Sleeper Stretch MWM

The Sleeper Stretch is a self-guided Mobilisation with Movement technique for The Shoulder Girdle that is indicated in the presence of Pain and/or limitation in movement associated with the Glenohumeral Joint , particularly in:

• GH Joint - Internal Rotation

• Posterior Glenohumeral Joint Capsule

This is one of several Shoulder - MWM Techniques described in Mulligan’s Concept of Manual Therapy (SOURCE-3).

Involved Muscle

• Infraspinatus

• Teres Minor

• Posterior Deltoid

Procedure

Starting Position:

• Patient is in the side-lying position with the symptomatic side resting on the table and in 90º GH Joint - Flexion , Elbow - Flexion and GH Joint - Internal Rotation

• A belt is looped around the Humerus and as close to the Glenohumeral Joint line as possible and then around the ipsilateral foot

The patient then produces an inferior glide on the Humerus by carefully extending their ipsilateral leg and pushing down on the belt. While this glide is maintained the patient simultaneously performs GH Joint - Internal Rotation .

Cluster

The following techniques share similarities to the Sleeper Stretch MWM and may be used to more suitably address a patients pathology:

Regression

The following techniques may be used to regress the Sleeper Stretch MWM when it exceeds the capabilities of the patient:

• Genie Stretch

• Sleeper Stretch

Progression

As the Sleeper Stretch MWM is a later stage Stretching technique, the direction of progression is contingent on the pathology in question and the desired outcome. The following lists common progressions and their desired outcome:

• Dead Hangs - whole body traction for Pull and Push muscles with large overhead range

• Shoulder Dislocates - mobility exercise that emphasises the greatest circumduction range possible

• Banded Capsule Rolls - split stance biceps variation that emphasises shoulder rotation

• Bretzel 1.0 - wholebody technical stretch that incorporates anterior shoulder

• Bretzel 2.0 - variation with greater hip extension range

• Jefferson Curl - maximal stretch for posterior chain with emphasis on intersegmental movment of the Vertebral Column and capacity to add load

Pathology

This stretch may be of benefit for those with the following conditions (SOURCE-1+2):

• Posterior Glenohumeral Joint Capsule Restriction

• GH Joint - Internal Rotation Restriction

• Scapular Dyskinesis - particularly with excessive Scapulothoracic Joint - Downward Rotation

• Subacromial Impingement - posterior capsule restriction leads to anterosuperior translation of the Humeral Head during GH Joint - Flexion

• Adhesive Capsulitis - leads to global capsular restriction

• Rotator Cuff Tear / Tendinopathy - pathologic states of the rotator cuff may be related to posterior capsule restriction

• Glenoid Labrum Tear - restriction in the posterior to inferior portion of the joint capsule increase stress on the Labrum, in particular its superior portion ( SLAP Lesion )

• Glenohumeral Instability - in particular posterior instability, with chronicity may lead to adaptive changes such as capsular thickening

References

1. Paine, R., & Voight, M. L. (2013). The role of the scapula. International journal of sports physical therapy, 8(5), 617–629.

2. Woon, C., & Miller, M. (2025, April 18). Glenohumeral internal rotation deficit (GIRD). Orthobullets. Retrieved from https://www.orthobullets.com/shoulder-and-elbow/3055/glenohumeral-internal-rotation-deficit-gird?hideLeftMenu=true

3. Hing, W., Rivett, D., Hall, T., Vicenzino, B., & Mulligan, B. (2014). The Mulligan Concept manual therapy: Textbook of techniques. Elsevier.