Over the years, several ways have been proposed to improve internal rotation or prevent the loss of internal rotation from occurring, as research has proposed that substantial loss of glenohumeral internal rotation has been tied to increased risk of shoulder injury.(2,3)
The sleeper stretch and the cross body stretch have been, and continue to be used as treatment options to improve internal rotation. Modifications of both of these stretches have been made to help increase their effectiveness, but how much of a difference do they make? If we start with the sleeper stretch, one study showed an acute improvement of 3.1 degrees in college baseball players.(4) Another showed a 12.4 degree improvement in shoulder internal rotation after performing the stretch daily for four weeks, but didn’t use symptomatic subjects or overhead athletes.(5)
As of late, several clinicians have preferred the cross body stretch over the sleeper stretch. It tends not to put an athlete into the “impingement” position, which decreases the subacromial space and can cause pain in the shoulder. Also, with the assistance of a clinician or positioning themselves against the wall, there is improved stabilization of the scapula to direct the stretch at the posterior shoulder. Acute improvement of 11 degrees was shown following the cross body stretch in 16 year-old volleyball players with a clinician stabilizing the scapula.(6) When comparing it to the sleeper stretch and performing daily over four weeks subjects did show a 20 degree improvement.(5)
Using the cross body stretch as the standard for improving shoulder internal rotation, I wanted to compare it to one of our pec minor protocols on the T-Dot Mobility System. I used a single subject’s left shoulder. He is a 39 year-old male with a history of a rotator cuff tear. He is a Crossfit coach and is performing overhead activities on a regular basis. For the first round of testing, I measured his internal rotation prior to performing the cross body stretch. Then, he used the T-Dot to stabilize the scapula when performing the stretch and it was performed 3 times holding for 30 seconds with a 10 second rest in-between sets.
The acute impact of the T-Dot Protocol was much more drastic than what I saw with the cross body stretch. The subject showed 13 degrees improvement in internal rotation while spending approximately the same amount of time working on improving motion as he did with the cross body stretch.
By looking at the pectoralis minor anatomically, it originates at ribs 3-5 and inserts at the coracoid process on the scapula. I think what we are seeing is that by decreasing tension on the coracoid process/scapula, the position of the scapula is changed, which alters the position of the glenoid fossa, and therefore changes how the head of the humerus sits in the glenoid. Ultimately this would impact internal rotation motion at the glenohumeral joint.
The challenge at this point in time is there is minimal to no formal research that has been conducted looking at addressing the anterior shoulder and how this impacts shoulder rotational range of motion. I am thankful for the team we have on board who has been willing to investigate this concept more and work toward publishing formal research on the T-Dot Mobility System.
I look forward to sharing more in the months to come discussing concepts that make the T-Dot Mobility System work. We didn’t reinvent the wheel, but have taken established principles and built them into a system that allows the user to independently improve their movement and function.
To learn more about the T-Dot Mobility System, check out www.movementguides.com
1. Wilk KE, Hooks TR, Macrina LC. The Modified Sleeper Stretch and Modified Cross-body Stretch to Increase Shoulder Internal Rotation Range of Motion in the Overhead Throwing Athlete. J Orthop Sports Phys Ther. 2013; 43: 891-894.
2. Wilk KE, Macrina LC, Fleisig GS, et al. Cor¬relation of glenohumeral internal rotation deficit and total rotational motion to shoulder injuries in professional baseball pitchers. Am J Sports Med. 2011; 39: 329-335.
3. Myers JB, Laudner KG, Pasquale MR, Bradley JP, Lephart SM. Glenohumeral range of motion defi¬cits and posterior shoulder tightness in throwers with pathologic internal impingement. Am J Sports Med. 2006; 34: 385-391.
4. Laudner KG, Sipes RC, Wilson JT. The acute effects of sleep stretches on shoulder range of motion. J Athl Train. 2008; 43: 359-363.
5. McClure P, Balaicuis J, Heiland D, Broersma ME, Thorndike CK, Wood A. A randomized controlled comparison of stretching procedures for posterior shoulder tightness. J Orthop Sports Phys Ther. 2007; 37: 108-114.
6. Salamh PA, Kolber MJ, Hanney WJ. Effect of Scapular Stabilization During Horizontal Adduction Stretching on Passive Internal Rotation and Posterior Shoulder Tightness in Young Women Volleyball Athletes: A Randomized Controlled Trial. Arch Phys Med Rehabil. 2015; 96: 349-356