Effectiveness of Manual Therapy and Stretching for Baseball Players With Shoulder Range of Motion Deficits

Abstract

Background:

Baseball players displaying deficits in shoulder range of motion (ROM) are at increased risk of arm injury. Currently, there is a lack of consensus regarding the best available treatment options to restore shoulder ROM.

Hypothesis:

Instrumented manual therapy with self-stretching will result in clinically significant deficit reductions when compared with self-stretching alone.

Study Design:

Controlled laboratory study.

Methods:

Shoulder ROM and humeral torsion were assessed in 60 active baseball players (mean age, 19 ± 2 years) with ROM deficits (nondominant − dominant, ≥15°). Athletes were randomly assigned to receive a single treatment of instrumented manual therapy plus self-stretching (n = 30) or self-stretching only (n = 30). Deficits in internal rotation, horizontal adduction, and total arc of motion were compared between groups immediately before and after a single treatment session. Treatment effectiveness was determined by mean comparison data, and a number-needed-to-treat (NNT) analysis was used for assessing the presence of ROM risk factors.

Results:

Prior to intervention, players displayed significant (P < 0.001) dominant-sided deficits in internal rotation (−26°), total arc of motion (−18°), and horizontal adduction (−17°). After the intervention, both groups displayed significant improvements in ROM, with the instrumented manual therapy plus self-stretching group displaying greater increases in internal rotation (+5°, P = 0.010), total arc of motion (+6°, P = 0.010), and horizontal adduction (+7°, P = 0.004) compared with self-stretching alone. For horizontal adduction deficits, the added use of instrumented manual therapy with self-stretching decreased the NNT to 2.2 (95% CI, 2.1-2.4; P = 0.010).

Conclusion:

Instrumented manual therapy with self-stretching significantly reduces ROM risk factors in baseball players with motion deficits when compared with stretching alone.

Clinical Relevance:

The added benefits of manual therapy may help to reduce ROM deficits in clinical scenarios where stretching alone is ineffective.

Keywords

posterior shoulder tightness (PST)glenohumeral internal rotation deficit (GIRD)instrumented manual therapy baseball

Get full access to this article

View all access options for this article.

References

Awan

Boon

Smith

. Measuring shoulder internal rotation range of motion: a comparison of 3 techniques. Arch Phys Med Rehabil. 2002;83:1229-1234.

Burkhart

Morgan

Kibler

. The disabled throwing shoulder: spectrum of pathology. Part I: pathoanatomy and biomechanics. Arthroscopy. 2003;19:404-420.

Crockett

Gross

Wilk

. Osseous adaptation and range of motion at the glenohumeral joint in professional baseball pitchers. Am J Sports Med. 2002;30:20-26.

Donatelli

Ellenbecker

Ekedahl

Wilkes

Kocher

Adam

. Assessment of shoulder strength in professional baseball pitchers. J Orthop Sports Phys Ther. 2000;30:544-551.

Ellenbecker

Roetert

Bailie

Davies

Brown

. Glenohumeral joint total rotation range of motion in elite tennis players and baseball pitchers. Med Sci Sports Exerc. 2002;34:2052-2056.

Laudner

Sipes

Wilson

. The acute effects of sleeper stretches on shoulder range of motion. J Athl Train. 2008;43:359-363.

Laudner

Stanek

Meister

. Assessing posterior shoulder contracture: the reliability and validity of measuring glenohumeral joint horizontal adduction. J Athl Train. 2006;41:375-380.

Leggin

Michener

Shaffer

Brenneman

Iannotti

Williams

Jr.

The Penn shoulder score: reliability and validity. J Orthop Sports Phys Ther. 2006;36:138-151.

Maenhout

Van Eessel

Van Dyck

Vanraes

Cools

. Quantifying acromiohumeral distance in overhead athletes with glenohumeral internal rotation loss and the influence of a stretching program. Am J Sports Med. 2012;40:2105-2112.

10.

Manske

Meschke

Porter

Smith

Reiman

. 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;2:94-100.

11.

McClure

Balaicuis

Heiland

Broersma

Thorndike

Wood

. A randomized controlled comparison of stretching procedures for posterior shoulder tightness. J Orthop Sports Phys Ther. 2007;37:108-114.

12.

Myers

Laudner

Pasquale

Bradley

Lephart

. Glenohumeral range of motion deficits and posterior shoulder tightness in throwers with pathologic internal impingement. Am J Sports Med. 2006;34:385-391.

13.

Myers

Oyama

Clarke

. Ultrasonographic assessment of humeral retrotorsion in baseball players: a validation study. Am J Sports Med. 2012;40:1155-1160.

14.

Myers

Oyama

Goerger

Rucinski

Blackburn

Creighton

. Influence of humeral torsion on interpretation of posterior shoulder tightness measures in overhead athletes. Clin J Sport Med. 2009;19:366-371.

15.

Myers

Oyama

Wassinger

. Reliability, precision, accuracy, and validity of posterior shoulder tightness assessment in overhead athletes. Am J Sports Med. 2007;35:1922-1930.

16.

Osbahr

Cannon

Speer

. Retroversion of the humerus in the throwing shoulder of college baseball pitchers. Am J Sports Med. 2002;30:347-353.

17.

Reagan

Meister

Horodyski

Werner

Carruthers

Wilk

. Humeral retroversion and its relationship to glenohumeral rotation in the shoulder of college baseball players. Am J Sports Med. 2002;30:354-360.

18.

Ruotolo

Price

Panchal

. Loss of total arc of motion in collegiate baseball players. J Shoulder Elbow Surg. 2006;15:67-71.

19.

Sauers

Dykstra

Bay

Bliven

Snyder

. Upper extremity injury history, current pain rating, and health-related quality of life in female softball pitchers. J Sport Rehabil. 2011;20:100-114.

20.

Shanley

Kissenberth

Thigpen

. Preseason shoulder ROM screening as a predictor of injury among youth, adolescent, and professional baseball pitchers. J Orthop Sports Phys Ther. 2013;43:A43.

21.

Shanley

Kissenberth

Thigpen

. Preseason shoulder range of motion screening as a predictor of injury among youth and adolescent baseball pitchers. J Shoulder Elbow Surg. 2015;24:1005-1013.

22.

Shanley

Rauh

Michener

Ellenbecker

Garrison

Thigpen

. 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;39:1997-2006.

23.

Shanley

Thigpen

Clark

. Changes in passive range of motion and development of glenohumeral internal rotation deficit (GIRD) in the professional pitching shoulder between spring training in two consecutive years. J Shoulder Elbow Surg. 2012;21:1605-1612.

24.

Thomas

Swanik

Higginson

. A bilateral comparison of posterior capsule thickness and its correlation with glenohumeral range of motion and scapular upward rotation in collegiate baseball players. J Shoulder Elbow Surg. 2011;20:708-716.

25.

Tyler

Nicholas

Lee

Mullaney

McHugh

. Correction of posterior shoulder tightness is associated with symptom resolution in patients with internal impingement. Am J Sports Med. 2010;38:114-119.

26.

Tyler

Nicholas

Roy

Gleim

. Quantification of posterior capsule tightness and motion loss in patients with shoulder impingement. Am J Sports Med. 2000;28:668-673.

27.

Whiteley

Ginn

Nicholson

Adams

. Indirect ultrasound measurement of humeral torsion in adolescent baseball players and non-athletic adults: reliability and significance. J Sci Med Sport. 2006;9:310-318.

28.

Wilk

Macrina

Fleisig

. Correlation of glenohumeral internal rotation deficit and total rotational motion to shoulder injuries in professional baseball pitchers. Am J Sports Med. 2011;39:329-335.

29.

Wilk

Reinold

Macrina

. Glenohumeral internal rotation measurements differ depending on stabilization techniques. Sports Health. 2009;1:131-136.

30.

Yamamoto

Itoi

Minagawa

. Why is the humeral retroversion of throwing athletes greater in dominant shoulders than in nondominant shoulders? J Shoulder Elbow Surg. 2006;15:571-575.