ACUTE EFFECTS OF INSTRUMENT ASSISTED SOFT TISSUE MOBILIZATION FOR IMPROVING POSTERIOR SHOULDER RANGE OF MOTION IN COLLEGIATE BASEBALL PLAYERS – Duke Center of Excellence in Manual and Manipulative Therapy

Author Names

Laudner, K , Compton, B , McLoda, T , Walters, C

Reviewer Name

Bradley Hudson, SPT

Reviewer Affiliation(s)

APTA, NSCA, Duke University School of Medicine, Doctor of Physical Therapy Division

Paper Abstract

Background: Due to the repetitive rotational and distractive forces exerted onto the posterior shoulder during the deceleration phase of the overhead throwing motion, limited glenohumeral (GH) range of motion (ROM) is a common trait found among baseball players, making them prone to a wide variety of shoulder injuries. Although utilization of instrument-assisted soft tissue mobilization (IASTM), such as the Graston® Technique, has proven effective for various injuries and disorders, there is currently no empirical data regarding the effectiveness of this treatment on posterior shoulder tightness. Purpose: To determine the effectiveness of IASTM in improving acute passive GH horizontal adduction and internal rotation ROM in collegiate baseball players. Methods: Thirty-five asymptomatic collegiate baseball players were randomly assigned to one of two groups. Seventeen participants received one application of IASTM to the posterior shoulder in between pretest and posttest measurements of passive GH horizontal adduction and internal rotation ROM. The remaining 18 participants did not receive a treatment intervention between tests, serving as the controls. Data were analyzed using separate 2×2 mixed-model analysis of variance, with treatment group as the between-subjects variable and time as the within-subjects variable. Results: A significant group-by-time interaction was present for GH horizontal adduction ROM with the IASTM group showing greater improvements in ROM (11.1°) compared to the control group (-0.12°) (p<0.001). A significant group-by-time interaction was also present for GH internal rotation ROM with the IASTM group having greater improvements (4.8°) compared to the control group (-0.14°) (p<0.001). Conclusions: The results of this study indicate that an application of IASTM to the posterior shoulder pro- vides acute improvements in both GH horizontal adduction ROM and internal rotation ROM among base- ball players. Level of Evidence: 2b Keywords: Manual therapy, rehabilitation, shoulder, throwing athlete

NIH Risk of Bias Tool

Quality Assessment of Controlled Intervention Studies

Was the study described as randomized, a randomized trial, a randomized clinical trial, or an RCT

Was the method of randomization adequate (i.e., use of randomly generated assignment)?

Was the treatment allocation concealed (so that assignments could not be predicted)?

Were study participants and providers blinded to treatment group assignment?

Were the people assessing the outcomes blinded to the participants’ group assignments?

Were the groups similar at baseline on important characteristics that could affect outcomes (e.g., demographics, risk factors, co-morbid conditions)?

Was the overall drop-out rate from the study at endpoint 20% or lower of the number allocated to treatment?

Was the differential drop-out rate (between treatment groups) at endpoint 15 percentage points or lower?

Was there high adherence to the intervention protocols for each treatment group?

Were other interventions avoided or similar in the groups (e.g., similar background treatments)?

Were outcomes assessed using valid and reliable measures, implemented consistently across all study participants?

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

Were outcomes reported or subgroups analyzed prespecified (i.e., identified before analyses were conducted)?

Were all randomized participants analyzed in the group to which they were originally assigned, i.e., did they use an intention-to-treat analysis?

Key Finding #1

A single application of IASTM treatment to the posterior shoulder can produce acute benefits in GH ROM in college baseball players.

Key Finding #2

IASTM treatment group showed greater improvements in GH horizontal adduction ROM in college baseball players.

Key Finding #3

IASTM treatment group showed greater improvements in GH internal rotation ROM in college baseball players.

Please provide your summary of the paper

This study examined the acute effects of instrumented assisted soft tissue mobilization (IASTM) to improve glenohumeral (GH) ROM in college baseball players. This study was done on 35 college baseball players and was a randomized blind study design. The inclusion criteria was as follows, must have been a member of a National Collegiate Athletic Association (NCAA) Division 1 baseball team and have had no recent history (within 6 months) of upper extremity (UE) or any previous UE surgeries on their throwing arm. The participants were split up into two randomly assigned groups. One group received the IASTM, and the other group did not receive the treatment since they were the control group. The IASTM treatment was applied for 20 seconds in the direction parallel to the muscle fibers treated with the instrument at a 45o angle immediately followed by 20 seconds of treatment perpendicular to the muscle fibers at a 45o angle. The total treatment time was 40 seconds. A single measurement of GH horizontal adduction and IR were taken pre and post treatment using a digital inclinometer. The results of this study indicate that using an IASTM treatment can acutely improve GH horizontal adduction ROM by 11.1 and IR ROM by 4.8 in college baseball players. IASTM is thought to localize and treat soft tissue restrictions to produce a localized inflammatory response, reduce new scar tissue, and break down existing scar tissue. Limitations to this study were that the Graston technique (GT) was predetermined for each patient by having the same amount of time, stroke rate, direction, and number of strokes. Secondly, the only GT tool that was used was the GT-4, when the recommendation is to use a variety of tools at different angles. Future studies should aim at incorporating different treatment techniques to determine which is most effective, look at ROM improvements with multiple treatments, and to track ROM improvements over a long period of time in asymptomatic individuals and individuals with documented ROM deficits. In conclusion, IASTM treatment is shown to be a beneficial treatment option to acutely improve GH ROM in college baseball players.

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

The findings of this article indicate IASTM to the posterior shoulder is a beneficial treatment choice to improve GH horizontal adduction and IR ROM in college baseball players. The results of this particular study were from only one treatment session, and it would be beneficial for future studies to look at improvements over multiple treatment session and over a longer period of time. Incorporating IASTM into treatment for college baseball players can yield acute gains in GH horizontal adduction and IR ROM which can be beneficial for sports performance.