Comparative Effects of Two Procedures for the Management of Posterior Shoulder Tightness

Study Overview
=================
Brief Summary
-----------------
This study aims to compare the effects of a self-stretch procedures versus a clinician applied musculoskeletal procedure in individuals with posterior shoulder tightness.

Detailed Description
-----------------
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.

Official Title
-----------------
Comparative Effects of Two Procedures for the Management of Posterior Shoulder Tightness

Conditions
-----------------
Posterior Shoulder Tightness

Intervention / Treatment
-----------------
* Other: Cross-body stretch (CBS)
* Other: Mobilisation with movement (MWM)


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Asymptomatic individuals without any history of shoulder pain necessitating medical attention. Presence of unilateral restriction of at least 10 degrees of internal rotation deficit during the internal rotation mobility test in 90 degrees of shoulder abduction. Exclusion Criteria: Asymptomatic individuals that present with shoulder pain on the assessment day. Individuals with chronic conditions not affecting the shoulder. Individuals with clinical depression. Individuals that used analgesic and/or anti-inflammatory medication in the previous 24 hours of assessment. Individuals with fibromialgia. Individuals engaged in overhead sports.

Ages Eligible for Study
-----------------
Minimum Age: 18 Years
Maximum Age: 45 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
Accepts Healthy Volunteers

Study Plan
=================
How is the study designed?
-----------------

Design Details

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


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Mobilisation with movement (MWM)<br>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. | Other: Mobilisation with movement (MWM)<br>* WMW is a musculoskeletal procedure that aims to improve restricted and/or painful range of movement<br>|
| Active Comparator: Cross-body stretch<br>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. | Other: Cross-body stretch (CBS)<br>* CBS is a self administered stretch that aims to stretch posterior shoulder structures<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | 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 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Mechanical sensitivity | Pain pressure threshold with an algometer (Wagner instruments, FPX 25) | change immediately after the intervention |