Posterior Shoulder Trigger Point

Alternatives to the Sleeper Stretch that May Actually Work Better

Sleeper Stretch AlternativeIt is no secret that I am not a huge fan of the sleeper stretch, I have written about why I don’t use the sleeper stretch that often in the past.  While I do realize that there is a need for it at times if you know how to perform the sleeper stretch correctly, I also think there are alternatives to the sleeper stretch that may be safer and even more effective.

To begin, let me ask the question – what is it we are trying to achieve by performing the sleeper stretch?  It is probably to work on shoulder internal rotation or cross body horizontal adduction mobility (we’ll refer to the later as posterior shoulder mobility).  So let’s explore what else we can do to work on those areas.


Alternatives to the Sleeper Stretch

A recent study in JOSPT compared the sleeper stretch and simple cross body horizontal adduction stretching.  The results were pretty interested.  The authors report that the cross body horizontal adduction stretch was significantly better at restoring internal rotation of the shoulder in comparison to the sleeper stretch.

It appears that the simple cross body horizontal adduction stretch is actually a better stretch than the sleeper stretch.

Another study from JOSPT also evaluated the use of muscle energy technique (MET) during the  cross body horizontal adduction stretch and found that MET was able to show an immediate increase in both horizontal adduction and internal rotation range of motion.

In both studies, the cross body horizontal adduction stretch improved posterior shoulder AND internal rotation mobility.

So, if we consider some of the disadvantageous of the sleep stretch in addition to the proven benefits of the cross body horizontal adduction stretch, I think we can see a nice alternative to the sleeper stretch.

Let’s break this down into two groups, manual and self stretching.  I realize that many different people will be reading this so here are some options to help work on people but also to help perform yourself if you are the one looking for an alternative to the sleeper stretch.


Manual Stretching

I tend to perform a variety of manual techniques in addition to simple cross body horizontal adduction stretching if someone needs a little extra work or has a deficit in internal rotation, including muscle energy techniques and pin and stretch techniques.  Both are really effective in my hands and show an immediate and noticeable increase in motion.  Here are some photos below but I am putting together a presentation on manual therapy techniques for the shoulder that I will try to present as a webinar over the next few months.

The below photos show me performing cross body horizontal adduction stretching with muscle energy and then adding a pin and stretch technique.  Simple and effective without being aggressive.

shoulder muscle energy technique     shoulder pin and stretch


Self Stretching

To perform these stretches yourself, it is best to stand in a doorway so that the wall can help block your scapula from moving.  You can place the border of your shoulder blade against the wall and perform the cross body stretch.  Here is a video demonstration:


Trigger Point BallI have also used TriggerPoint balls to provide both a trigger point release and pin and stretch to the posterior shoulder as well, they really tend to work great.  You can use something like a tennis ball, racquet ball, lacrosse ball etc. if you have them lying around the house, but I still find the TriggerPoint balls to be superior for techniques like this.  Just the right amount of give and the little nub on the ball is great for trigger points.  If you are serious about doing these stretches yourself buy one of these, you’ll be happy.  Here is a video demonstration:

Don’t forget to catch up and read my past articles:

However, next time you want to improve shoulder mobility, try the cross body horizontal adduction stretch and some of these variations for a good alternative to the sleeper stretch.

  • Trevor Winnegge DPT,MS,OCS,CSCS

    Isn’t the cross body stretch still creating a subcoracoid impingement with subscap irritation as well? I think the bottom line is, the posterior capsule is like the ITB, there are lots of ways to stretch it and none of them are perfect. Just some food for thought.

    • Trevor, sure, but there is a huge difference between the cross body stretch and the sleeper stretch.

      With the sleeper stretch, you actually close down the joint and compress, then IR is performed and adds shearing. So with the sleeper stretch, you have compression and shear. Sounds like some of our meniscal and labral tests, doesn’t it?

      You mention stretching the posterior capsule, interesting.

      On these last three posts every has talked about these stretches for the posterior capsule. These stretches are for the posterior musculature first. If we perform a stretch that is so aggressive on the joint that we are stretching the capsule, I am usually worried. Call me old fashioned but I still use joint mobilizations to stretch the capsule.

      But regardless, you state it very well, there are multiple ways to skin a cat (who skins a cat, by the way…), and pros and cons of each. I hope these posts have opened some eyes to the many cons of the sleeper stretch, as this has become the “golden stretch” for many without thinking of the consequences. Maybe after reading this people will see that there are less cons with other stretches that can be at least, and maybe more, effective.

  • Tim Stiles, PT, ATC

    I have tried the sleeper stretch with clients and it needs to be modified so much to stretch the posterior shoulder muscles it seems ineffective. The cross body stretch seems like a good alternative. Is the cross body stretch ever appropriate for a secondary impingement patient?

    • Sure Tom, as long as the don’t recreate symptoms during the stretch. Most people have subacromial impingement, not coracoacromial arch impingement. But let symptoms guide you.

  • i i try the same procedure of cross body hs but i get more result by contmoraney reposition the humeral head posterior and keep there during the cbhs .in this way you can reduce the anterior impingement

  • Ian Willows

    Hi Mike,

    I am an S&C coach from the UK with 11 years experience.

    I would like to say that I like your posts on the sleeper stretch, so kindly passed on by Mike Robertson. I have been reading your posts on the odd occasion but you have become on my list of daily reads along with the others: Eric Cressey, Mike Robertson, Mike Boyle, Nick Grantham, Dan John, Charlie Weingroff etc.

    I had been getting a stretch in the anterior of my shoulder in the sleeper stretch. I did not do the ART sleeper stretch often but maybe incorrectly? I was, unbeknown to me, doing this whilst performed in the sagittal plane, now I know why! After reading your posts on the do’s and don’ts, the anterior discomfort was not as much yet still apparent!? Like many S&C coaches I respect the need for diagnosis although your posts have given me valuable insight into your experience and thoughts i.e. not many people have post cap tightness etc. As Mr Robertson said if you are working for the red sox you must be doing something right. I digress, however, i tried the wall variation and no anterior discomfort. I shall continue with this to see how it improves my internal rotation and improve my shoulder health.

    Also interesting to know that 45 degrees is enough for most? I thought i was as tight as a board not being able to get the 70-80 degrees as one might presume to be the desired/norm.

    I have become an instant fan of your blogs due to the simplicity of your writing and videos, and yet full of huge detail that may go unnoticed to the inexperienced practitioner.

    I shall continue to read and thank you.


  • joel

    how do you feel about the cook rotation for t-spine mobility? my point is when the affected arm is placed on the floor in a side-lying position with the upside knee bent to beyond 90 degrees to create a type of lumbar lock. the hands are placed together with outstretched arms on the floor and the upper (uninvolved) arm reaches out onto the floor, pinning the affected side thus producing horizontal adduction that can be achieved through leveraging your upper body weight. seems to work well. i never did understand the point of torquing the arm at 90 degrees the way the traditional sleeper stretch has been performed in the past. thanks for your info

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