ShoulderNCT06854692
Impact of Cervical Exercises During Simulated Game on Throwing Shoulder Motion and Strength
A study testing Cervical retraction exercise in people with Shoulder, run by Sacred Heart University at 1 site in United States.
Trial summary
The goal of this clinical trial is to investigate the impact of performing cervical exercises during a simulated game on shoulder range of motion and strength in collegiate baseball picthers. Read more about this study
- Who is it for?
- Ages 18 years and older, men onlyHealthy volunteers can take part
- Conditions the study is for
- Shoulder
- What is being tested?
- Cervical retraction exercise
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 20 participants
- Where
- 1 siteUnited States
- Study dates
- 31 May 2025to 29 Dec 2025
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- Men only
- Healthy volunteers accepted
- Adult, Older adult
Who may be able to join
- an overhead thrower over the age of 18 years old
- currently painfree while throwing at their usual intensity
Who cannot join
- previous shoulder or elbow surgery on the throwing arm within the last 12 months
- currently in the post-operative phase of a shoulder or elbow surgery on the throwing arm
- currently participating in a rehabilitation program for shoulder or elbow pain
- currently not able to throw due to shoulder or elbow pain
Trial locations and contacts
1 site in 1 country.
United States1 site
Sacred Heart University
Fairfield, Connecticut, 06825
About this study
Official title: In-game Cervical Exercises to Reduce Subsequent Post-game Decrease of Shoulder Internal Rotation Range of Motion and External Rotation Strength in Baseball Pitchers
The goal of this clinical trial is to investigate the impact of performing cervical exercises during a simulated game on shoulder range of motion and strength in collegiate baseball picthers. The main questions it aims to answer are:
Can performing cervical retraction/extension exercises help to maintain shoulder internal rotation range of motion in the throwing shoulder after a pitching session? Can performing cervical retraction/extension exercises help to maintain shoulder external rotation strength in the throwing shoulder after a pitching session?
Read more
Researchers will compare the effects of cervical retraction/extension exercises to no exercise to see if shoulder range of motion or strength is impacted.
Participants will perform end-range cervical retraction and cervical retraction with extension, holding the end-range of motion for 3 seconds and performing 10 repetitions of each exercise between each inning of a simulated 5-inning game.
Read the detailed description
Glenohumeral internal rotation deficit (GIRD) and rotator cuff weakness have been identified as predisposing factors in sustaining a shoulder or elbow injury in pitchers. The appearance of GIRD in symptomatic throwers has been attributed to osseous adaptations as well as soft tissue restrictions of the posterior capsule, deltoid and posterior cuff. Trakis identified that those adolescent pitchers with pain complaints had presented with weakness of the posterior shoulder musculature. Tyler noted preseason supraspinatus weakness was significantly associated with an increase in shoulder and elbow injury risk in high school pitchers. Despite studies indicating a correlation with rotator cuff weakness and injury, there is a lack of consensus on the underlying cause of the rotator cuff weakness.
The presentation of GIRD and rotator cuff weakness typically occurs in tandem and a question arises if these are linked, and if they might actually occur in response to the act of throwing. A subsequent loss of internal rotation range of motion and weakness of external rotation has been noted immediately following pitching. In a study of 67 asymptomatic professional pitchers, Reinold found a significant loss of passive shoulder internal rotation (IR) immediately following pitching that was also evident 24 hours after throwing. Reinold purported that the altered range of motion may be related to acute musculotendinous adaptations in response to the eccentric muscle activity of the external rotators during the throwing motion. Gandhi found a decrease in external rotation strength and a statistically and clinically significant decrease in voluntary muscle activation of the infraspinatus immediately following pitching in a simulated game. His contention was that the weakness was due to incomplete neuromuscular recruitment.
The posterior rotator cuff demonstrates large electromyographic (EMG) activity during the act of throwing. Overused muscle shortens over time, changing the muscle length-tension properties and becoming more readily active and weaker after time. The cause of the weakness may be neuro-reflexive or structural in nature. The combination of loss of IR and weakness of the external rotators might be explained by the concept of "tightness weakness" as described by Janda. The author's propose that the loss of shoulder internal rotation range of motion and external rotation strength may be linked and centrally mediated from the cervical spine. The act of throwing will produce a compressive force in the mid-cervical spine related to the compensatory movement of cervical extension, lateral flexion and rotation towards the throwing side. Pheasant demonstrated a decrease in shoulder external rotator strength following a maintained postural position of forward head and rounded shoulders for only 5 minutes. He noted that the resultant lower cervical flexion that accompanies the forward head posture can create foraminal stenosis at C4-C5, thereby causing a compression of the C5 nerve root.
In a case series, Pheasant demonstrated an increase in external rotation strength and resolution of pain complaints in 2 overhead athletes presenting with shoulder impingement by performing cervical retraction and cervical retraction with extension. He surmised that intermittent compression of the C5 nerve root could impair nerve function and ultimately cause rotator cuff weakness by affecting the suprascapular and axillary nerve that innervate the supraspinatus, teres minor and infraspinatus, and that the cervical retraction exercises reduced the compression. Internal rotation range of motion pre-intervention was only visually estimated and there was no indication of that motion being compared to the non-involved shoulder or if there was an improvement in motion following implementation of the exercises.
- Conditions
- Shoulder
- Being tested
- Cervical retraction exercise
- Keywords
- shoulder, throwing athlete, range of motion, strength, cervical retraction
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Cervical retraction exerciseOther
Participants will perform end-range cervical retraction and cervical retraction with extension, holding the end-range of motion for 3 seconds and performing 10 repetitions of each exercise.
| Study group | Role | What they receive |
|---|---|---|
| Intervention group | Experimental | Not described Receives: Other: Cervical retraction exercise |
| Control group | No intervention | Not described |
What is being measured
The primary outcome is the main question the study is designed to answer.
Shoulder Internal Rotation ROM
measure of shoulder range of motion
Measured: Day 1
Shoulder External Rotation Strength
measure of shoulder strength
Measured: Day 1
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted3 Mar 2025
- Study start31 May 2025
- Primary completion29 Dec 2025
- Study completion29 Dec 2025
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (14)Papers the sponsor has linked to this study.
- Other trials for ShoulderStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Prevention
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind
- Who is masked
- Outcomes assessor
- Enrolment
- 20 participants (actual)
Sponsor and investigators
- Lead sponsor
- Sacred Heart University
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Jason Grimes, PT, PhD, OCS, ATC, Sacred Heart University
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT06854692
- Sponsor's protocol ID
- IRB-FY2025-188
- Status last verified
- Jan 2026
- First submitted
- 20 Feb 2025
- Last updated
- 28 Jan 2026
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Publications
Paige P, Frank CC, Larnder R. (2010) Assessment and treatment of muscle imbalance: The Janda approach. Human Kinetics.
Devaney LL, Denegar CR, Thigpen CA, Lepley AS, Edgar C, DiStefano LJ. Preseason Neck Mobility Is Associated With Throwing-Related Shoulder and Elbow Injuries, Pain, and Disability in College Baseball Pitchers. Orthop J Sports Med. 2020 May 18;8(5):2325967120920556. doi: 10.1177/2325967120920556. eCollection 2020 May.
PubMed 32523967Pheasant S, Haydt R, Gottstein T, Grasso A, Lombard N, Stone B. SHOULDER EXTERNAL ROTATOR STRENGTH IN RESPONSE TO VARIOUS SITTING POSTURES: A CONTROLLED LABORATORY STUDY. Int J Sports Phys Ther. 2018 Feb;13(1):50-57.
PubMed 29484241Pheasant S. CERVICAL CONTRIBUTION TO FUNCTIONAL SHOULDER IMPINGEMENT: TWO CASE REPORTS. Int J Sports Phys Ther. 2016 Dec;11(6):980-991.
PubMed 27904800Jobe FW, Tibone JE, Perry J, Moynes D. An EMG analysis of the shoulder in throwing and pitching. A preliminary report. Am J Sports Med. 1983 Jan-Feb;11(1):3-5. doi: 10.1177/036354658301100102.
PubMed 6829838Gandhi J, ElAttrache NS, Kaufman KR, Hurd WJ. Voluntary activation deficits of the infraspinatus present as a consequence of pitching-induced fatigue. J Shoulder Elbow Surg. 2012 May;21(5):625-30. doi: 10.1016/j.jse.2011.04.012. Epub 2011 Aug 10.
PubMed 21831667Reinold MM, Wilk KE, Macrina LC, Sheheane C, Dun S, Fleisig GS, Crenshaw K, Andrews JR. Changes in shoulder and elbow passive range of motion after pitching in professional baseball players. Am J Sports Med. 2008 Mar;36(3):523-7. doi: 10.1177/0363546507308935. Epub 2007 Nov 8.
PubMed 17991783Tyler TF, Mullaney MJ, Mirabella MR, Nicholas SJ, McHugh MP. Risk Factors for Shoulder and Elbow Injuries in High School Baseball Pitchers: The Role of Preseason Strength and Range of Motion. Am J Sports Med. 2014 Aug;42(8):1993-9. doi: 10.1177/0363546514535070. Epub 2014 Jun 3.
PubMed 24893778McClure P, Balaicuis J, Heiland D, Broersma ME, Thorndike CK, Wood A. A randomized controlled comparison of stretching procedures for posterior shoulder tightness. J Orthop Sports Phys Ther. 2007 Mar;37(3):108-14. doi: 10.2519/jospt.2007.2337.
PubMed 17416125Burkhart SS, Morgan CD, Kibler WB. The disabled throwing shoulder: spectrum of pathology Part I: pathoanatomy and biomechanics. Arthroscopy. 2003 Apr;19(4):404-20. doi: 10.1053/jars.2003.50128.
PubMed 12671624Crockett HC, Gross LB, Wilk KE, Schwartz ML, Reed J, O'Mara J, Reilly MT, Dugas JR, Meister K, Lyman S, Andrews JR. Osseous adaptation and range of motion at the glenohumeral joint in professional baseball pitchers. Am J Sports Med. 2002 Jan-Feb;30(1):20-6. doi: 10.1177/03635465020300011701.
PubMed 11798991Trakis JE, McHugh MP, Caracciolo PA, Busciacco L, Mullaney M, Nicholas SJ. Muscle strength and range of motion in adolescent pitchers with throwing-related pain: implications for injury prevention. Am J Sports Med. 2008 Nov;36(11):2173-8. doi: 10.1177/0363546508319049. Epub 2008 Jul 2.
PubMed 18596197Wilk KE, Macrina LC, Fleisig GS, Porterfield R, Simpson CD 2nd, Harker P, Paparesta N, Andrews JR. Correlation of glenohumeral internal rotation deficit and total rotational motion to shoulder injuries in professional baseball pitchers. Am J Sports Med. 2011 Feb;39(2):329-35. doi: 10.1177/0363546510384223. Epub 2010 Dec 4.
PubMed 21131681Garrison JC, Cole MA, Conway JE, Macko MJ, Thigpen C, Shanley E. Shoulder range of motion deficits in baseball players with an ulnar collateral ligament tear. Am J Sports Med. 2012 Nov;40(11):2597-603. doi: 10.1177/0363546512459175. Epub 2012 Sep 26.
PubMed 23019251
Study at a glance
From the registry record, last updated by the sponsor on 28 Jan 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- In-game Cervical Exercises to Reduce Subsequent Post-game Decrease of Shoulder Internal Rotation Range of Motion and External Rotation Strength in Baseball Pitchers
- ClinicalTrials.gov ID
- NCT06854692
- Acronym / sponsor ID
- IRB-FY2025-188
- Conditions
- Shoulder
- Keywords
- shoulder, throwing athlete, range of motion, strength, cervical retraction
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 20 participants (actual)
- Lead sponsor
- Sacred Heart UniversityUniversity, hospital or other
- Study start
- 31 May 2025 (actual)
- Primary completion
- 29 Dec 2025 (actual)
- Study completion
- 29 Dec 2025 (actual)
- First posted
- 3 Mar 2025 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
The goal of this clinical trial is to investigate the impact of performing cervical exercises during a simulated game on shoulder range of motion and strength in collegiate baseball picthers. The main questions it aims to answer are:
Can performing cervical retraction/extension exercises help to maintain shoulder internal rotation range of motion in the throwing shoulder after a pitching session? Can performing cervical retraction/extension exercises help to maintain shoulder external rotation strength in the throwing shoulder after a pitching session?
Researchers will compare the effects of cervical retraction/extension exercises to no exercise to see if shoulder range of motion or strength is impacted.
Participants will perform end-range cervical retraction and cervical retraction with extension, holding the end-range of motion for 3 seconds and performing 10 repetitions of each exercise between each inning of a simulated 5-inning game.
Detailed description
Glenohumeral internal rotation deficit (GIRD) and rotator cuff weakness have been identified as predisposing factors in sustaining a shoulder or elbow injury in pitchers. The appearance of GIRD in symptomatic throwers has been attributed to osseous adaptations as well as soft tissue restrictions of the posterior capsule, deltoid and posterior cuff. Trakis identified that those adolescent pitchers with pain complaints had presented with weakness of the posterior shoulder musculature. Tyler noted preseason supraspinatus weakness was significantly associated with an increase in shoulder and elbow injury risk in high school pitchers. Despite studies indicating a correlation with rotator cuff weakness and injury, there is a lack of consensus on the underlying cause of the rotator cuff weakness.
The presentation of GIRD and rotator cuff weakness typically occurs in tandem and a question arises if these are linked, and if they might actually occur in response to the act of throwing. A subsequent loss of internal rotation range of motion and weakness of external rotation has been noted immediately following pitching. In a study of 67 asymptomatic professional pitchers, Reinold found a significant loss of passive shoulder internal rotation (IR) immediately following pitching that was also evident 24 hours after throwing. Reinold purported that the altered range of motion may be related to acute musculotendinous adaptations in response to the eccentric muscle activity of the external rotators during the throwing motion. Gandhi found a decrease in external rotation strength and a statistically and clinically significant decrease in voluntary muscle activation of the infraspinatus immediately following pitching in a simulated game. His contention was that the weakness was due to incomplete neuromuscular recruitment.
The posterior rotator cuff demonstrates large electromyographic (EMG) activity during the act of throwing. Overused muscle shortens over time, changing the muscle length-tension properties and becoming more readily active and weaker after time. The cause of the weakness may be neuro-reflexive or structural in nature. The combination of loss of IR and weakness of the external rotators might be explained by the concept of "tightness weakness" as described by Janda. The author's propose that the loss of shoulder internal rotation range of motion and external rotation strength may be linked and centrally mediated from the cervical spine. The act of throwing will produce a compressive force in the mid-cervical spine related to the compensatory movement of cervical extension, lateral flexion and rotation towards the throwing side. Pheasant demonstrated a decrease in shoulder external rotator strength following a maintained postural position of forward head and rounded shoulders for only 5 minutes. He noted that the resultant lower cervical flexion that accompanies the forward head posture can create foraminal stenosis at C4-C5, thereby causing a compression of the C5 nerve root.
In a case series, Pheasant demonstrated an increase in external rotation strength and resolution of pain complaints in 2 overhead athletes presenting with shoulder impingement by performing cervical retraction and cervical retraction with extension. He surmised that intermittent compression of the C5 nerve root could impair nerve function and ultimately cause rotator cuff weakness by affecting the suprascapular and axillary nerve that innervate the supraspinatus, teres minor and infraspinatus, and that the cervical retraction exercises reduced the compression. Internal rotation range of motion pre-intervention was only visually estimated and there was no indication of that motion being compared to the non-involved shoulder or if there was an improvement in motion following implementation of the exercises.
Study design
- Primary purpose
- Prevention
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind (outcomes assessor)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Intervention group | Experimental | Other: Cervical retraction exercise |
| Control group | No intervention | – |
Who may qualify
- Ages
- 18 years and older
- Sex
- Male only
- Healthy volunteers
- Accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (2 listed)
- an overhead thrower over the age of 18 years old
- currently painfree while throwing at their usual intensity
Key exclusion criteria (4 listed)
- previous shoulder or elbow surgery on the throwing arm within the last 12 months
- currently in the post-operative phase of a shoulder or elbow surgery on the throwing arm
- currently participating in a rehabilitation program for shoulder or elbow pain
- currently not able to throw due to shoulder or elbow pain
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Cervical retraction exerciseParticipants will perform end-range cervical retraction and cervical retraction with extension, holding the end-range of motion for 3 seconds and performing 10 repetitions of each exercise. | Other | Intervention group |
Primary outcome
Shoulder Internal Rotation ROM
Time frame: Day 1
measure of shoulder range of motion
Shoulder External Rotation Strength
Time frame: Day 1
measure of shoulder strength
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 28 Jan 2026.
- BackgroundPaige P, Frank CC, Larnder R. (2010) Assessment and treatment of muscle imbalance: The Janda approach. Human Kinetics.
- Background: PubMed 32523967Devaney LL, Denegar CR, Thigpen CA, Lepley AS, Edgar C, DiStefano LJ. Preseason Neck Mobility Is Associated With Throwing-Related Shoulder and Elbow Injuries, Pain, and Disability in College Baseball Pitchers. Orthop J Sports Med. 2020 May 18;8(5):2325967120920556. doi: 10.1177/2325967120920556. eCollection 2020 May.
- Background: PubMed 29484241Pheasant S, Haydt R, Gottstein T, Grasso A, Lombard N, Stone B. SHOULDER EXTERNAL ROTATOR STRENGTH IN RESPONSE TO VARIOUS SITTING POSTURES: A CONTROLLED LABORATORY STUDY. Int J Sports Phys Ther. 2018 Feb;13(1):50-57.
- Background: PubMed 27904800Pheasant S. CERVICAL CONTRIBUTION TO FUNCTIONAL SHOULDER IMPINGEMENT: TWO CASE REPORTS. Int J Sports Phys Ther. 2016 Dec;11(6):980-991.
- Background: PubMed 6829838Jobe FW, Tibone JE, Perry J, Moynes D. An EMG analysis of the shoulder in throwing and pitching. A preliminary report. Am J Sports Med. 1983 Jan-Feb;11(1):3-5. doi: 10.1177/036354658301100102.
- Background: PubMed 21831667Gandhi J, ElAttrache NS, Kaufman KR, Hurd WJ. Voluntary activation deficits of the infraspinatus present as a consequence of pitching-induced fatigue. J Shoulder Elbow Surg. 2012 May;21(5):625-30. doi: 10.1016/j.jse.2011.04.012. Epub 2011 Aug 10.
- Background: PubMed 17991783Reinold MM, Wilk KE, Macrina LC, Sheheane C, Dun S, Fleisig GS, Crenshaw K, Andrews JR. Changes in shoulder and elbow passive range of motion after pitching in professional baseball players. Am J Sports Med. 2008 Mar;36(3):523-7. doi: 10.1177/0363546507308935. Epub 2007 Nov 8.
- Background: PubMed 24893778Tyler TF, Mullaney MJ, Mirabella MR, Nicholas SJ, McHugh MP. Risk Factors for Shoulder and Elbow Injuries in High School Baseball Pitchers: The Role of Preseason Strength and Range of Motion. Am J Sports Med. 2014 Aug;42(8):1993-9. doi: 10.1177/0363546514535070. Epub 2014 Jun 3.
- Background: PubMed 17416125McClure P, Balaicuis J, Heiland D, Broersma ME, Thorndike CK, Wood A. A randomized controlled comparison of stretching procedures for posterior shoulder tightness. J Orthop Sports Phys Ther. 2007 Mar;37(3):108-14. doi: 10.2519/jospt.2007.2337.
- Background: PubMed 12671624Burkhart SS, Morgan CD, Kibler WB. The disabled throwing shoulder: spectrum of pathology Part I: pathoanatomy and biomechanics. Arthroscopy. 2003 Apr;19(4):404-20. doi: 10.1053/jars.2003.50128.
- Background: PubMed 11798991Crockett HC, Gross LB, Wilk KE, Schwartz ML, Reed J, O'Mara J, Reilly MT, Dugas JR, Meister K, Lyman S, Andrews JR. Osseous adaptation and range of motion at the glenohumeral joint in professional baseball pitchers. Am J Sports Med. 2002 Jan-Feb;30(1):20-6. doi: 10.1177/03635465020300011701.
- Background: PubMed 18596197Trakis JE, McHugh MP, Caracciolo PA, Busciacco L, Mullaney M, Nicholas SJ. Muscle strength and range of motion in adolescent pitchers with throwing-related pain: implications for injury prevention. Am J Sports Med. 2008 Nov;36(11):2173-8. doi: 10.1177/0363546508319049. Epub 2008 Jul 2.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
The record lists no contact. Use the official record to reach the sponsor.
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Cervical retraction exercise in people with Shoulder, run by Sacred Heart University at 1 site in United States.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 2 inclusion and 4 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 28 Jan 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Shoulder Internal Rotation ROM (time frame: Day 1). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT06854692, which also lists 14 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 28 Jan 2026.