Sleeper stretch

Movement

The position studies describe

In one study of baseball players, the player lay on the side of the dominant arm¹. The shoulder and elbow were each bent to 90 degrees¹. The outer edge of the scapula (shoulder blade) was held firmly against the table¹. The forearm was then moved toward the table, which turned the shoulder inward¹.

In another study, participants did the stretch themselves, pressing the wrist toward inward rotation with the other hand⁸. The authors of a 2007 trial noted that some authors favoured it for tightness behind the joint because the shoulder blade is held still⁹.

The modified version

In the modified sleeper stretch, one trial had people lie on the side with the body rolled 20 to 30 degrees backward¹⁰. That trial described the roll as a change made to reduce pain¹⁰.

A 2013 clinical commentary recommended modified versions of both stretches for overhead athletes⁷. For the sleeper stretch, it cited the potential for subacromial impingement⁷. The authors of a 2021 trial wrote that this potential remained a concern for clinicians with both the traditional and modified versions¹¹.

Two trials reported how participants got on with the stretch^11,12:

• In one trial, 14 participants had pain at the start, and those doing the modified sleeper stretch reported no worsening of symptoms during stretching¹¹.
• In a randomised trial of 24 adolescent baseball players, no participant reported an adverse event (an unwanted effect seen during a trial) or discomfort¹².

The rotation loss it is studied for

Several trials on this page enrolled people with less inward rotation in one shoulder than the other^9,13. A 2013 clinical commentary describes a loss of inward shoulder rotation in overhead athletes as a normal finding that should be expected¹⁴. A systematic review of 82 articles found wide variation in how the deficit was defined¹⁵.

A 2013 clinical commentary describes a loss of inward shoulder rotation in overhead athletes as a normal finding that should be expected.

A systematic review of 1,152 overhead throwing athletes found more backward twist of the humerus (upper arm bone) in the throwing arm¹⁶. A 2020 review describes a bony part and a muscular part of the deficit, both of which can confound the capsule’s part¹⁷.

Two pooled analyses looked at the deficit and injury, and they read it differently^5,6:

• One, of 17 studies and 2,195 overhead athletes, found no shoulder motion measure with a statistically significant link to shoulder or elbow injury⁵. Its non-significant results leaned toward more injury with lost inward rotation⁵.
• The other, of 819 overhead athletes, found a weighted mean deficit of 13.8 degrees in injured athletes and 9.6 degrees in uninjured athletes⁶. It concluded that the usual 18 to 20 degree definition may be too conservative⁶.

What it loads

The authors of a 2015 study of baseball players wrote that there was no consensus on which tissues cause these athletes’ shoulder range deficits¹⁸. Studies of the stretch have measured two: the capsule and the muscles behind the shoulder^4,19.

The capsule account

The joint capsule completely encircles the shoulder joint²⁰. In baseball players, the capsule at the back of the shoulder was thicker in the throwing arm²¹.

Cadaver studies measured strain, how far something stretches as a share of its resting length, in set arm positions^3,22:

• In 8 cadaver shoulders turned inward, capsule strain rose significantly at 0, 30 and 60 degrees of elevation in the plane of the shoulder blade³. The other positions, which included 90 degrees of elevation, showed no positive strain³.
• In 8 other cadaver shoulders, inward rotation with the arm out sideways strained the lower back of the shoulder more than the cross-body position²².

A study in living people measured stiffness, how much force it takes to stretch something by a given amount⁴. It used shear wave elastography, an ultrasound method that estimates how stiff a tissue is, in 15 healthy young men⁴. Five minutes after the sleeper stretch, stiffness was lower in the middle and lower parts of the back capsule⁴. The cross-body stretch lowered it in the lower part alone⁴.

The muscle account

The infraspinatus and teres minor turn the top of the humerus outward²⁰. The tendons of the rotator cuff, a group of four muscles that help hold the shoulder joint steady, fuse with the capsule’s walls²³.

Study	What it found
Nine cadaver shoulders	Turning the arm inward at 30 and 60 degrees of elevation strained the lower infraspinatus significantly more24
24 college baseball players with limited rotation	After four weeks, infraspinatus stiffness fell in the modified sleeper group and teres minor stiffness fell in the modified cross-body group25
34 male professional volleyball players	Six weeks of sleeper and cross-body stretching had no effect on infraspinatus or posterior deltoid stiffness19
60 baseball players without symptoms but with shoulder range deficits; one session of self-stretching, with or without instrument-assisted soft tissue work	Range gained was associated with a fall in rotator cuff stiffness and with the twist of the humerus, not with joint surface glide18

In nine cadaver shoulders, the cross-body position strained the back part of the deltoid, not the infraspinatus²⁴. In 31 pitchers with a rotation deficit, outward-rotator strength fell after sleeper stretching, while rotation range rose⁸.

How the body adapts

After one session

In 33 college baseball players, inward rotation rose from 43.8 to 46.9 degrees after three 30-second passive sleeper stretches¹. The authors concluded the rise was statistically significant but may not be clinically significant¹.

Over weeks

Who was studied	What they did	What was found
54 people without symptoms; stretchers had over 10 degrees less inward rotation on one side	Sleeper or cross-body stretch, four weeks	Inward rotation rose 20.0 degrees with cross-body, significantly more than controls’ 5.9; the sleeper’s 12.4 did not differ significantly from either9
62 overhead athletes with over 15 degrees of deficit	Sleeper stretch programme or control, six weeks	The stretched shoulder gained 13.5 degrees of inward rotation compared with before stretching26
37 university athletes with deficits of 15 degrees or more	Daily sleeper stretch or control, eight weeks	Stretchers differed significantly from controls in inward rotation and cross-body range13

The authors of the first trial wrote that its small sample likely kept the two stretches from differing significantly⁹.

What reviews concluded

Three reviews reported on the stretches^2,27,28:

• A systematic review searches for all the research on a question in a set, checkable way and sums it up. A 2017 one, of ten randomised trials, found moderate evidence of positive short-term effects for the cross-body stretch in young people without symptoms²⁷. It found moderate evidence that the active sleeper stretch might not beat no intervention in the short term²⁷.
• A 2024 scoping review, which maps what research exists on a topic, covered 21 articles²⁸. It concluded the cross-body and sleeper stretches are the most researched approaches and seem to be effective²⁸.
• A 2026 meta-analysis of six randomised trials in 255 overhead athletes with a rotation deficit pooled both stretches². Stretching groups gained 7 degrees more inward rotation than controls, with a 95% confidence interval of 1 to 13². Its authors wrote, as the reason for the review, that how well the stretches work remained uncertain, and said afterwards that further research was needed to optimise them².

Studies in people with shoulder pain

A randomised trial took 35 competitive overhead athletes with shoulder pain and a rotation deficit²⁹. Over four weeks, pain intensity fell by 2.17 with the sleeper stretch and 1.54 with the cross-body stretch²⁹. The rotation deficit fell by about 15 degrees in each group, and the groups did not differ significantly²⁹.

Another trial took 67 people with subacromial impingement syndrome and a side-to-side difference in inward rotation¹⁰. All three groups improved over four weeks¹⁰. The two groups that added a modified stretch did better than the programme-alone group for pain with activity and inward rotation¹⁰. The two modified stretches did not differ significantly¹⁰.

Injury rates in high school pitchers

Two studies followed high school baseball pitchers^30,31. In the first, 92 pitchers chose their own group³⁰. Shoulder or elbow injury occurred in 25% of those doing a daily sleeper stretch and 57% of those doing neither, a significant difference³⁰. It occurred in 35% of those doing the stretch plus strength exercises³⁰.

The second was a randomised trial lasting 150 days³¹. Injury occurred in 22.6% of the 62 pitchers allocated to nightly sleeper stretching³¹. It occurred in 9.8% of the 51 allocated to nightly outward-rotation strength training³¹.

Progressive overload

The authors of a 2024 scoping review reported that their initial search found no consensus on dose²⁸. It found no protocol to inform how often, how hard or how long the stretches should be done²⁸. The doses below are what individual studies used^9,30:

• A four-week trial in people without symptoms: five 30-second holds, once a day⁹.
• High school pitchers: five 60-second repetitions a day, after practice³⁰.
• 31 pitchers with a rotation deficit: five 30-second repetitions, until the shoulder tissue felt pulled without pain⁸.
• 24 adolescent baseball players: three 30-second holds a day for three weeks, to the point of gentle tension¹².
• One four-week trial: three 30-second holds, three times a week, to the point of mild stretch discomfort¹¹.

The authors of the high school study said the amount and timing needed were not yet known³⁰.

In university overhead athletes stretching daily, inward rotation had improved significantly at 4 weeks¹³. Cross-body range showed a significant change at 8 weeks and not before¹³. A cross-sectional study, one that looks at a group once, covered 85 male professional pitchers³². Inward rotation rose with years in a stretching programme, up to a plateau after the third year³².

Connections

In 15 healthy young men, the stretch lowered stiffness in the capsule at the back of the shoulder joint⁴. In 24 college baseball players, four weeks of the modified sleeper stretch lowered infraspinatus stiffness²⁵. In the same trial, the modified cross-body stretch lowered teres minor stiffness²⁵. In cadavers, the cross-body position strained the back part of the deltoid²⁴.

The rotator cuff tendons fuse with the capsule, and the humerus is more twisted backward in throwers’ throwing arms^16,23. A 2013 commentary cited a potential for subacromial impingement with this stretch; the shoulder impingement page covers that condition⁷. One scoping review found no agreed dose for this kind of stretching²⁸.

Sources

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2. Iida N, Velasquez Garcia A, Kuroiwa T, Hsu KL, Selim OA (2026). Role of stretching interventions in enhancing the shoulder range of motion in overhead athletes with glenohumeral internal rotation deficit: A systematic review and meta-analysis.. PM & R : the journal of injury, function, and rehabilitation. doi:10.1002/pmrj.13453 PMID 40843660
3. Izumi T, Aoki M, Muraki T, Hidaka E, Miyamoto S (2008). Stretching positions for the posterior capsule of the glenohumeral joint. The American journal of sports medicine. doi:10.1177/0363546508318196 PMID 18567716
4. Yagi M, Umehara J, Noda T, Mukai H, Ichihashi N (2025). Effects of sleeper and cross-body stretching on posterior shoulder capsule stiffness.. Journal of biomechanics. doi:10.1016/j.jbiomech.2025.112922 PMID 40850150
5. Keller RA, De Giacomo AF, Neumann JA, Limpisvasti O, Tibone JE (2018). Glenohumeral Internal Rotation Deficit and Risk of Upper Extremity Injury in Overhead Athletes: A Meta-Analysis and Systematic Review.. Sports health. doi:10.1177/1941738118756577 PMID 29381423
6. Johnson JE, Fullmer JA, Nielsen CM, Johnson JK, Moorman CT (2018). Glenohumeral Internal Rotation Deficit and Injuries: A Systematic Review and Meta-analysis.. Orthopaedic journal of sports medicine. doi:10.1177/2325967118773322 PMID 29845083
7. Wilk KE, Hooks TR, Macrina LC (2013). The modified sleeper stretch and modified cross-body stretch to increase shoulder internal rotation range of motion in the overhead throwing athlete.. The Journal of orthopaedic and sports physical therapy. doi:10.2519/jospt.2013.4990 PMID 24175603
8. Lo CL, Hsueh YH, Wang CH, Chang HY (2021). Comparison of the Acute Effects of Kinesio Taping and Sleeper Stretching on the Shoulder Rotation Range of Motion, Manual Muscle Strength, and Sub-Acromial Space in Pitchers with Glenohumeral Internal Rotation Deficit.. Medicina (Kaunas, Lithuania). doi:10.3390/medicina57020102 PMID 33498704
9. McClure P, Balaicuis J, Heiland D, Broersma ME, Thorndike CK, Wood A (2007). A randomized controlled comparison of stretching procedures for posterior shoulder tightness.. The Journal of orthopaedic and sports physical therapy. doi:10.2519/jospt.2007.2337 PMID 17416125
10. Tahran Ö, Yeşilyaprak SS (2020). Effects of Modified Posterior Shoulder Stretching Exercises on Shoulder Mobility, Pain, and Dysfunction in Patients With Subacromial Impingement Syndrome.. Sports health. doi:10.1177/1941738119900532 PMID 32017660
11. Gharisia O, Lohman E, Daher N, Eldridge A, Shallan A, Jaber H (2021). Effect of a novel stretching technique on shoulder range of motion in overhead athletes with glenohumeral internal rotation deficits: a randomized controlled trial.. BMC musculoskeletal disorders. doi:10.1186/s12891-021-04292-8 PMID 33941143
12. Kawakami J, Karasuyama M, Tomohiko N, Takaki I, Ryota E, Mika K, et al. (2025). Cross-Body Versus Combined Sleeper Stretch for Posterior Shoulder Tightness: A Randomized Controlled Trial.. Cureus. doi:10.7759/cureus.92975 PMID 41141136
13. Chepeha JC, Magee DJ, Bouliane M, Sheps D, Beaupre L (2018). Effectiveness of a Posterior Shoulder Stretching Program on University-Level Overhead Athletes: Randomized Controlled Trial.. Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine. doi:10.1097/JSM.0000000000000434 PMID 28731885
14. Manske R, Wilk KE, Davies G, Ellenbecker T, Reinold M (2013). Glenohumeral motion deficits: friend or foe?. International journal of sports physical therapy. PMID 24175137
15. Kirsch JM, Bakshi NK, Ayeni OR, Khan M, Bedi A (2020). Clinical Outcomes and Quality of Literature Addressing Glenohumeral Internal Rotation Deficit: A Systematic Review.. HSS journal : the musculoskeletal journal of Hospital for Special Surgery. doi:10.1007/s11420-019-09691-1 PMID 33088237
16. Kay J, Kirsch JM, Bakshi N, Ekhtiari S, Horner N, Gichuru M, Alolabi B, Khan M, Bedi A (2018). Humeral Retroversion and Capsule Thickening in the Overhead Throwing Athlete: A Systematic Review.. Arthroscopy. doi:10.1016/j.arthro.2017.10.049 PMID 29373297
17. Zajac JM, Tokish JM (2020). Glenohumeral Internal Rotation Deficit: Prime Suspect or Innocent Bystander?. Current reviews in musculoskeletal medicine. doi:10.1007/s12178-020-09603-5 PMID 32052295
18. Bailey LB, Shanley E, Hawkins R, Beattie PF, Fritz S, Kwartowitz D, et al. (2015). Mechanisms of Shoulder Range of Motion Deficits in Asymptomatic Baseball Players.. The American journal of sports medicine. doi:10.1177/0363546515602446 PMID 26403207
19. Bicici Ulusahin S, Duzgun I, Ugurlu M, Ozcakar L (2024). Effects of the stretching program in male volleyball players with posterior shoulder tightness.. Musculoskeletal science & practice. doi:10.1016/j.msksp.2024.103148 PMID 39047592
20. Gray H; Lewis WH (editor) (1918). Anatomy of the Human Body. Lea & Febiger, Philadelphia (20th edition). Link
21. Thomas SJ, Swanik CB, Higginson JS, Kaminski TW, Swanik KA, Bartolozzi AR, Abboud JA, Nazarian LN (2011). A bilateral comparison of posterior capsule thickness and its correlation with glenohumeral range of motion and scapular upward rotation in collegiate baseball players.. Journal of shoulder and elbow surgery. doi:10.1016/j.jse.2010.08.031 PMID 21167742
22. Borstad JD, Dashottar A (2011). Quantifying strain on posterior shoulder tissues during 5 simulated clinical tests: a cadaver study.. The Journal of orthopaedic and sports physical therapy. doi:10.2519/jospt.2011.3357 PMID 21169717
23. Betts JG, Young KA, Wise JA, Johnson E, Poe B, Kruse DH, Korol O, Johnson JE, Womble M, DeSaix P (2022). Anatomy and Physiology 2e. OpenStax. Link
24. Muraki T, Aoki M, Uchiyama E, Murakami G, Miyamoto S (2006). The effect of arm position on stretching of the supraspinatus, infraspinatus, and posterior portion of deltoid muscles: a cadaveric study.. Clinical biomechanics (Bristol, Avon). doi:10.1016/j.clinbiomech.2005.12.014 PMID 16481080
25. Yamauchi T, Hasegawa S, Nakamura M, Nishishita S, Yanase K, Fujita K, et al. (2016). Effects of two stretching methods on shoulder range of motion and muscle stiffness in baseball players with posterior shoulder tightness: a randomized controlled trial.. Journal of shoulder and elbow surgery. doi:10.1016/j.jse.2016.04.025 PMID 27475455
26. Maenhout A, Van Eessel V, Van Dyck L, Vanraes A, Cools A (2012). Quantifying acromiohumeral distance in overhead athletes with glenohumeral internal rotation loss and the influence of a stretching program.. The American journal of sports medicine. doi:10.1177/0363546512454530 PMID 22869627
27. Mine K, Nakayama T, Milanese S, Grimmer K (2017). Effectiveness of Stretching on Posterior Shoulder Tightness and Glenohumeral Internal-Rotation Deficit: A Systematic Review of Randomized Controlled Trials.. Journal of sport rehabilitation. doi:10.1123/jsr.2015-0172 PMID 27632891
28. Fukushima Y, Avilineni M, Kao M, Tirmizey H, Faber KJ, Furtado R, et al. (2024). An evidence-informed rehabilitation management framework for posterior shoulder tightness: A scoping review.. Shoulder & elbow. doi:10.1177/17585732231193166 PMID 38425737
29. de Araújo JN, Oliveira ABA, de Araújo DLF, Dos Santos GA, da Silva MR, Kamonseki DH, et al. (2026). The effects of sleeper stretch vs. crossbody stretch in overhead athletes with shoulder pain and glenohumeral internal rotation deficit: a randomized controlled trial.. Journal of shoulder and elbow surgery. doi:10.1016/j.jse.2025.12.017 PMID 41580269
30. Shitara H, Yamamoto A, Shimoyama D, Ichinose T, Sasaki T, Hamano N, et al. (2017). Shoulder Stretching Intervention Reduces the Incidence of Shoulder and Elbow Injuries in High School Baseball Players: a Time-to-Event Analysis.. Scientific reports. doi:10.1038/srep45304 PMID 28345616
31. Shitara H, Tajika T, Kuboi T, Ichinose T, Sasaki T, Hamano N, et al. (2022). Shoulder stretching versus shoulder muscle strength training for the prevention of baseball-related arm injuries: a randomized, active-controlled, open-label, non-inferiority study.. Scientific reports. doi:10.1038/s41598-022-26682-1 PMID 36543874
32. Lintner D, Mayol M, Uzodinma O, Jones R, Labossiere D (2007). Glenohumeral internal rotation deficits in professional pitchers enrolled in an internal rotation stretching program.. The American journal of sports medicine. doi:10.1177/0363546506296736 PMID 17293473

Every source the library cites

Changes

• October 22, 2026 Links to the new cross-body stretch page
• October 8, 2026 Revised to report sources added after their published corrections were read