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Effects of self-stretching with mobilization on shoulder range of motion in individuals with glenohumeral internal rotation deficits: a randomized controlled trial. J Shoulder Elbow Surg 2020; 29:36-43. [PMID: 31627965 DOI: 10.1016/j.jse.2019.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 08/02/2019] [Accepted: 08/07/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND The combined effects of cross-body stretching and dorsal glide mobilization have not been examined previously, although both stretching and mobilization maneuvers are effective for improving shoulder range of motion (ROM). Thus, the aim of this study was to demonstrate the effects of stretching with mobilization (SWM) on glenohumeral (GH) internal rotation (IR) and horizontal adduction (HA) ROM. METHODS Forty individuals with GH IR deficits were randomized to perform simultaneous combined cross-body stretching and dorsal glide mobilization (SWM group, comprising 10 male and 10 female patients) or cross-body stretching alone (stretching group, comprising 10 male and 10 female patients). GH IR ROM, HA ROM, and shoulder mobility were assessed before and immediately following interventions. Group and time differences were analyzed using 2-way repeated-measures analysis of variance. RESULTS Greater changes in GH IR ROM (6°, P < .001), HA ROM (10°, P < .001), and shoulder mobility (-2 cm, P = .018) were observed in the SWM group than in the stretching group, although significant increases were observed in GH IR ROM (SWM group, P < .001; stretching group, P < .001), HA ROM (SWM group, P < .001; stretching group, P = .042), and shoulder mobility (SWM group, P < .001; stretching group, P < .001) after both interventions. CONCLUSION This study shows that SWM could be a useful exercise for shoulder ROM recovery in individuals with GH IR deficits.
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Joung HN, Yi CH, Jeon HS, Hwang UJ, Kwon OY. Effects of 4-week self-cross body stretching with scapular stabilization on shoulder motions and horizontal adductor strength in subjects with limited shoulder horizontal adduction: cross body stretching with stabilization. J Sports Med Phys Fitness 2018; 59:456-461. [PMID: 29845835 DOI: 10.23736/s0022-4707.18.08454-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Posterior shoulder tightness is related to shoulder conditions such as shoulder impingement and limited shoulder horizontal adduction (SHA). The purpose of this study was to compare the effects of self-cross body stretching (CBS) with and without scapular stabilization (SS) on SHA and shoulder internal rotation (SIR) range of motion (ROM) and shoulder horizontal adductor strength (SHAS) in subjects with limited SHA. METHODS Twenty-six subjects (14 males, 12 females) with limited SHA was participated in this study. The SS group and without stabilization (WS) group were assigned randomly. The SS group performed self-CBS with SS by applying belt just under the subject's axilla. The subjects were asked to perform self-CBS 4 times a week for 4 weeks. SHA and SIR RM were measured by Clinometer smartphone application, and SHAS by hand-held dynamometer before and after 4-week self-CBS. RESULTS 2 × 2 mixed analysis of variance (ANOVA) was used to identify the significance. If there was an interaction effect, t-test was used to confirm the simple effect. There was a significant interaction in SHA ROM and SHAS. The post-test value of SHA ROM was significantly greater in SS group than WS group (P<0.0125). In SHAS, there was no significant difference between groups (P>0.0125). CONCLUSIONS SS during self-CBS could enhance to improve SHA, SIR ROM, and SHAS in individuals with limited SHA.
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Affiliation(s)
- Ha-Na Joung
- Department of Physical Therapy, Graduate School, Yonsei University, Wonju, South Korea
| | - Chung-Hwi Yi
- Department of Physical Therapy, Graduate School, Yonsei University, Wonju, South Korea
| | - Hye-Seon Jeon
- Department of Physical Therapy, Graduate School, Yonsei University, Wonju, South Korea
| | - Ui-Jae Hwang
- Department of Physical Therapy, College of Health Science, Laboratory of Kinetic Ergocise Based on Movement Analysis, Yonsei University, Wonju, South Korea
| | - Oh-Yun Kwon
- Department of Physical Therapy, College of Health Science, Laboratory of Kinetic Ergocise Based on Movement Analysis, Yonsei University, Wonju, South Korea -
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Quantifying Range-of-Motion Changes Across 4 Simulated Measurements of the Glenohumeral Joint Posterior Capsule: An Exploratory Cadaver Study. J Orthop Sports Phys Ther 2016; 46:1080-1085. [PMID: 27796196 DOI: 10.2519/jospt.2016.6440] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Study Design Repeated-measures controlled laboratory cadaveric study. Background There is a lack of information about the most sensitive measure of glenohumeral joint posterior capsule length. Although maximum strains on the glenohumeral joint posterior capsule are observed in measurements combining glenohumeral joint flexion and internal rotation (IR), the range-of-motion (ROM) change after experimental contracture has never been compared across commonly used posterior capsular measurements. Objectives To evaluate the IR ROM change across 4 glenohumeral joint posterior capsule measurements after experimental capsule shrinkage using radiofrequency thermal energy. Methods Repeated measures of ROM across 4 test positions were compared after progressive experimental contracture of the posterior capsule in 12 cadaver shoulders. The ROM data were collected with a 3-D motion-capture device and evaluated using repeated-measures analysis of variance. Results Overall, ROM decreased after experimental capsular contracture. There was a significant interaction effect between test and condition (F = 4.26, P = .01). Two of the 4 tests, those that combined humeral flexion and IR, detected significant reductions in the ROM following experimental capsular contracture. Conclusion Greater ROM change was observed in tests combining flexion and IR of the glenohumeral joint after experimental posterior capsular contracture. These tests appear more responsive to capsular-length change. J Orthop Sports Phys Ther 2016;46(12):1080-1085. Epub 29 Oct 2016. doi:10.2519/jospt.2016.6440.
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Yamauchi T, Hasegawa S, Nakamura M, Nishishita S, Yanase K, Fujita K, Umehara J, Ji X, Ibuki S, Ichihashi N. Effects of two stretching methods on shoulder range of motion and muscle stiffness in baseball players with posterior shoulder tightness: a randomized controlled trial. J Shoulder Elbow Surg 2016; 25:1395-403. [PMID: 27475455 DOI: 10.1016/j.jse.2016.04.025] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 04/25/2016] [Accepted: 04/25/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND The cross-body stretch and sleeper stretch are widely used for improving flexibility of the posterior shoulder. These stretching methods were modified by Wilk. However, few quantitative data are available on the new, modified stretching methods. A recent study reported the immediate effects of stretching and soft tissue mobilization on the shoulder range of motion (ROM) and muscle stiffness in subjects with posterior shoulder tightness. However, the long-term effect of stretching for muscle stiffness is unknown. The objective of this study was to examine the effects of 2 stretching methods, the modified cross-body stretch (MCS) and the modified sleeper stretch (MSS), on shoulder ROM and muscle stiffness in baseball players with posterior shoulder tightness. METHODS Twenty-four college baseball players with ROM limitations in shoulder internal rotation were randomly assigned to the MCS or MSS group. We measured shoulder internal rotation and horizontal adduction ROM and assessed posterior shoulder muscle stiffness with ultrasonic shear wave elastography before and after a 4-week intervention. Subjects were asked to perform 3 repetitions of the stretching exercises every day, for 30 seconds, with their dominant shoulder. RESULTS In both groups, shoulder internal rotation and horizontal adduction ROM were significantly increased after the 4-week intervention. Muscle stiffness of the teres minor decreased in the MCS group, and that of the infraspinatus decreased in the MSS group. CONCLUSIONS The MCS and MSS are effective for increasing shoulder internal rotation and horizontal adduction ROM and decreasing muscle stiffness of the infraspinatus or teres minor.
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Affiliation(s)
- Taishi Yamauchi
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| | - Satoshi Hasegawa
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masatoshi Nakamura
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Kyoto, Japan
| | - Satoru Nishishita
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Ko Yanase
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kosuke Fujita
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Jun Umehara
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Xiang Ji
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Satoko Ibuki
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Noriaki Ichihashi
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Borstad JD, Dashottar A, Stoughton T. Validity and reliability of the Low Flexion measurement for posterior glenohumeral joint capsule tightness. ACTA ACUST UNITED AC 2015; 20:875-8. [DOI: 10.1016/j.math.2015.08.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 08/14/2015] [Accepted: 08/18/2015] [Indexed: 11/24/2022]
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Abstract
Pathology of the rotator cuff and sub-acromial bursa are considered to be the main cause of shoulder pain and dysfunction. In the absence of trauma, conservative care, including physiotherapy is the primary treatment. This paper aims to present the key features of a physiotherapy assessment, excluding diagnostic tests for rotator cuff pathology. It describes and explores how assessment can be used to direct management options and develop a treatment plan.
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Affiliation(s)
- Jane Moser
- Jane Moser, Physiotherapy Department, Nuffield
Orthopaedic Centre, Oxford University Hospitals Trust, Oxford OX3 7HE, UK.
Tel: +44 1865 738074. Fax: +44 1865
738043
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Abstract
Glenohumeral joint posterior capsule contracture may cause shoulder pain by altering normal joint mechanics. Contracture is commonly noted in throwing athletes but can also be present in nonthrowers. The cause of contracture in throwing athletes is assumed to be a response to the high amount of repetitive tensile force placed on the tissue, whereas the mechanism of contracture in nonthrowers is unknown. It is likely that mechanical and cellular processes interact to increase the stiffness and decrease the compliance of the capsule, although the exact processes that cause a contracture have not been confirmed. Cadaver models have been used to study the effect of posterior capsule contracture on joint mechanics and demonstrate alterations in range of motion and in humeral head kinematics. Imaging has been used to assess posterior capsule contracture, although standard techniques and quantification methods are lacking. Clinically, contracture manifests as a reduction in glenohumeral internal rotation and/or cross body adduction range of motion. Stretching and manual techniques are used to improve range of motion and often decrease symptoms in painful shoulders.
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Affiliation(s)
- Amitabh Dashottar
- Division of Physical Therapy, School of Health and Rehabilitation Sciences, Ohio State University, Columbus, OH, USA
| | - John Borstad
- Division of Physical Therapy, School of Health and Rehabilitation Sciences, Ohio State University, Columbus, OH, USA
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A Physiotherapy Perspective on Management of Degenerative Rotator Cuff Tendinopathy. TECHNIQUES IN SHOULDER AND ELBOW SURGERY 2012. [DOI: 10.1097/bte.0b013e31824dec72] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kolber MJ, Hanney WJ, Benevento JD. Quantifying Posterior Shoulder Tightness in the Athletic Population. Strength Cond J 2012. [DOI: 10.1519/ssc.0b013e31822fc298] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Yang JL, Chen SY, Hsieh CL, Lin JJ. Effects and predictors of shoulder muscle massage for patients with posterior shoulder tightness. BMC Musculoskelet Disord 2012; 13:46. [PMID: 22449170 PMCID: PMC3339516 DOI: 10.1186/1471-2474-13-46] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Accepted: 03/27/2012] [Indexed: 11/10/2022] Open
Abstract
Background Clinical approaches like mobilization, stretching, and/or massage may decrease shoulder tightness and improve symptoms in subjects with stiff shoulders. We investigated the effect and predictors of effectiveness of massage in the treatment of patients with posterior shoulder tightness. Methods A randomized controlled trial was conducted in a hospital-based outpatient practice (orthopedic and rehabilitation). Forty-three women and 17 men (mean age = 54 years, range 43-73 years) with posterior shoulder tightness participated and were randomized into massage and control groups (n = 30 per group). A physical therapist provided the massage on the posterior deltoid, infraspinatus, and teres minor of the involved shoulder for 18 minutes [about 6 minutes for each muscle] two times a week for 4 weeks. For the control group, one therapist applied light hand touch on the muscles 10 minutes two times a week for 4 weeks. Glenohumeral internal rotation ROM, functional status, and muscle tightness were the main outcomes. Additionally, the potential factors on the effectiveness of massage were analyzed by multivariate logistic regression. For this analysis, patients with functional score improvement at least 20% after massage were considered responsive, and the others were considered nonresponsive. Results Fifty-two patients completed the study (29 for the massage and 23 for the control). The overall mean internal rotation ROM increased significantly in the massage group compared to the control (54.9° v.s. 34.9°; P ≤ 0.001). There were 21 patients in the responsive group and 8 in the nonresponsive group. Among the factors, duration of symptoms, functional score, and posterior deltoid tightness were significant predictors of effectiveness of massage. Conclusions Massage was an effective treatment for patients with posterior shoulder tightness, but was less effective in patients with longer duration of symptoms, higher functional limitation, and less posterior deltoid tightness. Trial registration This clinical trial is registered at Trial Registration "Trial registration: Clinicaltrials.gov NCT01022827".
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Affiliation(s)
- Jing-lan Yang
- Department of Physical Medicine & Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
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Quantifying strain on posterior shoulder tissues during 5 simulated clinical tests: a cadaver study. J Orthop Sports Phys Ther 2011; 41:90-9. [PMID: 21169717 PMCID: PMC3032833 DOI: 10.2519/jospt.2011.3357] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Controlled laboratory study using a repeated-measures approach. OBJECTIVE To quantify the amount of strain on cadaver posterior shoulder tissues during simulated clinical tests across different tissue conditions. BACKGROUND Several clinical tests are used to quantify posterior glenohumeral joint (GHJ) tissue tightness; however, the ability of these tests to directly assess the flexibility or tightness of the posterior capsule has not been evaluated. METHODS The middle and lower regions of the posterior shoulder tissues were instrumented with strain gauges on 8 cadaver shoulder specimens. Strain was quantified on the posterior shoulder muscles, on the native posterior GHJ capsule (baseline condition), and on the posterior GHJ capsule after it was experimentally contracted using thermal energy. Five simulated clinical tests were compared across each of the 3 conditions: humerus cross-body adduction, and GHJ internal rotation with the humerus positioned in 4 combinations of plane and elevation angle. Repeated-measures analyses of variance were used to compare strain measured during the 5 simulated clinical tests across the 3 conditions, and to evaluate the change in strain after contracting the posterior capsule. RESULTS There was a statistically significant interaction between tests and conditions for the middle region of the posterior shoulder. In the experimentally contracted condition, strain was greater when GHJ internal rotation was added to humerus flexion than when GHJ internal rotation was added to humerus abduction. There was a statistically significant main effect of tests at the lower region of the posterior shoulder, with internal rotation in abduction and internal rotation in the GHJ resting position demonstrating greater strain than cross-body adduction. The percent change in strain between the baseline and contracted capsule conditions did not reach statistical significance at either region. CONCLUSION Strain on an experimentally contracted posterior GHJ capsule is highest when tested with a combination of GHJ internal rotation and humerus flexion.
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