Effective Stretching Positions of the Piriformis Muscle Evaluated Using Shear Wave Elastography.

CONTEXT: Piriformis syndrome is often associated with muscle spasms and shortening of the piriformis muscle (PM). Physical therapy, including static stretching of the PM, is one of the treatments for this syndrome. However, the effective stretching position of the PM is unclear in vivo. This study aimed to determine the effective stretching positions of the PM using ultrasonic shear wave elastography. DESIGN: Observational study. METHODS: Twenty-one healthy young men (22.7 [2.4] y) participated in this study. The shear elastic modulus of the PM was measured at 12 stretching positions using shear wave elastography. Three of the 12 positions were tested with maximum internal rotation at 0°, 20°, or 40° hip adduction in 90° hip flexion. Nine of the 12 positions were tested with maximum external rotation at positions combined with 3 hip-flexion angles (70°, 90°, and 110°) and 3 hip-adduction angles (0°, 20°, and 40°). RESULTS: The shear elastic modulus of the PM was significantly higher in the order of 40°, 20°, and 0° of adduction and higher in external rotation than in internal rotation. The shear elastic modulus of the PM was significantly greater in combined 110° hip flexion and 40° adduction with maximum external rotation than in all other positions. CONCLUSION: This study revealed that the position in which the PM was most stretched was maximum external rotation with 110° hip flexion and 40° hip adduction.

Synergistic Dominance Induced by Hip Extension Exercise Alters Biomechanics and Muscular Activity During Sprinting and Suggests a Potential Link to Hamstring Strain.

ABSTRACT: Iguchi, J, Hojo, T, Fujisawa, Y, Kuzuhara, K, Yanase, K, Hirono, T, Koyama, Y, Tateuchi, H, and Ichihashi, N. Synergistic dominance induced by hip extension exercise alters biomechanics and muscular activity during sprinting and suggests a potential link to hamstring strain. J Strength Cond Res 37(9): 1770-1776, 2023-Hamstring strain is likely to occur during the late swing phase or the first half of the stance phase in sprinting. During the late swing phase, the hamstrings and gluteus maximus (Gmax) contract eccentrically to decelerate the lower limb. We hypothesized that, when the Gmax becomes dysfunctional because of delayed onset muscle soreness (DOMS), the hamstring workload is increased (i.e., there is synergetic dominance), which could lead to an increased risk of strain. A total of healthy 15 male undergraduate or graduate students (age 23.1 ± 1.28 years) were recruited to perform exercises and maximal sprints. On day 1, before subjects performing DOMS-causing exercises, and on day 3, while subjects were experiencing DOMS in the Gmax, lower-limb biomechanical and muscle activity data were recorded using a motion analysis system and electromyography (EMG), respectively. Data were analyzed and compared between day 1 and day 3. Hip flexion angle on day 3 was significantly lower than that on day 1, but the opposite was true for the knee flexion angle (P < 0.05). Vastus medialis (VM), biceps femoris (BF), and Gmax muscle activities on day 3 were significantly higher than those on day 1 (P < 0.05). Peak propulsive forces on day 3 were significantly higher than those on day 1 (P < 0.05). Kinematic changes such as decreased hip flexion angle and EMG changes such as increased BF EMG activity on day 3 to compensate for the loss of function of the Gmax may potentially increase the risk of hamstring strain.

Effects of shoulder position during static stretching on shear elastic modulus of biceps brachii muscle.

Biceps brachii muscle consists of a long head (BBL) and a short head (BBS). Shortening the BBL and BBS causes tendinopathy of the intertubercular groove and coracoid process. Therefore, it is necessary to stretch the BBL and BBS separately. This study aimed to determine the positions where the BBL and BBS were most stretched, using shear wave elastography (SWE). Fifteen healthy young males participated in the study. The shear elastic moduli of the BBL and BBS of the non-dominant arm were measured using SWE. The measurement positions were the resting position (shoulder flexion and abduction 0°) and four stretching positions.. The elbow was extended, and the forearm was pronated in all positions. Statistical analysis was performed using Wilcoxon's signed-rank test to compare the shear elastic moduli between the resting and stretched limb positions. In addition, Wilcoxon's signed-rank test was used to compare shear elastic moduli between the stretching positions that were significantly different compared to the resting position.. Results show that for BBL and BBS, shear elastic moduli were significantly higher in the shoulder extension + external rotation and shoulder horizontal abduction + internal rotation positions than in the resting position. Moreover, the shear elastic modulus of the BBL was significantly higher in shoulder extension + external rotation than in shoulder horizontal abduction + internal rotation. In contrast, the shear elastic modulus of the BBS was significantly higher in shoulder horizontal abduction + internal rotation than in shoulder extension + external rotation. The BBL and BBS were effectively stretched by shoulder extension + external rotation and horizontal abduction + internal rotation.

Acute changes in passive stiffness of the individual hamstring muscles induced by resistance exercise: effects of contraction mode and range of motion.

PURPOSE: Recent studies raise an interesting possibility that resistance exercise also decreases passive muscle stiffness, as does stretching exercise. However, little is known about how program variables of resistance exercise acutely influence muscle stiffness. We aimed to examine the acute changes in passive stiffness of the individual hamstring muscles after resistance exercises using different combinations of contraction modes and ranges of motion (ROMs). METHODS: Thirteen healthy young male participants performed three sessions of resistance exercises that comprised stiff-leg deadlift with different contraction modes and exercise ROMs on separate days as follows: (1) eccentric contractions with a wide exercise ROM (EW); (2) eccentric contractions with a narrow exercise ROM (EN); and (3) concentric contractions with a wide exercise ROM (CW). Maximal joint ROM, passive torque, shear modulus of the individual hamstring muscles, and maximal isometric torque of knee flexion were measured before and 3 min, 30 min, and 60 min after completing each session. RESULTS: The shear modulus of the semimembranosus was significantly lower at 3 min post-exercise (121.8 ± 16.0 kPa) than at pre-exercise (129.0 ± 18.9 kPa, p = 0.021, r = 0.45) in EW, but not in EN or CW. There were no significant changes in the shear moduli of the biceps femoris long head or the semitendinosus at any timepoint in any exercise protocols. CONCLUSIONS: The present results suggest that the combination of eccentric contraction and wide ROM during resistance exercise has the potential to acutely decrease passive stiffness (shear modulus) of a specific muscle.

Effective stretching position for the posterior deltoid muscle evaluated by shear wave elastography.

BACKGROUND: Deteriorated extensibility of the posterior deltoid muscle is one of the factors of posterior shoulder tightness, and improvement in its extensibility is needed. However, no study has investigated which shoulder positions effectively stretch the posterior deltoid muscle in vivo. The aim of this study was to verify the effective stretching position of the posterior deltoid muscle in vivo by shear wave elastography. METHODS: Fifteen healthy men participated in this study. The shear modulus of the posterior deltoid was measured at resting and 13 stretching positions: 60°, 90°, and 120° shoulder flexion; maximum shoulder flexion, horizontal adductions at 60°, 90°, and 120° shoulder flexion; internal rotations at 60°, 90°, and 120° shoulder flexion; and combinations of horizontal adduction with internal rotation at 60°, 90°, and 120° shoulder flexion. The shear moduli of each stretching position were compared to those of the rest. Then, among the stretching positions for which the shear modulus was significantly different from the rest, the shear moduli were compared using a three-way analysis of variance with repeated measures of the 3 factors-flexion, horizontal adduction, and internal rotation. RESULTS: The shear moduli in all stretching positions were significantly higher than those of the rest, except for maximum shoulder flexion. The three-way analysis of variance with repeated measures revealed significant main effects in flexion and horizontal adduction. Comparing the flexion angles, the shear modulus was significantly higher at 90° than that at 60° and 120°. The shear modulus with horizontal adduction was significantly higher than that without horizontal adduction. Moreover, a significant two-way interaction was found only at flexion and horizontal adduction. The shear modulus with horizontal adduction was significantly higher at all angles than that without horizontal adduction at each flexion angle. Comparing the flexion angles with horizontal adduction, the shear modulus was significantly higher at 90° than that at 60° and 120°. No significant three-way interactions were found. CONCLUSION: Shoulder flexion and horizontal adduction affected the extensibility of the posterior deltoid muscle, whereas the effect of shoulder internal rotation was limited. More precisely, maximal horizontal adduction at 90° shoulder flexion was the most effective stretching position for the posterior deltoid muscle.

Effective muscle elongation positions for the neck extensor muscles: An ultrasonic shear wave elastography study.

This study aimed to clarify the effective stretching positions for neck extensor muscles. Fifteen healthy men were measured shear moduli of the right neck extensor muscles using ultrasound shear wave elastography in following positions: rest (Rest), flexion (Flex), contralateral bending (Bend), flexion + contralateral bending (Flex â†’ Bend), flexion + contralateral bending + contralateral rotation (Flex â†’ Bend â†’ ConRot), and flexion + contralateral bending + ipsilateral rotation (Flex â†’ Bend â†’ IpsRot). The increase in the shear modulus indicated a greater muscle elongation. Regarding the upper trapezius and splenius capitis, the shear moduli at Flex â†’ Bend, Flex â†’ Bend â†’ ConRot, and Flex â†’ Bend â†’ IpsRot were significantly higher than those at Rest. The shear moduli at stretching positions, including contralateral bending, were significantly higher than those at Rest and Flex in the levator scapulae. The results indicated that the stretching position with a combination of flexion and contralateral bending could be effective for elongation of the upper trapezius and splenius capitis. Furthermore, the stretching positions including contralateral bending could be effective for the levator scapulae.

Regional differential stretching of the pectoralis major muscle: An ultrasound elastography study.

Pectoralis major (PMa) muscle injuries are becoming more prevalent, and their incidence differs among the PMa regions, i.e., the clavicular, sternal, and abdominal regions. Therefore, identifying the position for effectively lengthening each PMa region is critical in preventing PMa injuries. The purpose of this study was to determine the effective stretching position for each PMa region through shear wave elastography, which can indirectly assess individual muscle lengthening. Fifteen men participated in this study. Twelve stretching positions were compounded with shoulder abductions (45°, 90°, and 135°), pelvic rotation (with or without), shoulder external rotation (with or without), and shoulder horizontal abductions. The shear modulus of each PMa region was measured through shear wave elastography in the stretching positions mentioned above. At the clavicular region, the shear modulus was higher for three stretching positions: shoulder horizontal abduction at 45° abduction during pelvic rotation and shoulder external rotation, shoulder horizontal abduction at 90° abduction, and shoulder horizontal abduction at 90° abduction while considering shoulder external rotation. For the sternal region, the shear modulus was higher in two stretching positions: shoulder horizontal abduction at 90° abduction while adding external rotation, and combination of pelvic rotation and external rotation. For the abdominal region, the shear modulus was higher in the shoulder horizontal abduction at 135° abduction with pelvic and external rotation. These results indicated that the effective stretching position was different for each PMa region.

Epimuscular myofascial force transmission from biarticular rectus femoris elongation increases shear modulus of monoarticular quadriceps muscles.

This study aimed to examine the effect of rectus femoris (RF) elongation with passive hip angle change on the shear moduli of the vastus lateralis (VL) and medialis (VM) to verify whether Epimuscular myofascial force transmission (EMFT) occurs in the human quadriceps. Fourteen healthy men participated in this study. The shear moduli of the RF, VL, and VM were measured in four hip positions: flexion (Flex), extension and abduction (Ext-Abd), extension (Ext), and extension and adduction (Ext-Add). As the behavior of shear moduli may differ depending on the parts of the vasti muscles, we measured the medial and lateral parts of the VL (Medial-VL and Lateral-VL) and VM (Medial-VM and Lateral-VM). The shear moduli at the Ext and Ext-Add positions were higher than at the Flex position in the RF, VL, and VM. The shear moduli during Ext and Ext-Add were higher than at the Ext-Abd in the RF, VL, and Lateral-VM. Moreover, the shear modulus of the Lateral-VM was higher than of the Medial-VM (Flex: 8.5% higher; Ext-Abd: 15.6%; Ext: 30.2%; Ext-Add: 32.6%). The shear moduli of the VL and VM, which are monoarticular muscles of the knee, increased with passive hip extension or adduction with extension, even when the knee angle was kept constant. The results suggest that EMFT occurs in the quadriceps, and EMFT had a great impact in the Lateral-VM, which is anatomically adjacent to the RF, but it had little effect in the Medial-VM, which is further away from the RF.

Acute and Prolonged Effects of Stretching on Shear Modulus of the Pectoralis Minor Muscle.

Increased muscle stiffness of the pectoralis minor (PMi) could deteriorate shoulder function. Stretching is useful for maintaining and improving muscle stiffness in rehabilitation and sport practice. However, the acute and prolonged effect of stretching on the PMi muscle stiffness is unclear due to limited methodology for assessing individual muscle stiffness. Using shear wave elastography, we explored the responses of shear modulus to stretching in the PMi over time. The first experiment (n = 20) aimed to clarify the acute change in the shear modulus during stretching. The shear modulus was measured at intervals of 30 s × 10 sets. The second experiment (n = 16) aimed to observe and compare the prolonged effect of different durations of stretching on the shear modulus. Short and long stretching duration groups underwent 30s × 1 set and 30s × 10 sets, respectively. The assessments of shear modulus were conducted before, immediately after, and at 5, 10, and 15 min post-stretching. In experiment I, the shear modulus decreased immediately after a bout (30 s) of stretching (p < 0.001, change: -2.3 kPa, effect size: r = 0.72) and further decreased after 3 repetitions (i.e., 90 s) of stretching (p = 0.03, change: -1.0 kPa, effect size: r = 0.53). In experiment II, the change in the shear modulus after stretching was greater in the long duration group than in the short duration group (p = 0.013, group mean difference: -2.5 kPa, partial η2 = 0.36). The shear modulus of PMi decreased immediately after stretching, and stretching for a long duration was promising to maintain the decreased shear modulus. The acute and prolonged effects on the PMi shear modulus provide information relevant to minimum and persistent stretching time in rehabilitation and sport practice.

Age-related changes in gait speeds and asymmetry during circular gait and straight-line gait in older individuals aged 60-79 years.

AIM: The present study aimed to investigate the age-related changes in gait speeds and asymmetry during circular and straight-line gaits among older adults aged 60-79 years. METHODS: The study included 391 community-dwelling older adults aged >60 years, who participated in the Nagahama cohort study. They were assigned to four age groups: 60-64 years (early 60s), 65-69 years (late 60s), 70-74 years (early 70s) and 75-79 years (late 70s). For the circular gait test, the time required to walk twice around a 1-m diameter circle for right and left rotations were measured. The average time of the two trials was measured as the circular gait time, and the side-to-side difference in the circular gait times was calculated as an asymmetry index. Walking speed, asymmetry of step length, and asymmetry of stance duration time during straight-line gait at comfortable and maximal walking pace were measured. RESULTS: Circular gait time in older women in the late 70s group was significantly slower than that in other age groups; however, no age-related change was observed in older men. Maximal gait speeds in the early and late 70s groups were significantly slower than those in the early 60s group. CONCLUSIONS: Age-related decline in circular gait speed was observed in older women aged ≥75 years, but not in older men. Maximal straight-line gait speed decreased significantly in both genders after the age of 70 years. Geriatr Gerontol Int 2021; 21: 404-410.

Differences in shear elastic modulus of the latissimus dorsi muscle during stretching among varied trunk positions.

The latissimus dorsi (LD) can be divided into the upper, middle, and lower parts, but the effective stretching positions for each part are unknown. In this study, we aimed to investigate effective trunk positions for stretching of the LD. A total of 14 healthy males participated in this study. The following seven trunk positions were chosen as the LD stretching positions; upright of the trunk (Baseline), flexion of the trunk (Flex), contralateral bending of the trunk (LB), contralateral rotation of the trunk (Rot), flexion and contralateral bending of the trunk (Flex + LB), flexion and contralateral rotation of the trunk (Flex + Rot), and contralateral bending and contralateral rotation of the trunk (LB + Rot). Maximal elevation of the upper limb was passively added to all positions. The shear elastic modulus, used as the index of muscle elongation, was measured at the four parts (upper, middle, lower, distal parts) of the LD. The shear elastic moduli showed obviously high values in Rot and LB + Rot at the upper, middle, and distal parts, and also in LB, Rot, and LB + Rot at the lower part. These findings suggest that contralateral trunk rotation, or a combination of contralateral trunk bending and rotation are effective trunk positions for stretching all parts of the LD. Contralateral trunk bending was also effective for stretching the lower part of the LD.

Association of Pain History and Current Pain With Sagittal Spinal Alignment and Muscle Stiffness and Muscle Mass of the Back Muscles in Middle-aged and Elderly Women.

STUDY DESIGN: A cross-sectional study. OBJECTIVE: To investigate the association of low back pain history (LBPH) and LBP with sagittal spinal alignment, stiffness assessed using ultrasonic shear wave elastography, and mass of the back muscle in community-dwelling middle-aged and elderly women. SUMMARY OF BACKGROUND DATA: The association of LBPH and LBP with sagittal spinal alignment, stiffness, and mass of the back muscles remains unclear in middle-aged and elderly women. PARTICIPANTS AND METHODS: The study comprised 19 asymptomatic middle-aged and elderly women [control (CTR) group], 16 middle-aged and elderly women with LBPH (LBPH group), and 23 middle-aged and elderly women with LBP (LBP group). Sagittal spinal alignment in the standing and prone positions (kyphosis angle in the thoracic spine, lordosis angle in the lumbar spine, and anterior inclination angle in the sacrum) was measured using a Spinal Mouse. The stiffness of the back muscles (lumbar erector spinae and multifidus) in the prone position was measured using ultrasonic shear wave elastography. The mass of the back muscles (thoracic and lumbar erector spinae, lumbar multifidus, and quadratus lumborum) was also measured. RESULTS: Multiple logistic regression analysis with a forward selection method showed that the stiffness of the lumbar multifidus muscle was a significant and independent factor of LBPH. The stiffness of the lumbar multifidus muscle was significantly higher in the LBPH group than in the CTR group. Multiple logistic regression analysis also indicated that lumbar lordosis angle in the standing position was a significant and independent factor of LBP. The lumbar lordosis angle was significantly smaller in the LBP group than in the CTR group. CONCLUSIONS: Our results suggest that LBPH is associated with increased stiffness of the lumbar multifidus muscle in the prone position, and that LBP is associated with the decreased lumbar lordosis in the standing position in community-dwelling middle-aged and elderly women.

Electrical Stimulation to the Infraspinatus on Hypertrophy and Strength of the Shoulder.

The purpose of this study was to determine the effects of six weeks of electrical muscle stimulation (EMS) on the strength and muscle mass of the infraspinatus muscle. Twenty non-athletes (age: 24±3.4 years, height: 171.5±5.6 cm, mass: 65.2±8.1 kg) were randomly classified into two groups, an electrical muscle stimulation group (EMS group) and a control group (CON group). The EMS group completed a total of 18 20- min EMS sessions, three times per week over a period of six weeks, while the CON group received no intervention. The muscle thicknesses of both the infraspinatus and the deltoid muscles, the cross-sectional area (CSA) of the whole infraspinatus muscle, and the isometric and isokinetic peak torques of shoulder external rotations were measured before and after intervention. It was found that the muscle thickness of the superior infraspinatus (Pre 0.92±0.19 cm2, Post 0.99±0.16 cm2, p=0.02) and the CSA (Pre 10.99±1.32 cm2, Post 11.99±1.02 cm2, p=0.03) significantly increased in the EMS group. This study demonstrated that EMS of the infraspinatus muscle over a period of six weeks resulted in hypertrophy of the infraspinatus muscle.

Improvement in muscle strength with low-load isotonic training depends on fascicle length but not joint angle.

INTRODUCTION: In this study we investigate whether low-load isotonic training will elicit greater improvement in muscle strength at the same fascicle length, rather than at the same joint angle. METHODS: Sixteen healthy men (24.1 ± 2.5 years of age) were randomly divided into intervention and control groups. Pre- and posttraining maximum isometric and isokinetic strengths and fascicle lengths of the medial gastrocnemius muscle were measured. Isotonic resistance training at 15 ° to 30 ° ankle plantarflexion at low intensity was conducted for 4 weeks. RESULTS: The maximum isometric and isokinetic strength of the intervention group increased significantly only at 15 ° dorsiflexion and 8 ° to 12 ° dorsiflexion. Fascicle length during maximum voluntary contraction at 15 ° dorsiflexion to 0 ° was similar to fascicle length under training conditions. DISCUSSION: It is possible that the improvement in muscle strength with low-load training depends on fascicle length rather than joint angle. Muscle Nerve 57: 83-89, 2018.

Association of low back pain with muscle stiffness and muscle mass of the lumbar back muscles, and sagittal spinal alignment in young and middle-aged medical workers.

BACKGROUND: Muscle stiffness of the lumbar back muscles in low back pain (LBP) patients has not been clearly elucidated because quantitative assessment of the stiffness of individual muscles was conventionally difficult. This study aimed to examine the association of LBP with muscle stiffness assessed using ultrasonic shear wave elastography (SWE) and muscle mass of the lumbar back muscle, and spinal alignment in young and middle-aged medical workers. METHODS: The study comprised 23 asymptomatic medical workers [control (CTR) group] and 9 medical workers with LBP (LBP group). Muscle stiffness and mass of the lumbar back muscles (lumbar erector spinae, multifidus, and quadratus lumborum) in the prone position were measured using ultrasonic SWE. Sagittal spinal alignment in the standing and prone positions was measured using a Spinal Mouse. The association with LBP was investigated by multiple logistic regression analysis with a forward selection method. The analysis was conducted using the shear elastic modulus and muscle thickness of the lumbar back muscles, and spinal alignment, age, body height, body weight, and sex as independent variables. FINDINGS: Multiple logistic regression analysis showed that muscle stiffness of the lumbar multifidus muscle and body height were significant and independent determinants of LBP, but that muscle mass and spinal alignment were not. Muscle stiffness of the lumbar multifidus muscle in the LBP group was significantly higher than that in the CTR group. INTERPRETATION: The results of this study suggest that LBP is associated with muscle stiffness of the lumbar multifidus muscle in young and middle-aged medical workers.

Ankle and toe muscle strength characteristics in runners with a history of medial tibial stress syndrome.

BACKGROUND: A high proportion of flexor digitorum longus attachment is found at the posteromedial border of the tibia, which is the most common location of medial tibial stress syndrome (MTSS). Therefore, plantar flexion strength of the lesser toes could be related to MTSS; however, the relationship between MTSS and muscle strength of the hallux and lesser toes is not yet evaluated due to the lack of quantitative methods. This study investigated the muscle strength characteristics in runners with a history of MTSS by using a newly developed device to measure the muscle strength of the hallux, lesser toes, and ankle. METHODS: This study comprised 27 collegiate male runner participants (20.0 ± 1.6 years, 172.1 ± 5.1 cm, 57.5 ± 4.0 kg). Maximal voluntary isometric contraction (MVIC) torque of the plantar flexion, dorsiflexion, inversion, and eversion of the ankle were measured by using an electric dynamometer. MVIC torque of the 1st metatarsophalangeal joint (MTPJ) and 2nd-5th MTPJ were measured by using a custom-made torque-measuring device. MVIC torques were compared between runners with and without a history of MTSS. RESULTS: MVIC torque of the 1st MTPJ plantar flexion was significantly higher in runners with a history of MTSS than in those without it. In contrast, there were no significant differences in the MVIC torque values of the 2nd-5th MTPJ plantar flexion and each MVIC torque of the ankle between runners with and without a history of MTSS. CONCLUSION: A history of MTSS increased the isometric FHL strength.

Shoulder horizontal abduction stretching effectively increases shear elastic modulus of pectoralis minor muscle.

BACKGROUND: Stretching maneuvers for the pectoralis minor muscle, which involve shoulder horizontal abduction or scapular retraction, are performed in clinical and sports settings because the tightness of this muscle may contribute to scapular dyskinesis. The effectiveness of stretching maneuvers for the pectoralis minor muscle is unclear in vivo. The purpose of this study was to verify the effectiveness of stretching maneuvers for the pectoralis minor muscle in vivo using ultrasonic shear wave elastography. METHODS: Eighteen healthy men participated in this study. Elongation of the pectoralis minor muscle was measured for 3 stretching maneuvers (shoulder flexion, shoulder horizontal abduction, and scapular retraction) at 3 shoulder elevation angles (30°, 90°, and 150°). The shear elastic modulus, used as the index of muscle elongation, was computed using ultrasonic shear wave elastography for the 9 aforementioned stretching maneuver-angle combinations. RESULTS: The shear elastic modulus was highest in horizontal abduction at 150°, followed by horizontal abduction at 90°, horizontal abduction at 30°, scapular retraction at 30°, scapular retraction at 90°, scapular retraction at 150°, flexion at 150°, flexion at 90°, and flexion at 30°. The shear elastic moduli of horizontal abduction at 90° and horizontal abduction at 150° were significantly higher than those of other stretching maneuvers. There was no significant difference between horizontal abduction at 90° and horizontal abduction at 150°. CONCLUSIONS: This study determined that shoulder horizontal abduction at an elevation of 90° and horizontal abduction at an elevation of 150° were the most effective stretching maneuvers for the pectoralis minor muscle in vivo.

Effects of two stretching methods on shoulder range of motion and muscle stiffness in baseball players with posterior shoulder tightness: a randomized controlled trial.

BACKGROUND: The cross-body stretch and sleeper stretch are widely used for improving flexibility of the posterior shoulder. These stretching methods were modified by Wilk. However, few quantitative data are available on the new, modified stretching methods. A recent study reported the immediate effects of stretching and soft tissue mobilization on the shoulder range of motion (ROM) and muscle stiffness in subjects with posterior shoulder tightness. However, the long-term effect of stretching for muscle stiffness is unknown. The objective of this study was to examine the effects of 2 stretching methods, the modified cross-body stretch (MCS) and the modified sleeper stretch (MSS), on shoulder ROM and muscle stiffness in baseball players with posterior shoulder tightness. METHODS: Twenty-four college baseball players with ROM limitations in shoulder internal rotation were randomly assigned to the MCS or MSS group. We measured shoulder internal rotation and horizontal adduction ROM and assessed posterior shoulder muscle stiffness with ultrasonic shear wave elastography before and after a 4-week intervention. Subjects were asked to perform 3 repetitions of the stretching exercises every day, for 30 seconds, with their dominant shoulder. RESULTS: In both groups, shoulder internal rotation and horizontal adduction ROM were significantly increased after the 4-week intervention. Muscle stiffness of the teres minor decreased in the MCS group, and that of the infraspinatus decreased in the MSS group. CONCLUSIONS: The MCS and MSS are effective for increasing shoulder internal rotation and horizontal adduction ROM and decreasing muscle stiffness of the infraspinatus or teres minor.