Pragmatic Posterior Capsular Stretch Versus Sleeper Stretch in Subject With Shoulder Pathologies

Pragmatic Posterior Capsular Stretch Versus Sleeper Stretch in Subject With Shoulder Pathologies: a Randomized Control Trial (RCT)

The glenohumeral joint is an articulation between the glenoid of the scapula and the head of the humerus that is enclosed by a synovial capsule divided into three main components: anterior, posterior, and the axillary pouch. Symptoms of posterior capsule tightness are linked to altered shoulder biomechanics and impairments which includes glenohumeral internal rotation deficit, incomplete glenohumeral adduction, impaired inferior glenohumeral ligament (IGHL) function, and increased risk of impingement symptoms. In the literature the two techniques available for stretching posterior capsule are pragmatic posterior capsular stretch and sleeper stretch. Pragmatic posterior capsular stretch is therapist administered and sleeper stretch is patient-administered. The work on the pragmatic posterior capsular stretch is more specified and rational to mark the tightness in the posterior capsule.

Study Overview

• Status: Recruiting
• Conditions: Shoulder Injuries; Shoulder Capsulitis; Shoulder Arthritis; Shoulder Impingement; Shoulder Bursitis; Shoulder Pain Chronic
• Intervention / Treatment: Other: Pragmatic Set of intervention and posterior capsular stretch; Other: Pragmatic Set of intervention and Sleeper Stretch

Detailed Description

Shoulder pathologies have been reported as the third most popular musculoskeletal problem after knee and back problems and are relatively common in 1 in 3 individuals in their lifetime and reported shoulder pain once a year. The Popular shoulder complex disorders are tendinopathies, rotator cuff lesions, serratus anterior paralysis, subacromial impingement syndrome, and adhesive capsulitis among these 44-65 percent shoulder disorders, contributing to subacromial impingement syndrome.

Posterior capsular tightness is more common in overhead activities which increases the force on shoulder joint which may cause posterior capsular tightness along with rotator cuff tear. The active stabilizer for shoulder is rotator cuff which avoid the superior translation of humeral head during shoulder abduction due to weakness of rotator cuff along with posterior inferior capsular tightness the humeral head may translate superiorly and ultimately lead to SAIS in which rotator cuff tendon long head of biceps and subacromial bursa impinge between acromion superiorly and greater tubercle of humeral head inferiorly. Tears of the subscapularis tendon are mostly the result of a degenerative process, but less commonly, traumatic injury can result in acute subscapularis tearing. The most common mechanisms of subscapularis injury are hyperextension and external rotation of the shoulder.6 The infraspinatus (ISP) muscle, one of the rotator cuff muscles. Pain in the infraspinatus is most likely caused by repetitive motion involving the shoulder. Swimmers, tennis players, painters, and carpenters get it more frequently. It also becomes more likely as you get older.

The serratus anterior play an important role in prevention of shoulder impingement by lifting the acromion process in overhead activities. The most common pathologies of serratus anterior is serratus anterior dysfunction which may cause scapula winging.8 In GHIRD glenohumeral internal rotation deficit there is 18 to 20 degree of limitation along with glenohumeral horizontal adduction and incomplete humeral rotation can lead to posterior capsular tightness. Therefore, posterior capsular stretch is more effective intervention for posterior capsular tightness.AC joint is responsible for shoulder disability and pain in inactive patient and athletic activities including skiing, cycling and mostly in contact sports which contribute 9 percent approximately of AC joint damage with shoulder injuries. Impairment of AC joint effects range of motion, pain and weakness along with poor posture and these leads to restriction in overhead activities.

The most frequent causes are posterior capsular tightness and rotator cuff tear involve overhead movements such as swimming and volleyball and basketball, which have high-velocity pressures on the joint shoulder.

In non-operative management of subacromial impingement, anti-inflammatory mediction,subacromial injection of steriods, ultrasound, lifestyle changes, and physical therapy management is normally given. Physical therapy is used to reduce the pain and enhance the functioning of the SIS. Patients should attempt to discontinue overhead movements unless symptoms diminish.

A pragmatic posterior capsular stretch (PPCS) is designed to stretch the posterior capsule when it is in torsion.Pragmatic Posterior capsular stretch can effectively improve the functional movements and shoulder ROM of healthy young adults.16 Another popular stretch is the "sleeper stretch". There is a significant increase in posterior shoulder flexibility by sleeper stretch.Scapular movement is restricted while performing the sleeper stretch and accomplished by lying on the side to be stretched, elevating the humerus to 90° on the support surface, then passively internally rotating the shoulder with the opposite arm.

• Study Type: Interventional
• Enrollment (Anticipated): 40
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: keramat ullah karamat, Ph.D.*; Phone Number: +923330927670; Email: karamatjee@yahoo.com
• Study Contact Backup: Name: Abdul Haseeb Bhutta, M.phil; Phone Number: +923479470947; Email: abdul.haseeb@hhirs.edu.pk

Study Locations

• Pakistan
  • Khyber Pakhtunkhwa
    • Mansehra, Khyber Pakhtunkhwa, Pakistan, 213000
      • Recruiting
      • HHIRST
      • Contact: Abdul Haseeb Bhutta, M.phil; Phone Number: +923479470947; Email: abdul.haseeb@hhirs.edu.pk
      • Contact: keramat ullah keramat, Ph.D*; Phone Number: +923330927670; Email: karamatjee@yahoo.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 60 years (ADULT)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

-Limitation in range of motion abduction or internal rotation or external rotation or reaching up behind the back or reaching behind down the neck are only one of the limitations in comparison with the unaffected joint.

A patient who fall in grade 1 and grade 2 of the shoulder mobility test of functional movement screening.

Exclusion Criteria:

-Patient with shoulder ligamentous instability Functional movement Screening score 0 or 3. Cancerous growth around the shoulder girdle Rheumatoid arthritis patients The patient has a recent fracture of less than the 6th-week duration or shoulder dislocation.

Long term use of steroids Cervical joint dysfunction, radicular pain. Systemic diseases.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: TREATMENT
• Allocation: RANDOMIZED
• Interventional Model: PARALLEL
• Masking: TRIPLE

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
EXPERIMENTAL: GROUP A; Pragmatic Set of intervention and posterior capsular stretch	Other: Pragmatic Set of intervention and posterior capsular stretch; Group 1 will receive a pragmatic set of interventions, including Serratus Anterior Stretch,Rotator Cuff Facilitation,Acromilcalavicular joint Mobilization,Stretch of Pectoralis Major and Minor,Thoracic Manipulation and posterior capsular stretch.
ACTIVE_COMPARATOR: GROUP B; Pragmatic Set of intervention and Sleeper Stretch	Other: Pragmatic Set of intervention and Sleeper Stretch; Group 2 will receive a pragmatic set of interventions, including Serratus Anterior Stretch, Rotator Cuff Facilitation, Acromilcalavicular joint Mobilization, Stretch of Pectoralis Major and Minor, Thoracic Manipulation and sleeper stretch.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
shoulder range of motion	shoulder range of motion will be measured in degrees by using digital inclinometer	6 weeks
shoulder pain	shoulder pain will be measured by numeric pain rating scale	6 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Shoulder related quality of life	quality of life will be measured by using HHIRS quality of life questionnaire	6 weeks
Shoulder disability	Shoulder disability will be measured by Shoulder Pain And Disability Index Urdu (SPADI-U)	6 weeks
satisfaction level of patient	satisfaction level of patient will be measured by Questionnaire for satisfaction level of patient receving this intervention	6 weeks

Collaborators and Investigators

• Sponsor: Helping Hand Institute of Rehabilitation Sciences
• Investigators: Principal Investigator: keramat ullah karamat, Ph.D.*, HHIRST

Publications and helpful links

General Publications

• Michener LA, McClure PW, Karduna AR. Anatomical and biomechanical mechanisms of subacromial impingement syndrome. Clin Biomech (Bristol, Avon). 2003 Jun;18(5):369-79. doi: 10.1016/s0268-0033(03)00047-0.
• Umer M, Qadir I, Azam M. Subacromial impingement syndrome. Orthop Rev (Pavia). 2012 May 9;4(2):e18. doi: 10.4081/or.2012.e18. Epub 2012 May 31.
• Cools AM, Johansson FR, Borms D, Maenhout A. Prevention of shoulder injuries in overhead athletes: a science-based approach. Braz J Phys Ther. 2015 Sep-Oct;19(5):331-9. doi: 10.1590/bjpt-rbf.2014.0109. Epub 2015 Sep 1.
• Lyons RP, Green A. Subscapularis tendon tears. J Am Acad Orthop Surg. 2005 Sep;13(5):353-63. doi: 10.5435/00124635-200509000-00009.
• Johnson JE, Fullmer JA, Nielsen CM, Johnson JK, Moorman CT 3rd. Glenohumeral Internal Rotation Deficit and Injuries: A Systematic Review and Meta-analysis. Orthop J Sports Med. 2018 May 22;6(5):2325967118773322. doi: 10.1177/2325967118773322. eCollection 2018 May.
• Keramat KU, Naveed Babur M. Pragmatic posterior capsular stretch and its effects on shoulder joint range of motion. BMJ Open Sport Exerc Med. 2020 Sep 9;6(1):e000805. doi: 10.1136/bmjsem-2020-000805. eCollection 2020.
• Laudner KG, Sipes RC, Wilson JT. The acute effects of sleeper stretches on shoulder range of motion. J Athl Train. 2008 Jul-Aug;43(4):359-63. doi: 10.4085/1062-6050-43.4.359.

Study record dates

Study Major Dates

• Study Start (ACTUAL): May 24, 2021
• Primary Completion (ANTICIPATED): December 24, 2021
• Study Completion (ANTICIPATED): March 24, 2022

Study Registration Dates

• First Submitted: September 29, 2021
• First Submitted That Met QC Criteria: September 29, 2021
• First Posted (ACTUAL): October 1, 2021

Study Record Updates

• Last Update Posted (ACTUAL): October 1, 2021
• Last Update Submitted That Met QC Criteria: September 29, 2021
• Last Verified: September 1, 2021

More Information

Terms related to this study

• Keywords: shoulder range of motion; sleeper stretch; shoulder pathologies; Posterior capsular tightness; pragmatic posterior capsular stretch; pragmatic intervention
• Additional Relevant MeSH Terms: Pain; Neurologic Manifestations; Wounds and Injuries; Joint Diseases; Musculoskeletal Diseases; Arthralgia; Shoulder Impingement Syndrome; Shoulder Pain; Shoulder Injuries; Bursitis
• Other Study ID Numbers: Rec.letter/st./2021/20/03/04

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: As per the decision of the research ethics committee.

Drug and device information, study documents

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