Today I hope to create a post that causes some discussion, so I hope to hear from people their thoughts on the topic. Over the past 7 months I have attended 2 shoulder courses with well known shoulder experts. One was with Dr. Dale Buchberger and the other was with Lyn Watson a physiotherapist from Australia. Both were well thought out and presented courses I would recommend, but it was interesting to see such different approaches to shoulder rehab. One stance they were different, that will be what this post is about today, is their views on what I believe has to be the most controversial exercise out there: The sleeper stretch. I can’t think of any other exercise that is so polarized on views from practitioner to practitioner. Some people love it and it can be an effective stretch for many shoulder injuries that walk in the door and other people cringe looking at it and think it is immediately the worst possible thing you can be doing for a shoulder injury.
Lets look at some of the reasons people may hate the stretch and some of the reasons people may like the stretch and analyze each point.
- People may HATE the stretch because if you look at it from a different angle it is the same motion as putting someone in a Hawkins-Kennedy impingement test.
Simple enough process. Flip the person lying on their side doing the stretch upwards and it looks exactly the same as the classic impingement test. So why would we want to put someone in such a terrible position??? To be honest this was the reason I didn’t use to ever perform sleeper stretch, but I think the reasoning for this doesn’t hold up clinically. What do you feel when you do a Hawkin’s Kennedy impingement test? Typically it would be a pinching type feel in the front/top of the shoulder. What should you be feeling when you do a sleeper stretch properly? A stretching sensation anywhere along the posterior aspect of the shoulder/humerus. Therefore you shouldn’t be causing impingement like symptoms and aggravating someones shoulder.
2. People may HATE the stretch because research showed that doing a cross body arm stretch can be more effective than doing the sleeper stretch in terms of regaining ROM.
Here is the article. Awesome, great stretch as well when done right and for the right person. However, I personally and clinically find that doing a cross body arm stretch is much trickier in terms of not inducing anterior impingement symptoms. So just because research says it may be greater I have not noticed it to be easier to implement.
3. People may HATE the stretch because it is easy to do wrong or people crank on it awkwardly.
Fair enough, but I think this can go with almost any exercise we give patients. They are likely going to do it wrong without proper education and or reminders on how to do it. I often try to get people to bring their phones out and I’ll take photos or videos of them doing the exercises. And again, if they feel anterior impingement, they are doing it wrong or they aren’t ready for it so we don’t do it.
4. People may HATE the stretch because they think tight posterior capsules are over rated.
Fair enough. I agree they can be over rated, but still think they are a piece of the puzzle and worth considering in some shoulder rehab situations. I do think though that probably a lot of the other views on shoulder rehab that focus on strength and motor control aspects are more important than mobility when it comes to the already unstable shoulder complex. Lets control that joint! It seems everyone has a major approach to shoulders, it’s all about scap position/strength, it’s all about rotator cuff strength, it’s all about stability and motor control exercises, it’s all about “let’s just get people strong!”, or it’s all about mobility. Heck, its likely all important guys and I think most people recognize this, but it can be confusing to think addressing one of the above is right for every patient which a lot of people seem to propose when self-endorsing their views. Every patient may respond to some approach more than another approach.
5. People may HATE the stretch because it involves lying on your injured side which most people with shoulder injuries hate and it can be provocative for some shoulders.
If this is someone’s shoulder then they are likely not a candidate for the stretch anyways. If they are highly aggravated, have raging night pain, are fairly fresh off acute injury than this stretch is likely not for them. Let’s calm that shit down and build that shit back up as Greg Lehman would say.
6. People may LIKE the stretch because it feels good
Simple and one of only 2 points I am going to write with the word LIKE in it vs HATE. If something feels good and creates a movement window for a patient to move somewhat better than I like it and I believe that despite all the hate, the sleeper stretch can do this. I also think stretches like the sleeper stretch can’t be denied in importance when working with someone with a “stiff” shoulder. I agree most shoulders issues come from issues of instability, so I can get the approach of not wanting to apply sleeper stretch on populations which that is the case (most), but when a shoulder is legit stiff….let’s get it moving in multiple planes of motion in particular in rotations to help restore more global motions like flexion/abduction. If the stretch feels bad or you feel it is somehow contributing to worsening of symptoms then don’t do it!
7. People may LIKE the stretch because we want to regain full ROM of the Glenohumeral complex so it can dissociate movement appropriately and thus reduce compensations in surrounding areas (e.g. Scapulothoracic, cervical, elbow etc.)
If you find someone’s GH lacks the ability to dissociate from scapulothoracic or neck when taking them through a movement screen then some mobilizations like sleeper stretch can be helpful in restoring the patient’s ability to have full ROM at GH and actively dissociate that motion from other joints. I can get why potentially a sleeper stretch hater would not want to give it to a symptomatic shoulder, but if the shoulder is healthy, lacking ROM and there are some surrounding joint (scap, neck) issues/symptoms, why not help create the proper ability for joints to move independently of one another.
I have been through flows in my career when I have never given anyone sleeper stretch because it was “evil” and times when I seemingly gave it to most shoulders. As always, I seem to have landed somewhere in the middle. I do think there is merit to doing it and if your reasoning for not doing it is any of the first 5 I would be interested to hear further thoughts. I do think you can’t be giving it to every shoulder that walks into your door, but if it helps with symptoms, feels good, and creates better movement than what is not to like about that? As I mentioned earlier, I think most clinicians would agree that when it comes to shoulders stability/strength are king. That can’t be denied, but I think having adequate ROM in all planes is important and can help contribute to an increased window of motor control at the GH joint as well.
Below is a video of the correct way to perform the sleeper stretch if you aren’t that familiar with the motion. I know some people may make some subtle changes to the technique in the below video, but the general idea of what he is doing is correct. Notice how he is not cranking on it super hard!
Please share your thoughts and I look forward to the conversation!