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Effect of fascial manipulation on glenohumeral internal rotation deficit in overhead athletes -- a randomized controlled trial
Mathew NP, G PR, Davis F
Muscles, Ligaments and Tendons Journal 2020 Jan-Mar;10(1):17-23
clinical trial
5/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: No; Baseline comparability: No; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: No. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

BACKGROUND: Glenohumeral internal rotation deficit (GIRD) is common among overhead 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 degrees 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 therapist 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 experimental 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 asymptomatic 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.

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