of a Posterior Shoulder Stretching Program on University-Level Overhead
Athletes: Randomized Controlled Trial
Chepeha, J; Magee, D;
Bouliane, M; Sheps, D; Beaupre, L. 
Clinical Journal of Sports
. 2017 April, e-pub ahead of
Home Message: Performing the sleeper stretch increases internal rotation in
overhead athletes with an internal rotation deficit. Effectively managing
posterior shoulder tightness could be important in reducing the incidence of
shoulder pathology in overhead athletes.
In overhead athletes, the intense
demands placed on the glenohumeral joint lead to anatomical adaptations that
result in altered range of motions; such as, reduced internal rotation and
increased external rotation.  Posterior
shoulder tightness due to changes in the posterior capsule and posterior
rotator cuff contribute to these rotational alterations.  Stretching programs that address posterior
shoulder tightness, such as the “cross-body stretch
and “sleeper stretch”, are effective in baseball
players.  However, few studies have
investigated the benefits of the stretch in other overhead athlete populations.  Additionally, the optimal dosage parameters,
expected rates of change, and the effect on pain and function of the sleeper
stretch are poorly defined.  Therefore,
the authors of this study had two goals: 1) to determine if an 8-week posterior
shoulder stretching program increased range of motion (ROM) in a variety of
overhead university-level athletes with deficits in internal rotation and 2) to
investigate the rate of change in internal rotation and horizontal adduction ROM
over time and to determine whether pain and/or function changes with
stretching.  A total of 37
university-level athletes from a variety of sports (i.e., volleyball, swimming,
and tennis) and with internal rotation ROM deficits (≥ 15º) were randomized
into intervention or control groups.  The
intervention group performed the “sleeper stretch” once daily for 5
repetitions, holding each stretch for 2 minutes. The control group performed
usual activities.  Study staff used a
goniometer to measure internal rotation ROM and horizontal adduction ROM at
baseline and 4 and 8 weeks.  Participants
self-reported shoulder pain and functional ability at similar time points using
visual analog scores. The researchers found that internal rotation ROM was increased
in a clinically meaningful way (>10º) at 4 and 8 weeks in the intervention
group.  The athlete’s self-reported
shoulder function was also improved in the intervention group at these time
Results from this study
show that overhead athletes with an internal rotation ROM deficit (≥ 15º)
benefit from performing posterior shoulder stretching daily.  These changes were observed during the
athlete’s competitive season as early as 4 weeks into the stretching
intervention and continued at 8 weeks. It is not clear whether these increases
in internal rotation ROM could be maintained and at what time point the effect
of stretching will level-off. The authors acknowledge that many reports advise
doing the sleeper stretch 3 to 5 times daily for 5 to 7 days per week, holding
each stretch for 30 to 60 seconds for 4 to 6 weeks.  The authors modified this dosage slightly to
incorporate longer duration stretching in an attempt to affect the viscoelastic
(time-dependent) properties of the posterior soft tissues.  It would be interesting to determine if
modifying dosage parameters for the stretch will lead to greater changes.  Ultimately, clinicians could use the sleeper
stretch as an effective method to combat glenohumeral internal rotation deficit
(GIRD).  The critical question that remains
is whether posterior shoulder stretching is effective in reducing the incidence
of shoulder injuries in overhead athletes.

for Discussion: Do you prescribe the sleeper stretch for your overhead athletes
with internal rotation deficits?  What
dosage parameters have you used? Do you think this may be an effective way to
prevent shoulder pathology in overhead athletes?
Written by: Katie Reuther
Reviewed by: Stephen
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