Skip to main content
SpringerLink
Log in

Principles of Rehabilitation in the Overhead Athlete

  • Chapter
  • First Online:
Mechanics, Pathomechanics and Injury in the Overhead Athlete

  • 780 Accesses

Abstract

Repetitive throwing places increased stress and demand on the shoulder of the overhead athlete resulting in unique ROM, postural, strength, and joint laxity characteristics. An effective rehabilitation program for the overhead athlete is dependent on the accurate recognition of the underlying condition and pathology responsible for the symptoms. The program should focus on correcting the cause of the dysfunction and/or pain with focus on re-establishing full ROM, dynamic shoulder stability, and implementing a progressive resistance exercise program to fully restore muscular strength, power and endurance of the shoulder, and scapular musculature. The program should incorporate exercises that link the upper extremity and the lower quarter including sport-specific drills and functional activities to facilitate a return to overhead sport. Additionally, proper throwing mechanics, utilization of pitch counts, appropriate rest, and proper off-season conditioning will help in decreasing the overall reinjury risk in the overhead throwing athlete.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 159.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Conte S, Requa RK, Garrick JG. Disability days in major league baseball. Am J Sports Med. 2001;29(4):431–6.

    Article  CAS  Google Scholar 

  2. Posner M, Cameron K, Wolf JM, Belmont PL Jr, Owens BD. Epidemiology of major league baseball injuries. Am J Sports Med. 2011;39(8):1678–80.

    Article  Google Scholar 

  3. Dick R, Sauers EL, Agel J, Keuter G, Marshall SW, McCarty K, McFarland E. Descriptive epidemiology of collegiate men’s baseball injuries: National Collegiate Athletic Association Injury Surveillance System, 1998-1989 through 2003-2004. J Athl Train. 2007;42(2):183–93.

    PubMed  PubMed Central  Google Scholar 

  4. Collins CL, Comstock RD. Epidemiological features of high school baseball injuries in the United States, 2005-2007. Pediatrics. 2008;121(6):1181–7.

    Article  Google Scholar 

  5. Wilk KE, Meister K, Andrews JR. Current concepts in rehabilitation of the overhead throwing athlete. Am J Sports Med. 2002;30:136–51.

    Article  Google Scholar 

  6. Borsa PA, Wilk KE, Jacobson JA, et al. Correlation of range of motion and glenohumeral translation in professional baseball pitchers. Am J Sports Med. 2005;33:1392–9.

    Article  Google Scholar 

  7. Burkhart SS, Morgan CD, Kibler WB. The disabled throwing shoulder: spectrum of pathology Part I: pathoanatomy and biomechanics. Arthroscopy. 2003;19(4):404–20.

    Article  Google Scholar 

  8. Meister K, Day T, Horodyski M, Kaminski TW, Wasik MP, Tillman S. Rotation motion changes in the glenohumeral joint of the adolescent/Little League baseball player. Am J Sports Med. 2005;33:693–8.

    Article  Google Scholar 

  9. Reinold MM, Wilk KE, Macrina LC, et al. Changes in shoulder and elbow passive range of motion after pitching in professional baseball players. Am J Sports Med. 2008;36(3):523–7.

    Article  Google Scholar 

  10. Wilk KE, Obma P, Simpson CD, et al. Shoulder injuries in the overhead athlete. J Orthop Sports Phys Ther. 2009;39(2):38–54.

    Article  Google Scholar 

  11. Wilk KE, Macrina LC, Arrigo CA. Passive range of motion characteristics in the overhead baseball pitcher and their implications for rehabilitation. Clin Ortho Relat Res. 2012;470:1586.

    Article  Google Scholar 

  12. Chant CB, Litchfield R, Griffin SS, Thain LM. Humeral head retroversion in competitive baseball players and its relationship to glenohumeral range of motion. J Orthop Sports Phys Ther. 2007;37(9):514–20.

    Article  Google Scholar 

  13. Crockett HC, Gross LB, Wilk KE, et al. Osseous adaptation and range of motion at the glenohumeral joint in professional baseball pitchers. Am J Sports Med. 2002;30:20–6.

    Article  Google Scholar 

  14. Hibberd EE, Oyama S, Myers JB. Increase in humeral retrotorsion accounts for age related increase in glenohumeral internal rotation deficit in youth and adolescent baseball players. Am J Sports Med. 2014;42(4):851–8.

    Article  Google Scholar 

  15. Osbahr DC, Cannon DL, Speer KP. Retroversion of the humerus in the throwing shoulder of college baseball pitchers. Am J Sports Med. 2002;30(3):347–53.

    Article  Google Scholar 

  16. Pieper HG. Humeral torsion in the throwing arm of handball players. Am J Sports Med. 1998;26(2):247–53.

    Article  CAS  Google Scholar 

  17. Polster JM, Bullen J, Obuchowski NA, Bryan JA, Soloff L, Schickendantz MS. Relationship between humeral torsion and injury in professional baseball pitchers. Am J Sports Med. 2013;41(9):2015–21.

    Article  Google Scholar 

  18. Reagan KM, Meister K, Horodyski MB, Werner DW, Carruthers C, Wilk K. Humeral retroversion and its relationship to glenohumeral rotation in the shoulder of college baseball players. Am J Sports Med. 2002;20:354–60.

    Article  CAS  Google Scholar 

  19. Kibler WB, Sciascia A, Wilkes T. Scapular dyskinesis and its relation to shoulder injury. J Am Acad Orhop Surg. 2012;20(6):364–72.

    Article  Google Scholar 

  20. Kibler WB, Sciascia A. Current concepts: scapular dyskinesis. Br J Sports Med. 2010;44(5):300–5.

    Article  Google Scholar 

  21. Kibler WB, Press J, Sciascia A. The role of core strength in athletic function. Sports Med. 2006;36(3):189–98.

    Article  Google Scholar 

  22. Yamamoto N, Itoi E, Minagawa H, et al. Why is the humeral retroversion of throwing athletes greter in dominant shoulders than in nondominant shoulders? J Shoulder Elb Surg. 2006;15(5):571–5.

    Article  Google Scholar 

  23. Robb AJ, Fleisig GS, Wilk K, et al. Passive ranges of motion of the hips and their relationship with pitching biomechanics and ball velocity in professional baseball pitchers. Am J Sports Med. 2010;38(12):2487–93.

    Article  Google Scholar 

  24. Burkhart SS, Morgan CD, Kibler WB. The disabled throwing shoulder: spectrum of pathology Part III. The SICK scapula, scapular dyskinesis, the kinetic chain, and rehabilitation. Arthroscopy. 2003;19:641–61.

    Article  Google Scholar 

  25. Burkhart SS, Morgan CD, Kibler WB. The disabled throwing shoulder: spectrum of pathology Part II. Evaluation and treatment of SLAP lesions in throwers. Arthroscopy. 2003;19:531–9.

    Article  Google Scholar 

  26. Wilk KE, Reinhold MM, Macrina LC, Porterfield R, Devine KM, Suarez K, Andrews JR. Glenohumeral internal rotation measurements differ depending on stabilization techniques. Sports Health. 2009;1:131–6.

    Article  Google Scholar 

  27. Wilk KE, Macrina LC, Fleisig GS, Porterfield R, Simpson CD 2nd. Correlation of glenohumeral internal rotation deficit and total rotational motion to shoulder injuries in professional baseball pitchers. Am J Sports Med. 2011;39(2):329–35.

    Article  Google Scholar 

  28. Proske U, Morgan DL. Muscle damage from eccentric exercise: mechanism, mechanical signs, adaptation and clinical applications. J Physiol. 2001;537:333–45.

    Article  CAS  Google Scholar 

  29. Decker MJ, Hintermeister RA, Faber KJ, et al. Serratus anterior muscle activity during selected rehabilitation exercises. Am J Sports Med. 1999;27:784–91.

    Article  CAS  Google Scholar 

  30. Kibler WB. Role of the scapula in the overhead throwing motion. Contemp Orthop. 1991;22:525–32.

    Google Scholar 

  31. Knott M, Voss DE. Proprioceptive neuromuscular facilitation: patterns and techniques. 2nd ed. New York: Hoeber; 1968. p. 84–5.

    Google Scholar 

  32. Borich MR, Bright JM, Lorello DJ, et al. Scapular angular positioning at end range internal rotation in cases of glenohumeral internal rotation deficit. J Orthop Sports Phys Ther. 2006;36:926–34.

    Article  Google Scholar 

  33. Macrina LC, Wilk KE, Geus JJ, et al. The effects of throwing on scapula position in professional baseball pitchers. J Orthop Sports Phys Ther. 2007;37:A69.

    Google Scholar 

  34. Baker CL, Liu SH, Blackburn TA. Neuromuscular compression syndrome of the shoulder. In: Andrews JR, Wilk KE, editors. The athlete’s shoulder. New York: Churchill Livingstone; 1994. p. 261–73.

    Google Scholar 

  35. Nuber GW, McCarthy WJ, Yao JST, et al. Arterial abnormality of the shoulder in athletes. Am J Sports Med. 1990;18:514–9.

    Article  CAS  Google Scholar 

  36. Rohrer MJ, Cardullo PA, Pappas AM, et al. Axillary artery compression and thrombosis in throwing athletes. J Vasc Surg. 1990;11:761–9.

    Article  CAS  Google Scholar 

  37. Sotta RP. Vascular problems in the proximal upper extremity. Clin Sports Med. 1990;9:379–88.

    CAS  PubMed  Google Scholar 

  38. DiGiovine NM, Jobe FW, Pink M, et al. An electromyographic analysis of the upper extremity in pitching. J Shoulder Elb Surg. 1992;1:15–25.

    Article  CAS  Google Scholar 

  39. Wilk KE, Arrigo CA. An integrated approach to upper extremity exercises. Orthop Phys Ther Clin North Am. 1992;1:337–60.

    Google Scholar 

  40. Wilk KE, Arrigo CA, Andrews JR. Current concepts : the stabilizing structures of the glenohumeral joint. J Orthop Sports Phys Ther. 1997;25:364–79.

    Article  CAS  Google Scholar 

  41. Perry J. Muscle control of the shoulder. In: Rowe CR, editor. The shoulder. New York: Churchill Livingstone; 1988. p. 17–34.

    Google Scholar 

  42. Wuelker N, Wirth CJ, Plitz W, Roetman B. A dynamic shoulder model: relibility testing and muscle force study. J Biomech. 1995;28:489–99.

    Article  CAS  Google Scholar 

  43. Stackhouse SK, Eisennagel A, Eisennagel J, Lenker H, Sweitzer BA, McClure PW. Experimental pain inhibits infraspinatus activation during isometric external rotation. J Shoulder Elb Surg. 2013;22(4):478–84.

    Article  Google Scholar 

  44. Thomas SJ, Swanik KA, Swanik CB, Kelly JD 4th. Internal rotation deficits affect scapular positioning in baseball players. Clin Orthop Relat Res. 2010;468(6):1551–7.

    Article  Google Scholar 

  45. Thomas SJ, Swanik CB, Higginson JS, et al. A bilateral comparison of posterior capsule thickness and its correlation with glenohumeral range of motion and scapular upward rotation in collegiate baseball players. J Shoulder Elb Surg. 2011;20(5):708–16.

    Article  Google Scholar 

  46. Kibler WB, Kuhn JE, Wilk K, Sciascia A, et al. The disabled throwing shoulder: spectrum of pathology – 10-year update. Arthroscopy. 2013;29(1):141–61.

    Article  Google Scholar 

  47. Borstad JD, Ludewig PM. Comparison of three stretches for the pectoralis minor muscle. J Shoulder Elb Surg. 2006;15(3):324–30.

    Article  Google Scholar 

  48. Muraki T, Aoki M, Izumi T, Fujii M, Hidaka E, Miyamoto S. Lengthening of the pectoralis minor muscle during passive shoulder motions and stretching techniques: a cadaveric biomechanical study. Phys Ther. 2009;89(4):333–41.

    Article  Google Scholar 

  49. Butterfield TA. Eccentric exercise in vivo: strain-induced muscle damage and adaptation in a stable system. Exerc Sport Sci Rev. 2010;38:51–60.

    Article  Google Scholar 

  50. Wilk KE, Hooks TR, Macrina LC. The modified sleeper stretch and modified cross-body stretch to increase shoulder internal rotation range of motion in the overhead throwing athlete. J Orthop Sports Phys Ther. 2013;33(8):455–67.

    Google Scholar 

  51. Beckett M, Hannon M, Ropiak C, Gerona C, Mohr K, Limpisuasti O. Clinical assessment of scapula and hip joint function in preadolescent and adolescent baseball players. Am J Sports Med. 2014;42(10):2502–9.

    Article  Google Scholar 

  52. Poppen NK, Walker PS. Forces at the glenohumeral joint in abduction. Clin Orthop Relat Res. 1978;135:165–70.

    Google Scholar 

  53. Walker PS, Poppen NK. Biomechanics of the shoulder joint during abduction in the plane of the scapula [proceedings]. Bull Hosp Joint Dis. 1977;38(2):107–11.

    CAS  PubMed  Google Scholar 

  54. Wilk KE, Andrews JR, Arrigo C. Preventive and rehabilitative exercises for the shoulder and elbow. 6th ed. Birmingham: American Sports Medicine Institute; 2001.

    Google Scholar 

  55. Fleisig GS, Jameson GG, Cody KE, et al. Muscle activity during shoulder rehabilitation exercises. In: Proceedings of NACOB ‘98, the third North American congress on biomechanics. Waterloo; August 14, 1998. p. 223–34.

    Google Scholar 

  56. Blackburn TA, McLeod WD, White B, et al. EMG analysis of posterior rotator cuff exercises. Athl Train J Natl Athl Train Assoc. 1990;25:40–5.

    Google Scholar 

  57. Decker MJ, Hintermeister RA, Faber KJ, Hawkins RJ. Serratus anterior muscle activity during selected rehabilitation exercises. Am J Sports Med. 1992;7(6):784–91.

    Article  Google Scholar 

  58. Hintermeister RA, Lange GW, Schultheis JM, et al. Electromyographic activity and applied load during shoulder rehabilitation exercises using elastic resistance. Am J Sports Med. 1998;26:210–20.

    Article  CAS  Google Scholar 

  59. Jobe FW, Tibone JE, Jobe CM, et al. The shoulder in sports. In: Rockwood Jr CA, Matsen FAIII, editors. The Shoulder. Philadelphia: WB Saunders; 1990. p. 961–90.

    Google Scholar 

  60. Jobe FW, Moynes DR, Tibone JE, Perry J. An EMG analysis of the shoulder in pitching. A second report. Am J Sports Med. 1984;12(3):218–20.

    Article  CAS  Google Scholar 

  61. Am P, Zawacki RM, McCarthy CF. Rehabilitation of the pitching shoulder. Am J Sports Med. 1985;13(4):223–35.

    Article  Google Scholar 

  62. Townsend H, Jobe FW, Pink M, Perry J. Electromyographic analysis of the glenohumeral muscles during a baseball rehabilitation program. Am J Sports Med. 1991;19(3):264–72.

    Article  CAS  Google Scholar 

  63. Moseley JB Jr, Jobe FW, Pink M, Perry J, Tibone J. EMG analysis of the scapular muscles during a shoulder rehabilitation program. Am J Sports Med. 1992;29(2):128–34.

    Article  Google Scholar 

  64. Tucker WS, Armstrong CW, Gribble PA, Timmons MK, Yeasting RA. Scapular muscle activity in overhead athletes with symptoms of secondary shoulder impingement during closed chain exercises. Arch Phys Med Rehabil. 2010;91(4):550–6.

    Article  Google Scholar 

  65. Hardwick DH, Beebe JA, McDonnell MK, Lang CE. A comparison of serratus anterior muscle activation during a wall slide exercise and other traditional exercises. J Orthop Sports Phys Ther. 2006;36(12):903–10.

    Article  Google Scholar 

  66. Wilk KE, Yenchak AJ, Arrigo CA, Andrews JR. The advanced throwers ten exercise program: a new exercise exercise series for enhanced dynamic shoulder control in the overhead throwing athlete. Phys Sportsmed. 2011;39(4):90–7.

    Article  Google Scholar 

  67. Wilk KE, Voight ML, Keirns MA, Gambetta V, Andrews JR, Dillman CJ. Stretch-shortening drills for the upper extremities: theory and clinical application. J Orthop Sports Phys Ther. 1993;17(5):225–39.

    Article  CAS  Google Scholar 

  68. Wilk KE. Restoration of functional motor patterns and functional testing in the throwing athlete. In: Lephart SM, Fu FH, editors. Prioprioception and neuromuscular control in joint stability. Champaign: Human Kinetics; 2000. p. 415–38.

    Google Scholar 

  69. Voight ML, Hardin JA, Blackburn TA, Tippett S, Canner GC. The effects of muscle fatigue on and the relationship of arm dominance to shoulder proprioception. J Orthop Sports Phys Ther. 1996;23(6):348–52.

    Article  CAS  Google Scholar 

  70. Murray TA, Cook TD, Werner SL, Schlegel TF, Hawkins RJ. The effects of extended play on professional baseball pitchers. Am J Sports Med. 2001;29(2):137–42.

    Article  CAS  Google Scholar 

  71. Chen SK, Simonian PT, Wickiewicz TL, Otis JC, Warren RF. Radiographic evaluation of glenohumeral kinematics: a muscle fatigue model. J Shoulder Elb Surg. 1999;8(1):49–52.

    Article  CAS  Google Scholar 

  72. Lyman SL, Fleisig GS, Osinski ED, et al. Incidence and determinants of arm injury in youth baseball pitchers: a pilot study. Med Sci Sports Exerc. 1998;30(S5):S4.

    Article  Google Scholar 

  73. Reinold MM, Wilk KE, Reed J, Crenshaw K, Andrews JR. Interval sport programs: guidelines for baseball, tennis, and golf. J Orthop Sports Phys Ther. 2002;32(6):293–8.

    Article  Google Scholar 

  74. Verkhoshansky YV. Programming and organization of training. Livonia: Sportivny Press; 1988.

    Google Scholar 

  75. Reinold MM, Macrina LC, Fleisig GS, Aune K, Andrews JR. Effect of a 6-week weighted baseball throwing program on pitching velocity, pitching arm biomechanics, passive range of motion, and injury rates. Sports Health. 2018;10(4):327–33.

    Article  Google Scholar 

  76. Fleisig GS, Bolt B, Fortenbough D, Wilk KE, Andrews JR. Biomechanical comparison of baseball pitching and long-toss: implications for training and rehabilitation. J Orthop Sports Phys Ther. 2011;41(5):296–303.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Champion Sports Medicine, A Physiotherapy Associates Clinic, Birmingham, AL, USA

    Kevin E. Wilk

  2. American Sports Medicine Institute, Birmingham, AL, USA

    Kevin E. Wilk

  3. Advanced Rehabilitation, Tampa, FL, USA

    Christopher A. Arrigo

  4. MedStar Sports Medicine, Washington, DC, USA

    Christopher A. Arrigo

Authors
  1. Kevin E. Wilk
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christopher A. Arrigo
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Shoulder Center of Kentucky, Lexington Clinic, Lexington, KY, USA

    W. Ben Kibler

  2. Eastern Kentucky University, Richmond, KY, USA

    Aaron D. Sciascia

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Wilk, K.E., Arrigo, C.A. (2019). Principles of Rehabilitation in the Overhead Athlete. In: Kibler, W., Sciascia, A. (eds) Mechanics, Pathomechanics and Injury in the Overhead Athlete. Springer, Cham. https://doi.org/10.1007/978-3-030-12775-6_8

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-12775-6_8

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-12774-9

  • Online ISBN: 978-3-030-12775-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation