Are stretches effective in the prevention and treatment of glenohumeral internal rotation deficit?

Background: Shoulder injuries are well documented in overhead throwing athletes and glenohumeral internal rotation deficit (GIRD) has been identified in this population. There is evidence to suggest that GIRD and pain or pathology may be linked. Stretches are a common treatment to increase range of movement and have been advocated as a treatment to reduce GIRD. Objectives: To review the efficacy of stretches on reducing GIRD. Methods: A systematic literature search of Ovid MEDLINE (R), AMED, EMBASE, and CINAHL for studies investigating the efficacy of stretches alone on GIRD was performed from database inception to July 2011. Results: Six studies met the inclusion criteria, all of which investigated the efficacy of stretches on glenohumeral internal rotation as a preventative measure for asymptomatic subjects. A variety of stretching interventions were utilized, ranging from single stretches to multiple position stretching programs, with different follow-up periods. Although all studies demonstrated reduced GIRD after stretching, four of the studies report changes within or only just above the standard error of measurement. The data suggested that stretching over a period of weeks, rather than a single session, demonstrated the greatest reduction in GIRD. All studies were either cohorts or clinical trials, only one of which included a no treatment and stretching group, similar at baseline. There was evidence from this study to suggest that stretching in one direction was superior to another. Conclusions: There is weak evidence to suggest that stretches may be effective in reducing GIRD in subjects with asymptomatic shoulder pain.