The efficacy of stretching exercises to reduce posterior shoulder tightness acutely in the postoperative population: a single blinded randomized controlled trial

An evidence-informed rehabilitation management framework for posterior shoulder tightness: A scoping review

Objective

To systematically scope the literature on posterior shoulder tightness (PST) and define a therapist-instructed and therapist-administered management framework.

Design

Scoping review.

Literature search

We searched MEDLINE, EMBASE, CINAHL, Scopus and Google Scholar from inception to December 2021.

Study selection criteria

Peer-reviewed studies written in English, French, Greek, Japanese or Tamil, with extractable pre- and post-intervention data. Physiotherapy interventions amenable for posterior shoulder structural (muscle, capsule) causes of PST within an adult population.

Data synthesis

Arksey and O'Malley's framework was implemented and the PRISMA extension for scoping reviews directed our data synthesis. The data charted from each study included authors, title, study year, location, study design; participant number, age, sex; PST intervention and parameters; patient-reported outcomes; and results. Themes were organized into therapist-instructed and therapist-administered rehabilitation strategies, as well as combined treatment methods.

Results

Of 2777 articles identified from our search strategy, 21 articles were included. Therapist-instructed interventions included cross-body stretch (CBS), sleeper stretch (SS), a combination of the two and general stretching. Therapist-administered interventions included CBS, SS, instrument-assisted soft tissue mobilization (IASTM), muscle energy techniques, dry needling and Fauls protocol (12 therapist-assisted stretches). Combined interventions of tape with self-stretching and IASTM and stretching were also identified.

Conclusion

Based on the current evidence, CBS and SS are the most researched treatments for PST and seem to be effective at improving PST. Furthermore, stabilization of the scapula while performing these stretches optimized the stretch targeted to the PST and ROM benefits for horizontal adduction.

The Influence of Stretching the Hip Flexor Muscles on Performance Parameters. A Systematic Review with Meta-Analysis

The hip flexor muscles are major contributors to lumbar spine stability. Tight hip flexors can lead to pain in the lumbar spine, and hence to an impairment in performance. Moreover, sedentary behavior is a common problem and a major contributor to restricted hip extension flexibility. Stretching can be a tool to reduce muscle tightness and to overcome the aforementioned problems. Therefore, the purpose of this systematic review with meta-analysis was to determine the effects of a single hip flexor stretching exercise on performance parameters. The online search was performed in the following three databases: PubMed, Scopus, and Web of Science. Eight studies were included in this review with a total of 165 subjects (male: 111; female 54). In contrast to other muscle groups (e.g., plantar flexors), where 120 s of stretching likely decreases force production, it seems that isolated hip flexor stretching of up to 120 s has no effect or even a positive impact on performance-related parameters. A comparison of the effects on performance between the three defined stretch durations (30–90 s; 120 s; 270–480 s) revealed a significantly different change in performance (p = 0.02) between the studies with the lowest hip flexor stretch duration (30–90 s; weighted mean performance change: −0.12%; CI (95%): −0.49 to 0.41) and the studies with the highest hip flexor stretch duration (270–480 s; performance change: −3.59%; CI (95%): −5.92 to −2.04). Meta-analysis revealed a significant (but trivial) impairment in the highest hip flexor stretch duration of 270–480 s (SMD effect size = −0.19; CI (95%) −0.379 to 0.000; Z = −1.959; p = 0.05; I² = 0.62%), but not in the lowest stretch duration (30–90 s). This indicates a dose-response relationship in the hip flexor muscles. Although the evidence is based on a small number of studies, this information will be of great importance for both athletes and coaches.

The effects of restricted glenohumeral horizontal adduction motion on shoulder and elbow forces in collegiate baseball pitchers

BACKGROUND

Decreased glenohumeral (GH) horizontal adduction range of motion (ROM) among baseball pitchers has been associated with the development of various shoulder and elbow pathologies. No research has examined how this tightness may affect the forces placed on the shoulder and elbow during the pitching motion.

METHODS

Fifty-five asymptomatic National Collegiate Athletic Association Division I baseball pitchers participated. Twenty-five participants had -10° or less horizontal adduction ROM in their throwing shoulder. The remaining 30 participants had greater than -10° of horizontal adduction. A digital inclinometer was used to measure GH horizontal adduction, internal rotation, and external rotation ROM while in 90° of shoulder abduction. Forces produced in the throwing shoulder and elbow were assessed with a 3-dimension, high-speed video capture system and based on the sum of angular momenta of the kinetic chain segments around the center of gravity. Separate 2-tailed t tests were run to determine significant differences between groups (P < .05).

RESULTS

Both groups presented with significant bilateral differences in their total arcs of motion (P < .04). This suggests that the loss of horizontal adduction in these groups was at least partially due to soft tissue tightness. There were no significant between-group differences for shoulder external rotation torque or shoulder and elbow distraction (P > .10). The restricted ROM group had significantly more shoulder abduction torque (P = .04), shoulder horizontal abduction torque (P = .004), elbow flexion torque (P = .002), and elbow valgus torque (P = .02) compared with the control group.

CONCLUSIONS

These results demonstrate that collegiate pitchers with -10° or less of horizontal adduction ROM in their throwing shoulder create significantly more shoulder abduction and horizontal abduction torque, as well as more elbow flexion and valgus torque, during the pitching motion than those with more ROM.

Effects of Modified Posterior Shoulder Stretching Exercises on Shoulder Mobility, Pain, and Dysfunction in Patients With Subacromial Impingement Syndrome

BACKGROUND

Posterior shoulder stretching exercises (PSSEs) aim to reduce posterior shoulder tightness (PST). Position modification of traditional PSSEs has been suggested to minimize inadequate control of scapular and glenohumeral rotation, possibly leading to increased subacromial impingement.

HYPOTHESIS

Modified PSSEs will have positive effects on shoulder mobility, pain, and dysfunction.

STUDY DESIGN

Randomized controlled trial.

LEVEL OF EVIDENCE

Level 1.

METHODS

A total of 67 symptomatic patients with subacromial impingement syndrome (SIS) and shoulder internal rotation asymmetry were randomly assigned to 3 groups: modified cross-body stretch (MCS) (n = 22; treatment program + MCS), modified sleeper stretch (MSS) (n = 22; treatment program + MSS), and a control group (n = 23; treatment program consisting of only modalities, range of motion [ROM], and strength training but no PSSEs) for 4 weeks. Pain, PST, shoulder rotation ROM, and dysfunction were evaluated.

RESULTS

Pain, PST, shoulder rotation ROM, function, and disability improved in all groups (P < 0.05). The MCS and MSS groups had better results compared with the control group with regard to pain with activity, internal rotation ROM, function, and disability (P < 0.05). There was no significant difference between the stretching groups (P > 0.05).

CONCLUSION

All treatments improved pain, shoulder mobility, function, and disability in patients with SIS. However, modified PSSEs in addition to a treatment program was superior to the treatment program alone (without PSSEs) in improving pain with activity, internal rotation ROM, and dysfunction. Moreover, stretching provided clinically significant improvements.

CLINICAL RELEVANCE

Modified PSSEs, in addition to a treatment program, are beneficial for patients with SIS. Both modified cross-body and sleeper stretches are safe and efficacious for improving shoulder mobility, pain, and dysfunction.

The efficacy and fidelity of clinical interventions used to reduce posterior shoulder tightness: a systematic review with meta-analysis

BACKGROUND

Posterior shoulder tightness (PST) has been implicated in the etiology of numerous shoulder disorders and is a source of stiffness in both postoperative and nonsurgical cohorts. Identifying efficacious interventions to address PST has the potential to impact patient outcomes in both operative and nonoperative cohorts. Our purpose was to analyze the efficacy of nonoperative clinician-assisted interventions used to mitigate PST.

METHODS

We performed a systematic review and meta-analysis. Relevant studies were assessed for inclusion, and selected studies were identified from the PubMed, Embase, Cochrane, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases by a biomedical librarian. Data extracted from the selected studies underwent quality appraisal using Grading of Recommendations, Assessment, Development, and Evaluation analysis; fidelity assessment; and meta-analysis.

RESULTS

The search identified 374 studies, with 13 ultimately retained. Grading of Recommendations, Assessment, Development, and Evaluation analysis revealed areas of concern regarding consistency and imprecision of reporting within the included studies overall. Treatment fidelity assessment showed that only 3 of the 13 studies received a rating of good to excellent, indicating a high risk of bias. When clinician-assisted interventions were compared with no treatment, meta-analysis showed a moderate effect size in favor of clinician-assisted interventions for improving range of motion. When a multimodal treatment approach for PST was compared with active comparator interventions, a small effect size was present for improving range of motion in favor of the multimodal approach.

CONCLUSION

The efficacy of clinician-assisted interventions for reducing PST was identified when using both a single treatment and multimodal treatments. Current evidence focuses mostly on populations with PST who were not seeking care and the immediate- to short-term effects of clinician-assisted interventions, which may limit generalization of findings.