Effect of A Novel Stretching Technique on Shoulder Range of Motion in Overhead Athletes with Glenohumeral Internal Rotation Deficits: A Randomized Controlled Trial

Abstract Background: The cross-body and the modified sleeper stretch have been used to improve posterior shoulder soft tissue flexibility and to increase glenohumeral joint internal rotation (GHJ IR) in overhead athletes. However, due to the inability to stabilize patient’s scapula and control GHJ rotation with the cross-body stretch and the potential for subacromial impingement or symptoms’ aggravation with the modified sleeper stretch, a new stretching technique was developed as an alternative to these commonly used stretches that may allow for greater stability of the scapula without reproducing symptoms, as well as providing an inhibition component to the posterior shoulder girdle muscles. Thus, the current study aimed to examine and compare a novel stretching technique to the traditional modified sleeper stretch to determine the effect on glenohumeral IR range of motion (ROM), self-reported pain, and subject satisfaction in overhead athletes with glenohumeral internal rotation deficits (GIRD). Methods: Forty-two overhead athletes with GIRD [mean age 25.9 ± 2.6 years, 20 males and 22 females] participated in this study. Participants were randomly assigned into either novel stretching group or modified sleeper stretching group. IR ROM was measured with a digital inclinometer, pain was measured with Numeric Pain Rating Scale, and subject satisfaction level was measured by a 6-item questionnaire developed and validated by the study’s authors. Outcomes were measured before, immediately, and at week 4 post intervention. Results: There was no significant group by time interaction effect for IR ROM (p=0.27); however, there was a significant change over time (p<0.001, η2=0.77). Both groups demonstrated a significant increase in IR from baseline to immediate and week 4, and from immediate to week 4 (p<0.001). There was also a significant reduction in pain intensity over time for the novel group (p=0.016, r=0.6) compared to the traditional group (p=0.080). For the satisfaction level, only the easiness of performance was significantly different and in favor of the traditional group (p=0.020, r=0.5) following the 4 weeks of the stretching protocols. Conclusion: Both stretches appear to be effective at improving IR ROM in overhead athletes with GIRD. However, the novel stretching is more effective at reducing shoulder pain and thus might be more appropriate for symptomatic patients. Trial registration: Prospectively registered in February 6, 2017 under Clinical Trial Registry # NCT03044236

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Effect of a Novel Stretching Technique on Shoulder Range of Motion in Overhead Athletes with Glenohumeral Internal Rotation Deficits: A Randomized Controlled Trial

10.21203/rs.2.16116/v3 ◽

2020 ◽

Author(s):

Omar Gharisia ◽

Everett Lohman ◽

Noha Daher ◽

Alan Eldridge ◽

Amjad Shallan ◽

...

Keyword(s):

Range Of Motion ◽

Internal Rotation ◽

The Novel ◽

Satisfaction Level ◽

Traditional Group ◽

Overhead Athletes ◽

Shoulder Range Of Motion ◽

Posterior Shoulder ◽

The Cross ◽

Over Time

Abstract Background: The cross-body and the modified sleeper stretch have been used to improve posterior shoulder soft tissue flexibility and to increase glenohumeral joint internal rotation (GHJ IR) in overhead athletes. However, due to the inability to stabilize patient’s scapula and control GHJ rotation with the cross-body stretch and the potential for subacromial impingement or symptoms’ aggravation with the modified sleeper stretch, a new stretching technique (Passive Glenohumeral Internal Rotation with Clam Shell Bridging) was developed as an alternative to these commonly used stretches that may allow for greater stability of the scapula without reproducing symptoms, as well as providing an inhibition component to the posterior shoulder girdle muscles. Thus, the current study aimed to examine and compare a novel stretching technique to the traditional modified sleeper stretch to determine the effect on glenohumeral IR range of motion (ROM), self-reported pain, and subject satisfaction in overhead athletes with glenohumeral internal rotation deficits (GIRD). Methods: Forty-two overhead athletes with GIRD [mean age 25.9 ± 2.6 years, 20 males and 22 females] participated in this study. Participants were randomly assigned into either novel stretching group or modified sleeper stretching group. IR ROM was measured with a digital inclinometer, pain was measured with Numeric Pain Rating Scale, and subject satisfaction level was measured by a 6-item questionnaire developed and validated by the study’s authors. Outcomes were measured before, immediately, and at week 4 post intervention.Results: There was no significant group by time interaction effect for IR ROM (p=0.27); however, there was a significant change over time (p<0.001, η2=0.77). Both groups demonstrated a significant increase in IR from baseline to immediate and week 4, and from immediate to week 4 (p<0.001). There was also a significant reduction in pain intensity over time for the novel group (p=0.016, r=0.6) compared to the traditional group (p=0.080). For the satisfaction level, only the easiness of performance was significantly different and in favor of the traditional group (p=0.020, r=0.5) following the 4 weeks of the stretching protocols. Conclusion: Both stretches appear to be effective at improving IR ROM in overhead athletes with GIRD. However, the novel stretching is more effective at reducing shoulder pain and thus might be more appropriate for symptomatic patients. Trial registration: Prospectively registered in February 6, 2017 under Clinical Trial Registry # NCT03044236

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Effect of a Novel Stretching Technique on Shoulder Range of Motion in Overhead Athletes with Glenohumeral Internal Rotation Deficits: A Randomized Controlled Trial

10.21203/rs.2.16116/v1 ◽

2019 ◽

Author(s):

Omar Gharisia ◽

Everett Lohman ◽

Noha Daher ◽

Alan Eldridge ◽

Amjad Shallan ◽

...

Keyword(s):

Range Of Motion ◽

Internal Rotation ◽

The Novel ◽

Satisfaction Level ◽

Traditional Group ◽

Overhead Athletes ◽

Shoulder Range Of Motion ◽

Posterior Shoulder ◽

The Cross ◽

Over Time

Abstract Background The cross-body and the modified sleeper stretch have been used to improve posterior shoulder soft tissue flexibility and to increase glenohumeral joint internal rotation (GHJ IR) in overhead athletes. However, due to the inability to stabilize patient’s scapula and control GHJ rotation with the cross-body stretch and the potential for subacromial impingement or symptoms’ aggravation with the modified sleeper stretch, a new stretching technique was developed as an alternative to these commonly used stretches that may allow for greater stability of the scapula without reproducing symptoms, as well as providing an inhibition component to the posterior shoulder girdle muscles. Thus, the current study aimed to examine and compare a novel stretching technique to the traditional modified sleeper stretch to determine the effect on glenohumeral IR range of motion (ROM), self-reported pain, and subject satisfaction in overhead athletes with glenohumeral internal rotation deficits (GIRD).Methods Forty-two overhead athletes with GIRD [mean age 25.9 ± 2.6 years] participated in this study. Participants were randomly assigned into either novel stretching group or modified sleeper stretching group. IR ROM was measured with a digital inclinometer, pain was measured with Numeric Pain Rating Scale, and subject satisfaction level was measured by a 6-item questionnaire developed and validated by the study’s authors. Outcomes were measured before, immediately, and at week 4 post intervention.Results There was no significant group by time interaction effect for IR ROM (p=0.27); however, there was a significant change over time (p<0.001). Both groups demonstrated a significant increase in IR from baseline to immediate and week 4, and from immediate to week 4 (p<0.001). There was also a significant reduction in pain intensity over time for the novel group (p=0.016) compared to the traditional group (p=0.080). For the satisfaction level, only the easiness of performance was significantly different and in favor of the traditional group (p=0.020) following the 4 weeks of the stretching protocols.Conclusion Both stretches appear to be effective at improving IR ROM in overhead athletes with GIRD. However, the novel stretching is more effective at reducing shoulder pain and thus might be more appropriate for symptomatic patients.

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Effect of a novel stretching technique on shoulder range of motion in overhead athletes with glenohumeral internal rotation deficits: a randomized controlled trial

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04292-8 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Omar Gharisia ◽

Everett Lohman ◽

Noha Daher ◽

Alan Eldridge ◽

Amjad Shallan ◽

...

Keyword(s):

Pain Intensity ◽

Range Of Motion ◽

Internal Rotation ◽

The Novel ◽

Post Intervention ◽

Significant Group ◽

Overhead Athletes ◽

Time Interaction ◽

The Cross ◽

Over Time

Abstract Background The cross-body and the modified sleeper stretch have been used to improve posterior shoulder soft tissue flexibility and to increase glenohumeral joint internal rotation (GHJ IR) in overhead athletes. However, due to the inability to stabilize patient’s scapula and control GHJ rotation with the cross-body stretch and the potential for subacromial impingement or symptoms’ aggravation with the modified sleeper stretch, a new stretching technique (Passive Glenohumeral Internal Rotation with Clam Shell Bridging) was developed as an alternative to these commonly used stretches that may allow for greater stability of the scapula without reproducing symptoms. Thus, the current study aimed to examine and compare a novel stretching technique to the traditional modified sleeper stretch to determine the effect on glenohumeral IR range of motion (ROM) and self-reported pain in overhead athletes with glenohumeral internal rotation deficits (GIRD). Methods Forty-two overhead athletes with GIRD [mean age 25.9 ± 2.6 years, 20 males and 22 females] participated in this study. Participants were randomly assigned into either novel stretching group or modified sleeper stretching group. IR ROM was measured with a digital inclinometer before, immediately, and at week 4 post intervention, while pain was measured with Numeric Pain Rating Scale before and at week 4 post intervention. Results There was no significant group by time interaction effect for IR ROM (p = 0.27); however, there was a significant change over time (p < 0.001, η2 = 0.77). Both groups demonstrated a significant increase in IR from baseline to immediate and week 4, and from immediate to week 4 (p < 0.001). There was a significant group by time interaction for pain intensity (p < 0.001, η2 = 0.72). Results showed a significant reduction in pain intensity over time in the novel group (p = 0.001, d = 2.18), but not in the traditional group (p = 0.231, d = 0.46). Conclusion Both stretches appear to be effective at improving IR ROM in overhead athletes with GIRD. However, the novel stretching might be more effective at reducing shoulder pain and thus may be more appropriate for symptomatic patients. Trial registration Prospectively registered in February 6, 2017 under Clinical Trial Registry # NCT03044236.

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Effect of a Novel Stretching Technique on Shoulder Range of Motion in Overhead Athletes with Glenohumeral Internal Rotation Deficits: A Randomized Controlled Trial

10.21203/rs.2.16116/v4 ◽

2021 ◽

Author(s):

Omar Gharisia ◽

Everett Lohman ◽

Noha Daher ◽

Alan Eldridge ◽

Amjad Shallan ◽

...

Keyword(s):

Pain Intensity ◽

Range Of Motion ◽

Internal Rotation ◽

The Novel ◽

Post Intervention ◽

Significant Group ◽

Overhead Athletes ◽

Time Interaction ◽

Posterior Shoulder ◽

Over Time

Abstract Background: The cross-body and the modified sleeper stretch have been used to improve posterior shoulder soft tissue flexibility and to increase glenohumeral joint internal rotation (GHJ IR) in overhead athletes. However, due to the inability to stabilize patient’s scapula and control GHJ rotation with the cross-body stretch and the potential for subacromial impingement or symptoms’ aggravation with the modified sleeper stretch, a new stretching technique (Passive Glenohumeral Internal Rotation with Clam Shell Bridging) was developed as an alternative to these commonly used stretches that may allow for greater stability of the scapula without reproducing symptoms, as well as providing an inhibition component to the posterior shoulder girdle muscles. Thus, the current study aimed to examine and compare a novel stretching technique to the traditional modified sleeper stretch to determine the effect on glenohumeral IR range of motion (ROM) and self-reported pain in overhead athletes with glenohumeral internal rotation deficits (GIRD). Methods: Forty-two overhead athletes with GIRD [mean age 25.9 ± 2.6 years, 20 males and 22 females] participated in this study. Participants were randomly assigned into either novel stretching group or modified sleeper stretching group. IR ROM was measured with a digital inclinometer before, immediately, and at week 4 post intervention, while pain was measured with Numeric Pain Rating Scale before and at week 4 post intervention.Results: There was no significant group by time interaction effect for IR ROM (p=0.27); however, there was a significant change over time (p<0.001, η2=0.77). Both groups demonstrated a significant increase in IR from baseline to immediate and week 4, and from immediate to week 4 (p<0.001). There was a significant group by time interaction for pain intensity (p=0.032, η2=0.31). Results showed a significant reduction in pain intensity over time in the novel group (p=0.001, η2=0.85), but not in the traditional group (p=0.150, η2=0.27).Conclusion: Both stretches appear to be effective at improving IR ROM in overhead athletes with GIRD. However, the novel stretching might be more effective at reducing shoulder pain and thus may be more appropriate for symptomatic patients. Trial registration: Prospectively registered in February 6, 2017 under Clinical Trial Registry # NCT03044236

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The Relationship Between Shoulder Range of Motion and Arm Stress in College Pitchers: A MOTUS Baseball Study

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120s00401 ◽

2020 ◽

Vol 8 (7_suppl6) ◽

pp. 2325967120S0040

Author(s):

Caleb Gulledge ◽

Toufic Jildeh ◽

Joseph Tramer ◽

Fabien Meta ◽

Kevin Taylor ◽

...

Keyword(s):

Range Of Motion ◽

Upper Extremity ◽

Internal Rotation ◽

External Rotation ◽

Outcome Measurement ◽

Overhead Athletes ◽

Shoulder Range Of Motion ◽

Patient Reported ◽

The Relationship ◽

Shoulder Range

Objectives: Overuse injuries in overhead athletes are becoming more prevalent, with an unclear relationship between shoulder biomechanics and medial elbow symptoms and injury. The purpose of this study was to investigate the relationship of shoulder range of motion to torque across the medial elbow in college pitchers using a validated MOTUS sensor baseball sleeve. Methods: Pitchers were recruited from three local university baseball teams. Exclusion criteria included injury or restricted activity due to pain. They were evaluated in the preseason, within two weeks before their first game of the season. Pitchers completed workload questionnaires and patient reported outcome measurement information system (PROMIS) pain interference (PI), physical function (PF), and upper extremity (UE) surveys. Shoulder range of motion and upper extremity lengths were measured bilaterally. After adequate warm-up, pitchers were fitted with a MOTUS sensor baseball sleeve (Motus Global, Massapequa, NY) and instructed to throw 5 fastballs in a standardized manner off the mound at game-speed effort. The sensor placed at the medial elbow reported elbow torque, arm speed, arm slot, and shoulder rotation for each pitch, while a radar gun measured peak ball velocity. The primary outcome was to evaluate the relationship between shoulder range of motion and increased stress across the medial elbow. Additional outcomes evaluated pitcher characteristics, demographics, and outcome scores. Outcomes were assessed via a multivariable model, which controlled for possible covariates. Results: Twenty-eight pitchers were included in the preseason analysis with an average (SD) age of 20.1 (1.3) years and playing experience of 15.3 (1.8) years, 2.5 (1.2) of those years at collegiate level. The dominant shoulder demonstrated decreased internal rotation (54.5+/-10.6 vs 65.8+/-9.1) and increased external rotation (ER, 94.1+/-10.4 vs 88.4+/-9.2) relative to the non-dominant side (p < 0.001), while total rotational range of motion (TRROM) was significantly decreased in the dominant arm (148.6+/-12.4 vs 154.1+/-10.6, p < 0.001). The average glenohumeral internal rotation deficiency (GIRD) was 11.3 (9.87) and average external rotation gain (ERG) was 5.71 (8.8). External rotation was found to be a predictor of arm stress, with an increase in 0.35 Nm of elbow torque for every degree increase in ER (beta = 0.35+/-0.06, p = 0.003); there was moderate correlation between ER and arm stress (r = .45, P<.001). Pitchers demonstrated significantly greater arm stress with the following shoulder ROM measurements: GIRD < 20 as compared to greater than 20 degrees (46.6 +/- 0.5 versus 43.5 +/- 1.1, P=.011), ERG greater than 5 as compared to < 5 degrees (47.4 +/- 0.7 versus 45.1 +/- 0.6, P=.014), and loss of total rotational ROM less than 5 as compared to > 5 degrees (46.6 +/- 0.5 versus 43.6 +/- 1.1, P=.013). Multivariate analysis demonstrated significant predictors of PROMIS PF and UE scores were arm stress, ERG, and GIRD (p<0.05), while increased PROMIS PI scores were predicted by increased ERG and GIRD (p<0.05). Conclusion: We found medial elbow stress, arm speed, arm slot, and shoulder rotation as measured by the MOTUS baseball sensor sleeve were influenced by rotational adaptations of the pitching shoulder in collegiate throwing athletes prior to their season. Likewise, arm stress and shoulder rotational adaptations were reflected as predictors of PROMIS PF, UE, and PI scores.

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The Comparison of Instrument-Assisted Soft Tissue Mobilization and Self-Stretch Measures to Increase Shoulder Range of Motion in Overhead Athletes: A Critically Appraised Topic

Journal of Sport Rehabilitation ◽

10.1123/jsr.2016-0213 ◽

2018 ◽

Vol 27 (4) ◽

pp. 385-389 ◽

Cited By ~ 1

Author(s):

Matthew J. Hussey ◽

Alex E. Boron-Magulick ◽

Tamara C. Valovich McLeod ◽

Cailee E. Welch Bacon

Keyword(s):

Soft Tissue ◽

Range Of Motion ◽

Internal Rotation ◽

Proper Function ◽

Clinical Question ◽

Bottom Line ◽

Overhead Athletes ◽

Shoulder Range Of Motion ◽

Soft Tissue Mobilization ◽

Shoulder Range

Clinical Scenario: Shoulder range of motion (ROM) in throwing athletes relies on a balance of mobility and stability to maintain proper function and health that, if disrupted, can lead to shoulder injury. There have been several studies that address the relationship between ROM deficits and overhead injuries; however, it may be unclear to clinicians which interventions are most effective for increasing ROM in the glenohumeral joints of overhead athletes. Clinical Question: In overhead athletes who have deficient shoulder ROM, is instrument-assisted soft tissue mobilization (IASTM) more effective at acutely increasing ROM over the course of a patient’s treatment when compared with self-stretching? Summary of Key Findings: A thorough literature review yielded 3 studies relevant to the clinical question, and all 3 studies were included. Two articles found a significant increase in acute ROM when compared with a self-stretch measure. All 3 articles showed increases in internal rotation and horizontal adduction, and 1 study reported an increase in total arc of shoulder ROM. Clinical Bottom Line: There is moderate evidence to support the use of IASTM to acutely increase ROM in the glenohumeral joint of overhead athletes. Clinicians should be aware of the variability with recommended treatment times; however, positive results have been seen with treatments lasting 5 to 6 minutes per treatment region. There is no consensus for treatment intensity, and certain IASTM tools require certification. Strength of Recommendation: Grade B evidence exists that IASTM is more effective at increasing shoulder ROM (ie, internal rotation, horizontal adduction, external rotation, total arc of motion) in overhead athletes than self-stretching measures.

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Effects of Rigid and Kinesio Taping on Shoulder Rotation Motions, Posterior Shoulder Tightness, and Posture in Overhead Athletes: A Randomized Controlled Trial

Journal of Sport Rehabilitation ◽

10.1123/jsr.2017-0047 ◽

2019 ◽

Vol 28 (3) ◽

pp. 256-265 ◽

Cited By ~ 4

Author(s):

Damla Gulpinar ◽

Sibel Tekeli Ozer ◽

Sevgi Sevi Yesilyaprak

Keyword(s):

Randomized Controlled Trial ◽

Range Of Motion ◽

Internal Rotation ◽

Controlled Trial ◽

Shoulder Injuries ◽

Overhead Athletes ◽

Randomized Controlled ◽

Kinesio Taping ◽

Posterior Shoulder ◽

Posterior Shoulder Tightness

Context:Alterations in posture and motion patterns are thought to play a role in developing shoulder injuries in overhead athletes. Taping is widely used in the sporting population, but there are limited empirical data regarding its effectiveness.Objectives:To determine and compare the effects of rigid and kinesio taping on shoulder rotation motions, posterior shoulder tightness (PST), and posture in overhead athletes.Design:Randomized controlled trial.Setting:Athletic training rooms.Participants:Eighty-six asymptomatic elite overhead athletes.Interventions:Participants were randomly divided into 4 groups: rigid taping group (RTG) that underwent therapeutic rigid taping, kinesio taping group (KTG) that underwent therapeutic kinesio taping, placebo group that underwent placebo kinesio taping (shoulder and scapular region taping for taping groups), and control group (no taping).Main Outcome Measures:Shoulder rotation motions, PST, and head and shoulder posture were evaluated at baseline, immediately after application and 60 to 72 hours after application for all groups.Results:Glenohumeral internal rotation increased immediately (P < .001) and at 60 to 72 hours after application in the KTG (P = .01), whereas it decreased immediately after application in the RTG (P < .001). Immediately after application, total rotation range of motion increased in the KTG (P =.02) and decreased in the RTG (P < .001), and there was a difference between groups (P = .02). Immediately after application, PST increased in the RTG (P < .001); after 60 to 72 hours, it decreased in the KTG (P = .04) and increased in the RTG (P = .01). Posture outcomes did not change significantly (P > .05).Conclusions:Kinesio taping may improve and rigid taping may worsen glenohumeral internal rotation and PST in overhead athletes. For increasing total rotation range of motion, kinesio taping is superior to rigid taping. Taping did not affect posture. Short-term kinesio taping in overhead athletes may be useful to improve glenohumeral internal rotation, total rotation range of motion, and PST.

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A Comparison of the Immediate Effect of Swedish Massage vs Passive Stretching on Range of Motion in Overhead Athletes

The Asian Journal of Kinesiology ◽

10.15758/ajk.2020.22.3.1 ◽

2020 ◽

Vol 22 (3) ◽

pp. 1-7

Author(s):

Jim Schilling ◽

Sujeiry Guzman ◽

Chad Lewis ◽

Jupil Ko

Keyword(s):

Range Of Motion ◽

Internal Rotation ◽

External Rotation ◽

Intervention Group ◽

Post Treatment ◽

Static Stretching ◽

Post Intervention ◽

Overhead Athletes ◽

Passive Stretching ◽

Shoulder Range Of Motion

OBJECTIVES To compare the clinical outcome and effectiveness of Swedish massage and a traditional passive stretching program, on the shoulder of ROM in overhead athletes.PARTICIPANTS A total of 10 overhead throwing overhead male athletes (age= 23.5 ± 1.5yrs; height= 186.69 ± 6.35 cm; mass= 91.86 ± 12.48 kg).METHODS Participants were randomly assigned to either Swedish massage or a traditional passive static stretching program for 1 session of 5 minutes. Baseline and post-intervention shoulder ROM to end range in the flexed, external rotation, internal rotation, horizontal adduction and abduction positions. The Pearson chi-square test was applied to compare the differences of shoulder ROM of both therapeutic variables. Recorded outcome measures on the participants’ shoulder ROM (flexion with scapula fixed, horizontal adduction, horizontal abduction, internal rotational & external rotation) pre- & post-interventions.RESULTS Results indicate that participants in the Swedish massage therapeutic intervention group had significant improvements in their internal rotation post-treatment (M=5.20, SD= 1.304, p=.038) and the traditional passive stretching protocol group had significant improvements in shoulder external rotation post-treatment (M=11.20, SD=2.68, p=.016).CONCLUSION Swedish massage had better effects in four out of the five shoulder motions measured compared to passive static stretching. Educating overhead athletes on the potential beneficial effects of massage therapy and its role in maintaining shoulder range of motion.

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GIRD syndrome in male handball and volleyball players: Is the decrease of total range of motion the turning point to pathology?

Journal of Back and Musculoskeletal Rehabilitation ◽

10.3233/bmr-191767 ◽

2021 ◽

pp. 1-8

Author(s):

Jonas Schmalzl ◽

Helen Walter ◽

Wolfram Rothfischer ◽

Sören Blaich ◽

Christian Gerhardt ◽

...

Keyword(s):

Range Of Motion ◽

Internal Rotation ◽

Turning Point ◽

External Rotation ◽

Constant Score ◽

High Rate ◽

Overhead Athletes ◽

Glenohumeral Internal Rotation Deficit ◽

Total Range ◽

Volleyball Players

BACKGROUND: Adaptations in glenohumeral range of motion may affect overhead athletes and lead to shoulder pathologies. OBJECTIVE: The purpose of this study was to evaluate glenohumeral internal rotation deficit (GIRD) and postero-superior impingement among male handball and volleyball players and the relationship between these pathologies and training level (amateur vs. professional), position (attack vs. no attack), experience (> 5 years vs. < 5 years) and sports. METHODS: Sixty-seven handball players and 67 volleyball players with a mean age of 25 [± 5] years were included. The range of motion including external and internal rotation in 90∘ abduction of the dominant and non-dominant shoulder was measured of each examined athlete. Visual analogue scale, disabilities of the shoulder and hand score, constant score and subjective shoulder value were recorded. The athletes were examined for postero-superior impingement and abduction force was measured with an isokinetic dynamometer. RESULTS: Internal rotation was significantly lower and external rotation was significantly greater in the dominant arm for both sports. 72% presented with GIRD. GIRD was more prevalent in athletes active for > 5 years (odds ratio (OR) 3), in those training > 3 times per week (OR 1.4) and in handball players (OR 2.7). 24% presented with postero-superior impingement. Players active for > 5 years (OR 1.22), professionals (OR 1.14), volleyball players (OR 1.19), offensive players (OR 2.2) and athletes with GIRD > 10∘ (OR 1.5) showed a higher prevalence of postero-superior impingement. CONCLUSION: GIRD is a common phenomenon in handball and volleyball players. Offensive players are frequently suffering from postero-superior impingement. GIRD > 10∘ leads in nearly 75% of the athletes to a decrease of total range of motion and a high rate of postero-superior impingement. Thus, a decreased range of motion seems to be the turning point from adaptation to pathology. Therefore, regular controls of range of motion and countermeasures by means of stretching the posterior shoulder joint should be integrated in the training content.

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