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

Omar Gharisia, Everett Lohman, Noha Daher, Alan Eldridge, Amjad Shallan, Hatem Jaber, Omar Gharisia, Everett Lohman, Noha Daher, Alan Eldridge, Amjad Shallan, Hatem Jaber

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 .

Keywords: Glenohumeral internal rotation deficits; Novel stretch technique; Overhead athletes.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Passive Glenohumeral Internal Rotation with Clam Shell Bridging
Fig. 2
Fig. 2
Modified Sleeper Stretch: Passive Glenohumeral Joint Internal Rotation
Fig. 3
Fig. 3
Flow diagram of participants’ recruitment and retention

References

    1. Laudner K, Sipes R. The incidence of shoulder injury among collegiate overhead athletes. J Intercollegiate Sport. 2009;2(2):260–268. doi: 10.1123/jis.2.2.260.
    1. Lin DJ, Wong TT, Kazam JK. Shoulder injuries in the overhead-throwing athlete: epidemiology, mechanisms of injury, and imaging findings. Radiology. 2018;286(2):370–387. doi: 10.1148/radiol.2017170481.
    1. Leonard J, Hutchinson MR. Shoulder injuries in skeletally immature throwers: review and current thoughts. Br J Sports Med. 2010;44(5):306–310. doi: 10.1136/bjsm.2009.062588.
    1. Bonza JE, Fields SK, Yard EE, Dawn Comstock R. Shoulder injuries among United States high school athletes during the 2005–2006 and 2006–2007 school years. J Athl Train. 2009;44(1):76–83. doi: 10.4085/1062-6050-44.1.76.
    1. Shankar PR, Fields SK, Collins CL, Dick RW, Comstock RD. Epidemiology of high school and collegiate football injuries in the United States, 2005-2006. Am J Sports Med. 2007;35(8):1295–1303. doi: 10.1177/0363546507299745.
    1. Luime J, Koes B, Hendriksen I, Burdorf A, Verhagen A, Miedema H, Verhaar JAN. Prevalence and incidence of shoulder pain in the general population; a systematic review. Scand J Rheumatol. 2004;33(2):73–81. doi: 10.1080/03009740310004667.
    1. Nygren A, Berglund A, Von Koch M. Neck-and-shoulder pain, an increasing problem. Strategies for using insurance material to follow trends. Scand J Rehabil Med Suppl. 1995;32:107.
    1. Borsa PA, Laudner KG, Sauers EL. Mobility and stability adaptations in the shoulder of the overhead athlete. Sports Med. 2008;38(1):17–36. doi: 10.2165/00007256-200838010-00003.
    1. Lintner D, Mayol M, Uzodinma O, Jones R, Labossiere D. Glenohumeral internal rotation deficits in professional pitchers enrolled in an internal rotation stretching program. Am J Sports Med. 2007;35(4):617–621. doi: 10.1177/0363546506296736.
    1. Myers JB, Laudner KG, Pasquale MR, Bradley JP, Lephart SM. Glenohumeral range of motion deficits and posterior shoulder tightness in throwers with pathologic internal impingement. Am J Sports Med. 2006;34(3):385–391. doi: 10.1177/0363546505281804.
    1. Shanley E, Michener LA, Ellenbecker TS, Rauh MJ. Shoulder range of motion, pitch count, and injuries among interscholastic female softball pitchers: a descriptive study. Int J Sports Phys Ther. 2012;7(5):548–557.
    1. Shanley E, Rauh MJ, Michener LA, Ellenbecker TS, Garrison JC, Thigpen CA. Shoulder range of motion measures as risk factors for shoulder and elbow injuries in high school softball and baseball players. Am J Sports Med. 2011;39(9):1997–2006. doi: 10.1177/0363546511408876.
    1. Dutton M. Orthopaedics for the physical therapist assistant. Burlington: Jones & Bartlett Publishers; 2011.
    1. Grossman MG, Tibone JE, McGarry MH, Schneider DJ, Veneziani S, Lee TQ. A cadaveric model of the throwing shoulder: a possible etiology of superior labrum anterior-to-posterior lesions. J Bone Joint Surg Am. 2005;87(4):824–831.
    1. Burkhart SS, Morgan CD, Kibler WB. The disabled throwing shoulder: spectrum of pathology part I: pathoanatomy and biomechanics. Arthroscopy. 2003;19(4):404–420. doi: 10.1053/jars.2003.50128.
    1. Burkhart SS, Morgan CD, Kibler WB. Shoulder injuries in overhead athletes: the “dead arm” revisited. Clin Sports Med. 2000;19(1):125–158. doi: 10.1016/S0278-5919(05)70300-8.
    1. Kibler W, Chandler T. Range of motion in junior tennis players participating in an injury risk modification program. J Sci Med Sport. 2003;6(1):51–62. doi: 10.1016/S1440-2440(03)80008-7.
    1. Meister K. Injuries to the shoulder in the throwing athlete: part two: evaluation/treatment. Am J Sports Med. 2000;28(4):587–601. doi: 10.1177/03635465000280042701.
    1. Manske RC, Meschke M, Porter A, Smith B, Reiman M. A randomized controlled single-blinded comparison of stretching versus stretching and joint mobilization for posterior shoulder tightness measured by internal rotation motion loss. Sports Health. 2010;2(2):94–100. doi: 10.1177/1941738109347775.
    1. Laudner KG, Sipes RC, Wilson JT. The acute effects of sleeper stretches on shoulder range of motion. J Athl Train. 2008;43(4):359–363. doi: 10.4085/1062-6050-43.4.359.
    1. Wilk KE, Hooks TR, Macrina LC. The modified sleeper stretch and modified cross-body stretch to increase shoulder internal rotation range of motion in the overhead throwing athlete. J Orthop Sports Phys Ther. 2013;43(12):891–894. doi: 10.2519/jospt.2013.4990.
    1. Mine K. Immediate effects of two types of stretching techniques on glenohumeral internal rotation deficit and posterior shoulder tightness; a crossover randomised controlled trial. Phys Ther Sports Med. 2017;1:3.
    1. Johnson JE, Fullmer JA, Nielsen CM, Johnson JK, Moorman CT., III Glenohumeral internal rotation deficit and injuries: a systematic review and meta-analysis. Orthop J Sports Med. 2018;6(5):2325967118773322. doi: 10.1177/2325967118773322.
    1. Kolber MJ, Corrao M. Shoulder joint and muscle characteristics among healthy female recreational weight training participants. J Strength Cond Res. 2011;25(1):231–241. doi: 10.1519/JSC.0b013e3181fb3fab.
    1. Williamson A, Hoggart B. Pain: a review of three commonly used pain rating scales. J Clin Nurs. 2005;14(7):798–804. doi: 10.1111/j.1365-2702.2005.01121.x.
    1. Oyama S, Goerger CP, Goerger BM, Lephart SM, Myers JB. Effects of non-assisted posterior shoulder stretches on shoulder range of motion among collegiate baseball pitchers. Athl Train Sports Health Care. 2010;2(4):163–170. doi: 10.3928/19425864-20100524-01.
    1. Lakens D. Calculating and reporting effect sizes to facilitate cumulative science: a practical primer for t-tests and ANOVAs. Front Psychol. 2013;4:863. doi: 10.3389/fpsyg.2013.00863.
    1. Cohen J. Statistical power analysis for the behavioral sciences. New York: Academic Press INC; 2013.
    1. Schmitt JS, Di Fabio RP. Reliable change and minimum important difference (MID) proportions facilitated group responsiveness comparisons using individual threshold criteria. J Clin Epidemiol. 2004;57(10):1008–1018. doi: 10.1016/j.jclinepi.2004.02.007.
    1. Kolber MJ, Hanney WJ. The reliability, minimal detectable change and construct validity of a clinical measurement for identifying posterior shoulder tightness. N Am J Sports Phys Ther. 2010;5(4):208–219.
    1. Kolber MJ, Vega F, Jr, Widmayer K, Cheng M-SS. The reliability and minimal detectable change of shoulder mobility measurements using a digital inclinometer. Physiother Theory Pract. 2011;27(2):176–184. doi: 10.3109/09593985.2010.481011.
    1. Bernstein JA, Mauger DT. The minimally clinically important difference (MCID): what difference does it make? J Allerg Clin Immunol Pract. 2016;4(4):689–690. doi: 10.1016/j.jaip.2016.04.022.
    1. Bailey LB, Thigpen CA, Hawkins RJ, Beattie PF, Shanley E. Effectiveness of manual therapy and stretching for baseball players with shoulder range of motion deficits. Sports Health. 2017;9(3):230–237. doi: 10.1177/1941738117702835.
    1. McClure P, Balaicuis J, Heiland D, Broersma ME, Thorndike CK, Wood A. A randomized controlled comparison of stretching procedures for posterior shoulder tightness. J Orthop Sports Phys Ther. 2007;37(3):108–114. doi: 10.2519/jospt.2007.2337.
    1. Lee JS, Hobden E, Stiell IG, Wells GA. Clinically important change in the visual analog scale after adequate pain control. Acad Emerg Med. 2003;10(10):1128–1130. doi: 10.1197/S1069-6563(03)00372-5.
    1. Hao Q, Devji T, Zeraatkar D, Wang Y, Qasim A, Siemieniuk RA, et al. Minimal important differences for improvement in shoulder condition patient-reported outcomes: a systematic review to inform a BMJ rapid recommendation. BMJ. 2019;9(2):e028777.
    1. Simovitch R, Flurin P-H, Wright T, Zuckerman JD, Roche CP. Quantifying success after total shoulder arthroplasty: the minimal clinically important difference. J Shoulder Elb Surg. 2018;27(2):298–305. doi: 10.1016/j.jse.2017.09.013.
    1. Cools AM, Johansson FR, Cagnie B, Cambier DC, Witvrouw EE. Stretching the posterior shoulder structures in subjects with internal rotation deficit: comparison of two stretching techniques. Should Elb. 2012;4(1):56–63. doi: 10.1111/j.1758-5740.2011.00159.x.
    1. Wilk KE, Macrina LC, Fleisig GS, Porterfield R, Simpson CD, Harker P, et al. Correlation of glenohumeral internal rotation deficit and total rotational motion to shoulder injuries in professional baseball pitchers. Am J Sports Med. 2011;39(2):329–335. doi: 10.1177/0363546510384223.
    1. Salamh PA, Kolber MJ, Hanney WJ. Effect of scapular stabilization during horizontal adduction stretching on passive internal rotation and posterior shoulder tightness in young women volleyball athletes: a randomized controlled trial. Arch Phys Med Rehabil. 2015;96(2):349–356. doi: 10.1016/j.apmr.2014.09.038.

Source: PubMed

Sponsors en medewerkers

Medische omstandigheden

Geneesmiddelinterventies

3
Abonneren