A Better Alternative for the Sleeper Stretch
It is October, which means I am subjecting my wife to a long list of horror movies in preparation for Halloween. What can I say? October is one of my favorite months. The weather is great, all 4 sports are in gear, and it gives me a great reason to watch all my favorite scary movies. In a lot of the movies the ending has a similar formula. The villain is defeated and the protagonists are sitting around breathing a sigh of relief only to be blind sided by the villain one last time. The ability for the villain to return over and over despite everything the stories heroes do reminds me of the Sleeper Stretch.
I have been working with baseball players for quite some time and I can not seem to put this stretch in its final resting place. Just this week I had another pitcher tell me that his surgeon recommended him to perform the sleeper stretch every day to improver his shoulder mobility. In this blog we will discuss what the sleeper stretch is, why is it commonly prescribed, why I am not a fan, and what I recommend instead. Let’s get started!
The Birth of the Sleeper Stretch
The Sleeper Stretch
The first mentioning of the Sleeper Stretch dates back to the early 2000s. The problem the stretch was trying to solve was GIRD, and posterior capsule stiffness specifically. When a pitcher throws there is significant eccentric load placed on the posterior capsule. The Posterior Capsule Theory states that the eccentric load causes tearing of the capsule. This tearing turns into scar tissue and thus thickens the capsule.
A thickened posterior capsule causes the head of the humerus to glide forward. This forward migration increases stress of the frontside structures (Long Head of the Biceps Tendon, Anterior Joint Capsule, Subscapularis Tendon), and reduces internal rotation mobility.
To combat this humeral head shift clinicians developed the sleeper stretch to stretch out the posterior capsule. Thus a monster was born.
Validity of the Posterior Capsule Theory
The first issue with the Sleeper Stretch is actually an issue with the problem it is trying to solve. Yes, several studies have measured posterior capsule thickness on throwers and compared them to non-throwers, and the pitchers non-throwing arm. The posterior capsule does seem to thicken with repeated stress. The question is how much is this contributing to the loss of mobility in comparison to Soft Tissue Tightness, and Humeral Retroversion. When you talk to leaders in the field of baseball rehab the majority lean towards Soft Tissue Tightness and Humeral Retroversion.
In my experience all pitchers are different. I have had pitchers who are naturally stiff individuals. With these guys I do like to work on more mobility work and may spend some time on that posterior capsule. Other pitchers are hypermobile, and that also goes for their thickened posterior capsule. The capsule, when assessed, has plenty of mobility. In these cases I do not like to stress that structure a whole lot. Blindly prescribing the Sleeper Stretch without an individualized assessment is a recipe for disaster. The last thing you want is to increase their hypermobility which will destabilize the shoulder.
Provocation Test Turned Treatment
In physical therapy we are taught a test called the Hawkins-Kennedy Impingement Test. The test is designed to narrow the subacromial space to see if the structures within it can withstand the pressure. This is normally no problem for a healthy individual, but in the case of injury it can cause pain. When painful the test helps diagnose Shoulder Impingement. As you will notice the test puts the shoulder in the same position as the Sleeper Stretch. The Sleeper Stretch is putting stress on those same structures. Studies have shown that in cases with impingement the sleeper stretch can increase a players pain level.
Throughout a season the pitchers shoulder is put through enough stress, there is no need to add to the pile. It has not been shown in the research that the Sleeper Stretch can cause impingement symptoms to arise, only worsen them. Theoretically this can be possible, and gives another reason I like to stay away from it.
A Better Alternative
The Cross Body Stretch
My pick for improving posterior shoulder mobility is the Cross Body Stretch. This stretch targets the same areas as the Sleeper Stretch, but has zero downside risk. Unlike the Sleeper Stretch, the Cross Body Stretch has never been linked to increasing pain in pitchers with impingement symptoms. Research shows similar or better results with this stretch for Total Range of Motion, and Posterior Capsule Mobility. In fact, this stretch showed similar results to posterior shoulder mobilizations performed by a PT. That is great because you can get all the benefits from an in-person session without leaving your house.
In addition, the Cross Body Stretch has been utilized as a part of the 2 Out Drill. That Drill has been proven to keep pitchers velocity high during games. We will get into this drill and its use in another post. So why not choose a stretch that has all the benefits and more of the Sleeper with zero of the risk? If you are a ball player and are looking to improve that backside shoulder mobility, I highly recommend picking this as your stretch of choice.
References
1. Iida, N., Taniguchi, K., Soma, S., Saizaki, K., Toda, H., Watanabe, K., & Katayose, M. (2022). Posterior shoulder capsule of the dominant arm is stiffer in baseball players than that in nonthrowing population. Journal of Shoulder and Elbow Surgery, 31(7), 1335–1343. https://doi.org/10.1016/j.jse.2022.01.119
2. Thomas, S. J., Swanik, C. “B., Higginson, J. S., Kaminski, T. W., Swanik, K. A., Bartolozzi, A. R., Abboud, J. A., & Nazarian, L. N. (2011). A bilateral comparison of posterior capsule thickness and its correlation with glenohumeral range of motion and scapular upward rotation in collegiate baseball players. Journal of Shoulder and Elbow Surgery, 20(5), 708–716. https://doi.org/10.1016/j.jse.2010.08.031
3. Takenaga, T., Sugimoto, K., Goto, H., Nozaki, M., Fukuyoshi, M., Tsuchiya, A., Murase, A., Ono, T., & Otsuka, T. (2015). Posterior shoulder capsules are thicker and stiffer in the throwing shoulders of healthy college baseball players. The American Journal of Sports Medicine, 43(12), 2935–2942. https://doi.org/10.1177/0363546515608476
4. Gharisia, O., Lohman, E., Daher, N., Eldridge, A., Shallan, A., & Jaber, H. (2020). Effect of a novel stretching technique on shoulder range of motion in overhead athletes with glenohumeral internal rotation deficits: A randomized controlled trial. https://doi.org/10.21203/rs.2.16116/v3
5. Tahran, Ö., & Yeşilyaprak, S. S. (2020). Effects of modified posterior shoulder stretching exercises on shoulder mobility, pain, and dysfunction in patients with subacromial impingement syndrome. Sports Health: A Multidisciplinary Approach, 12(2), 139–148. https://doi.org/10.1177/1941738119900532
