Modified Cross Body Stretch Verses Modified Sleeper Stretch in Basketball Players for Posterior Capsule Tightness

Study Overview
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Brief Summary
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The aim of this research is to compare the effect of modified cross body stretch and modified sleeper stretch on pain, range of motion, disability and throwing ability in athletes with posterior capsule tightness. Randomized controlled trials done at International Islamic University. The sample size was 32. The subjects were divided in two groups, 16 subjects in modified cross body stretch group and 16 in modified sleeper stretch group. Study duration was of 6 months. Sampling technique applied was non probability connivance sampling technique. Tools used in the study are PENN shoulder score, gonoiometer, thumb up back(TUB) and seated basketball throw test(SBBT). Data was be analyzed through SPSS 21.

Detailed Description
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Basketball is considered as the highly demanding sports due to high demand and complexity of the game. The overhead throwing activities makes it more vulnerable to the injuries. In repetitive throwing there are different type of violet forces placed on shoulder joint It causes adaptation in soft tissue anatomically which in turn limits ROM of shoulder joint and Posterior shoulder tightness. Posterior capsule tightness can result due to abnormal humeral head motion which decreases subacromial space during overhead activities leading to compression of tissues causing limited shoulder flexion, internal rotation and horizontal adduction. Posterior capsule tightening occurs when the capsular tissue and musculature of the shoulder tighten, usually due to repeated overload in the eccentric portion of arm deceleration. This loss of internal rotation results from contracture and tightening of the posterior inferior portion of the glenohumeral joint capsule, which occurs from the repetitive microtrauma imparted during the deceleration phase of the throwing motion. Repetitive throwing motion creates adaptive increased external rotation and decreased internal rotation in the dominant shoulder joint which is termed as GIRD (Glenohumeral internal rotation deficit).Posterior capsule tightness is often treated without surgery. It can be treated by strengthening, stretching, neuromuscular control exercises. Strengthening protocol can perform specifically on Weak muscles by using resistance and weight. The neuromuscular training helps the body to act and react on different pattern of stress demand on it through neural pathways. The mainstay of the posterior capsule tightness treatment for athlete is the stretching of the posterior capsule. One author proposed the modified forms, the modified sleeper stretch and the modified cross body stretch. And found these modified stretching more effective and beneficial than the sleeper and cross body stretch Literature review: Kevin et al investigated the acute effects of sleeper stretch on posterior shoulder tightness and internal rotation of shoulder. There was significant improvement in results. A study conducted in 2018 to determine whether posterior shoulder stretch was effective in increasing internal rotation and horizontal adduction ROM in volleyball and tennis players with internal rotation deficit >¬¬15 degrees. The intervention group performs the sleeper stretch daily for 8 weeks. Results showed significant improvement in internal rotation and horizontal adduction. Another article was published in 2014, with the aim to compare the effects of horizontal adduction stretch with scapular stabilization versus horizontal adduction stretch without scapular stabilization on posterior shoulder tightness and passive internal rotation. Results showed significant improvement among the scapular stabilization group. A RCT conducted in which each subject completed stretching interventions for two days. Purpose of the study was to investigate acute effects of modified sleeper stretch and modified cross body stretch on posterior shoulder tightness and glenohumral internal rotation deficit with more than 10-degree loss.

Official Title
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Comparison of Modified Cross Body Stretch and Modified Sleeper Stretch in Basketball Players for Posterior Capsule Tightness in Basketball Players

Conditions
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Shoulder Capsulitis

Intervention / Treatment
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* Other: Modified cross body stretch
* Other: Modified sleeper stretch


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Basketball Players Internal rotation deficit greater than 20° degrees BMI 18.5-24.9 Exclusion Criteria: Having a systemic pathology including inflammatory joint disease Having musculoskeletal or neurological disease Having taken anti-inflammatory medication

Ages Eligible for Study
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Minimum Age: 15 Years
Maximum Age: 30 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: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Modified cross body stretch<br>modified cross body stretch | Other: Modified cross body stretch<br>* Athlete was in side lying positioned. trunk was moved posteriorly 200 to 300 and shoulder is raised to 900 and semi flex both knees. Athlete was ask to passively pull the humerus across the body into horizontal adduction with the opposite hand. 5 reps once daily 3 sets for 4 weeks was given<br>|
| Experimental: Modified sleeper stretch<br>modified sleeper stretch | Other: Modified sleeper stretch<br>* Athlete was in side lying positioned on the involved side, trunk was rolled posteriorly 200 to 300 and shoulder is raised to 900 and elbow is flexed to 900 and semiflex both knees. athlete was ask to perform internal rotation passively by using the opposite arm. 5 reps once daily 3 sets for 4 weeks was given<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| PENN shoulder score | The disability of shoulder conditions was measured by Penn score. Which consists of 3 categories i.e.; pain, satisfaction and functional ability. Pain consists of 3 questionnaires that consists of 10 scores each (total 30) and then satisfaction, it consists of 1 questionnaire consists of 10 scores, functional ability consists of 20 questionnaires with 10 scores each for the questionnaire (total 60) | 4th week | 
| Seated basketball throw | SBBT (seated basketball throws) was used to test the explosiveness of the upper extremity. | 4th week | 
| Thumb up back(TUB) | (Thumb-up-the back- measurement) was used to measure the ability to actively move thumb up the back with the help of inch tape. | 4th week | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Shoulder ROM (flexion) | Changes from the Baseline ROM range of Motion of Shoulder flexion was taken with the Help of Goniometer | 4th week | 
| Shoulder ROM Extension | Changes from the Baseline ROM range of Motion of Shoulder extension was taken with the Help of Goniometer | 4th week | 
| Shoulder ROM abduction | Changes from the Baseline ROM range of Motion of shoulder abduction was taken with the Help of Goniometer | 4th week | 
| Shoulder ROM adduction | Changes from the Baseline ROM range of Motion of shoulder adduction was taken with the Help of Goniometer | 4th week | 
| Shoulder ROM external rotation | Changes from the Baseline ROM range of Motion of Shoulder external rotation was taken with the Help of Goniometer | 4th week | 
| Shoulder ROM internal rotation | Changes from the Baseline ROM range of Motion of Shoulder internal rotation was taken with the Help of Goniometer | 4th week | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Modified cross body stretch, Modified sleeper stretch, Posterior capsule tightness, Range of motion, Seated basketball throw, Thumb up back