Effects of stretching and manual therapy on shoulder range of motion

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Massage Therapy and Pitching

Stretching and Manual Therapy

Changes in the passive elastic properties of skeletal muscle can be induced by stretch training, this has been demonstrated.

  • In one study 8 weeks of high-intensity stretch training on biceps femoris induced architectural adaptation and improved range of motion (Freitas et al. 2015).
  • In another study - 3 weeks of twice daily stretch training (4 × 30 s) lead to an increase in dorsiflexion range of motion (ROM)  a 28% increase in passive joint moment (Blazevich et al. 2014). 
  • A similar study showed that 6 weeks of stretch training of the plantar flexors resulted in hypertrophic like adaptations of the gastrocnemius. (Simpson et al. 2017)

In these studies it is proposed that improved range of motion is due to both neurological increases in stretch tolerance AND changes in passive properties of muscle. In terms of performance care, this basic supporting science may help design rehabilitation programs for overhead athletes.

Massage therapy for Overhead Athletes

It has been documented that changes in rotator cuff stiffness are associated with the ROM deficits in pitchers, so rehabilitation programs that decrease tissue stiffness and improve range of motion have potential clinical implications for injury prevention.

If the goal is improving shoulder range of motion, a number of papers have demonstrated the effects of soft tissue mobilization or stretch training on tissue stiffness, shoulder internal rotation and horizontal adduction.  

  • 4 weeks of soft tissue mobilization had an affect on tissue stiffness, shoulder internal rotation and horizontal adduction in baseball players with posterior shoulder tightness (Yamauchi et al. 2016).
  • Modified cross body stretch and modified sleeper stretch leads to decreased the stiffness of the teres minor and infraspinatus (Umehara et al. 2017)
  • Instrumented manual therapy with self-stretching significantly reduces ROM risk factors in baseball players with motion deficits (Bailey et al. 2017)
  • A 4-week treatment program of manual therapy or dry needling demonstrated a significant improvement in pain pressure threshold, muscle elasticity, and stiffness of neck and shoulder muscles (De Meulemeester et al. 2017).

More to Explore

Apostolopoulos, N., Metsios, G.S., ... Wyon, M.A. (2015). The relevance of stretch intensity and position-a systematic review. Front Psychol.
https://www.ncbi.nlm.nih.gov/pubmed/26347668

Bailey, L.B., Thigpen, C.A., Hawkins, R.J., Beattie, P.F., Shanley, E. (2017). Effectiveness of Manual Therapy and Stretching for Baseball Players With Shoulder Range of Motion Deficits. Sports Health.
https://www.ncbi.nlm.nih.gov/pubmed/28402756

Bailey, L.B., Shanley, E., Hawkins, R., Beattie, P.F., Fritz, S., Kwartowitz, D., Thigpen, C.A. (2015). Mechanisms of Shoulder Range of Motion Deficits in Asymptomatic Baseball Players. Am J Sports Med.
https://www.ncbi.nlm.nih.gov/pubmed/26403207

Cheatham, S.W., Lee, M., Cain, M., Baker, R. (2016). The efficacy of instrument assisted soft tissue mobilization: a systematic review. J Can Chiropr Assoc. 
https://www.ncbi.nlm.nih.gov/pubmed/27713575 (OPEN ACCESS)

De Meulemeester, K.E., Castelein, B., Coppieters, I., Barbe, T., Cools, A., Cagnie, B. (2017). Comparing Trigger Point Dry Needling and Manual Pressure Technique for the Management of Myofascial Neck/Shoulder Pain: A Randomized Clinical Trial. J Manipulative Physiol Ther. https://www.ncbi.nlm.nih.gov/pubmed/28017188

Gerber, L.H., Sikdar, S., Aredo, J.V., Armstrong, K., Rosenberger, W.F., Shao, H., Shah, J.P. (2017). Beneficial Effects of Dry Needling for Treatment of Chronic Myofascial Pain Persist for 6 Weeks After Treatment Completion. PM R.
https://www.ncbi.nlm.nih.gov/pubmed/27297448

Gigliotti, D., Xu, M.C., Davidson, M.J., Macdonald, P.B., Leiter, J.R., Anderson, J.E. (2017). Fibrosis, low vascularity, and fewer slow fibers after rotator-cuff injury. Muscle Nerve.
https://www.ncbi.nlm.nih.gov/pubmed/2757128

Kim, S.Y., Ko, J.B., Farthing, J.P., Butcher, S.J. (2015). Investigation of supraspinatus muscle architecture following concentric and eccentric training. J Sci Med Sport.
https://www.ncbi.nlm.nih.gov/pubmed/24969812

Nordez, A., Gross, R., Andrade, R., Le Sant, G., Freitas, S., Ellis, R., McNair, P.J., Hug, F. (2017). Non-Muscular Structures Can Limit the Maximal Joint Range of Motion during Stretching. Sports Med.
https://www.ncbi.nlm.nih.gov/pubmed/28255938 

Parravicini, G., Bergna, A., (2017). Biological effects of direct and indirect manipulation of the fascial system. Narrative review, Journal of Bodywork & Movement Therapies.
http://www.bodyworkmovementtherapies.com/article/S1360-8592(17)30004-9/fulltext 

Thompson, W. R., Scott, A., Loghmani, M. T., Ward, S. R., & Warden, S. J. (2016). Understanding Mechanobiology: Physical Therapists as a Force in Mechanotherapy and Musculoskeletal Regenerative Rehabilitation. Physical Therapy. 
https://www.ncbi.nlm.nih.gov/pubmed/26637643 (OPEN ACCESS)

Umehara, J., Hasegawa, S., Nakamura, M., Nishishita, S., Umegaki, H., Tanaka, H., . . . Ichihashi, N. (2017). Effect of scapular stabilization during cross-body stretch on the hardness of infraspinatus, teres minor, and deltoid muscles: An ultrasonic shear wave elastography study. Manual Therapy.
https://www.ncbi.nlm.nih.gov/pubmed/27847244

Umehara, J., Nakamura, M., Fujita, K., Kusano, K., Nishishita, S., Araki, K., Tanaka, H., Yanase, K., Ichihashi, N. (2017). Shoulder horizontal abduction stretching effectively increases shear elastic modulus of pectoralis minor muscle. J Shoulder Elbow Surg.
https://www.ncbi.nlm.nih.gov/pubmed/28169137

Weppler, C.H., Magnusson, S.P. (2010). Increasing muscle extensibility: a matter of increasing length or modifying sensation? Phys Ther.
https://www.ncbi.nlm.nih.gov/pubmed/20075147 

Yamauchi, T., Hasegawa, S., Nakamura, M., Nishishita, S., Yanase, K., Fujita, K., . . . Ichihashi, N. (2016). Effects of two stretching methods on shoulder range of motion and muscle stiffness in baseball players with posterior shoulder tightness: A randomized controlled trial. Journal of Shoulder and Elbow Surgery.
http://www.ncbi.nlm.nih.gov/pubmed/27475455 

Zaremski, J.L., Wasser, J.G., Vincent, H.K. (2017). Mechanisms and Treatments for Shoulder Injuries in Overhead Throwing Athletes. Curr Sports Med Rep.
https://www.ncbi.nlm.nih.gov/pubmed/28498227