Impact of Cervical Exercises During Simulated Game on Throwing Shoulder Motion and Strength

January 26, 2026 updated by: Jason Grimes, PT, PhD, OCS, ATC, Sacred Heart University

In-game Cervical Exercises to Reduce Subsequent Post-game Decrease of Shoulder Internal Rotation Range of Motion and External Rotation Strength in Baseball Pitchers

The goal of this clinical trial is to investigate the impact of performing cervical exercises during a simulated game on shoulder range of motion and strength in collegiate baseball picthers. The main questions it aims to answer are:

Can performing cervical retraction/extension exercises help to maintain shoulder internal rotation range of motion in the throwing shoulder after a pitching session? Can performing cervical retraction/extension exercises help to maintain shoulder external rotation strength in the throwing shoulder after a pitching session?

Researchers will compare the effects of cervical retraction/extension exercises to no exercise to see if shoulder range of motion or strength is impacted.

Participants will perform end-range cervical retraction and cervical retraction with extension, holding the end-range of motion for 3 seconds and performing 10 repetitions of each exercise between each inning of a simulated 5-inning game.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

Glenohumeral internal rotation deficit (GIRD) and rotator cuff weakness have been identified as predisposing factors in sustaining a shoulder or elbow injury in pitchers. The appearance of GIRD in symptomatic throwers has been attributed to osseous adaptations as well as soft tissue restrictions of the posterior capsule, deltoid and posterior cuff. Trakis identified that those adolescent pitchers with pain complaints had presented with weakness of the posterior shoulder musculature. Tyler noted preseason supraspinatus weakness was significantly associated with an increase in shoulder and elbow injury risk in high school pitchers. Despite studies indicating a correlation with rotator cuff weakness and injury, there is a lack of consensus on the underlying cause of the rotator cuff weakness.

The presentation of GIRD and rotator cuff weakness typically occurs in tandem and a question arises if these are linked, and if they might actually occur in response to the act of throwing. A subsequent loss of internal rotation range of motion and weakness of external rotation has been noted immediately following pitching. In a study of 67 asymptomatic professional pitchers, Reinold found a significant loss of passive shoulder internal rotation (IR) immediately following pitching that was also evident 24 hours after throwing. Reinold purported that the altered range of motion may be related to acute musculotendinous adaptations in response to the eccentric muscle activity of the external rotators during the throwing motion. Gandhi found a decrease in external rotation strength and a statistically and clinically significant decrease in voluntary muscle activation of the infraspinatus immediately following pitching in a simulated game. His contention was that the weakness was due to incomplete neuromuscular recruitment.

The posterior rotator cuff demonstrates large electromyographic (EMG) activity during the act of throwing. Overused muscle shortens over time, changing the muscle length-tension properties and becoming more readily active and weaker after time. The cause of the weakness may be neuro-reflexive or structural in nature. The combination of loss of IR and weakness of the external rotators might be explained by the concept of "tightness weakness" as described by Janda. The author's propose that the loss of shoulder internal rotation range of motion and external rotation strength may be linked and centrally mediated from the cervical spine. The act of throwing will produce a compressive force in the mid-cervical spine related to the compensatory movement of cervical extension, lateral flexion and rotation towards the throwing side. Pheasant demonstrated a decrease in shoulder external rotator strength following a maintained postural position of forward head and rounded shoulders for only 5 minutes. He noted that the resultant lower cervical flexion that accompanies the forward head posture can create foraminal stenosis at C4-C5, thereby causing a compression of the C5 nerve root.

In a case series, Pheasant demonstrated an increase in external rotation strength and resolution of pain complaints in 2 overhead athletes presenting with shoulder impingement by performing cervical retraction and cervical retraction with extension. He surmised that intermittent compression of the C5 nerve root could impair nerve function and ultimately cause rotator cuff weakness by affecting the suprascapular and axillary nerve that innervate the supraspinatus, teres minor and infraspinatus, and that the cervical retraction exercises reduced the compression. Internal rotation range of motion pre-intervention was only visually estimated and there was no indication of that motion being compared to the non-involved shoulder or if there was an improvement in motion following implementation of the exercises.

Study Type

Interventional

Enrollment (Actual)

20

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • United States
    • Connecticut
      • Fairfield, Connecticut, United States, 06825
        • Sacred Heart University

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

Yes

Description

Inclusion Criteria:

  • an overhead thrower over the age of 18 years old
  • currently painfree while throwing at their usual intensity

Exclusion Criteria:

  • previous shoulder or elbow surgery on the throwing arm within the last 12 months
  • currently in the post-operative phase of a shoulder or elbow surgery on the throwing arm
  • currently participating in a rehabilitation program for shoulder or elbow pain
  • currently not able to throw due to shoulder or elbow pain

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

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

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
No Intervention: Control group
Experimental: Intervention group
Other: Cervical retraction exercise
Participants will perform end-range cervical retraction and cervical retraction with extension, holding the end-range of motion for 3 seconds and performing 10 repetitions of each exercise.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Shoulder Internal Rotation ROM
Time Frame: Day 1
measure of shoulder range of motion
Day 1
Shoulder External Rotation Strength
Time Frame: Day 1
measure of shoulder strength
Day 1

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Sacred Heart University

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

May 31, 2025

Primary Completion (Actual)

December 29, 2025

Study Completion (Actual)

December 29, 2025

Study Registration Dates

First Submitted

February 20, 2025

First Submitted That Met QC Criteria

February 25, 2025

First Posted (Actual)

March 3, 2025

Study Record Updates

Last Update Posted (Actual)

January 28, 2026

Last Update Submitted That Met QC Criteria

January 26, 2026

Last Verified

January 1, 2026

More Information

Terms related to this study

Keywords

Other Study ID Numbers

  • IRB-FY2025-188

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

product manufactured in and exported from the U.S.

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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