Journal CME February 2026: Role of stretching interventions in enhancing the shoulder range of motion in overhead athletes with glenohumeral internal rotation deficit: A systematic review and meta-analysis-PM R - 2025 - Iida - Role of stretching interventions in enhancing the shoulder range of motion in overhead athletes with

PM R - 2025 - Iida - Role of stretching interventions in enhancing the shoulder range of motion in overhead athletes with

Back to course

Pdf Summary

This systematic review and meta-analysis evaluated the effectiveness of stretching interventions, specifically sleeper stretching (SS) and cross-body stretching (CS), in improving shoulder internal rotation (IR) range of motion (ROM) in overhead athletes with glenohumeral internal rotation deficit (GIRD). GIRD, characterized by reduced IR in the dominant shoulder, is common in athletes involved in overhead sports such as baseball, volleyball, tennis, and swimming, and is associated with posterior shoulder tightness and injury risk.<br /><br />The analysis included six randomized controlled trials comprising 255 athletes, mostly asymptomatic, participating in various overhead sports. Interventions involved SS alone or combined SS and CS, compared with control conditions including no treatment, joint mobilization, or novel stretching techniques.<br /><br />Meta-analysis showed that stretching interventions led to a statistically significant improvement in shoulder IR ROM compared to controls, with a mean difference (MD) of approximately 7 degrees. Additionally, SS notably improved horizontal adduction (HAD) ROM (MD ~6 degrees), reflecting enhanced posterior shoulder flexibility. Sensitivity analyses indicated greater benefits of stretching with follow-up periods of at least four weeks, in studies without active control interventions, and among asymptomatic athletes. SS alone produced significant ROM gains, but the effect of CS alone could not be assessed due to lack of isolated studies.<br /><br />Biomechanistically, SS appears to reduce stiffness in posterior shoulder structures such as the infraspinatus and posterior deltoid, contributing to improved ROM. The findings highlight SS and, to a lesser extent, combined stretching approaches as beneficial conservative treatments for managing GIRD-related shoulder stiffness in overhead athletes.<br /><br />Limitations include a small number of studies, high risk of bias due to challenges in participant blinding, heterogeneity in interventions and controls, and underrepresentation of symptomatic athletes. No studies isolated CS effects, limiting comparative conclusions.<br /><br />In conclusion, SS or combined SS and CS significantly improve shoulder IR ROM in overhead athletes with GIRD and may enhance HAD ROM. Further high-quality research is needed to optimize stretching protocols, assess symptomatic populations, and clarify the specific role of CS in managing GIRD. These insights inform clinical practice for injury prevention and rehabilitation in overhead sports.

Keywords

shoulder internal rotation

glenohumeral internal rotation deficit

sleeper stretching

cross-body stretching

overhead athletes

range of motion improvement

posterior shoulder tightness

randomized controlled trials

horizontal adduction

injury prevention