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This study aims to compare the effects of a self-stretch procedures versus a clinician applied musculoskeletal procedure in individuals with posterior shoulder tightness.
Posterior shoulder mobility has been considered a contributing factor to shoulder related movement dysfunction. There is evidence indicating that posterior shoulder tightness (PST) might be present in individuals with impingement related symptoms, post-operative conditions and overhead athletes. Several studies have investigated the effects of musculoskeletal procedures (joint mobilisations and stretch) in subjects with posterior shoulder tightness (PST). This cross-over design aims to compare the differences between a well-established procedure - the crossbody stretch - versus mobilisation with movement, on range of motion and pain pressure threshold of asymptomatic individuals with unilateral PST.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Mobilisation with movement (MWM) | Experimental | With the participant standing, the restricted shoulder will rest on the clinician's shoulder in the following starting position: 90 degrees of glenohumeral abduction and 90 degrees of elbow flexion and hand holding a treatment belt. The belt will loop around the clinician and patient and will be held by the participant's contralateral hand. The clinician will apply and sustain a pain free caudal or posterolateralcaudal humeral head mobilisation force (whichever is more comfortable to the subject), followed by an active internal rotation (IR) performed by the patient. The IR movement will be performed to a pain free end of range. If possible, an overpressure with be requested, this is achieved by pulling the belt with the contralateral hand. The overpressure should not produce pain, if it does, it will not be performed. 3 sets of 8 repetitions will be applied, sustaining the end of available range for 2 seconds. An interval of 45 seconds will be respected amongst the repetitions. |
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| Cross-body stretch | Active Comparator | With the participant standing, the restricted shoulder will be self-stretched by conducting a horizontal adduction in 90 degrees of shoulder flexion to a level tolerated by the participant. This position will be held for thirty seconds and repeated four times. An interval of forty five seconds will be respected amongst the repetitions. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Cross-body stretch (CBS) | Other | CBS is a self administered stretch that aims to stretch posterior shoulder structures |
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| Measure | Description | Time Frame |
|---|---|---|
| Horizontal adduction | Horizontal adduction in 90 degrees of shoulder flexion | change immediately after the intervention |
| Internal rotation | Internal rotation at 90 degrees of shoulder abduction | change immediately after the intervention |
| Measure | Description | Time Frame |
|---|---|---|
| Mechanical sensitivity | Pain pressure threshold with an algometer (Wagner instruments, FPX 25) | change immediately after the intervention |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Marcelo Faria Silva, PhD | Federal University of Health Science of Porto Alegre | Study Chair |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Faculdades Integradas de Taquara | Taquara | Rio Grande do Sul | 95612-150 | Brazil |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 12620608 | Background | Picavet HS, Schouten JS. Musculoskeletal pain in the Netherlands: prevalences, consequences and risk groups, the DMC(3)-study. Pain. 2003 Mar;102(1-2):167-78. doi: 10.1016/s0304-3959(02)00372-x. | |
| 29490601 | Background | Hall K, Borstad JD. Posterior Shoulder Tightness: To Treat or Not to Treat? J Orthop Sports Phys Ther. 2018 Mar;48(3):133-136. doi: 10.2519/jospt.2018.0605. |
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Data will be provided on reasonable request.
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| ID | Term |
|---|---|
| D009068 | Movement |
| ID | Term |
|---|---|
| D010829 | Physiological Phenomena |
| D009142 | Musculoskeletal Physiological Phenomena |
| D055687 | Musculoskeletal and Neural Physiological Phenomena |
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All measurements will be conducted by research assistants unaware of the interventions applied. Statistical analyses will be performed by a blinded research assistant.
| Mobilisation with movement (MWM) | Other | WMW is a musculoskeletal procedure that aims to improve restricted and/or painful range of movement |
|
| 32635824 | Background | Schwartz C, Croisier JL, Bruls O, Denoel V, Forthomme B. Tight shoulders: A clinical, kinematic and strength comparison of symptomatic and asymptomatic male overhead athletes before and after stretching. Eur J Sport Sci. 2021 May;21(5):781-791. doi: 10.1080/17461391.2020.1785015. Epub 2020 Jul 7. |
| 30921461 | Background | Rosa DP, Borstad JD, Ferreira JK, Camargo PR. The Influence of Glenohumeral Joint Posterior Capsule Tightness and Impingement Symptoms on Shoulder Impairments and Kinematics. Phys Ther. 2019 Jul 1;99(7):870-881. doi: 10.1093/ptj/pzz052. |
| 19966099 | Background | Tyler TF, Nicholas SJ, Lee SJ, Mullaney M, McHugh MP. Correction of posterior shoulder tightness is associated with symptom resolution in patients with internal impingement. Am J Sports Med. 2010 Jan;38(1):114-9. doi: 10.1177/0363546509346050. Epub 2009 Dec 4. |
| 28901811 | Background | Salamh PA, Kolber MJ, Hegedus EJ, Cook CE. The efficacy of stretching exercises to reduce posterior shoulder tightness acutely in the postoperative population: a single blinded randomized controlled trial. Physiother Theory Pract. 2018 Feb;34(2):111-120. doi: 10.1080/09593985.2017.1376020. Epub 2017 Sep 13. |
| 30287146 | Background | Salamh PA, Liu X, Kolber MJ, Hanney WJ, Hegedus EJ. The reliability, validity, and methodologic quality of measurements used to quantify posterior shoulder tightness: a systematic review of the literature with meta-analysis. J Shoulder Elbow Surg. 2019 Jan;28(1):178-185. doi: 10.1016/j.jse.2018.07.013. Epub 2018 Oct 1. |
| 27632891 | Background | Mine K, Nakayama T, Milanese S, Grimmer K. Effectiveness of Stretching on Posterior Shoulder Tightness and Glenohumeral Internal-Rotation Deficit: A Systematic Review of Randomized Controlled Trials. J Sport Rehabil. 2017 Jul;26(4):294-305. doi: 10.1123/jsr.2015-0172. Epub 2016 Aug 24. |
| 30902594 | Background | Salamh PA, Liu X, Hanney WJ, Sprague PA, Kolber MJ. The efficacy and fidelity of clinical interventions used to reduce posterior shoulder tightness: a systematic review with meta-analysis. J Shoulder Elbow Surg. 2019 Jun;28(6):1204-1213. doi: 10.1016/j.jse.2018.12.006. Epub 2019 Mar 20. |
| 31627965 | Background | Kang MH, Oh JS. 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 Jan;29(1):36-43. doi: 10.1016/j.jse.2019.08.007. Epub 2019 Oct 15. |
| 32742721 | Background | Hall K, Lewis J, Moore A, Ridehalgh C. Posterior shoulder tightness; an intersession reliability study of 3 clinical tests. Arch Physiother. 2020 Jul 29;10:14. doi: 10.1186/s40945-020-00084-w. eCollection 2020. |
| 28460708 | Result | Oliveira VMA, Pitangui ACR, Gomes MRA, Silva HAD, Passos MHPD, Araujo RC. Shoulder pain in adolescent athletes: prevalence, associated factors and its influence on upper limb function. Braz J Phys Ther. 2017 Mar-Apr;21(2):107-113. doi: 10.1016/j.bjpt.2017.03.005. Epub 2017 Mar 17. |