title: Effectiveness of Manual Therapy and Stretching for Baseball Players With Shoulder Range of Motion Deficits.
abstract: BACKGROUND
  Baseball players displaying deficits in shoulder range of motion (ROM) are at increased risk of arm injury. Currently, there is a lack of consensus regarding the best available treatment options to restore shoulder ROM.
  
  
  OBJECTIVE
  Instrumented manual therapy with self-stretching will result in clinically significant deficit reductions when compared with self-stretching alone.
  
  
  METHODS
  Controlled laboratory study.
  
  
  METHODS
  Shoulder ROM and humeral torsion were assessed in 60 active baseball players (mean age, 19 ± 2 years) with ROM deficits (nondominant - dominant, ≥15°). Athletes were randomly assigned to receive a single treatment of instrumented manual therapy plus self-stretching (n = 30) or self-stretching only (n = 30). Deficits in internal rotation, horizontal adduction, and total arc of motion were compared between groups immediately before and after a single treatment session. Treatment effectiveness was determined by mean comparison data, and a number-needed-to-treat (NNT) analysis was used for assessing the presence of ROM risk factors.
  
  
  RESULTS
  Prior to intervention, players displayed significant ( P < 0.001) dominant-sided deficits in internal rotation (-26°), total arc of motion (-18°), and horizontal adduction (-17°). After the intervention, both groups displayed significant improvements in ROM, with the instrumented manual therapy plus self-stretching group displaying greater increases in internal rotation (+5°, P = 0.010), total arc of motion (+6°, P = 0.010), and horizontal adduction (+7°, P = 0.004) compared with self-stretching alone. For horizontal adduction deficits, the added use of instrumented manual therapy with self-stretching decreased the NNT to 2.2 (95% CI, 2.1-2.4; P = 0.010).
  
  
  CONCLUSIONS
  Instrumented manual therapy with self-stretching significantly reduces ROM risk factors in baseball players with motion deficits when compared with stretching alone.
  
  
  CONCLUSIONS
  The added benefits of manual therapy may help to reduce ROM deficits in clinical scenarios where stretching alone is ineffective.
authors.affiliation: Memorial Hermann's Ironman Sports Medicine Institute, Houston, Texas.
authors.forename: Lane B
authors.initials: LB
authors.lastname: Bailey
authors.affiliation: ATI Physical Therapy, Greenville, South Carolina.
authors.forename: Charles A
authors.initials: CA
authors.lastname: Thigpen
authors.affiliation: Greenville Health System, Department of Orthopedics, Greenville, South Carolina.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Hawkins
authors.affiliation: Department of Physical Therapy, The University of South Carolina, Columbia, South Carolina.
authors.forename: Paul F
authors.initials: PF
authors.lastname: Beattie
authors.affiliation: ATI Physical Therapy, Greenville, South Carolina.
authors.forename: Ellen
authors.initials: E
authors.lastname: Shanley
mesh_terms: D000293:Adolescent; D001484:Baseball / Q000293:injuries*; D006801:Humans; D006811:Humerus / Q000503:physiopathology; D008297:Male; D052580:Muscle Stretching Exercises; D026201:Musculoskeletal Manipulations; D016059:Range of Motion, Articular; D012399:Rotation; D012782:Shoulder / Q000503:physiopathology; D000070599:Shoulder Injuries / Q000503:physiopathology* / Q000628:therapy*; D055815:Young Adult
keywords: baseball; glenohumeral internal rotation deficit (GIRD); instrumented manual therapy; posterior shoulder tightness (PST)