduced from T1 to T3 (P = .003). There was a reduction in bilateral IR and HADD ROM from T1 to T3. PSET values increased on the right from T1 to T3 (P = .014). There was a significant positive correlation between swimming yardage at T1 and T2 and PCT at T3 (P = .034, P = .028). A loss of shoulder IR and HADD was observed across the season concurrent with less swimming-related disability, which may indicate a favorable adaptation. Improved PSET scores over the season is consistent with prior research linking endurance and less pain and disability.

Effects of self-stretching with mobilization on shoulder range of motion in individuals with glenohumeral internal rotation deficits: a randomized controlled trial

The combined effects of cross-body stretching and dorsal glide mobilization have not been examined previously, although both stretching and mobilization maneuvers are effective for improving shoulder range of motion (ROM). Thus, the aim of this study was to demonstrate the effects of stretching with mobilization (SWM) on glenohumeral (GH) internal rotation (IR) and horizontal adduction (HA) ROM. Forty individuals with GH IR deficits were randomized to perform simultaneous combined cross-body stretching and dorsal glide mobilization (SWM group, comprising 10 male and 10 female patients) or cross-body stretching alone (stretching group, comprising 10 male and 10 female patients). GH IR ROM, HA ROM, and shoulder mobility were assessed before and immediately following interventions. Group and time differences were analyzed using 2-way repeated-measures analysis of variance. Greater changes in GH IR ROM (6°, P < .001), HA ROM (10°, P < .001), and shoulder mobility (-2 cm, P = .018) were observed in the SWM group than in the stretching group, although significant increases were observed in GH IR ROM (SWM group, P < .001; stretching group, P < .001), HA ROM (SWM group, P < .001; stretching group, P = .042), and shoulder mobility (SWM group, P < .001; stretching group, P < .001) after both interventions. This study shows that SWM could be a useful exercise for shoulder ROM recovery in individuals with GH IR deficits.

Assessment of posterior shoulder muscle stiffness related to posterior shoulder tightness in college baseball players using shear wave elastography

Limitations of shoulder range of motion (ROM) have been reported to be at high risk for shoulder disorders in baseball players. In this study, we assessed posterior shoulder muscle stiffness using shear wave elastography in baseball players with and without posterior shoulder tightness. In total, 21 college baseball players volunteered to participate in this study. Passive ROMs for shoulder abduction and horizontal adduction were measured using a goniometer. Subsequently, we divided all participants into 2 groups based on the differences between bilateral shoulder ROMs: STIFF+and STIFF-groups. Thickness and elasticity of the posterior and inferior shoulder muscles were assessed using ultrasound. Shoulder abduction ROM on the throwing side was 114.5° ± 5.3° and 131.3° ± 5.7° in the STIFF+and STIFF-groups, respectively, which was significantly different between the 2 groups (P= .023). Horizontal adduction ROM on the throwing side was 96.6° ± 4.9° and 110.9° ± 4.8° in the STIFF+and STIFF-groups, respectively, which was also significantly different between the 2 groups (P = .014). The elasticity of infraspinatus and lower trapezius in the STIFF+group was significantly greater than that in the STIFF-group (P = .018 and .033, respectively). In this study, we found that the elasticity of infraspinatus and lower trapezius in stiff shoulders was significantly greater than that in nonstiff shoulders, which indicated that the infraspinatus and lower trapezius could be the key muscles in posterior shoulder tightness.

Long-Term Characteristics of Injured Shoulders in Overhead Sports: A Gender Comparison

Overhead sports require high levels of mobility and force produced by the shoulder joint. Additionally, gender differences in glenohumeral joint mobility and upper extremity strength are apparent in various athletic populations. Previous studies have found relationships in shoulder range of motion (ROM) and strength in several shoulder injuries. However, data are lacking regarding the long-term effects of shoulder injuries and considerations with respect to gender. PURPOSE: To determine the long-term effects of shoulder injuries on shoulder ROM and strength and examine gender differences in collegiate overhead athletes. METHODS: 35 male (age:20.3±1.2yr, mass:84.1±9.7kg) and 25 female (age:19.6±0.8yr, mass:70.8±10.9kg) overhead athletes fully participating in NCAA division I baseball, softball, volleyball, or tennis were recruited and divided into injury history group and healthy group depending on the existence of a history of shoulder injury. Active ROM of shoulder internal rotation (IR), external rotation (ER) and horizontal adduction (HAD) were measured using a digital inclinometer. Isometric shoulder IR and ER strength were assessed using a hand-held dynamometer and normalized by body mass. A two (group) by two (gender) factorial ANOVA was used to evaluate the dominant shoulder ROM and strength. Cohen’s d effect sizes were calculated to assess the magnitude of differences. RESULTS: Females showed significantly lower IR ROM (p=.03, d=0.88), IR strength (p=.04, d=0.83), and ER strength (p=.04, d=0.86) in the injury history group versus the healthy group, whereas there were no group differences in males (p>.05). Additionally, male overhead athletes had lower IR (p=.01, d=0.67) and HAD ROM (p=.01, d=0.85) and greater IR strength (p=.02, d=0.64) compared to female overhead athletes. CONCLUSION: The results of this study indicate that shoulder injuries may have longer-lasting effects in female overhead athletes compared to male athletes. Furthermore, male overhead athletes demonstrated larger differences in posterior shoulder tightness and rotator cuff strength imbalances compared to female overhead athletes. This study may have significant implications for protocols aimed at preventing shoulder reinjury for specific genders in overhead sports.

Effectiveness of a Posterior Shoulder Stretching Program on University-Level Overhead Athletes: Randomized Controlled Trial.

To determine whether a posterior shoulder stretch was effective in increasing internal rotation (IR) and horizontal adduction (HAd) range of motion (ROM) in overhead athletes identified as having reduced mobility. Randomized controlled trial (parallel design). University-based sports medicine clinic. Thirty-seven university-level athletes in volleyball, swimming, and tennis, with IR ROM deficits ≥15°, were randomized into intervention or control groups. No subjects withdrew or were lost to follow-up. The intervention group performed the "sleeper stretch" daily for 8 weeks, whereas the control group performed usual activities. Independent t tests determined whether IR and HAd ROM differences between groups were significant at 8 weeks and 2-way repeated-measures analysis of variance tests measured the rate of shoulder ROM change. Subject-reported shoulder pain and function were obtained at each evaluation. Significant differences were found between the intervention and control groups' IR and HAd ROM at 8 weeks (P < 0.001 and P = 0.003, respectively) compared with baseline (zero weeks) (P = 0.19 and P = 0.82, respectively). Significant improvements in IR were detected in the intervention group at 4 weeks (P < 0.001), whereas HAd demonstrated significant changes only at 8 weeks (P = 0.003). Reported shoulder function (P = 0.002) was different between study groups at 8 weeks. Overhead, university-level athletes with an IR deficit ≥15° significantly increased their IR and HAd ROM after performing a posterior shoulder stretch for 8 weeks. Effective management of posterior shoulder tightness through stretching may reduce the incidence of shoulder pathology in overhead athletes.

Effects of two stretching methods on shoulder range of motion and muscle stiffness in baseball players with posterior shoulder tightness: a randomized controlled trial

The cross-body stretch and sleeper stretch are widely used for improving flexibility of the posterior shoulder. These stretching methods were modified by Wilk. However, few quantitative data are available on the new, modified stretching methods. A recent study reported the immediate effects of stretching and soft tissue mobilization on the shoulder range of motion (ROM) and muscle stiffness in subjects with posterior shoulder tightness. However, the long-term effect of stretching for muscle stiffness is unknown. The objective of this study was to examine the effects of 2 stretching methods, the modified cross-body stretch (MCS) and the modified sleeper stretch (MSS), on shoulder ROM and muscle stiffness in baseball players with posterior shoulder tightness. Twenty-four college baseball players with ROM limitations in shoulder internal rotation were randomly assigned to the MCS or MSS group. We measured shoulder internal rotation and horizontal adduction ROM and assessed posterior shoulder muscle stiffness with ultrasonic shear wave elastography before and after a 4-week intervention. Subjects were asked to perform 3 repetitions of the stretching exercises every day, for 30 seconds, with their dominant shoulder. In both groups, shoulder internal rotation and horizontal adduction ROM were significantly increased after the 4-week intervention. Muscle stiffness of the teres minor decreased in the MCS group, and that of the infraspinatus decreased in the MSS group. The MCS and MSS are effective for increasing shoulder internal rotation and horizontal adduction ROM and decreasing muscle stiffness of the infraspinatus or teres minor.

Effects of dry needling to the symptomatic versus control shoulder in patients with unilateral subacromial pain syndrome

BackgroundInitial reports suggest that treating myofascial trigger points in the infraspinatus with dry needling may be effective in treating patients with shoulder pain. However, to date, high quality clinical trials and thorough knowledge of the physiologic mechanisms involved is lacking. ObjectivesTo examine the effect of dry needling to the infraspinatus muscle on muscle function, nociceptive sensitivity, and shoulder range of motion (ROM) in the symptomatic and asymptomatic shoulders of individuals with unilateral subacromial pain syndrome. DesignWithin-subjects controlled trial. MethodsFifty-seven volunteers with unilateral subacromial pain syndrome underwent one session of dry needling to bilateral infraspinatus muscles. Outcome assessments, including ultrasonic measures of infraspinatus muscle thickness, pressure algometry, shoulder internal rotation and horizontal adduction ROM, and questionnaires regarding pain and related disability were taken at baseline, immediately after dry needling, and 3–4 days later. ResultsParticipants experienced statistically significant and clinically relevant changes in all self-report measures. Pressure pain threshold and ROM significantly increased 3–4 days, but not immediately after dry needling only in the symptomatic shoulder [Pressure pain threshold: 5.1 (2.2, 8.0) N/cm2, internal rotation ROM: 9.6 (5.0, 14.1) degrees, horizontal adduction ROM: 5.9 (2.5, 9.4) degrees]. No significant changes occurred in resting or contracted infraspinatus muscle thickness in either shoulder. ConclusionsThis study found changes in shoulder ROM and pain sensitivity, but not in muscle function, after dry needling to the infraspinatus muscle in participants with unilateral subacromial pain syndrome. These changes generally occurred 3–4 days after dry needling and only in the symptomatic shoulders.

Effects of Modified Cross-body Stretching on Range of Motion in Glenohumeral Joint

PURPOSE: The purpose of this study was to compare the effects of cross-body stretching (CBS) and modified cross-body stretching (MCBS) on the range of motion (ROM) of glenohumeral joint (GHJ) in healthy subjects. METHODS: Thirty subjects were randomly assigned to 1 of 2 groups: CBS group without stabilization of scapula (n=15) and MCBS group with stabilization of scapula (n=15). We measured horizontal adduction and internal rotation ROM of GHJ in pre- and post-intervention. The data were analyzed using the analyses of covariate (ANCOVA) and least significant difference (LSD) post hoc tests (p=.05). RESULTS: In the post-intervention, the MCBS group had a significantly greater increase in horizontal adduction ROM (mean SD, ) compared to the CBS group () (p=.007) and a greater increase in internal rotation ROM () compared to the CBS group () (p=.004). CONCLUSION: A single session application of an MCBS provides immediate more improvements in both horizontal adduction and internal rotation ROM than CBS. These results suggest that application of MCBS with stabilization of scapula may be a more useful to gain ROM of GHJ than CBS without stabilization of scapula.

The relationship between clinically measured hip rotational motion and shoulder biomechanics during the pitching motion.

To examine how clinically measured hip motion is related to shoulder biomechanics during the pitching motion. Cross-sectional. Bilateral hip rotational range of motion was measured clinically among 34 collegiate baseball pitchers. External rotation torque and maximum horizontal adduction range of motion of the throwing shoulder were measured using a three-dimensional, high speed video capture system. Separate standard multiple regression analyses showed that the total hip rotational range of motion of the lead leg had a significant relationship with shoulder external rotation torque during the throwing motion (r=0.56, P=0.003). Both lead leg hip external rotation range of motion (r=-0.39, P=0.02) and internal rotation range of motion (r=0.42, P=0.009) made significant contributions to this dependent variable. Lead leg external rotation range of motion also had a significant negative relationship with shoulder horizontal adduction range of motion (r=-0.36, P=0.04). The total rotational range of motion of the trail leg had a significant relationship with shoulder horizontal adduction range of motion (r=0.43, P=0.04). However, trail leg external rotation range of motion was the only significant contributor to this relationship (r=-0.35, P=0.04). No other significant relationships were noted (r<0.37, P>0.11). Our results demonstrate that altered hip rotational range of motion, measured clinically, has a direct effect on the amount of external rotation torque and horizontal adduction range of motion of the shoulder during the throwing motion.

The Modified Sleeper Stretch and Modified Cross-body Stretch to Increase Shoulder Internal Rotation Range of Motion in the Overhead Throwing Athlete

Stretching techniques that focus on increasing posterior shoulder soft tissue flexibility are commonly incorporated into prevention and treatment programs for the overhead athlete. The cross-body and sleeper stretch exercises have been described as stretching techniques to improve posterior shoulder soft tissue flexibility and to increase glenohumeral joint internal rotation and horizontal adduction range of motion in the overhead athlete. But, based on the inability to stabilize the scapula and control glenohumeral joint rotation with the cross-body stretch and the potential for subacromial impingement with the sleeper stretch, the authors recommend modifications to both of these commonly performed stretches. This clinical commentary reviews the literature on posterior shoulder stretches, describes modifications to both of these commonly performed stretches, and outlines a strategy to maintain or improve posterior shoulder soft tissue flexibility and glenohumeral joint internal rotation range of motion in the overhead athlete. Therapy, level 5.

Shoulder Adaptations Among Pitchers and Position Players Over the Course of a Competitive Baseball Season

To determine if throwing arm shoulder range of motion (ROM) and scapular kinematic differences exist between baseball pitchers and position players over the course of a baseball season. Prospective cohort. Professional baseball athletic training room. Sixteen asymptomatic professional baseball pitchers and 16 position players. Preseason glenohumeral (GH) posterior tightness and scapular position. Throwing arm GH horizontal adduction ROM and GH internal rotation bilateral asymmetry ROM, as well as bilateral differences in forward scapular posture and throwing arm scapular upward rotation at rest, 60, 90, and 120 degrees of humeral elevation were measured. These measurements were taken before and at the conclusion of a 140-game baseball season. Analyses of covariances showed no significant differences in GH horizontal adduction or internal rotation asymmetry ROM between groups over the course of the season. However, the pitchers developed significantly less scapular upward rotation at 60 degrees (P = 0.007) and 90 degrees (P = 0.006) of humeral elevation compared with the position players during the season. Forward scapular posture (P = 0.23) and scapular upward rotation at 0 degrees (P = 0.93) and 120 degrees (P = 0.29) of humeral elevation were not significantly different between groups. These results suggest that baseball position players develop more scapular upward rotation over the course of a competitive season than pitchers. This discrepancy may increase the pitchers' risk of injury and may partially explain their higher incidence of shoulder injury compared with position players. Therefore, pitchers may benefit from strengthening exercises and stretches aimed at increasing scapular upward rotation throughout the competitive baseball season.

A Comparison of Glenoid Morphology and Glenohumeral Range of Motion Between Professional Baseball Pitchers With and Without a History of SLAP Repair

We sought to examine the relation among glenoid morphology, glenohumeral range of motion (ROM), and history of shoulder injury in professional baseball pitchers. We studied 58 professional baseball pitchers. Internal rotation (IR) and external rotation (ER) ROM was measured at 90° of abduction. Horizontal adduction (HAdd) ROM was also measured. Glenoid superior inclination and glenoid retroversion (GRV) were then measured radiographically. Separate mixed-model analyses of variance were used to compare dependent measures between the dominant and nondominant shoulders of pitchers with or without a history of SLAP repair. Significant interaction effects were interpreted by use of a test for simple main effects (α = .05). GRV was significantly greater on the dominant side (8.7° ± 5.6°) versus nondominant side (5.5° ± 5.2°) (P = .001), whereas glenoid superior inclination was equivalent (99.5° ± 4.3° for dominant side v 99.2° ± 4.4° for nondominant side, P = .853). Post hoc analysis indicated that pitchers with a history of SLAP repair did not display an adaptive increase in dominant GRV compared with nondominant GRV (P = .016). There were no statistical differences between groups for ER (P = .29), IR (P = .39), or HAdd (P = .39). The dominant shoulder displayed greater ER (mean increase, 6.2° ± 12.2°) with a complementary decrease in IR (mean decrease, 5.8° ± 13.2°) and HAdd (mean decrease, 8.9° ± 13.7°) compared with the nondominant side. Our findings suggest that the development of increased GRV in the dominant shoulder of professional baseball pitchers may be a protective adaptive change not reflected in glenohumeral ROM measures. Level IV, therapeutic case series.

Anterior Glenohumeral Laxity Is Associated With Posterior Shoulder Tightness Among Professional Baseball Pitchers

Background: Baseball pitchers often have increased anterior glenohumeral (GH) laxity and posterior shoulder tightness due to large forces produced during the throwing motion. As such, many clinicians have hypothesized that a relationship exists between these common characteristics. Hypothesis: A negative relationship will exist between anterior GH laxity and the summation of GH adduction range of motion (ROM) and GH internal rotation ROM asymmetry. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Anterior GH laxity, GH rotation ROM, and GH horizontal adduction ROM were measured in 58 asymptomatic professional baseball pitchers. Differences in GH internal rotation at 90° of abduction were calculated between both shoulders. A multiple regression analysis was used to determine the strength of the relationships between anterior GH laxity (dependent variable) and GH adduction ROM and GH internal rotation ROM asymmetry (independent variables) (P < .05). Results: A large portion of anterior GH laxity was predicted by the summation of GH adduction ROM and GH internal rotation ROM asymmetry (r2 = .45, P = .001). Furthermore, increased anterior GH laxity had a significant relationship with both decreased GH horizontal adduction ROM (r = .53, P = .001) and differences in GH internal rotation ROM (r = .43, P = .001). Conclusion: The results of this study suggest that decreased GH horizontal adduction and internal rotation ROM may be considered partial predictors for increased anterior GH laxity in the throwing arm of baseball players. Because of the association between these variables, clinicians may find it advantageous to address posterior shoulder tightness during the prevention, diagnosis, and treatment of shoulder injuries associated with anterior GH laxity.