Mike Reinold recently had a post about the sleeper stretch - a stretch that is commonly prescribed to increase glenohumeral internal rotation ROM. Mike discusses how the sleeper stretch actually is more likely to stretch the posterior capsule. With the frequency instability is seen in the clinic, increasing that instability with capsular stretching should not be a goal of ours. In fact, if you take a step back you might realize that the sleeper stretch looks very similar to the Hawkins-Kennedy Impingement test (just on it's side). Any time an exercise is the same motion as a provocative test, we should rethink the reasoning behind that exercise, especially with how overly aggressive patients can be with this particular exercise. Finally, Mike also discusses the instances where the sleeper stretch may actually be appropriate (young athletes that don't have anyone to stretch them and people that truly have posterior capsule tightness) and provides a video/explanation of how to properly perform the motion, along with alternatives to the exercises. Check it out!
7/6/2013 01:45:35 pm
I haven't actually read his post yet, which I plan to do, but is his point just to say not to use this stretch if the limitation is muscular? Because I was under the impression that the purpose of this stretch was to improve internal rotation ROM for patients with capsular restriction.
Hi Brent, thanks for the comment! Reinold starts the article off by stating that he rarely finds the posterior capsule to be tight at all in overhead athletes. Instead, he finds instability to be a far greater issue and doesn't want to increase instability by stretching the posterior capsule. That being said, he also goes over a couple instances where stretching the posterior capsule would be appropriate and goes so far as to offer proper technique, along with alternatives, of the sleeper stretch.
2/28/2014 05:12:08 am
I think both you and Reinold are inadvertantly misleading. The key phrase that seems to be glossed over is "in overhead athletes that don't have posterior capsule tightness". It begs the question, why stretch something that isn't tight or mobilize something with normal mobility? If one reads to the end we read that for the patient with posterior capsular tightnes, when performed properly, the sleeper stretch is a good stretch. PT101: the proper exercise/technique for the proper patient/problem. I think what Reinold is alluding to, in a way, is that we should not be assigning blanket, protocol programs. We need to assess our patient first and apply what we learned in school.
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