MIRM Versus PIRT in Athletes With Glenohumeral Internal Rotation Deficit

NCT04894786 | Completed

• 1 other identifier: REC/20/0108 Agha Salman Khan
• Study Type: interventional
• Target: 16
• Locations: 1 country
• Sites: 1

Brief Summary

Glenohumeral internal rotation deficit (GIRD) is common physical deficiency found both teenager and overhead many sports for example baseball, cricket, and tennis. GIRD is generally categorized as simultaneous deficits of internal rotation (IR) and total arc of motion in the dominant side. GIRD causes increase muscle stiffness, capsular changes ( hyperplasia) , muscle imbalance leads to humeral retroversion. The objective of the study will be to Compare the effects of Mulligan internal rotation Mobilization and post isometric relaxation technique on Pain, Range of motion and function in athletes with Glenohumeral Internal Rotation Deficit This study will be a Randomise Control trial and will be conducted Pakistan cricket board acedmy and in outpatient department of physical therapy, AL REHMAN Hospital Lahore . The study will be completed within the time duration of six months . Convenient sampling technique will be used to collect the data. A sample size of 14 patients will be taken in this study Comparison of Mulligan internal rotation Mobilization and post isometric relaxation technique on Pain and function in athletes with Glenohumeral Internal Rotation Deficit. Patients will be divided into two groups. (Group A will be treated with mulligan MWM AND Sleeper stretch whereas Group B will be treated with post isometic relaxtion technique and sleeper stretch ). SPADI score will be used to ask some questions related to patients symptoms and daily activities and Numeric pain rating scale will be used to measure pain intensity. UNIVERSAL GONIOMETER will be used to measure ROM of shoulder joint All participants of the study will fill the SPADI score and Numeric pain rating scale on day 1 as pre treatment values and at the end of week 2 as post treatment values respectively . The collected data will be analyzed on SPSS 25.

Conditions

Glenohumeral Internal Rotation Deficit; Rotator Cuff Impingement; Internal Rotation Contracture-shoulder

Outcome Measures

Primary Outcomes (3)

• NUMERIC PAIN RATING SCALE

  NPRS is anchored by terms describing pain severity extremes. The 11 -point numeric scale ranges from '0' representing one pain extreme (e.g. "no pain") to '10' representing the other pain extreme (e.g. "pain as bad as you can imagine" or "worst pain imaginable

  2 weeks

• Shoulder Pain and Disability Index (SPADI)

  The Shoulder Pain and Disability Index (SPADI) is a self-administered questionnaire that consists of two dimensions, one for pain and the other for functional activities. The pain dimension consists of five questions regarding the severity of an individual's pain. Functional activities are assessed with eight questions designed to measure the degree of difficulty an individual has with various activities of daily living that require upper-extremity use. The SPADI takes 5 to 10 minutes for a patient to complete and is the only reliable and valid region-specific measure for the shoulder.

  2 weeks

• Universal Goniometer

  Universal goniometer will be used to measure Shoulder internal rotation range of motion .

  2 weeks

Study Arms (2)

Mulligan Internal Rotation Mobilization

EXPERIMENTAL

Mulligan Internal Rotation Mobilization \& Sleeper Stretch

Other: Mulligan Internal Rotation Mobilization

Post Isometric Relaxation Technique

ACTIVE COMPARATOR

Post Isometric Relaxation Technique and Sleeper Stretch

Other: Post Isometric Relaxation Technique

Interventions

Mulligan Internal Rotation Mobilization OTHER

Mulligan Internal Rotation Mobilization (MIRM) Sleeper Stretch The therapist places a web of his one hand around patient's axilla and thumb of another hand in the bent elbow and the glide will be applied to the head of the humerus down in the glenoid fossa using thumb while stabilizing the scapula with another hand. Therapist will ensures that the other hand is stabilizing up and inwards. While this distraction is taking place the patient internally rotated his shoulder with the help of another hand, at the same time his affected upper arm will abduct by therapist abdomen distracting the head of the humerus laterally. The hand in axilla acts as a fulcrum. Mulligan MWM will be applied for 3 days alternate days by following the rule of 3

Mulligan Internal Rotation Mobilization

Post Isometric Relaxation Technique OTHER

Post Isometric Relaxation Technique (PIRT) Sleeper Stretch The subject will be positioned supine on the treatment table with the shoulder and elbow, at 90 degree of abduction and flexion. The shoulder will be stabilized at the acromion process with one hand, and the other hand will be used to passively move the arm into internal rotation until the first barrier of motion will reached. The subject will be then instructed to perform a 5second isometric contraction of approximately 25% maximal effort in the direction of external rotation, against an opposing force provided at the distal forearm. Following the contraction, the subject will be instructed to internally rotate the arm toward the ground as a 30-second active assisted stretch will be applied. The subject will be instructed to relax, and a new movement barrier will then engage.

Post Isometric Relaxation Technique

Eligibility Criteria

• Age: 18 Years - 35 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64)

You may qualify if:

• Subjects within the age group 18-35 years will be taken.
• Both male and female will be taken.
• Subjects with glenohumeral internal rotation deficit will be taken.
• Subjects with minimum 50% reduction in the internal rotation range of motion will be taken compared to the unaffected side.
• Subjects with shoulder abduction ROM at least 90 degrees
• Subjects with shoulder Extension ROM at least 20 degrees
• Subjects with positive lift-off test and belly compression test

You may not qualify if:

• History of shoulder surgery
• Any Shoulder joint complex fracture
• Frozen shoulder (Adhesive capsulitis)
• post traumatic and rotator cuff tear
• neurological deficit affecting shoulder
• Pain or disorder of cervical spine
• Osteoporosis, Malignancies ,Open wound and Pregnancy
• Rheumatoid arthritis
• a recent steroid injection and previous manipulation under anesthesia

Sponsors & Collaborators

• Riphah International University: lead

Study Sites (1)

Al Rehman Hospital Lahore

Lahore, Punjab Province, 54000, Pakistan

Location

Related Publications (6)

• Manske RC, Meschke M, Porter A, Smith B, Reiman M. A randomized controlled single-blinded comparison of stretching versus stretching and joint mobilization for posterior shoulder tightness measured by internal rotation motion loss. Sports Health. 2010 Mar;2(2):94-100. doi: 10.1177/1941738109347775.

  PMID: 23015927 BACKGROUND

• Kotagiri N, Cooper ML, Rettig M, Egbulefu C, Prior J, Cui G, Karmakar P, Zhou M, Yang X, Sudlow G, Marsala L, Chanswangphuwana C, Lu L, Habimana-Griffin L, Shokeen M, Xu X, Weilbaecher K, Tomasson M, Lanza G, DiPersio JF, Achilefu S. Radionuclides transform chemotherapeutics into phototherapeutics for precise treatment of disseminated cancer. Nat Commun. 2018 Jan 18;9(1):275. doi: 10.1038/s41467-017-02758-9.

  PMID: 29348537 BACKGROUND

• Sehgal R, Cheung CX, Hills T, Waris A, Healy D, Khan T. Perforated jejunal diverticulum: a rare case of acute abdomen. J Surg Case Rep. 2016 Oct 7;2016(10):rjw169. doi: 10.1093/jscr/rjw169.

  PMID: 27765806 BACKGROUND

• Wilk KE, Macrina LC, Fleisig GS, Porterfield R, Simpson CD 2nd, Harker P, Paparesta N, Andrews JR. Correlation of glenohumeral internal rotation deficit and total rotational motion to shoulder injuries in professional baseball pitchers. Am J Sports Med. 2011 Feb;39(2):329-35. doi: 10.1177/0363546510384223. Epub 2010 Dec 4.

  PMID: 21131681 BACKGROUND

• Tokish JM, Curtin MS, Kim YK, Hawkins RJ, Torry MR. Glenohumeral internal rotation deficit in the asymptomatic professional pitcher and its relationship to humeral retroversion. J Sports Sci Med. 2008 Mar 1;7(1):78-83. eCollection 2008.

  PMID: 24150137 BACKGROUND

• Keller RA, De Giacomo AF, Neumann JA, Limpisvasti O, Tibone JE. Glenohumeral Internal Rotation Deficit and Risk of Upper Extremity Injury in Overhead Athletes: A Meta-Analysis and Systematic Review. Sports Health. 2018 Mar/Apr;10(2):125-132. doi: 10.1177/1941738118756577. Epub 2018 Jan 30.

  PMID: 29381423 BACKGROUND

MeSH Terms

Conditions

Shoulder Impingement Syndrome

Condition Hierarchy (Ancestors)

Joint Diseases; Musculoskeletal Diseases; Shoulder Injuries; Wounds and Injuries

Study Officials

• Saima Zahid, PhD*

  Riphah International University

  STUDY CHAIR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: DOUBLE
• Who Masked: PARTICIPANT, INVESTIGATOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: May 19, 2021
• First Posted: May 20, 2021
• Study Start: March 1, 2021
• Primary Completion: September 5, 2021
• Study Completion: September 10, 2021
• Last Updated: March 10, 2022

Record last verified: 2022-03

Data Sharing

• IPD Sharing: Will not share

Locations

PA (1)