Posterior Shoulder Tightness Research Articles

The Impact of Fascial Manipulation® on Posterior Shoulder Tightness in Asymptomatic Handball Players: A Randomized Controlled Trial.

This prospective study aimed to determine the impact of Fascial Manipulation® by Stecco (FM) on the range of motion (ROM) of internal rotation (IR) and horizontal adduction (HADD) in asymptomatic handball players, representing significant risk factors for shoulder injuries. A randomized controlled trial was conducted, with participants randomly assigned to either the investigated group (N = 29) receiving a single session of FM or the control group (N = 27) receiving no treatment. The ROM for IR and HADD were measured before, immediately after, and one month after the FM session. The investigated group experienced a statistically significant acute increase in glenohumeral IR (14 degrees, p < 0.001) and HADD (14 degrees, p < 0.001) compared to the control group (p < 0.001). The positive effects of FM persisted one month post-treatment, with increased IR ROM by 12 degrees (p < 0.001) and HADD ROM by 11 degrees (p < 0.001). Participants in the investigated group reported lower subjective tightness/stiffness immediately after (p < 0.001) and one month after treatment (p = 0.002) compared to the control group. This study demonstrates that a single application of FM effectively improves glenohumeral ROM in the dominant throwing shoulder of asymptomatic handball players. It highlights the immediate and sustained positive effects of FM on IR and HADD. These findings support the use of FM as an effective method for enhancing shoulder ROM and reducing subjective tightness/stiffness. The study was registered at ClinicalTrials.gov (NCT06009367).

Effects of the stretching program in male volleyball players with posterior shoulder tightness

BackgroundStretching programs are often used to improve muscle stiffness and thereby posterior shoulder tightness (PST); however, knowledge about their effects on the viscoelastic properties of muscles and performance is limited. ObjectiveThe aim of this study was to investigate the effects of a six-week stretching program on the viscoelastic properties of posterior shoulder muscles, shoulder functional performance and range of motion in volleyball players with PST. Study designA Randomized Controlled Trial. Level of evidenceLevel II. MethodsThe study was conducted in 34 male (aged 19–26) professional volleyball players with PST. They were randomly assigned to stretching and control groups. A stretching routine (combining sleeper stretch and cross body stretch exercises) was performed in the stretching group for six weeks. Measurements were taken during the first assessment and six weeks after the initiation of stretching for the following: shoulder external/internal rotation range of motion, spike velocity, single arm seated shot-put test, and infraspinatus– posterior deltoid muscle stiffness (by shear wave elastography). ResultsWhile the stretching group had statistically better results regarding increased shoulder internal rotation (p < 0.01), spike velocity (p = 0.02) and seated single arm shot put distance (p < 0.01), stretching did not have any effect on tissue stiffness. ConclusionsA 6-week program of sleeper stretch, and cross body stretch exercises improved shoulder internal rotation and functional performance. A clinically meaningful change in muscle mechanical properties cannot be detected after a 6-week stretching program.

Combined Effects of Glenohumeral Mobilization, Stretching, and Thoracic Manipulation on Shoulder Internal Rotation Range of Motion.

Interventions including posterior glenohumeral mobilizations (PGM), sleeper stretches, and thoracic manipulation are commonly used to address posterior shoulder tightness. The purpose of this study was to assess the effects of adding thoracic manipulation to PGM and sleeper stretches on passive range of motion (PROM), joint mobility, and infraspinatus electromyographic (EMG) activity in shoulders with decreased internal rotation (IR) PROM. Randomized Sequential Intervention Laboratory Study. Forty individuals with clinically significant IR loss attended two study sessions. Participants were randomized to receive five 30 seconds bouts of either grade III PGM or sleeper stretching. Following a seven-day washout period, all participants attended a second session and received a prescriptive supine HVLA manipulation targeting the T3-4 segment, followed by the previously randomized intervention. Outcome measures included internal rotation PROM, horizontal adduction PROM, posterior glenohumeral joint translation assessed via ultrasound imaging, and EMG activity of the infraspinatus during a PGM. All outcome measures were assessed pre- and immediately post-intervention and compared statistically. There were significant within-group, but not between-group, differences for IR and horizontal adduction PROM following a single session of PGM or sleeper stretch. When combined with thoracic manipulation, significantly smaller within session changes of IR PROM were observed for both PGM (mean difference 4.4, p=0.017) and sleeper stretches (mean difference 6.4, p=0.0005). There were no significant between group differences for horizontal adduction PROM, humeral head translation, or EMG activity across all time points. Both GH posterior mobilizations and sleeper stretches improved IR and horizontal adduction PROM in a single session. The addition of thoracic manipulation prior to local shoulder interventions resulted in smaller gains of both IR and horizontal adduction ROM. Level 2.

Posterior deltoid shoulder tightness and greater contralateral lower limb muscle strength are associated with swimmers' shoulder pain

ObjectivesTo identify factors associated with shoulder pain in swimmers based on elastic muscle modulus, joint range of motion, and isometric muscle strength. DesignCohort study. MethodsForty-eight competitive swimmers without shoulder pain (age: 18–28 years; men: 29) were followed-up for 6 months. Baseline measurements of the elastic modulus of the pectoralis minor, supraspinatus, infraspinatus, posterior deltoid, and pectoralis minor muscles were obtained using shear wave elastography. Range of motion and isometric strength were measured using a goniometer and a hand-held dynamometer, respectively. A questionnaire was administered weekly for 6 months to determine shoulder pain occurrence. Each item was compared between shoulders with and without pain at baseline. For participants with shoulder pain exceeding 2 weeks, shear wave elastography and range of motion at baseline (pre pain) and during follow-up (post pain) were compared. ResultsOf 46 swimmers followed-up for 6 months, 20 reported shoulder pain. 14 swimmers with pain were evaluated twice. Participants with shoulder pain during follow-up had significantly higher posterior deltoid and pectoralis minor stiffness at baseline and high lower extremity isometric muscle strength contralateral to the shoulder with pain compared to those without pain (p < 0.05). Swimmers with pain exceeding 2 weeks exhibited no differences in ultrasound shear wave elastography and range of motion at baseline and after pain onset. ConclusionsPosterior deltoid and pectoralis minor muscle stiffness, and high isometric lower extremity strength contralateral to the shoulder with pain may be associated with shoulder pain development, thereby indicating the importance of maintaining posterior deltoid and pectoralis minor muscle flexibility during conditioning.

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.

MODİFİYE POSTERİOR OMUZ GERME EGZERSİZLERİNİN POSTERİOR OMUZ GERGİNLİĞİ VE GLENOHUMERAL İNTERNAL ROTASYON DEFİSİTİNDEKİ ETKİNLİĞİ: BİR SİSTEMATİK DERLEME

Purpose: Posterior shoulder tightness (PST) and Glenohumeral internal rotation deficit (GIRD) can impact shoulder biomechanics and damage shoulder function. Posterior shoulder stretching exercises (PSSEs) are often performed in traditional positions to improve posterior shoulder inflexibility. However, these traditional positions can cause inadequate control of the scapula and glenohumeral rotation. The modified PSSEs through scapular stabilization are preferred as current trends to effective management of the GIRD and PST. However, there is a lack of consensus regarding which type of modified PSSE is more effective on PST and GIRD improvement. Therefore, we aimed to describe the efficacy of modified PSSEs on PST and GIRD in symptomatic and asymptomatic populations to aid clinicians when making decisions for these populations. &#x0D; Methods:A literature search was conducted for a systematic review. Relevant studies were searched from appropriate electronic databases (CINAHL, Cochrane Review, Pubmed (MEDLINE), Web of Science as well as Google Scholar©), and selected the eligible studies for inclusion.&#x0D; Results: The present systematic literature search generated 127 relevant citations and 17 articles were included in the final review. As an outcome measure GIRD was assessed in all included studies, whereas PST was assessed in 10 studies.There was high evidence related to the positive effects of both modified cross-body and sleeper stretch to improve GIRD and PST.&#x0D; Conclusion: According to this systematic literature review, both modified cross-body and sleeper stretch are effective in the improvement of GIRD and PST. Future research should focus on other specific shoulder diseases and should also recruit specific participants to address the effectiveness of modified PSSEs on GIRD and PST.

EFFECTIVENESS OF MUSCLE ENERGY TECHNIQUES ON GLENOHUMERAL INTERNAL ROTATION DEFICIT IN OVERHEAD ATHLETES: A SYSTEMATIC REVIEW

Purpose: Posterior shoulder tightness (PST) and Glenohumeral Internal Rotation Deficit (GIRD) are frequent biomechanical changes in overhead athletes. Evidence has shown that PST and the presence of GIRD increase subacromial pain syndrome. Posterior shoulder stretching exercises are used to improve posterior shoulder tightness. Muscle Energy Techniques (MET) are a long-established and effective approach, and the number of studies investigating the effects of MET on GIRD has been increasing in recent years. Despite the use of static stretching techniques in training, GIRD continues to be common in athletes performing overhead activities. Therefore, revealing the effects of MET on GIRD might be effective in determining the type of stretching most appropriate for preventing GIRD in athletes.&#x0D; Methods: We performed a systematic literature review, assessing the relevance of studies for inclusion and selecting the studies from appropriate electronic databases (CINAHL, Cochrane Review, Pubmed (MEDLINE), Web of Science as well as Google Scholar©).&#x0D; Results: The present systematic literature search generated 178 relevant citations and 8 articles were included in the final review. As an outcome measure, GIRD was assessed in all eight, whereas PST was assessed in four.&#x0D; Conclusion: According to this systematic literature review, MET is effective in the improvement of GIRD and PST in overhead athletes. Future research should focus on symptomatic shoulders and investigate the long-term benefits of MET.

An evidence-informed rehabilitation management framework for posterior shoulder tightness: A scoping review.

To systematically scope the literature on posterior shoulder tightness (PST) and define a therapist-instructed and therapist-administered management framework. Scoping review. We searched MEDLINE, EMBASE, CINAHL, Scopus and Google Scholar from inception to December 2021. Peer-reviewed studies written in English, French, Greek, Japanese or Tamil, with extractable pre- and post-intervention data. Physiotherapy interventions amenable for posterior shoulder structural (muscle, capsule) causes of PST within an adult population. Arksey and O'Malley's framework was implemented and the PRISMA extension for scoping reviews directed our data synthesis. The data charted from each study included authors, title, study year, location, study design; participant number, age, sex; PST intervention and parameters; patient-reported outcomes; and results. Themes were organized into therapist-instructed and therapist-administered rehabilitation strategies, as well as combined treatment methods. Of 2777 articles identified from our search strategy, 21 articles were included. Therapist-instructed interventions included cross-body stretch (CBS), sleeper stretch (SS), a combination of the two and general stretching. Therapist-administered interventions included CBS, SS, instrument-assisted soft tissue mobilization (IASTM), muscle energy techniques, dry needling and Fauls protocol (12 therapist-assisted stretches). Combined interventions of tape with self-stretching and IASTM and stretching were also identified. Based on the current evidence, CBS and SS are the most researched treatments for PST and seem to be effective at improving PST. Furthermore, stabilization of the scapula while performing these stretches optimized the stretch targeted to the PST and ROM benefits for horizontal adduction.

Poster 161: Musculoskeletal Adaptations to Baseball Pitching Differ Markedly Between Righthand Dominant Versus Lefthand Dominant Pitchers

Objectives: Musculoskeletal adaptations on the dominant arm of baseball pitchers are typically (1) a gain in glenohumeral external rotation (ER) range of motion (ROM), (2) a loss of glenohumeral internal rotation (IR) ROM, (3) posterior shoulder tightness, (4) weakness in the empty can test, and (5) increased IR strength. The purpose of this study was to determine if these adaptations differed between righthand dominant (RHD) versus lefthand dominant (LHD) pitchers. Based on recent work it was hypothesized that ROM adaptations would be less apparent in LHD pitchers, but strength adaptations would not differ between RHD and LHD pitchers. Methods: Shoulder ROM and strength were measured in 327 baseball pitchers in preseason screening (91 were tested on more than one season, 418 player-seasons, 322 RHD vs. 96 LHD). There were 157 youth pitchers (age 11-15 yr) 146 adolescent pitchers (age 16-17 yr) and 115 adult pitchers (age 18-24 yr). ER ROM, IR ROM and posterior shoulder ROM (Tyler test) were measured with a digital level. Empty can, ER, IR and scapular retraction strength were measured with a hand-held dynamometer. Differences between the dominant and nondominant arms, between RHD and LHD pitchers, and between age groups, were assessed using mixed model analysis of variance (mean and SD reported). Results: ROM Adaptations RHD pitchers had 11±10° more ER ROM on the dominant versus nondominant arm (P&lt;0.001) but LHD pitchers had no ER ROM difference (0±10°, P=0.685). The difference in ER ROM between RHD and LHD pitchers (P&lt;0.001) was unaffected by age (P=0.829). IR ROM loss on the dominant versus nondominant arm for RHD pitchers (10±11°) was greater (P&lt;0.001) than for LHD pitchers (5±10°). This difference was apparent for youth pitchers (RHD 9±9° vs. LHD 1±9°, P&lt;0.001) and adolescent pitchers (RHD 12±10 vs. LHD 5±11°, P&lt;0.001) but not for adult pitchers (RHD 9±14° vs. LHD 8±10°, P=0.863; RHD vs. LHD by Age Group P=0.040). Total ROM (ER+IR ROM) adaptations also differed between RHD and LHD pitchers (P&lt;0.001) and this effect was more apparent in the adult pitchers (Age Group by RHD vs. LHD P=0.027): RHD adult pitchers had a 4±15° gain in total ROM on the dominant side (P=0.007) while LHD adult pitchers had a 7±10° loss in total ROM on the dominant side (P=0.002). Posterior shoulder tightness on the dominant side was affected by arm dominance and age (P=0.038); for youth and adolescent pitchers there was no difference between RHD and LHD pitchers (youth RHD 6±13° vs. LHD 10±11°, P=0.156; adolescent RHD 5±10° vs. LHD 8±15°) but for adult pitchers, posterior shoulder tightness was greater for RHD versus LHD pitchers (6±8° vs. 1±11°, P=0.032). Strength Adaptations For the empty can test, RHD pitchers were weaker on the dominant versus nondominant arm (5±15%, P&lt;0.001) while there was no difference between the dominant and nondominant arms for LHD pitchers (3±16% stronger on dominant side P=0.100; RHD vs. LHD P&lt;0.001). For IR strength, RHD pitchers were stronger on the dominant arm (7±17%, P&lt;0.001) while there was no difference between the dominant and nondominant arms for LHD pitchers (2±21% P=0.360; RHD vs. LHD P=0.032). By contrast, for scapular retraction strength, LHD pitchers were stronger on the dominant arm (6±19%, P=0.007) while there was no difference between the dominant and nondominant arms for RHD pitchers (0±15% P=0.723; RHD vs. LHD P=0.003). Dominant versus nondominant ER strength was not different between RHD and LHD pitchers (P=0.323). Conclusions: The typical strength and ROM adaptations seen in baseball pitchers were mostly absent, or diminished, in LHD pitchers, but with some age dependent effects for ROM. Adult RHD pitchers had IR ROM loss and posterior shoulder tightness, but paradoxically adult LHD pitchers had IR ROM loss without associated posterior shoulder. The opposite was the case for youth and adolescent pitchers, with LHD pitchers having posterior shoulder tightness in the absence of IR ROM loss. Differences in strength adaptations between RHD and LHD pitchers have not been reported previously. Epidemiological studies examining the role of strength and ROM in injury risk for baseball pitchers have not previously accounted for differences between lefthanded and righthanded pitchers.

大学野球投手の投球課題前後での肩関節内旋時の受動トルク比較

Previous study reported that baseball pitchers had a decreased shoulder internal rotation (IR) range of motion after pitching. However, whether the decreased range of motion associated with pitching is caused by tightness of the posterior shoulder has not been clarified yet. The joint stiffness in the passive torque can be compared with posterior shoulder tightness before and after pitching. Hence, this study aimed to compare shoulder IR stiffness based on passive torque before and after pitching in baseball pitcher. Eleven health male collage baseball pitchers were recruited. Passive torque during IR (max IR, peak torque and stiffness) of dominant and non-dominant arms was measured using an isokinetic dynamometer. Measurements were taken before, after, and post 24 hours after pitching (105 pitches). It was observed that after pitching, max IR and peak torque were significantly decreased compared to those before pitching. However, there was no difference in the stiffness of passive torque among three measurements. In conclusion, healthy college baseball pitchers have a decreased IR range of motion after pitching. However, this result is not due to posterior shoulder tissue tightness, but because of altered stretch tolerance.

Effect of Sleeper Stretch with Muscle Energy Technique on Posterior Shoulder Tightness Among College Level Cricket Bowlers

Introduction: Posterior shoulder tightness is the extensibility limitations of the soft tissue, due to repetitive tensile loading in overhead athletes such as cricket and other sports. Bowling is the main cause for Posterior shoulder tightness. Hence the Sleeper stretch with muscle energy technique is proposed to be effecting in improving range, flexibility and functional ability. Purpose: To examine the effectiveness of Sleeper stretch with Muscle energy technique on posterior shoulder tightness among college level cricket bowlers. Materials and Methods: The study design was a single group experimental study design. On inclusion criteria one hundred and thirty one subjects were selected through convenient sampling technique. The subjects were given sleeper stretch combined with muscle energy technique for 8 consecutive weeks for 5 times in a week, post-test assessment was taken and the data analysis was done respectively. Results: The result of the study post intervention of internal rotation is (72.29° ± 3.73°, P = 0.001&lt;0.05), Horizontal adduction (38.51° ± 2.70°. P = 0.001&lt;0.05), flexibility of posterior capsule (109.81° ± 2.65° P = 0.001&lt;0.05), DASH score for functional ability is (4.43 ± 1.53). Through Pearson chi square test there is a significant association in internal rotation (χ2 = 61.38, P = 0.001&lt;0.005), Horizontal adduction (χ2 = 16.11, P = 0.001&lt;0.05) and no significant association in flexibility of posterior capsule (χ2 = 0.98, P = 0.806&gt;0.05) and DASH Score (χ2 = 4.25, P = 0.120&gt;0.05). Conclusion: Effect of sleeper stretch with MET on PST showed effective results in improving internal rotation range, horizontal adduction, flexibility, functional ability among college level cricket bowlers.

Relationship Between Posterior Shoulder Tightness and Lower-Limb Flexibility in College Baseball Players.

Posterior shoulder tightness evaluated as limited glenohumeral internal rotation and horizontal adduction is a risk factor for throwing-related shoulder and elbow injuries. Given that the throwing motion uses the entire body kinematics, limited lower-limb flexibility might be associated with posterior shoulder tightness. Therefore, we aimed to investigate the relationships between posterior shoulder tightness and lower-limb flexibility in college baseball players. Cross-sectional study. University laboratory. Twenty-two college baseball players (20 right-handed and 2 left-handed). To investigate the relationships between glenohumeral range of motion and lower-limb flexibility using simple linear regression analysis, we measured passive range of motion of glenohumeral internal rotation and horizontal adduction, hip internal/external rotation in the prone/sitting position, ankle dorsiflexion, and quadriceps and hamstrings flexibility from both shoulders and legs. Our analysis indicated that decreases in the lead leg hip external rotation in the prone position were moderately associated with limitations in glenohumeral internal rotation (R2 = .250, β [95% confidence interval, CI] = 0.500 [0.149 to 1.392], P = .018) and horizontal adduction (R2 = .200, β [95% CI] = 0.447 [0.051 to 1.499], P = .019) on the throwing shoulder. Furthermore, there were significant moderate relationships between decreases in glenohumeral internal rotation and limited lead leg quadriceps flexibility (R2 = .189, β [95% CI] = 0.435 [0.019 to 1.137], P = .022), and between decreases in glenohumeral horizontal adduction and limited stance leg ankle dorsiflexion (R2 = .243, β [95% CI] = 0.493 [0.139 to 1.438], P = .010). College baseball players with limited lower-limb flexibilities including the lead leg hip external rotation in the prone position, the lead leg quadriceps flexibility, and the stance leg ankle dorsiflexion showed excessive posterior shoulder tightness. The current results support the hypothesis that lower-limb flexibility is associated with posterior shoulder tightness in college baseball players.

A Comparative Study of Muscle Energy Technique and Cross Body Stretch for Improving Posterior Shoulder Tightness and Pain in Patients with Shoulder Pain - A Randomised Controlled Study

A Comparative Study of Muscle Energy Technique and Cross Body Stretch for Improving Posterior Shoulder Tightness and Pain in Patients with Shoulder Pain - A Randomised Controlled Study

Effective stretching position for the posterior deltoid muscle evaluated by shear wave elastography.

Deteriorated extensibility of the posterior deltoid muscle is one of the factors of posterior shoulder tightness, and improvement in its extensibility is needed. However, no study has investigated which shoulder positions effectively stretch the posterior deltoid muscle invivo. The aim of this study was to verify the effective stretching position of the posterior deltoid muscle invivo by shear wave elastography. Fifteen healthy men participated in this study. The shear modulus of the posterior deltoid was measured at resting and 13 stretching positions: 60°, 90°, and 120° shoulder flexion; maximum shoulder flexion, horizontal adductions at 60°, 90°, and 120° shoulder flexion; internal rotations at 60°, 90°, and 120° shoulder flexion; and combinations of horizontal adduction with internal rotation at 60°, 90°, and 120° shoulder flexion. The shear moduli of each stretching position were compared to those of the rest. Then, among the stretching positions for which the shear modulus was significantly different from the rest, the shear moduli were compared using a three-way analysis of variance with repeated measures of the 3 factors-flexion, horizontal adduction, and internal rotation. The shear moduli in all stretching positions were significantly higher than those of the rest, except for maximum shoulder flexion. The three-way analysis of variance with repeated measures revealed significant main effects in flexion and horizontal adduction. Comparing the flexion angles, the shear modulus was significantly higher at 90° than that at 60° and 120°. The shear modulus with horizontal adduction was significantly higher than that without horizontal adduction. Moreover, a significant two-way interaction was found only at flexion and horizontal adduction. The shear modulus with horizontal adduction was significantly higher at all angles than that without horizontal adduction at each flexion angle. Comparing the flexion angles with horizontal adduction, the shear modulus was significantly higher at 90° than that at 60° and 120°. No significant three-way interactions were found. Shoulder flexion and horizontal adduction affected the extensibility of the posterior deltoid muscle, whereas the effect of shoulder internal rotation was limited. More precisely, maximal horizontal adduction at 90° shoulder flexion was the most effective stretching position for the posterior deltoid muscle.

Effectiveness of Scapular Stabilization Versus Non-Stabilization Stretching on Shoulder Range of Motion, a Randomized Clinical Trial

Background Previous research has demonstrated the benefits of both stabilization and non-stabilization of the scapula during stretching in individuals with posterior shoulder tightness, but limited evidence exists in patients with shoulder pain. Hypothesis/Purpose The aim of this study was to determine the effect of stabilized scapular stretching on patients with shoulder pain. The primary hypothesis of this study is that stabilized scapular stretching will improve glenohumeral motion and pain compared to non-stabilized stretch program. A secondary hypothesis of this study is that stabilized scapular stretching will produce greater improvement in function compared to the non-stabilized stretching program. Study Design Randomized Clinical Trial Methods Sixteen patients with sub-acromial pain associated with tendinopathy and associated pathologies presenting to physical therapy were randomized into two groups (stabilized or non-stabilized scapular stretching). Baseline pain and range of motion were measured prior to and following each treatment session for three visits that occurred over the course five to seventeen days depending on the patients availability. The dependent measurements were stabilized horizontal adduction, stabilized internal rotation, stabilized shoulder flexion, non-stabilized shoulder flexion, and current pain level. Results Patients in the scapular stabilization stretching group increased horizontal adduction 40° (CI95 31, 48°) compared to the non-stabilization stretching group increase of 8° (CI95 0, 17°) over the course of the three treatments (p&lt;0.001). Similarly, the stabilized stretching group increased internal rotation 48° (CI95 26, 69°) compared to the non-stabilized stretching group increase of 26° (CI95 4, 48°) (p=0.001). Pain decreased in the stabilized stretching group by 1.4 points (CI95 -0.4, 3.2) but increased slightly in non-stabilized group by -0.5 points (CI95 -2.3, 1.3) which was not a clinically meaningful change. (p=0.03) Conclusion Stabilized scapular stretching was more effective than non-stabilized stretching at gaining shoulder mobility in patients with shoulder pain. Benefits were immediate and sustained between treatment sessions. Stretching interventions improved range of motion but had limited effect on shoulder pain. Level of Evidence 2

Age-related differences in glenohumeral internal rotation deficit, humeral retrotorsion angle, and posterior shoulder tightness in baseball players.

Glenohumeral internal rotation deficit is generally recognized as a risk factor for throwing disability in baseball players. However, the pathology, timing of onset, role in the onset of humeral retrotorsion angle (HTA) and soft tissue extensibility (STE), and the relationshipwith age remain unclear. Therefore, the purpose of this cross-sectional study was to investigate age-related glenohumeral internal rotation deficit, HTA, and STE in Japanese baseball players and determine whether these factors correlate with throwing disability. Participants were 172 male baseball players divided into a symptomatic group (n=68) and an asymptomatic group (n=104). The mean age at examination was 15.4±3.2 (range, 8-22) years. Measurement items were range of motion of bilateral internal and external rotation at 90° abduction (2ndIR and 2ndER, respectively), bilateral HTA, and posterior shoulder muscle elasticity. Correlations of age, symptom, and dominance with these measurements were investigated, and significant bilateral differences in HTA and STE by age and symptom were analyzed. HTA and 2ndER of the dominant side were significantly greater than those of the nondominant side in those over the age of 13 years in both the asymptomatic and symptomatic groups. In contrast, 2ndIR of the dominant side was significantly smaller than that of the nondominant side in those over the age of 13 years in both the asymptomatic and symptomatic groups. The difference in HTA between the dominant and nondominant sides increased and then plateaued at 12° after the age of 16 years. STE was observed only in the symptomatic group, and the value of STE was significantly greater in players aged >16 years compared with that in players aged <12 years (P=.001). Muscle elasticity did not differ significantly between sides and showed no correlation with STE. The difference in HTA between the dominant and nondominant sides increased with age until 16 years old regardless of symptoms. STE in the dominant side was observed only in symptomatic baseball players after the age of 13 years and increased with age, plateauing around the age of 16 years. Posterior shoulder muscle elasticity was not indicated as a cause of STE.

Posterior shoulder tightness treatment in combination with exercise rehabilitation: The Posterior Shoulder Tightness (PoST) pilot feasibility trial

Posterior shoulder tightness treatment in combination with exercise rehabilitation: The Posterior Shoulder Tightness (PoST) pilot feasibility trial

Effectiveness of Sleeper and Cross Body Stretches and Muscle Energy Techniques for Periarthritis Shoulder: Comparative Study

Background: Periarthritis of shoulder typically is referred to as the spontaneous onset of gradually progressiveshoulder pain and severe limitation of movement. Recently Sleeper stretch and Cross body stretch are used tostretch the posterior shoulder tightness to improve internal rotation range of motion and they prove effective inimproving internal rotation range of motion of shoulder joint in posterior capsular tightness.Aim &amp; objectives of the study: To compare the effect of sleeper and cross body stretch versus muscle energytechniques in subjects with Periarthritis of shoulder.Data analysis and results: Data analysis and result of this study shows that there was statistically significantimprovement in the variable of pain in VAS and Shoulder Abduction ROM in pre post analysis of data afterthe intervention of Sleeper, cross body stretches in control group and Muscle Energy Techniques (MET) afterintervention in both groups. After intervention of treatment, the experimental group is showing statistically betterimprovement in reduction of Pain in VAS but not Shoulder Abduction ROM when compared to control group.Conclusion: It was concluded that both sleeper, cross body stretches of shoulder and Muscle Energy Techniquesfor Shoulder have statistically significant better reduction in Pain in VAS and Shoulder Abduction ROM in thetreatment of Periarthritis, whereas Muscle Energy Techniques have statistically slightly better results of painreduction and range increase in Periarthritis shoulder ROM when compared to sleeper and cross body stretchesof shoulder.

Immediate effect of combining glenohumeral and scapulothoracic mobilization with stretching on improving shoulder internal rotation in overhead throwing athletes with glenohumeral internal rotation deficit: A randomized clinical trial study

BACKGROUND: Posterior shoulder tightness as demonstrated by glenohumeral internal rotation deficit (GIRD) is a common contributor to many shoulder pathologies in overhead throwing athletes. PURPOSE: This study aimed to assess immediate effect of combining glenohumeral and scapulothoracic mobilization with stretching on improving internal rotation range of motion (ROM) in overhead athletes with GIRD METHODS: This study was a single-blind randomized controlled trial with parallel groups. The participants were 30 asymptomatic male volleyball players who had a loss of shoulder internal rotation ROM of 15 degrees or more on their dominant compared to their nondominant side. They were randomly assigned to 1 of 2 groups: stretching only (n = 15) or stretching plus joint mobilization (n = 15). Participants in the stretching group performed cross-body stretches, and those in stretching plus mobilization group were treated with both cross-body stretching and mobilization techniques for the glenohumeral and scapulothoracic joints. Both groups received the intervention every other day for 1 week. Shoulder internal and external ROM were measured before and after the intervention. RESULTS: Before the intervention, dominant-side deficits in internal rotation ROM compared to the nondominant side were 20.11±5.27 degrees in the stretching group and 21.87±8.06 degrees in the stretching plus mobilization group. After the intervention, internal rotation ROM deficit between the dominant and nondominant side decreased to 11.28±5.82 in the stretching group (P &lt; 0.001) and 10.85±9.19 in the stretching plus mobilization group (P &lt; 0.001). However, the between-group difference was not statistically significant (P = 0.389). External rotation ROM remained unchanged in both groups (P &gt; 0.05). CONCLUSION: Both interventions (stretching and stretching plus mobilization) can have the same beneficial effect in decreasing GIRD in asymptomatic overhead athletes.

A study to assess the effectiveness of muscle energy technique with sleeper stretch on posterior shoulder tightness in tennis players

The objective of this study was to assess the effectiveness of muscle energy technique with sleeper stretch on posterior shoulder tightness in tennis players. The study was conducted on 50 tennis players with posterior shoulder tightness by using GIRD (Gleno-humeral internal rotation deficit) criteria and the subjects fulfilling the inclusion and exclusion criteria were included in the study. All subjects were evaluated for the range of motion of shoulder joint using a goniometer and SPADI scale was used to measure pain and disability index of the shoulder joint. The results showed the statistically significant (p