A Randomized Controlled Single-Blinded Comparison of Stretching Versus Stretching and Joint Mobilization for Posterior Shoulder Tightness Measured by Internal Rotation Motion Loss

Abstract

Background:Posterior shoulder tightness, as demonstrated by limited internal rotation range of motion, is a suggested factor in many shoulder pathologies. Methods to increase posterior shoulder mobility may be beneficial.Hypothesis:Shoulder internal rotation range of motion will not change with either of 2 interventions: cross-body stretch alone and cross-body stretch plus posterior capsule joint mobilization.Study Design:Randomized controlled single-blinded clinical trial.Methods:The study comprised 39 college-age asymptomatic participants (7 men, 32 women) who were randomly assigned to 1 of 2 groups: stretching only (n, 20) and stretching plus posterior joint mobilizations (n, 19). All had a between-shoulder difference of internal rotation of 10° or more. Shoulder internal and external rotation was measured before and after a 4-week intervention period and 4 weeks postintervention. Participants in the stretching-only group performed the cross-body stretch on the limited side. Those in the other group (cross-body stretch plus joint mobilization) were treated with posterior joint mobilization techniques on the limited side.Results:Overall means for internal rotation of the treated shoulders significantly increased over baseline at the end of the intervention period and at 4 weeks postintervention. External rotation in all shoulders remained unchanged. By the end of intervention, total motion increased significantly from baseline but decreased significantly from the end of intervention to 4 weeks postintervention. Although not statistically significant, the second group (cross-body stretch plus joint mobilization) had greater increases in internal rotation. At 4 weeks postintervention, the second group had maintained its internal rotation gains to a greater degree than those of the stretching-only group.Conclusion:Internal rotation increased in both groups. Inclusion of joint mobilization in a rehabilitation program created trends toward increased shoulder internal rotation mobility.Clinical Relevance:Both methods—cross-body stretch and cross-body stretch plus joint mobilization—may be beneficial for those with limited internal rotation range of motion.

Increased treatment durations lead to greater improvements in non-weight bearing dorsiflexion range of motion for asymptomatic individuals immediately following an anteroposterior grade IV mobilisation of the talus

“…This is of particular importance when improvements in ROM are sought within asymptomatic individuals. Indeed, many researchers have demonstrated ROM improvements at various joints following accessory mobilisation treatments in asymptomatic individuals (MacRae et al, 2012;Manske et al, 2010;McCollam & Benson, 1993;Thomson et al, 2009). …”

Reliability of Shoulder Internal Rotation Passive Range of Motion Measurements in the Supine Versus Sidelying Position

“…9,10,33,37,42 Furthermore, posterior glenohumeral soft tissue tightness has been identified as a cause of restricted glenohumeral IR. 7,13,14,18,23,25,27,30,33,37,39,42 Thus assessment of IR ROM is a critical t stuDY DesiGn: Clinical measurement, reliability.…”

The Modified Sleeper Stretch and Modified Cross-body Stretch to Increase Shoulder Internal Rotation Range of Motion in the Overhead Throwing Athlete

“…4, 21 Tyler et al 21 reported that the cross-body stretch, or horizontal adduction stretch, also improved shoulder IR. In addition, Manske et al 12 reported that combining horizontal adduction stretching exercises with posteriorly directed glenohumeral joint mobilization techniques increased shoulder IR. Cadaveric studies designed to determine the best position to stretch the posterior shoulder soft tissue structures have quantified the strain on the posterior cuff and capsule in a number of positions.…”

“…McClure et al 13 reported a significantly greater increase in IR using the cross-body stretch as compared to the sleeper stretch. Manske et al 12 reported that subjects treated …”