Glenohumeral internal rotation deficit (GIRD) and posterior shoulder stiffness have been associated with impingement symptoms in the overhead athlete. Stretching of the posterior shoulder is advised in injury prevention as well as rehabilitation programs. The purpose of the present study was to determine if stretching of the posterior shoulder improves ROM and reduces symptoms, and to compare angular with non-angular stretching techniques.
Methods
60 overhead athletes with GIRD (age 25 ± 7.2 years, height 176 ± 8 cm, weight 69.8 ± 10.2 kg) participated to the study. Thirty athletes had no shoulder pain, 30 had impingement symptoms on the dominant shoulder. The subjects were randomly assigned into an “angular” or a “non-angular” treatment group. They were treated for 3 weeks (9 sessions) and followed for another period of 3 weeks after completion of the treatment. Treatment outcome variables were glenohumeral internal rotation range of motion, and, in the patient group, pain (VAS) scores and functional performance (ROWE-score).
Results
Statistical analysis showed a significant increase in ROM (p < .05) in both treatment groups, in the patient as well as in the healthy control group. In addition, patients showed a significant improvement in pain assessment scores, and a significant increase in the Modified Rowe Score. There were no significant differences between both treatment techniques.
Discussion
Stretching, angular as well as non-angular techniques, increases internal rotation ROM in overhead athletes, and may decrease sport specific shoulder pain in overhead athletes with impingement symptoms.
BurkhartSS, MorganCD, KiblerWB. The disabled throwing shoulder: spectrum of pathology Part I: pathoanatomy and biomechanics. Arthroscopy2003; 19: 404–20.
2.
BorsaPA, LaudnerKG, SauersEL. Mobility and stability adaptations in the shoulder of the overhead athlete: a theoretical and evidence-based perspective. Sports Med2008; 38: 17–36.
3.
ThomasSJ, SwanikKA, SwanikCB,. Internal rotation and scapular position differences: a comparison of collegiate and high school baseball players. J Athl Train2010; 45: 44–50.
4.
WilkKE, MeisterK, AndrewsJR. Current concepts in the rehabilitation of the overhead throwing athlete. Am J Sports Med2002; 30: 136–51.
5.
WilkKE, ObmaP, SimpsonCD,. Shoulder injuries in the overhead athlete. J Orthop Sports Phys Ther2009; 39: 38–54.
6.
BorsaPA, DoverGC, WilkKE,. Glenohumeral range of motion and stiffness in professional baseball pitchers. Med Sci Sports Exerc2006; 38: 21–6.
7.
CrockettHC, GrossLB, WilkKE,. Osseous adaptation and range of motion at the glenohumeral joint in professional baseball pitchers. Am J Sports Med2002; 30: 20–6.
8.
EllenbeckerTS, RoetertEP, BailieDS,. Glenohumeral joint total rotation range of motion in elite tennis players and baseball pitchers. Med Sci Sports Exerc2002; 34: 2052–6.
9.
MyersJB, LaudnerKG, PasqualeMR,. Glenohumeral range of motion deficits and posterior shoulder tightness in throwers with pathologic internal impingement. Am J Sports Med2006; 34: 385–91.
10.
NakamizoH, NakamuraY, NobuharaK,. Loss of glenohumeral internal rotation in little league pitchers: a biomechanical study. J Shoulder Elbow Surg2008; 17: 795–801.
11.
PoserA, CasonatoO. Posterior glenohumeral stiffness: capsular or muscular problem? A case report. Man Ther2008; 13: 165–70.
12.
ReinoldMM, WilkKE, MacrinaLC,. Changes in shoulder and elbow passive range of motion after pitching in professional baseball players. Am J Sports Med2008; 36: 523–7.
13.
ThomasSJ, SwanikKA, SwanikC,. Glenohumeral rotation and scapular position adaptations after a single high school female sports season. J Athl Train2009; 44: 230–7.
14.
TorresRR, GomesJLE. Measurement of glenohumeral internal rotation in asymptomatic tennis players and swimmers. Am J Sports Med2009; 37: 1017–23.
15.
TylerTF, NicholasSJ, LeeSJ,. Correction of posterior shoulder tightness is associated with symptom resolution in patients with internal impingement. Am J Sports Med2010; 38: 114–19.
16.
CoolsAM, DeclercqG, CagnieB,. Internal impingement in the tennis player: rehabilitation guidelines. Br J Sports Med2008; 42: 165–71.
17.
PappasAM, ZawackiRM, McCarthyCF. Rehabilitation of the pitching shoulder. Am J Sports Med1985; 13: 223–35.
18.
BarberFA, MorganCD, BurkhartSS,. Current controversies. Point counterpoint. Labrum/biceps/cuff dysfunction in the throwing athlete. Arthroscopy1999; 15: 852–7.
19.
GageyOJ, BoisrenoultP. Shoulder capsule shrinkage and consequences on shoulder movements. Clin Orthop Relat Res2004; 419: 218–22.
20.
GrossmanMG, TiboneJE, McGarryMH,. A cadaveric model of the throwing shoulder: a possible etiology of superior labrum anterior-to-posterior lesions. J Bone Joint Surg Am2005; 87: 824–31.
21.
LaudnerKG, StanekJM, MeisterK. Assessing posterior shoulder contracture: the reliability and validity of measuring glenohumeral joint horizontal adduction. J Athl Train2006; 41: 375–80.
22.
LintnerD, MayolM, UzodinmaO,. Glenohumeral internal rotation deficits in professional pitchers enrolled in an internal rotation stretching program. Am J Sports Med2007; 35: 617–21.
23.
ReaganKM, MeisterK, HorodyskiMB,. Humeral retroversion and its relationship to glenohumeral rotation in the shoulder of college baseball players. Am J Sports Med2002; 30: 354–60.
24.
McClureP, BalaicuisJ, HeilandD,. A randomized controlled comparison of stretching procedures for posterior shoulder tightness. J Orthop Sports Phys Ther2007; 37: 108–14.
25.
TickerJB, BeimGM, WarnerJJ. Recognition and treatment of refractory posterior capsular contracture of the shoulder. Arthroscopy2000; 16: 27–34.
26.
HuffmanGR, TiboneJE, McGarryMH,. Path of glenohumeral articulation throughout the rotational range of motion in a thrower's shoulder model. Am J Sports Med2006; 34: 1662–9.
27.
EdwardsSL, LeeJA, BellJE,. Nonoperative treatment of superior labrum anterior posterior tears: improvements in pain, function, and quality of life. Am J Sports Med2010; 38: 1456–61.
28.
KirchhoffC, ImhoffAB. Posterosuperior and anterosuperior impingement of the shoulder in overhead athletes-evolving concepts. Int Orthop2010; 34: 1049–58.
29.
McClureP. Shoulder function and 3-dimensional kinematics in people with shoulder impingement syndrome before and after a 6-week exercise program. Phys Ther2004; 84: 832–48.
30.
EllenbeckerTS, CoolsAM. Rehabilitation of shoulder impingement syndrome and rotator cuff injuries: an evidence based review. Br J Sports Med2010; 44: 319–27.
31.
BachHG, GoldbergBA. Posterior capsular contracture of the shoulder. J Am Acad Orthop Surg2006; 14: 265–77.
LaudnerKG, SipesRC, WilsonJT. The acute effects of sleeper stretches on shoulder range of motion. J Athl Train2008; 43: 359–63.
34.
MaitlandGD. Treatment of the glenohumeral joint by passive movement. Physiotherapy1983; 69: 3–7.
35.
MichenerLA, McClurePW, KardunaAR. Anatomical and biomechanical mechanisms of subacromial impingement syndrome. Clin Biomech (Bristol, Avon)2003; 18: 369–79.
36.
VermeulenHM, RozingPM, ObermannWR,. Comparison of high-grade and low-grade mobilization techniques in the management of adhesive capsulitis of the shoulder: randomized controlled trial. Phys Ther2006; 86: 355–68.
37.
ScherS, AndersonK, WeberN,. Associations among hip and shoulder range of motion and shoulder injury in professional baseball players. J Athl Train2010; 45: 191–7.
38.
CoolsAM, WitvrouwEE, DeclercqGA,. Scapular muscle recruitment patterns: trapezius muscle latency with and without impingement symptoms. Am J Sports Med2003; 31: 542–9.
39.
CoolsAM, CambierD, WitvrouwEE. Screening the athlete's shoulder for impingement symptoms: a clinical reasoning algorithm for early detection of shoulder pathology. Br J Sports Med2008; 42: 628–35.
40.
CoolsAM, DeclercqGA, CambierDC,. Trapezius activity and intramuscular balance during isokinetic exercise in overhead athletes with impingement symptoms. Scand J Med Sci Sports2007; 17: 25–33.
41.
KirkleyA, GriffinS, DaintyK. Scoring systems for the functional assessment of the shoulder. Arthroscopy2003; 19: 1109–20.
42.
WilkKE, ReinoldMM, MacrinaLC,. Glenohumeral internal rotation measurements differ depending on stabilization techniques. Sports Health: A Multi Approach2009; 1: 131–6.
43.
AwanR, SmithJ, BoonAJ. Measuring shoulder internal rotation range of motion: a comparison of 3 techniques. Arch Phys Med Rehabil2002; 83: 1229–34.
44.
MullaneyMJ, MchughMP, JohnsonCP,. Reliability of shoulder range of motion comparing a goniometer to a digital level. Physiother Theory Pract2010; 26: 327–33.
45.
HsuAT, HedmanT, ChangJH,. Changes in abduction and rotation range of motion in response to simulated dorsal and ventral translational mobilization of the glenohumeral joint. Phys Ther2002; 82: 544–56.
46.
JohnsonAJ, GodgesJJ, ZimmermanGJ,. The effect of anterior versus posterior glide joint mobilization on external rotation range of motion in patients with shoulder adhesive capsulitis. J Orthop Sports Phys Ther2007; 37: 88–99.
47.
IzumiT, AokiA, MurakiT,. Stretching positions for the posterior capsule of the glenohumeral joint: strain measurement using cadaver specimens. Am J Sports Med2008; 36: 2014–22.
48.
BorstadJD, DashotterA. Quantifying strain on posterior shoulder tissues during 5 simulated clinical tests: a cadaver study. J Orthop Sports Phys Ther2011; 41: 90–9.
49.
DeciccoPV, FisherMM. The effects of proprioceptive neuromuscular facilitation stretching on shoulder range of motion in overhand athletes. J Sports Med Phys Fitness2005; 45: 183–7.
50.
FarrarJT, YoungJP, LaMoreauxLWJ,. Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale. Pain2001; 94: 149–58.
