THE SUSTAINED EFFECT OF SHORT DURATIONS OF WARM UP AND STRETCHING EXERCISES ON SHOULDER JOINT PROPRIOCEPTION

Bala Jyoti*, Pacheri Bari, Gupta Manish**, Shaina Sandeep, Kumar Satish

ABSTRACT

OBJECTIVE: To study the sustained effect of Short Durations of Warm up and Stretching Exercises on
Shoulder joint Proprioception. DESIGN: Pre-test and Post test control group design. SETTING: Inpatient and rehabilitation hospital. PARTICIPANTS: A total number of 75 subjects free from pain and discomfort and any pathology in and around shoulder joint are allocated randomly into 1 of 5 groups.

INTERVENTION: Group A received 1 min. of warm up and stretching(n=15),Group B received 2 min. of

warm up and stretching (n=15), Group C received 3 min. of warm up and stretching (n=15), Group D received 4 min. of warm up and stretching (n=15) and Group E control group received no warm and stretching (n=15)). All groups received intervention. MAIN OUTCOME MEASURES: A CPM Machine was used to move a desired joint continuously through controlled ROM without the subjects active effort. To measure the JPS, passive CPM was used. Outcomes were measured before and immediately after intervention and 5 min. after 2nd data. All JPS scores were measured on same day. RESULTS: Outcome measures for all groups showed the effect of warm up and stretching still persisted after 5 min of 2nd data collection, except at 150 degrees of shoulder flexion in Group A. At 2 min, 3 min and 4 min of warm up and stretching, the improvement in joint position sense appreciation were significant at all ranges/target positions checked and this improvement sustained even after 5 min of 2nd data collection. Also group C i.e. 3 minutes warm up had the maximum gains, Group A had the minimum gains and Group D had the fewer gains due to the effects of muscular fatigue as reported by the subjects after performing this warm up.The control group

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showed the minimum non-significance across all the groups. CONCLUSION: This study concludes that warm up and stretching exercises improve shoulder joint position sense appreciation and this improvement sustained even after 5 min of 2nd data collection.

KEYWORDS: Contract-Relax Stretch, Performance, Proprioception, Sports, Injury Prevention

INTRODUCTION Proprioception is defined as the cumulative input to central nervous system from specialized nerve endings called mechanoreceptors. They are located in the joint capsules, ligaments, muscles, tendon and skin . It is currently acknowledged that proprioception is a complex entity
1

depending on the joint tested. The exact mechanism of proprioceptive control remains unclear, particularly in the shoulder. Shoulder proprioception is

indispensable because the glenohumeral joint relics primarily on dynamic restraint of rotator cuff to maintain stability. Proprioception may also affect injury predisposition and rehabilitation. Several studies suggest that shoulder

encompassing several different components such as sense of position, velocity, movement detection, and force and that the afferent signals that give rise to them may well have origins in different types of receptors2. Proprioception is the ability to

proprioception is impaired after fatigue, injury and in overhand athletes. Clinicians commonly use proprioception exercise during rehabilitation of shoulder because the rotator cuff is vital for glenohumeral joint stability4. In the present study our focus is on position sense here in defined as the awareness of actual position of the limb. Many researchers have used joint position sense appreciation tests to evaluate knee joint performance after the administration of warm up exercises and stretching of different duration and intensities. physical
5,6,7,8,9,10

determine the location of a joint in space where as kinesthesia is the ability to detect movement. Joint position sense is mediated by joint and muscle receptors as well as visual, vestibular and cutaneous input3. Early research suggested that the joint receptor had the predominant role in

proprioception and kinesthesia.

Joint receptors

have been identified in joint capsules, ligaments, menisci, labrum and fat pads3. Recent research has identified ruffinilike ending in the glenohumeral joint capsules, found pacinian corpuscles in glenohumeral ligaments, and free nerve endings in the glenoid labrum of human cadavers3. Most

.Stretching is used as a part of and rehabilitation programs

fitness

because it is thought to positively influence performance and injury prevention 11. Many researchers have used different

proprioception research has examined the elbow, wrist, knee, and ankle. Some authors have

durations and intensities of stretching for different purposes viz. soft tissue extensibility modulation, prevention of injury during sporting activity and

attempted to generalize their findings to other joints. However, proprioceptive control may differ
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Scientific Research Journal of India Volume: 2, Issue: 2, Year: 2013

also to increase proprioception in human joints.

12,13,14,15,16

interviewed

and

examined

by

clinical

.Therefore

this

study

is

aimed

to

physiotherapist of Sir Ganga Ram Hospital who was unaware of their group. By using random sampling method, the subjects were assigned to 1 of 5 treatment groups. Group A received 1 min. of warm up and stretching(n=15),Group B received 2

investigate whether varying intensities of warm up and stretching exercises helps in improving shoulder joint position sense appreciation

METHODOLOGY A total number of 75 subjects(N-15 X 5 groups) were included in the study, were recruited from the physiotherapy department of Sir Ganga Ram Hospital, NewDelhi, India.Subjects (N-15 X 5 groups) were included in the study.

min. of warm up and stretching (n=15), Group C received 3 min. of warm up and stretching (n=15), Group D received 4 min. of warm up and stretching (n=15) and Group E control group received no warm and stretching (n=15)). The joint position sense score was measured before warm up and stretching, after warm up and stretching and 5 min. after 2nd data with the help of CPM Machine. CPM machine was considered most appropriate and yield reliable and valid data. The subjects were instructed to remove their shirt and vest to allow for acclimatization to room temperature for affecting 10 minutes. The rig of CPM machine and chair was adjusted so that the rotation axis of the rig was congruent with centre of glenohumeral joint. The rotation axis of shoulder was adjusted by laser

Inclusion criteria were: 1. Mean Age of subject is 20-30 years, 2. Right Hand Dominant 3. Free from pain and discomfort in and around shoulder joint 4. No pathological conditions and

musculo-skeletal system.

neuromuscular

5. Only Males are included.

Exclusion criteria were: 1. Patients with previous shoulder surgery 2. Patients who have signs and symptoms of gross shoulder instability 3. Patients who had red flags suggesting serious shoulder pathology 4. Patients with cardio pulmonary diseases 5. Patients with tumor, infection and fracture 6. Patients with History of soft tissue injury within one last year 7. Patients pathological conditions affecting musculo-skeletal system and neuromuscular

detection ray, which was present in machine. Subjects were seated in chair and blind folded and cotton gauge was put in the ear. All movements were performed on right shoulder joint. Subjects were required to match a previously presented angle from starting position to target position by machine respectively i.e. Flexion 30-90, flexion 60-120 and flexion 90150. The shoulder joint (arm) was passively

moved at 2 degree/sec to predetermined target position. The arm remained at target position for 5 sec. (Same duration for all trials) and returned at a speed 2/sec to starting position. Three

Subjects who are willing to participate were

familiarizing trails were given before data was

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collected.

Stop switch was given to subjects.

When the button was pressed by the subject, it indicated recognition of target position. movement data was collected two Each times

measurements of JPS difference between the perceived angle and angle of flexion was recorded with the +ve sign of error. After recording data, warm-up and stretching were performed by the subjects for 1 min (Group A), 2 min (Group B), 3 min (Group C), 4 min (Group D) and no exercises for control group (Group E). Again data was collected immediately after warm up and also 5 min. after 2nd data . RESULTS Since the data did not follow normal distribution, therefore, repeated measure Anova was not used, instead Non-parametric tests were used. Wilcoxon-signed ranks test was used to Similarly, at 2 min, 3 min and 4 min of warm up and stretching, the improvement in joint position sense appreciation were significant at all ranges/target positions checked and this

improvement sustained even after 5 min of 2nd data collection.The control group result indicated no improvements at all target positions checked. Examining the results (through master chart) from a clinical perspective, we observe that the third group i.e. 3 minutes warm up had the maximum gains, 1 minute warm up had the minimum gains and 4 minute warm up had the fewer gains due to the effects of muscular fatigue as reported by the subjects after performing this warm up. Examining Mann Whitney multiple group comparison test results the 3 minute warm up group showed maximum significance across all the groups. And the control group showed the

compare the pre-intervention, post-intervention data collection errors among themselves (between group comparison) for all the 5 groups. One way Anova was used to calculate the significance value of pre-intervention and postintervention data collection of all the 5 groups for both between-group comparison and within group comparison. Post-HOC and Mann-Whitney tests were used to compare significance values among all the groups (multiple comparisons). The gains in joint position sense appreciation were significant after 1 min of warm up at all the target positions checked. The effect of warm up and stretching still persisted after 5 min of 2nd data collection, except at 150 degrees of shoulder flexion.

minimum non-significance across all the groups. findings of this study indicate that warm up and stretching exercises improve shoulder joint

Table 1: Wilcoxon Signed Ranks Test.

position sense appreciation. This improvement in shoulder

4

joint

position

sense

appreciation

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enhances with increase in duration and intensity of warm up upto 4 minutes. At 4 minutes there are lesser gains in joint position sense because muscular fatigue starts setting in.

Table 2: Mann Whitney Tests (Multiple Group Comparison)

Graph 2: Mann Whitney Tests (Multiple Comparison 60-120)

Graph 1: Mann Whitney Tests (Multiple Comparison 30-90) Table 4: Mann Whitney Tests (Multiple Group Comparison)

Table 3: Mann Whitney Tests (Multiple Group Comparison)

Graph 3: Mann Whitney Tests (Multiple Comparison 60-120)

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warm up upto 4 minutes. At 4 minutes there are lesser gains in joint position sense because muscular fatigue starts setting in. In this study, the gains in joint position sense appreciation were significant after 1 min of warm up at all the target positions checked. The effect of warm up and stretching still persisted after 5 min of 2nd data collection, except at 150 degrees of shoulder flexion. Interpretation: The Table-1 showed that Similarly, at 2 min, 3 min and 4 min of warm up and stretching, the improvement in joint position sense appreciation were significant at all ranges/target positions checked and this improvement sustained even after 5 min of 2nd data collection. The control group result indicated no improvements at all target positions checked. Examining the results (through master chart) from a clinical perspective, we observe that the third group i.e. 3 minutes warm up had the maximum gains, 1 minute warm up had the minimum gains and 4 minute warm up had the fewer gains due to the effects of muscular fatigue as reported by the subjects after performing this warm up. Examining Mann Whitney multiple group comparison test results the 3 minute warm up group showed maximum significance across all the groups. And the control group showed the

Wilcoxon-signed ranks test was used to compare the pre-intervention and post-intervention

(between group comparison) for all the 5 groups. the gains in joint position sense appreciation were significant after 1 min, 2 min, 3 min and 4 min of warm up and stretching, The table-2,3,4 showed that three Examining Mann Whitney multiple group comparison test results the 3 minute warm up group showed maximum significance across all the groups. And the control group showed the minimum nonsignificance across all the groups. The improvement in joint position sense appreciation still persisted after 5 min of 2nd data collection, except at 150 degrees of shoulder flexion in Group A. At 2 min, 3 min and 4 min of warm up and stretching, the improvement in joint position sense appreciation were significant at all ranges/target positions checked and this improvement sustained even after 5 min of 2nd data collection.

minimum non-significance across all the groups. The results of this study match with the results of previous studies done on same subject indicating that warming up exercises improve joint position sense appreciation5,20.

DISCUSSION The findings of this study indicate that warm up and stretching exercises improve shoulder joint position sense appreciation. This improvement in shoulder joint position sense appreciation

CONCLUSION The findings of this study support that the larger amount or duration of warm up and stretching will give more accuracy of joint position

enhances with increase in duration and intensity of

Scientific Research Journal of India Volume: 2, Issue: 2, Year: 2013

sense before the occurrence of muscular fatigue. Also the effect of warm up and stretching still persisted after 5 min of 2nd data collection, Clinicians should be aware of this information in making decisions during rehabilitation of shoulder injuries or proprioceptive training of athletes. The results suggest that shoulder joint

position sense alter across the ROM with potentially greater position sense acuity in the outer range of shoulder flexion where there is more tension upon the restraints of motion. Muscular fatigue should not be allowed to set in during warm up period so as to prevent the loss of proprioceptive acuity.

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Lonn J., Albert M.S. and Pederson., Position sense testing: influence of starting position and type of displacement, APMR., 81, 592-593(2000)

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The effect of time on static stretch on flexibility of hamstring muscles, PHY. THER.,74(9),845850(1994)

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The effect of duration of stretching of hamstrings for increasing ROM in people aged 65 years or older, PHY. THER., 81(5),1110-1117(2001)

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Duration of stretching effect on ROM in lower limb, A.P.M.R., 66,171-173(1985) Effects of static stretch versus static stretch and U.S. combined on triceps surae muscle extensibility in healthy women, PHY. THER.,67(5), 674-679 (1987)
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SWD and prolonged stretching increase hamstring flexibility more than prolonged stretching alone, J.O.S.P.T.,34( 1), (2004)

CORRESPONDENCE

*Research Scholar, Singhania University. Rajasthan, India **Consultant Orthopaedics, Kapoor Medical Center