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Phys. Ther. Korea 2023; 30(1): 59-67

Published online February 20, 2023

https://doi.org/10.12674/ptk.2023.30.1.59

© Korean Research Society of Physical Therapy

Comparative Effects of Novel Modified Sleeper and Cross-body Stretching on Scapular Anterior Tilting and Shoulder Internal Rotation in Subjects With Anterior Tilted Scapular and Shoulder Internal Rotation Deficits

Yeonghun Han1 , PT, MSc, Chung-hwi Yi2 , PT, PhD, Woochol Joseph Choi3 , PT, PhD, Oh-yun Kwon2,4 , PT, PhD

1Department of Ergonomic Therapy, The Graduate School of Health and Environment, Yonsei University, 2Department of Physical Therapy, College of Software and Digital Healthcare Convergence, Yonsei University, 3Injury Prevention and Biomechanics Laboratory, Department of Physical Therapy, Yonsei University, 4Kinetic Ergocise Based on Movement Analysis Laboratory, Wonju, Korea

Correspondence to: Oh-yun Kwon
E-mail: kwonoy@yonsei.ac.kr
https://orcid.org/0000-0002-9699-768X

Received: January 17, 2023; Revised: January 28, 2023; Accepted: January 30, 2023

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

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Background: Posterior capsule tightness (PCT), commonly seen in overhead athletes, is a soft tissue adaptation that is also noted in non-throwers. PCT is associated with scapular and humeral kinematic alterations, significant restriction of shoulder internal rotation (IR) range of motion (ROM), and significant scapular anterior tilting. Sleeper and cross-body stretches (CBS) are suggested for PCT and IR deficits, and have been modified since introduction. A novel modified sleeper stretch (NMSS) was designed in this study to prevent the risk of anterior translation of the humeral head. Though the effects of posterior shoulder stretching exercise have been widely studies, to the best of our knowledge, no previous studies have investigated the effectiveness of posterior shoulder exercises in decreasing scapular anterior tilting. Objects: To compare the immediate effects of two posterior shoulder stretching exercises (NMSS and CBS) on scapular anterior tilting and shoulder IR ROM.
Methods: Thirty-two subjects with anteriorly tilted scapula and IR deficits [mean age: 24.3 ± 2.5 years; 15 males and 17 females] participated in this study. Subjects were randomly assigned to either the NMSS or CBS groups. Scapular anterior tilting (at rest and at shoulder 60° active IR) and shoulder IR ROM were measured before and immediately after intervention.
Results: Scapular anterior tilting significantly decreased, while the shoulder IR ROM significantly increased in both groups. However, there was no significant group-by-time interaction effect or significant difference between the groups.
Conclusion: Both stretching exercises were effective in restoring shoulder IR ROM and decreasing scapular anterior tilting.

Keywords: Joint capsule, Range of motion, Scapula, Shoulder, Stretching

Article

Original Article

Phys. Ther. Korea 2023; 30(1): 59-67

Published online February 20, 2023 https://doi.org/10.12674/ptk.2023.30.1.59

Copyright © Korean Research Society of Physical Therapy.

Comparative Effects of Novel Modified Sleeper and Cross-body Stretching on Scapular Anterior Tilting and Shoulder Internal Rotation in Subjects With Anterior Tilted Scapular and Shoulder Internal Rotation Deficits

Yeonghun Han1 , PT, MSc, Chung-hwi Yi2 , PT, PhD, Woochol Joseph Choi3 , PT, PhD, Oh-yun Kwon2,4 , PT, PhD

1Department of Ergonomic Therapy, The Graduate School of Health and Environment, Yonsei University, 2Department of Physical Therapy, College of Software and Digital Healthcare Convergence, Yonsei University, 3Injury Prevention and Biomechanics Laboratory, Department of Physical Therapy, Yonsei University, 4Kinetic Ergocise Based on Movement Analysis Laboratory, Wonju, Korea

Correspondence to:Oh-yun Kwon
E-mail: kwonoy@yonsei.ac.kr
https://orcid.org/0000-0002-9699-768X

Received: January 17, 2023; Revised: January 28, 2023; Accepted: January 30, 2023

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background: Posterior capsule tightness (PCT), commonly seen in overhead athletes, is a soft tissue adaptation that is also noted in non-throwers. PCT is associated with scapular and humeral kinematic alterations, significant restriction of shoulder internal rotation (IR) range of motion (ROM), and significant scapular anterior tilting. Sleeper and cross-body stretches (CBS) are suggested for PCT and IR deficits, and have been modified since introduction. A novel modified sleeper stretch (NMSS) was designed in this study to prevent the risk of anterior translation of the humeral head. Though the effects of posterior shoulder stretching exercise have been widely studies, to the best of our knowledge, no previous studies have investigated the effectiveness of posterior shoulder exercises in decreasing scapular anterior tilting. Objects: To compare the immediate effects of two posterior shoulder stretching exercises (NMSS and CBS) on scapular anterior tilting and shoulder IR ROM.
Methods: Thirty-two subjects with anteriorly tilted scapula and IR deficits [mean age: 24.3 ± 2.5 years; 15 males and 17 females] participated in this study. Subjects were randomly assigned to either the NMSS or CBS groups. Scapular anterior tilting (at rest and at shoulder 60° active IR) and shoulder IR ROM were measured before and immediately after intervention.
Results: Scapular anterior tilting significantly decreased, while the shoulder IR ROM significantly increased in both groups. However, there was no significant group-by-time interaction effect or significant difference between the groups.
Conclusion: Both stretching exercises were effective in restoring shoulder IR ROM and decreasing scapular anterior tilting.

Keywords: Joint capsule, Range of motion, Scapula, Shoulder, Stretching

Fig 1.

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Figure 1.Scapular anterior tilting measurement at rest. The length shown on display (distance from lower jaw's tip to upper jaw's tip) plus the length of the lower jaw (1,500 mm) was measured.
Physical Therapy Korea 2023; 30: 59-67https://doi.org/10.12674/ptk.2023.30.1.59

Fig 2.

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Figure 2.Flowchart of the study. NMSS, novel modified sleeper stretch; CBS, cross-body stretch.
Physical Therapy Korea 2023; 30: 59-67https://doi.org/10.12674/ptk.2023.30.1.59

Fig 3.

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Figure 3.Novel modified sleeper stretch.
Physical Therapy Korea 2023; 30: 59-67https://doi.org/10.12674/ptk.2023.30.1.59

Fig 4.

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Figure 4.Cross-body stretch.
Physical Therapy Korea 2023; 30: 59-67https://doi.org/10.12674/ptk.2023.30.1.59

Fig 5.

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Figure 5.Scapular anterior tilting measurement at shoulder 60° active internal rotation.
Physical Therapy Korea 2023; 30: 59-67https://doi.org/10.12674/ptk.2023.30.1.59

Fig 6.

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Figure 6.Shoulder internal rotation range of motion measurement.
Physical Therapy Korea 2023; 30: 59-67https://doi.org/10.12674/ptk.2023.30.1.59

Fig 7.

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Figure 7.Comparison of scapular anterior tilting and shoulder IR ROM in the NMSS and CBS between pre- and post-stretch. (A) Scapular anterior tilting at rest, (B) scapular anterior tilting at shoulder 60° active IR, and (C) shoulder IR ROM. NMSS, novel modified sleeper stretch; CBS, cross-body stretch; IR, internal rotation; ROM, range of motion. *p < 0.05.
Physical Therapy Korea 2023; 30: 59-67https://doi.org/10.12674/ptk.2023.30.1.59

Table 1 . General characteristics of the subjects (N = 32).

VariableNMSS group (n = 16)CBS group (n = 16)p-value
Sex (male/female)8/87/90.723a
Dominant arm (right/left)14/216/00.144a
Age (y)24.6 ± 2.824.1 ± 2.50.640b
Height (cm)170.9 ± 7.9167.2 ± 7.40.179b
Weight (kg)66.1 ± 12.860.9 ± 12.40.254b
BMI (kg/m2)22.5 ± 3.021.7 ± 3.50.495b

Values are presented as number only or mean ± standard deviation. NMSS, novel modified sleeper stretch; CBS, cross-body stretch; BMI, body mass index. aχ2-test. bIndependent t-test..

Table 2 . Comparison of scapular anterior tilting and shoulder IR ROM between pre- and post-stretch (N = 32).

VariableNMSS groupCBS groupGroupTimeGroup × Time
PrePostPrePostp-value
AT rest (cm)5.80 ± 1.085.05 ± 1.025.26 ± 1.324.51 ± 1.330.191< 0.001*0.968
AT 60˚ (cm)4.36 ± 1.123.95 ± 0.924.20 ± 1.293.77 ± 1.250.666< 0.001*0.859
IR ROM (˚)46.69 ± 2.6163.04 ± 8.0345.23 ± 1.7665.08 ± 7.240.844< 0.001*0.203

Values are presented as mean ± standard deviation. NMSS, novel modified sleeper stretch; CBS, cross-body stretch; AT rest, scapular anterior tilting at rest; AT 60°, scapular anterior tilting at shoulder active 60˚ internal rotation; IR ROM, shoulder internal rotation range of motion. *p < 0.05, by two-way mixed ANOVA..

Table 3 . Paired t-test analysis within each group (N = 32).

VariableGroupMean ± SDtpEffect size
AT rest (cm)NMSS0.74 ± 0.694.322< 0.001*1.08
CBS0.75 ± 0.446.840< 0.001*1.71
AT 60˚ (cm)NMSS0.41 ± 0.433.0190.002*0.94
CBS0.44 ± 0.443.9950.001*1.00
IR ROM (˚)NMSS–16.36 ± 7.71–8.490< 0.001*–2.12
CBS–19.85 ± 7.51–10.568< 0.001*–2.64

SD, standard deviation; AT rest, scapular anterior tilting at rest; AT 60°, scapular anterior tilting at shoulder 60˚ active internal rotation; IR ROM, shoulder internal rotation range of motion; NMSS, novel modified sleeper stretch; CBS, cross-body stretch. *p < 0.05, by paired t-test..