The overhead throwing motion is a high-velocity, extremely stressful athletic movement. Its repetitive nature places tremendous demands on the entire body, frequently resulting in injury to the throwing shoulder. Such injuries, whether managed nonoperatively or surgically, require a multiphased approach beginning with exercises to restore muscular strength and proprioception, and advancing to more demanding exercises to improve power, endurance, and dynamic control. This article presents a new and innovative approach to the rehabilitation of the overhead throwing athlete, The Advanced Throwers Ten Exercise Program. This expanded program incorporates throwing motion-specific exercises and movement patterns performed in a discrete series, utilizing principles of coactivation, high-level neuromuscular control, dynamic stabilization, muscular facilitation, strength, endurance, and coordination, which all serve to restore muscle balance and symmetry in the overhead throwing athlete. This program is a continuation of the Throwers Ten Exercise Program, which has been utilized with excellent results in clinical practice and in athletic performance training. This unique combination of advanced exercise techniques bridges the gap between rehabilitation and training, facilitating a kinetic linking of the upper and lower extremities and providing a higher level of humeral head control necessary for the overhead throwing athlete's symptom-free return to sports.

Study Design Case report. Background Joint stiffness, also called arthrofibrosis, remains the primary complication following any reconstructive knee surgery. Acute anterior cruciate ligament surgery, performed with concomitant multiple ligamentous repair and/or reconstruction, further increases the likelihood of developing impaired knee motion following surgery. The purpose of this case report is to present a criteria-based approach to the postoperative management of a multiligament knee injury. Case Description A 25-year-old male professional football player sustained a contact injury to his right knee while making a tackle during a regular season game in 2007. He underwent an acute anterior cruciate ligament reconstruction, with concomitant posterolateral corner repair, biceps femoris/iliotibial band repair, lateral collateral ligament repair, and a medial meniscocapsular junction repair. He completed 17 weeks of a multiphased rehabilitation program that emphasized immediate range of motion, low-load long-duration stretching, therapeutic exercise, neuromuscular reeducation/perturbation training, plyometrics, and sport-specific functional drills. Electrical neurostimulation was implemented during the early stages of rehabilitation to control postoperative pain and to promote a steady progression of therapeutic exercise activity. Outcomes The patient was cleared to begin sport-specific activity 7 months after major multistructure reconstructive knee surgery. He began the 2008 season on the physically-unable-to-perform list, but was activated midseason and played in every game thereafter. During the 2009 and 2010 seasons, he played all regular season games and all playoff games as a starter, and continues to start as a defensive cornerback in the National Football League. Discussion This case report highlights the clinical decision-making process and management involved in an acute multiple ligamentous knee injury/reconstruction. Level of Evidence Therapy, level 4. J Orthop Sports Phys Ther 2011;41(9):675–686.doi:10.2519/jospt.2011.3453