The Effect of Fascial Manipulation Technique by Stecco on the Shoulder Range of Motion and External Rotation Strength of Asymptomatic Handball Players

All participants aged 18 or older signed informed consent to participate in the study. For participants under 18 years of age, informed consent was signed by their parents or legal guardians. Exclusion criteria were prior upper extremity injury or upper extremity surgery preventing the player from playing in the last three months, any previous shoulder surgery, and goalkeeper position. A cluster random sampling strategy was used. The participants were randomly divided into investigated and control groups so that each group had approximately the same number of units regarding sex and age. In the investigated group, the Fascial manipulation (FM) was performed, whereas, in the control group, the participants did not receive the FM.

One session of Fascial Manipulation® by Stecco was chosen as the therapeutic procedure. The principal investigator who performed the FM in the investigated group is a qualified therapist with extensive knowledge in manual therapy and a certificate in FM Levels I and II. Based on the collected information (a complete medical history, including the chronology of any traumatic events, fractures, significant musculoskeletal dysfunctions, scars and surgical procedures, specific range of motion, and palpation examinations) and according to the Stecco model for the interpretation of the dysfunction of the fascial system, the therapist selected an individual combination of condensed points of treatment (centers of coordination - CC and/or centers of fusion - CF). All CC and/or CF points that were treated in an individual subject were recorded.

All participants completed three test sessions (pre-test, immediate post-test, and one-month post-test). The immediate post-test measurements were recorded directly after the application of the FM in the investigated group and after a one-minute waiting period in the control group. Testing was repeated 27-34 days (one month) after FM was performed. All three measurements for both groups were performed in the same way. All the measurements were performed by the two independent examiners - experienced physical therapists, whereby FM was performed only by the principal investigator-experienced physical therapist who did not participate in the measurements. Before the measurements, participants completed a specific standard warm-up for their team consisting of gentle jogging, static and dynamic full-body stretching. The warm-up was not standardized for this study.

Range of motion (ROM) measurements for internal rotation (IR) and horizontal adduction (HADD) were recorded using a classic goniometer. For the HADD assessment, participants were positioned supine on a standard examination table with both shoulders aligned. The examiner stood on top of the table, facing the participant's head, and stabilized the lateral edge of the scapula. The participant's upper limb was positioned at 90 degrees of GH abduction with 90 degrees of elbow flexion. The examiner held the subject's arm distal to the elbow and passively moved it into HADD. At the first point of resistance, a second examiner used a digital inclinometer to record the amount of motion in degrees (°) by aligning it with the humerus.

Passive IR measurements were taken with the participant lying supine on an examination table, with the shoulder at 90 degrees of abduction in the frontal plane and the elbow at 90 degrees of flexion. The examiner applied a posterior stabilizing force to the acromial process of the scapula and internally rotated the upper limb until the first point of resistance. A second investigator then recorded the amount of movement in degrees by aligning the digital inclinometer with the axis of the forearm.