Author Names

Mathew, N., Raja, P., Davis, F.

Reviewer Name

Jasmin Flores, SPT

Reviewer Affiliation(s)

Duke University School of Medicine, Doctor of Physical Therapy Division

 

Paper Abstract

Background. Glenohumeral Internal Rotation Deficit (GIRD) is common among over- head athletes and is considered as one of the risk factors for upper extremity injuries. GIRD is usually managed by stretching and soft tissue release of the posterior shoulder capsule. Fascial manipulation is a manual therapy technique used in the management of musculoskeletal disorders. This study compared the efficacy of fascial manipulation (FM) with posterior capsular ball release and stretching on GIRD. Purpose. The purpose of this study is to determine the effect of Fascial Manipulation (FM) on the Internal Rotation Range of Motion (IRROM) in athletes with GIRD. Since studies have shown a possible association between GIRD and shoulder injuries, improving the IRROM in athletes with GIRD may help in reducing the risk of shoulder injuries. Thus, FM may be used as an effective strategy in increasing IRROM in overhead athletes with GIRD, thus preventing upper extremity injuries. Study Design. Randomized controlled trial. Methods. Asymptomatic overhead athletes with GIRD more than 20° when compared with the non-dominant shoulder were randomly assigned to two groups. The experimental group has received three sessions of FM treatment in two weeks. FM applied to densified Centre of Coordination (CC) points located on the myofascial sequences for 5 to 8 minutes at each CC point. The control group has received three sessions of posterior shoulder capsule release using a tennis ball under supervision. Along with the ball release, the thera- pist taught home-based, unsupervised sleeper, and cross-body adduction stretches, for the control group. A universal goniometer was used to measure the IRROM before and after all three treatment sessions in both groups. Results. There were no statistically significant differences between the control and experi- mental groups (p< 0.05). However, immediate improvement in the IRROM following FM was more substantial in the experimental group following each session. Conclusions. This study indicates that FM may be used as an adjunct to stretching in asymp- tomatic participants with GIRD to increase the IRROM. There is a scope for future studies to be done to investigate the effect of FM on symptomatic overhead athletes with GIRD.  KEY WORDS Fascial manipulation (FM); Glenohumeral internal rotation deficit (GIRD); internal rota- tion range of motion

 

NIH Risk of Bias Tool

Quality Assessment of Controlled Intervention Studies

  1. Was the study described as randomized, a randomized trial, a randomized clinical trial, or an RCT
  • Yes
  1. Was the method of randomization adequate (i.e., use of randomly generated assignment)?
  • Yes
  1. Was the treatment allocation concealed (so that assignments could not be predicted)?
  • Cannot Determine, Not Reported, or Not Applicable
  1. Were study participants and providers blinded to treatment group assignment?
  • No
  1. Were the people assessing the outcomes blinded to the participants’ group assignments?
  • Yes
  1. Were the groups similar at baseline on important characteristics that could affect outcomes (e.g., demographics, risk factors, co-morbid conditions)?
  • Yes
  1. Was the overall drop-out rate from the study at endpoint 20% or lower of the number allocated to treatment?
  • Cannot Determine, Not Reported, or Not Applicable
  1. Was the differential drop-out rate (between treatment groups) at endpoint 15 percentage points or lower?
  • Cannot Determine, Not Reported, or Not Applicable
  1. Was there high adherence to the intervention protocols for each treatment group?
  • Cannot Determine, Not Reported, or Not Applicable
  1. Were other interventions avoided or similar in the groups (e.g., similar background treatments)?
  • Yes
  1. Were outcomes assessed using valid and reliable measures, implemented consistently across all study participants?
  • Yes
  1. Did the authors report that the sample size was sufficiently large to be able to detect a difference in the main outcome between groups with at least 80% power?
  • Cannot Determine, Not Reported, or Not Applicable
  1. Were outcomes reported or subgroups analyzed prespecified (i.e., identified before analyses were conducted)?
  • Cannot Determine, Not Reported, or Not Applicable
  1. Were all randomized participants analyzed in the group to which they were originally assigned, i.e., did they use an intention-to-treat analysis?
  • Yes

 

Key Finding #1

There was a significant improvement in the internal rotation range of motion in athletes with GIRD between the treatment sessions in both the conventional treatment group and the control group.

Key Finding #2

The control group, which received stretching and tennis ball release, had no immediate significant effects, but there was a gradual improvement in the IRROM after the 3 sessions.

Key Finding #3

The experimental group received three sessions of fascial manipulation treatment in two weeks, and they showed a clinically significant improvement in IRROM, but it did not last long as there was a decrease in IRROM during follow-ups.

 

Please provide your summary of the paper

This randomized controlled trial compared 2 groups of athletes with Glenohumeral Internal Rotation Deficit (GIRD). The control group received three sessions of posterior shoulder capsule release with a tennis ball, along with a home exercise program of the cross-body adduction and sleeper stretches. The experimental group received three session of fascial manipulation treatment in two weeks. Between both groups, there was no significant improvement in the internal rotation ROM. However, there was an immediate improvement in internal rotation following each session in the experimental group, but the improvement did not last long. For the control group, there was a gradual improvement in internal ROM, but no significant immediate effects. The study did have some limitations in that it was only 3 sessions, they did not track the patients for any long term affects, and there were only 20 participants.

Please provide your clinical interpretation of this paper.  Include how this study may impact clinical practice and how the results can be implemented.

Considering there weren’t any statistically significant findings from this study, it is difficult to know if these methods should be used in treating patients with GIRD. Even though there was some significant improvement in internal rotation, when using fascial manipulation, immediately following the treatment sessions, it did not last long/it did not carry over to the next session. However, this article does give some insight on the importance of using fascial manipulation alongside stretching of the shoulder posterior capsule and a tennis ball release in the management of patients with GIRD. Long term effects are unknown based on this article, which leaves some unanswered questions on the most effective treatment method. All in all, when treating patients with GIRD, it can be useful to use different treatments to improve shoulder internal rotation to prevent injuries in overhead athletes.