Effect of a Novel Stretching Technique on Shoulder Range of Motion and Voluntary Contraction in Overhead Athletes With Glenohumeral Internal Rotation Deficits "GIRD" (GIRD)

Effect of a Novel Stretching Technique on Shoulder Range of Motion and Maximum Voluntary Contraction in Overhead Athletes With Glenohumeral Internal Rotation Deficits: A Randomized Control Trial

To examine and compare the effect of a novel stretching technique and traditional stretching on glenohumeral range of motion, strength, maximum voluntary contraction, pain, and subject satisfaction in overhead athletes with glenohumeral internal rotation deficits through a randomized clinical study.

Study Overview

• Status: Completed
• Conditions: Glenohumeral Internal Rotation Deficits
• Intervention / Treatment: Procedure: Stretching

Detailed Description

To examine and compare the effect of a novel stretching technique and traditional stretching on glenohumeral range of motion, strength, maximum voluntary contraction, pain, and subject satisfaction in overhead athletes with glenohumeral internal rotation deficits through a randomized clinical study. The investigators hypothesize that this type of novel intervention will help subjects with GIRD to restore range of motion, experience less pain and maintain the strength and motor unit recruitment following the novel intervention. This will help us to assess the potential beneficial effect of such intervention and to fill the gap in knowledge and help health care professionals to adequately select the right treatment modality.

Independent Variable

1. Type of Intervention:

• Traditional Stretching (Modified Sleep Stretch). VS
• Novel Stretching (Active Shoulder Internal Rotation while Bridging) 2. Time

• Pre VS post intervention Dependent Variables

  1. Glenohumeral internal rotation ROM
  2. Maximal glenohumeral external rotation isometric strength.
  3. Mean motor unit recruitment (EMG) of the glenohumeral external rotator (infraspinatus) and internal rotators (pectoralis major and latissumus dorsi)
  4. Pain
  5. Subject satisfaction

Instrumentation :

1. Glenohumeral internal & external rotation ROM: will be measured at baseline and at week four-post intervention for all participants. We will use the digital inclinometer. Research by (Kolber et al.,2011 ) showed this instrument to be reliable with an intra-rater ICC =0.87 and inter-rater ICC =0.93
2. Electronic push/pull dynamometer: At the end feel ROM, and before ROM is measured, the therapist will apply the same amount of pressure to all subjects to ensure reliable/ valid ROM measurements.
3. Maximal Glenohumeral External Rotation Isometric Strength will be measured using a MicroFET2 handheld digital dynamometer. This device was shown to be reliable with an intra-rater ICC =0.85 and inter-rater ICC =0.85.
4. Maximum Voluntary Contraction: will be measured using a 44 Delsys Bagnoli portable surface electromyography (sEMG) system.
5. Pain: will be measured using the Numeric Pain Rating Scale (NPRS). The NPRS has shown to have a valid, reliable and appropriate for use in clinical practice

Procedures:

All participants will perform the static stretching (SS) conditions by themselves. The two stretching techniques will be home-based program.

• Study Type: Interventional
• Enrollment (Actual): 56
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • California
    • Loma Linda, California, United States, 92354
      • Loma Linda U

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 45 years (Adult)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Participants must be between the age of 18 and 45.
• Perform overhead sports activities in the past 3 months.
• Participants are required to display ≥ 20° less glenohumeral internal rotation ROM in their dominant shoulder compare to the non- dominate shoulder.
• Participants will be included with or without pain during shoulder activities.

Exclusion Criteria:

• Will exclude participants who are still recovering from previous surgery of the shoulder and elbow complex in the past 3 months, and currently receiving medical intervention for the shoulder.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Novel Stretching Technique; Participants will perform the novel stretch in a supine position. Participants will place a small ball between their knees and squeeze the ball. Participants will be then bridge as high as possible . Participants will then flex their shoulder and elbow to 90°, and actively rotate to the end of ROM. Participants will use the other hand to push to the point of mild discomfort and simultaneously maintain contraction while progressing the stretch.	Procedure: Stretching; The novel stretching technique will be done on a supine position. subjects will be asked bridge as high as possible. After That, Participants will then flex their shoulder and elbow to 90°. Participants will use the other hand to push to the point of mild discomfort and simultaneously maintain contraction while progressing the stretch.
Active Comparator: Traditional Stretching Technique; Participants will perform the modified sleeper stretch in a side-lying position on the side of the throwing shoulder with the throwing shoulder and elbow flexed to 90° . The participants will be instructed to allow the throwing shoulder to naturally fall into internal rotation to the end ROM where resistance will be felt . The participants will be then instructed to use the non-throwing hand to push the throwing shoulder into further internal rotation to the point of mild discomfort by applying pressure at the area of the wrist joint.	Procedure: Stretching; The novel stretching technique will be done on a supine position. subjects will be asked bridge as high as possible. After That, Participants will then flex their shoulder and elbow to 90°. Participants will use the other hand to push to the point of mild discomfort and simultaneously maintain contraction while progressing the stretch.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Glenohumeral internal rotation ROM	The investigators will use the digital inclinometer	Change from baseline at week 4

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Maximal glenohumeral external rotation isometric strength	will be measured using a MicroFET2 handheld digital dynamometer	Change from baseline at week 4

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Mean motor unit recruitment (EMG) of the glenohumeral external rotator (infraspinatus) and internal rotators (pectoralis major and latissumus dorsi)	will be measured using surface electromyography (sEMG) system	Change from baseline at week 4
Pain will be measured using the Numeric Pain Rating Scale	will be measured using the Numeric Pain Rating Scale	Change from baseline at week 4
Subject satisfaction will be measured using the Subject satisfaction Form	will be measured using the Subject satisfaction Form	Week 4

Collaborators and Investigators

• Sponsor: Loma Linda University

Publications and helpful links

General Publications

• Gharisia O, Lohman E, Daher N, Eldridge A, Shallan A, Jaber H. Effect of a novel stretching technique on shoulder range of motion in overhead athletes with glenohumeral internal rotation deficits: a randomized controlled trial. BMC Musculoskelet Disord. 2021 Apr 30;22(1):402. doi: 10.1186/s12891-021-04292-8.

Study record dates

Study Major Dates

• Study Start (Actual): April 19, 2017
• Primary Completion (Actual): March 19, 2019
• Study Completion (Actual): June 1, 2019

Study Registration Dates

• First Submitted: January 30, 2017
• First Submitted That Met QC Criteria: February 3, 2017
• First Posted (Estimate): February 6, 2017

Study Record Updates

• Last Update Posted (Actual): June 11, 2019
• Last Update Submitted That Met QC Criteria: June 10, 2019
• Last Verified: August 1, 2018

More Information

Terms related to this study

• Other Study ID Numbers: 5170032

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No