Background: Posterior capsule tightness (PCT), commonly seen in overhead athletes, is a soft tissue adaptation that is also noted in non-throwers. PCT is associated with scapular and humeral kinematic alterations, significant restriction of shoulder internal rotation (IR) range of motion (ROM), and significant scapular anterior tilting. Sleeper and cross-body stretches (CBS) are suggested for PCT and IR deficits, and have been modified since introduction. A novel modified sleeper stretch (NMSS) was designed in this study to prevent the risk of anterior translation of the humeral head. Though the effects of posterior shoulder stretching exercise have been widely studies, to the best of our knowledge, no previous studies have investigated the effectiveness of posterior shoulder exercises in decreasing scapular anterior tilting. Objects: To compare the immediate effects of two posterior shoulder stretching exercises (NMSS and CBS) on scapular anterior tilting and shoulder IR ROM. Methods: Thirty-two subjects with anteriorly tilted scapula and IR deficits [mean age: 24.3 ± 2.5 years; 15 males and 17 females] participated in this study. Subjects were randomly assigned to either the NMSS or CBS groups. Scapular anterior tilting (at rest and at shoulder 60° active IR) and shoulder IR ROM were measured before and immediately after intervention. Results: Scapular anterior tilting significantly decreased, while the shoulder IR ROM significantly increased in both groups. However, there was no significant group-by-time interaction effect or significant difference between the groups. Conclusion: Both stretching exercises were effective in restoring shoulder IR ROM and decreasing scapular anterior tilting.

A normal range of motion is essential for performing activities of daily living. The capsular pattern is the proportional motion restriction in range of motion during passive exercises due to tightness of the joint capsule. Although the capsular pattern is widely referred to in clinical practice, there is no scientific evidence to support the concept. In this review, the appropriateness of the capsular pattern for evaluation of joint pathology was assessed. In the Textbook of Orthopaedic Medicine written by Cyriax, the capsular pattern did not specify how much reduction in angular motion is considered motion restriction. As the definition proposed initially was unclear, different methods have been used in previous studies investigating capsular pattern. In addition, the capsular pattern described all the major joints of the human body, but only the hip joint, knee joint, and shoulder joint were studied in experimental studies. Sensitivity and specificity were reported in one study and were meaningful in specific pathologies (loss of extension to loss of flexion). There was no consensus on the reliability and validity. In summary, the capsular pattern suggested by Cyriax or Kaltenborn is not supported or applies only to certain conditions. Various components around a joint complement each other and provide stability to the joint. It is recommended that the therapist perform multiple assessments rather than rely on a single assessment when evaluating joints.