Posterior Shoulder Tightness: To Treat or Not to Treat?

Abstract

Shoulder pain is a common musculoskeletal complaint that is difficult to treat because of the biomechanical complexity of the shoulder region, the interplay between mobility and stability, and the vital role played by the shoulder in moving, positioning, and providing stability for hand function. Despite advances in biomechanics and pain science, there is still much to learn about how impairments influence shoulder function and health. One impairment, posterior shoulder tightness (PST), is often noted in individuals with shoulder pain and consequently has generated much discussion and debate in recent years. Range-of-motion shifts and deficits are the clinical indicators of PST, with 3 tissue alterations potentially contributing to these modifications: (1) increased humeral retrotorsion (retroversion), (2) reduced posterior glenohumeral joint capsule extensibility, and (3) reduced posterior shoulder muscle/tendon extensibility. The significance of each alteration for shoulder function and the interaction among them remain unclear. It is also unknown if, or to what extent, these impairments can be resolved through interventions. This raises a clinically relevant and straightforward question: when PST is present, should we treat or not treat? In this Viewpoint, we will debate this question and propose that physical therapy interventions have the potential to improve only 1 of the 3 tissue alterations contributing to PST. J Orthop Sports Phys Ther 2018;48(3):133-136. doi:10.2519/jospt.2018.0605.

The challenge of the sporting shoulder: From injury prevention through sport-specific rehabilitation toward return to play

“…GIRD or posterior shoulder stiffness is one of the most common adaptations seen at the dominant side of overhead athletes of multiple sports disciplines. GIRD manifests clinically as decreased glenohumeral cross-body adduction and IR mobility and is believed to result from both capsular tightness and muscular contracture [57]. The cumulative loads on the posterior shoulder during the deceleration phase of the throwing motion is suggested to cause microtrauma and scarring of these soft tissues [58].…”

“…Some studies attribute the changes in rotational ROM to increased humeral retrotorsion of the throwing arm [59]. Because increased retrotorsion is a fixed bony adaptation after skeletal maturation, if the physical examination reveals no deficit in total rotation motion of the glenohumeral joint but rather a shift in the rotational range, then no treatment should be applied [57].…”

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

“…Glenohumeral horizontal adduction can be quantified in supine position or side lying position. 1 Conditions that are considered a contributor to posterior shoulder tightness includes posterior impingement, rotator cuff tendinopathy, subacromial impingement, making it a collection of rotator cuff related shoulder pain, adhesive capsulitis and labral lesions. 1,2 Rotator cuff related shoulder pain has shown tight posterior capsule which causes some changes in the glenohumeral joint motion, which could further lead to impingement.…”

“…1 Conditions that are considered a contributor to posterior shoulder tightness includes posterior impingement, rotator cuff tendinopathy, subacromial impingement, making it a collection of rotator cuff related shoulder pain, adhesive capsulitis and labral lesions. 1,2 Rotator cuff related shoulder pain has shown tight posterior capsule which causes some changes in the glenohumeral joint motion, which could further lead to impingement. As the rotator cuff tendinopathy is related to posterior shoulder tightness, main emphasis should be on the examination of Yavanika: A comparative study of muscle energy technique and cross body stretch for improving posterior shoulder tightness horizontal adduction and internal rotation range of motion.…”

“…So, not just capsular stretching, muscle-based treatment has been found effective such as stretching, massage, cryotherapy, instrument assisted soft tissue manipulation and Muscle Energy Technique. 1…”