Comparison of Immediate Effects of Different Shoulder Stretching Techniques in Overhead Athletes

Study Overview
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Brief Summary
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81 overhead athletes with Glenohumeral Internal Rotation Deficit (GIRD) will be included in this study. Participants will be randomly divided into 3 different groups of 26 people. In each group will be applied posterior shoulder stretching exercises (PSSE) performed with different Muscle Energy Techniques (MET).

Detailed Description
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Post Isometric Relaxation Group (PIRG) participants will perform a PSSE with post isometric relaxation (PIR) technique, Isolytic Stretching Group (ISG) participants will perform a PSSE with isolytic stretching technique and Static Stretching Group Group (SSG) participants will perform a PSSE with static stretching technique. All exercises will be performed in the modified cross-body position. Subacromial space and posterior capsule thickness will be measured using a 7-12 MHz linear transducer with USG (LOGIQ e Ultrasound, GE Healthcare, USA). Athletes' GIRD results and rotational ROM measurements will be measured and recorded using a bubble inclinometer (Fabrication End Inc, New York, USA). The upper extremity functional performance of the athletes will be evaluated with the Functional Throwing Performance Index (FTPI). Evaluations will be repeated tree times before, after the stretching exercise and 30 minutes later and the effects of different muscle energy techniques (MET) will be compared. Investigators hypothesized PSSE made with different MET techniques have different effects on Acromio-Humeral Distance, posterior capsule thickness, rotational ROM measurements and performance on overhead athletes with GIRD and the effects of MET would be superior to static stretching.

Official Title
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Comparison of Immediate Effects of Different Posterior Shoulder Stretching Techniques in Overhead Athletes With Glenohumeral Internal Rotation Deficits

Conditions
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Glenohumeral Internal Rotation Deficit

Intervention / Treatment
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* Other: Post Isometric Relaxation Group
* Other: Isolytic Stretching Group
* Other: Static Stretching Group Group


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Being overhead athlete Glenohumeral internal rotation range of motion of the affected shoulder should be less than other shoulder and bilateral shoulder internal rotation range of motion difference should be ≥15 º Exclusion Criteria: Shoulder pain required medical attention for the last year. Current shoulder pain Cervical pain during upper extremity movement History of fracture to the shoulder girdle Systemic musculoskeletal disease History of shoulder surgery, Glenohumeral instability (positive apprehension, relocation, or positive sulcus test) or positive findings for a full thickness rotator cuff tear (positive lag sign, positive drop arm test, or marked weakness with shoulder external rotation)

Ages Eligible for Study
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Minimum Age: 13 Years
Maximum Age: 40 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Post Isometric Relaxation Group<br>The participants in this group will receive post isometric relaxation stretching in modified cross body position. | Other: Post Isometric Relaxation Group<br>* Athletes will be positioned in a modified cross-body position. They will be asked to actively bring their underlying arm in the direction of horizontal adduction up to the physiological barrier barrier. The participants will be asked to perform an isometric contraction for 5 seconds in the horizontal abduction direction with 20% of the maximum muscle strength. After the relaxation, the arm will be moved towards horizontal adduction and 15 seconds active-assistive stretching will be applied. Participants will be given a 5-second rest period between contractions. This stretching exercise will be applied in 5 repetitions for one session.<br>|
| Experimental: Isolytic Stretching Group<br>The participants in this group will receive isolytic stretching in modified cross body position. | Other: Isolytic Stretching Group<br>* Athletes will be positioned in a modified cross-body position. They will be asked to actively bring their underlying arm in the direction of horizontal adduction up to the physiological barrier barrier. The participants will be asked to perform a contraction in the horizontal abduction direction with 20% of the maximum muscle strength. When the muscle contraction occurs, the arm will be moved quickly in 2-4 seconds towards horizontal adduction and 15 seconds active-assistive stretching will be applied. Participants will be given a 5-second rest period between stretches. This stretching exercise will be applied in 5 repetitions for one session.<br>|
| Experimental: Static Stretching Group Group<br>The participants in this group will receive static stretching in modified cross body position. | Other: Static Stretching Group Group<br>* Athletes will be positioned in a modified cross-body position. They will be asked to actively bring their underlying arm in the direction of horizontal adduction up to the physiological barrier. Then, the arm will be moved towards horizontal adduction and 15 seconds active-assistive stretching will be applied. Participants will be given a 5-second rest period between stretching exercises. This stretching exercise will be applied in 5 repetitions for one session.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Shoulder internal rotation range of motion | Change of shoulder internal rotation range of motion (with bubble inclinometer) | baseline measurements, 3 minutes and 30 minutes | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Subacromial space | Change of subacromial space ( with Ultrasound) | baseline measurements, 3 minutes and 30 minutes | 
| Posterior capsule thickness | Change of posterior capsule thickness ( with Ultrasound) | baseline measurements, 3 minutes and 30 minutes | 
| Functional Throwing Performance Index | Participants will throw a ball to shot a frame on a wall. Number of correct shots will be recorded | baseline measurements, 3 minutes and 30 minutes | 
| Shoulder Total rotation range of motion | Change of shoulder internal rotation + external rotation range of motion (with bubble inclinometer) | baseline measurements, 3 minutes and 30 minutes | 
| Posterior shoulder tightness | Change of posterior shoulder tightness (with bubble inclinometer) | baseline measurements, 3 minutes and 30 minutes |