Comparison of The Effects of Different Stretching Techniques in Overhead Athletes

Study Overview
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Brief Summary
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78 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 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 crossbody position, for 5 times a week total of 6 weeks. Subacromial space, posterior capsule and muscle tendon thicknesses 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 and Posterior shoulder tightness will be measured and recorded using a bubble inclinometer (Fabrication End Inc, New York, USA). Scapula kinematics (posterior tilt, upward rotation) will be evaluated with a digital inclinometer. Shoulder and scapular muscles will be evaluated with hend held dynamometer. Tightness of Levator scapulae and pectoralis minor will be assessed. The upper extremity functional performance of the athletes will be evaluated with the Functional Throwing Performance Index (FTPI). Evaluations will be performed before training program and repeated after 6 weeks of training, and at the 1st, 3th and 6th months after training program is completed and the effects of different muscle energy techniques (MET) will be compared. Investigators hypothesized 6 weeks of PSSE with different MET would have different effects on Acromio-Humeral Distance, posterior capsule thickness, muscle tendon thickness, rotational ROM measurements, scapula kinematics, muscle strength, posterior shoulder tightness 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 The Effects of Different Stretching Techniques in Overhead Athletes With Glenohumeral Internal Rotation Deficit

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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Accepts Healthy Volunteers

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: Post Isometric Relaxation Group<br>The participants in this group will perform post isometric relaxation stretching in modified cross body position for 6 weeks. | 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 in one session for 6 weeks 5 times a week.<br>|
| Experimental: Isolytic Stretching Group<br>The participants in this group will perform isolytic stretching in modified cross body position for 6 weeks.. | 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 in one session for 6 weeks 5 times a week.<br>|
| Experimental: Static Stretching Group Group<br>The participants in this group will receive static stretching in modified cross body position for 6 weeks. | 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 in one session for 6 weeks 5 times a week.<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, 6 weeks of training, at the 1st, 3th and 6th months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Subacromial space | Change of subacromial space ( with Ultrasound) | baseline, 6 weeks of training, at the 1st, 3th and 6th months | 
| Posterior shoulder tightness | Change of posterior shoulder tightness (with bubble inclinometer) | baseline, 6 weeks of training, at the 1st, 3th and 6th months | 
| Shoulder Total rotation range of motion | Change of shoulder internal rotation + external rotation range of motion (with bubble inclinometer) | baseline, 6 weeks of training, at the 1st, 3th and 6th months | 
| Functional Throwing Performance Index | Participants will throw a ball to shot a frame on a wall. Number of correct shots will be recorded. | baseline, 6 weeks of training, at the 1st, 3th and 6th months | 
| Posterior capsule thickness | Change of posterior capsule thickness ( with Ultrasound) | baseline, 6 weeks of training, at the 1st, 3th and 6th months | 
| Muscle tendon thickness | Change of supraspinatus, infraspinatus and teres minor tendon thicknesses ( with Ultrasound) | baseline, 6 weeks of training, at the 1st, 3th and 6th months | 
| Scapula kinematics | Posterior tilt and upward rotation of the scapula during arm elevation (with digital inclinometer) | baseline, 6 weeks of training, at the 1st, 3th and 6th months | 
| Muscle Shortness | Levator scapula and pectoralis minor shortness (with caliper and tape measure) | baseline, 6 weeks of training, at the 1st, 3th and 6th months | 
| Eccentric strength | Change of shoulder abduction and external rotation eccentric strength (in kg, with hand held dynamometer) | baseline, 6 weeks of training, at the 1st, 3th and 6th months | 
| Isometric strength | Change of lower trapezius muscle, serratus anterior and rotator cuff muscles isometric strength (in kg, with hand held dynamometer) | baseline, 6 weeks of training, at the 1st, 3th and 6th months |