Effect of a Novel Stretching Technique on Shoulder Range of Motion and Voluntary Contraction in Overhead Athletes With Glenohumeral Internal Rotation Deficits "GIRD" (GIRD)

• ClinicalTrials.gov Identifier: NCT03044236
• Recruitment Status: Completed
• First Posted: February 6, 2017
• Last Update Posted: June 11, 2019
• Sponsor: Loma Linda University
• Information provided by (Responsible Party): Everett Lohman, Loma Linda University

Study Description

Brief Summary:

To examine and compare the effect of a novel stretching technique and traditional stretching on glenohumeral range of motion, strength, maximum voluntary contraction, pain, and subject satisfaction in overhead athletes with glenohumeral internal rotation deficits through a randomized clinical study.

Condition or disease	Intervention/treatment	Phase
Glenohumeral Internal Rotation Deficits	Procedure: Stretching	Not Applicable

Detailed Description:

To examine and compare the effect of a novel stretching technique and traditional stretching on glenohumeral range of motion, strength, maximum voluntary contraction, pain, and subject satisfaction in overhead athletes with glenohumeral internal rotation deficits through a randomized clinical study. The investigators hypothesize that this type of novel intervention will help subjects with GIRD to restore range of motion, experience less pain and maintain the strength and motor unit recruitment following the novel intervention. This will help us to assess the potential beneficial effect of such intervention and to fill the gap in knowledge and help health care professionals to adequately select the right treatment modality.

Independent Variable

1. Type of Intervention:

• Traditional Stretching (Modified Sleep Stretch). VS
• Novel Stretching (Active Shoulder Internal Rotation while Bridging) 2. Time

• Pre VS post intervention Dependent Variables

  1. Glenohumeral internal rotation ROM
  2. Maximal glenohumeral external rotation isometric strength.
  3. Mean motor unit recruitment (EMG) of the glenohumeral external rotator (infraspinatus) and internal rotators (pectoralis major and latissumus dorsi)
  4. Pain
  5. Subject satisfaction

Instrumentation :

1. Glenohumeral internal & external rotation ROM: will be measured at baseline and at week four-post intervention for all participants. We will use the digital inclinometer. Research by (Kolber et al.,2011 ) showed this instrument to be reliable with an intra-rater ICC =0.87 and inter-rater ICC =0.93
2. Electronic push/pull dynamometer: At the end feel ROM, and before ROM is measured, the therapist will apply the same amount of pressure to all subjects to ensure reliable/ valid ROM measurements.
3. Maximal Glenohumeral External Rotation Isometric Strength will be measured using a MicroFET2 handheld digital dynamometer. This device was shown to be reliable with an intra-rater ICC =0.85 and inter-rater ICC =0.85.
4. Maximum Voluntary Contraction: will be measured using a 44 Delsys Bagnoli portable surface electromyography (sEMG) system.
5. Pain: will be measured using the Numeric Pain Rating Scale (NPRS). The NPRS has shown to have a valid, reliable and appropriate for use in clinical practice

Procedures:

All participants will perform the static stretching (SS) conditions by themselves. The two stretching techniques will be home-based program.

Study Design

• Study Type: Interventional (Clinical Trial)
• Actual Enrollment: 56 participants
• Allocation: Randomized
• Intervention Model: Parallel Assignment
• Masking: Single (Participant)
• Primary Purpose: Treatment
• Official Title: Effect of a Novel Stretching Technique on Shoulder Range of Motion and Maximum Voluntary Contraction in Overhead Athletes With Glenohumeral Internal Rotation Deficits: A Randomized Control Trial
• Actual Study Start Date: April 19, 2017
• Actual Primary Completion Date: March 19, 2019
• Actual Study Completion Date: June 1, 2019

Arms and Interventions

Arm	Intervention/treatment
Experimental: Novel Stretching Technique; Participants will perform the novel stretch in a supine position. Participants will place a small ball between their knees and squeeze the ball. Participants will be then bridge as high as possible . Participants will then flex their shoulder and elbow to 90°, and actively rotate to the end of ROM. Participants will use the other hand to push to the point of mild discomfort and simultaneously maintain contraction while progressing the stretch.	Procedure: Stretching; The novel stretching technique will be done on a supine position. subjects will be asked bridge as high as possible. After That, Participants will then flex their shoulder and elbow to 90°. Participants will use the other hand to push to the point of mild discomfort and simultaneously maintain contraction while progressing the stretch.
Active Comparator: Traditional Stretching Technique; Participants will perform the modified sleeper stretch in a side-lying position on the side of the throwing shoulder with the throwing shoulder and elbow flexed to 90° . The participants will be instructed to allow the throwing shoulder to naturally fall into internal rotation to the end ROM where resistance will be felt . The participants will be then instructed to use the non-throwing hand to push the throwing shoulder into further internal rotation to the point of mild discomfort by applying pressure at the area of the wrist joint.	Procedure: Stretching; The novel stretching technique will be done on a supine position. subjects will be asked bridge as high as possible. After That, Participants will then flex their shoulder and elbow to 90°. Participants will use the other hand to push to the point of mild discomfort and simultaneously maintain contraction while progressing the stretch.

Outcome Measures

Primary Outcome Measures :

1. Glenohumeral internal rotation ROM [ Time Frame: Change from baseline at week 4 ]
   The investigators will use the digital inclinometer

Secondary Outcome Measures :

1. Maximal glenohumeral external rotation isometric strength [ Time Frame: Change from baseline at week 4 ]
   will be measured using a MicroFET2 handheld digital dynamometer

Other Outcome Measures:

1. Mean motor unit recruitment (EMG) of the glenohumeral external rotator (infraspinatus) and internal rotators (pectoralis major and latissumus dorsi) [ Time Frame: Change from baseline at week 4 ]
   will be measured using surface electromyography (sEMG) system
2. Pain will be measured using the Numeric Pain Rating Scale [ Time Frame: Change from baseline at week 4 ]
   will be measured using the Numeric Pain Rating Scale
3. Subject satisfaction will be measured using the Subject satisfaction Form [ Time Frame: Week 4 ]
   will be measured using the Subject satisfaction Form

Eligibility Criteria

• Ages Eligible for Study: 18 Years to 45 Years (Adult)
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: Yes

Criteria

Inclusion Criteria:

• Participants must be between the age of 18 and 45.
• Perform overhead sports activities in the past 3 months.
• Participants are required to display ≥ 20° less glenohumeral internal rotation ROM in their dominant shoulder compare to the non- dominate shoulder.
• Participants will be included with or without pain during shoulder activities.

Exclusion Criteria:

• Will exclude participants who are still recovering from previous surgery of the shoulder and elbow complex in the past 3 months, and currently receiving medical intervention for the shoulder.

Contacts and Locations

Locations

United States, California

Loma Linda U

Loma Linda, California, United States, 92354

Sponsors and Collaborators

Loma Linda University

Investigators

• Principal Investigator: Everett Lohman, DSc; Loma Linda University

More Information

Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):

Gharisia O, Lohman E, Daher N, Eldridge A, Shallan A, Jaber H. Effect of a novel stretching technique on shoulder range of motion in overhead athletes with glenohumeral internal rotation deficits: a randomized controlled trial. BMC Musculoskelet Disord. 2021 Apr 30;22(1):402. doi: 10.1186/s12891-021-04292-8.

• Responsible Party: Everett Lohman, Professor, Loma Linda University
• ClinicalTrials.gov Identifier: NCT03044236
• Other Study ID Numbers: 5170032
• First Posted: February 6, 2017
• Last Update Posted: June 11, 2019
• Last Verified: August 2018

Individual Participant Data (IPD) Sharing Statement:

• Plan to Share IPD: No

• Studies a U.S. FDA-regulated Drug Product: No
• Studies a U.S. FDA-regulated Device Product: No