Current Concepts in the Rehabilitation of the Overhead Throwing Athlete

Abstract

The overhead throwing motion is an extremely skillful and intricate movement that is very stressful on the shoulder joint complex. The overhead throwing athlete places extraordinary demands on this complex. Excessively high stresses are applied to the shoulder joint because of the tremendous forces generated by the thrower. The thrower's shoulder must be lax enough to allow excessive external rotation, but stable enough to prevent symptomatic humeral head subluxations, thus requiring a delicate balance between mobility and functional stability. We refer to this as the "thrower's paradox." This balance is frequently compromised, which leads to injury. Numerous types of injuries may occur to the surrounding tissues during overhead throwing. Frequently, injuries can be successfully treated with a well-structured and carefully implemented nonoperative rehabilitation program. The key to successful nonoperative treatment is a thorough clinical examination and accurate diagnosis. Athletes often exhibit numerous adaptive changes that develop from the repetitive microtraumatic stresses observed during overhead throwing. Treatment should focus on the restoration of these adaptations during the rehabilitation program. In this article, the typical musculoskeletal profile of the overhead thrower and various rehabilitation programs for specific injuries are discussed. Rehabilitation follows a structured, multiphase approach with emphasis on controlling inflammation, restoring muscle balance, improving soft tissue flexibility, enhancing proprioception and neuromuscular control, and efficiently returning the athlete to competitive throwing.

Association between the increased thoracic curvature and the prevalence of pain in the shoulder complex on roping practitioners

“…In this sense, due to the high amount of repetitive movements with the upper limb in an elevated position, pain is frequently reported in the literature in individuals under these conditions (19)(20)(21)(22) . Similar to the results of the present study changes and symptoms in the shoulder Table 2 complex are also evidenced in baseball (23) , swimming (24)(25)(26) , volleyball (19) players and in other sports, which also use the upper limb above the shoulder joint and shoulder girdle (27) . Thus, the practice of Lasso Throwing, due to its characteristics, may generate overload in the shoulder complex, which may favor the onset of pain and injuries, as well as the decrease of the practitioner's performance.…”

Scapular taping alters kinematics in asymptomatic subjects

“…Overhead athletes and other 44 professionals that require use of the arm in a predominant overhead position are at a 45 high risk of developing associated shoulder pains and injuries. A number of studies 46 have reported high prevalence of shoulder pain and injury in swimmers [Lo et al,47 1990, Rupp et al, 1995, Su et al, 2004, tennis players [Cools et al, 2008], baseball 48 players [Hsu et al, 2009] and other overhead throwing athletes [Laudner et al, 2006, 49 Lo et al, 1990, Wilk et al, 2002. Shoulder impingement accounts for the majority of 50 the reported complaints [Michener et al, 2003].…”

Side-to-side differences in range of motion, muscle strength, and medial elbow laxity in young baseball players with medial elbow injuries

“…However, a notable change in shoulder IR ROM provokes medial elbow injuries 4,5) . Muscular tightness 3,34) , posterior capsular tightness 35,36) , and scapular position 37) induced by repetitive throwing are all involved in shoulder IR ROM deficits. Therefore, prevention of shoulder IR ROM deficit from school age is important for baseball players.…”