Effect of a novel stretching technique on shoulder range of motion in overhead athletes with glenohumeral internal rotation deficits: a randomized controlled trial

Abstract

Background 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. 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). Methods Forty-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. Results There 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). Conclusion Both 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 registration Prospectively registered in February 6, 2017 under Clinical Trial Registry # NCT03044236.

Effects of Dynamic Stretching Combined with Manual Therapy on Pain, ROM, Function, and Quality of Life of Adhesive Capsulitis

“…The stiffness of the posterior inferior capsule and rotator cuff is the main cause of the reduction in the range of motion during the medial and external rotation of the Glenohumeral joint. The increased stiffness of the posterior structure causes the humerus head to move anteriorly or posteriorly, resulting in the arm being raised or medially rotated, which may induce pain during rotation or external rotation [ 32 ]. Static, dynamic, and proprioceptive neuromuscular facilitation have all been reported to increase the range of motion [ 33 ].…”

Efficacy of Conservative Therapy in Overhead Athletes with Glenohumeral Internal Rotation Deficit: A Systematic Review and Meta-Analysis

“…All studies considered the GIRD as a diagnostic criterion. Two studies included athletes with a GIRD > 15° [23,24], four studies with a GIRD < 15° [20,21,25,26], and two studies included athletes with a 15° deficit in the total arc of motion (15° deficit in internal rotation or/and 15° deficit in horizontal adduction) [27,28]. Another study considered a reduction greater than 10% for the inclusion [29].…”

“…The intervention in each trial consisted of different approaches. Eight studies applied self-stretching or passive stretching [20,[23][24][25][26][27][28][29]; six studies used manual therapy, frequently based on anteroposterior mobilization [24,26,27,[30][31][32]; two studies applied exercise therapy [23,31] and one study used a kinesiotaping application [29]. Three studies mixed conservative therapy (self-stretching plus manual therapy [24,27] and exercise therapy associated with manual therapy [26]).…”

“…The number of sessions involved varied for different studies. The studies in which exercise therapy was applied were performed for 8 weeks [23,31]; when stretching was used, the duration was between 4 to 8 weeks [20,25,28]. The rest of the conservative therapies' interventions varied in the duration of the studies.…”

“…Steuri et al and Dolder et al proposed exercise, manual therapy, tape, electrotherapy, or soft tissue mobilizations as feasibility tools to manage shoulder restriction ROM in adults with shoulder pain [16,17]. Recent clinical trials have been developed to demonstrate the effects of conservative therapy on symptoms, shoulder ROM and physical function in overhead athletes, mostly focusing on achieving greater joint mobility with manual therapy, stretching, and self-stretching or strengthening exercises [18][19][20][21]. However, the effects of these conservative therapies on the management of the main clinical signs in overhead athletes with GIRD remain unclear.…”