Ah, the sleeper stretch. It seems like every doctor thinks that the sleeper stretch should be performed on every baseball pitcher.
I don’t think so.
And, in pitchers that do have a loss of internal rotation, I still don’t use the sleeper stretch.
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#AskMikeReinold Episode 267: Should All Baseball Pitchers Perform the Sleeper Stretch?
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Anthony from DC asks, “When treating baseball players with shoulder pain and with normal total arc range of motion, is there any benefit to performing a sleeper stretch? Many ortho MDs in my clinic received referrals from what all their baseball players performing this stretch. When looking at current research, I’m not sure if this makes any sense.”
Maybe we’re biased because we see this a ton, but I feel like this is one of those things that every doctor says. Is this part of MD school or something, where they say baseball players-
It was passed down in their residency and fellowship. Just passed down from their senior doc to them as [crosstalk 00:01:58] scapular dyskinesia, GIRD, work on sleeper stretch. Yeah.
Not that many people were all over the sleeper stretch at the beginning of this, 20 something years ago. Not that many doctors were going around and telling everybody to do this. I’m still surprised how this became fundamental: this is how you work with your baseball players is do the sleeper stretch. So I don’t know, Len, let’s knock this one out quick. To answer your question, Anthony, is no. I mean, you shouldn’t apply any treatment that doesn’t have a rationale. So what you identified was this baseball player has normal range of motion, according to you, according to that normal total arc. And what Anthony mentioned with that total arc is, remember, baseball players aren’t supposed to be symmetrical. They’re not supposed to have equal ER and IR on both sides. So maybe some doctors don’t understand that. So they think internal rotation is different side to side, that you must try to make internal rotation symmetrical, which is-
I see that a lot in some of the local area doctors. When they send people to us, they have the kid stand up and do this and be like, “Oh yeah, you have loss of internal rotation. You need to crank on that.” That’s their symbol test is just having them stand here. And this is my right hand. You can see, I have less internal rotation on my right, but I play baseball on my right side, so it’s normal. And that’s what I show my athletes when they come in. I’m like, “No, you’re fine.” We’ll dive deeper into that because there’s more to it than just standing this motion. But Mike, we definitely see that.
That’s crazy right there alone too. So I mean, if you have a loss of 10 degrees of internal rotation and you have a gain of 10 degrees of external rotation, that is a bony adaptation that occurs. That’s fine. Maybe some doctors don’t understand that. So we talked about, why are the physicians doing that? Maybe they don’t understand that. So Anthony, I mean, that’s the first thing you do is, you measure their ER and their IR. You come up with a total rotational arc. So put external and internal rotation together and have that total arc. And if it’s symmetrical and the loss of internal rotation is equal to the gain of external rotation, then I think you have the ammo or the information, the data, it’s really hard to argue with that, to talk to the patient and the parent probably, and just say, “No, look, his motion looks pretty good.” And just say, “No, you’re supposed to be a little bit different. I am not worried about where you’re at.” I think that’s a big one.
You definitely should not overstretch, because what’s going to happen if you overstretch, your total arc now is just making up numbers, but instead of being 180 degrees symmetrical on one side, if you add 10 degrees more internal rotation, you’re going to have 10 more degrees of total rotation. That’s a lot. You’re de-stabilizing the joint and you’re doing it in a very aggressive torquing manner with the sleep stretch. So I sincerely have not performed the sleeper stretch for over 15 years. Not once. Not once. I mean, I just, I really don’t. I’ve been trying to tell everybody for 15 years to stop doing this. None of the players I work with, which is probably a lot more than most people have a loss of internal rotation that I’m worried about. And if they do, we maintain it usually with soft tissue, not by torquing it with a sleeper stretch, because they’ll have soft tissue adaptations just from throwing yesterday. You know what I mean? So I don’t know. What else? Anything else, Len?
Yeah, I mean, I get it, they lose internal rotation after throwing. Acutely, we showed that in a study years ago. So I get it that doctor’s are trying and PTs are trying to use this stretch as a way for the athlete to self-stretch them out, but like you said, I think foam rolling or lacrosse ball or manual therapy from a PT or a strength coach or a athletic trainer more than adequately gets that motion back. And we have other issues, other low-hanging fruit usually with the athlete then trying to get five or 10 degrees of internal rotation. They usually get weaker as the season goes on or they’re weak in general on their throwing side. We see that a ton. I’d say 90% of the kids that come to us and we measure their strength with the handheld dynamometer are weaker on their throwing side than their non-throwing side.
And so, I mean, that’s the low-hanging fruit right here is, get them stronger, especially the 15, 16, 17, 18 year old who has not developed a strong body, to get them stronger. And then everything else usually falls into place and then you start working on mechanics and you start going higher level stuff. But sleeper stretch to me, having a kid lie on their side, we’ll just kind of crank on their shoulder is just a recipe for disaster. And I’ve pulled that out of exercises on numerous people and their shoulder just magically improves because they’re not impinging essentially their shoulder every time.
Yeah. That’s actually a good tidbit that we can chat. I don’t mind sharing this with everybody too, even though it keeps us in business. But I think one of the keys to our success on people that fail physical therapy elsewhere and then come to us, the first thing we do is take away their sleeper stretch. And that’s probably what puts them over the edge. So they think we’re really smart and their past therapist wasn’t doing things right, but it was just taking one thing away, and oftentimes that was it. To summarize maybe our shortest episode ever, which I think is great, but a good point that Lenny makes here too is, if you have normal total rotational arc, they’re equal symmetrically, of course we don’t do sleeper stretch because they don’t need more motion. We wouldn’t do something they don’t need. But even if they do have less and it’s because of internal rotation being a little tight, we still don’t do sleeper stretch. We work the soft tissue and it comes back instantly with most people, because you don’t want to just blindly torque.
When you blindly torque and stretch something, you don’t know what structures you’re doing. Are you working on the caps? Are you working on the ligaments? Are you working on the muscles? I mean, that’s just a blind stretch. So we want to focus on the thing that caused their acute loss of motion, and that was soft tissue tightness with their muscles. So, no, we don’t do sleeper stretch if you have normal motion. And even if you don’t, we still don’t do sleeper stretch. There’s other ways to gain internal rotation. So check it out. I’ll put it in the show notes here for this episode. I have a bunch of articles on this. Hopefully, this is our modern thought process about it. I haven’t done sleeper stretch in over 15 years. Barely did it. Even with modifications, I still don’t think it’s the way to go.
So awesome. Anthony, great question. I know the physicians keep sending them to you. So all you can do is, you don’t want to be the contrarian. You don’t want to sound like you’re arguing with the doctor, but just measure them and say, “You know what? Today you look great. And if you ever don’t, we’ll work on it a little bit and we’ll try to get that motion back.” And you show them that you get their motion back without the sleeper stretch, and I don’t think they’re going to care how you get there. They just care about the end result. So awesome. Thanks, Anthony. Appreciate it. Great question. If you have a question like that, head to mikereinold.com, click on that podcast link. And be sure to go to iTunes, Spotify, rate and review us. We’ll keep answering these questions in the future. Thanks again. Take care.