The overhead throwing athlete places extraordinary demands on this complex. Current concepts in the scientific and clinical rationale. Current concepts in the assessment and rehabilitation of the. Rehabilitation principles a nonoperative rehabilitation program is designed based on the patient. Andrews, md3 ehabilitation following an injury to the elbow is a common occur rence in orthopaedic. Make sure to rest from all painful activities until swelling subsides. The player shoulder be going through this program, 2 days on, 1 day off. Throwers exostosis in a collegiate pitcher journal of.
Rehabilitation following selected shoulder surgery kevin e wilk, pt, dpt, fapta champion sports medicine birmingham, al i. Keep arm straight with palm forward toward ground until you are at shoulder level. The throwers ten program is designed to exercise the major muscles necessary for throwing. Start with your arm straight at your side and palm facing your leg. In throwing athletes, these high stresses are repeated many times and can lead to a wide range of overuse injuries. Keeping shoulder abducted, rotate the shoulder back, keeping elbow at 90 degrees. The act of throwing the baseball involves the transfer or energy from the feet through the legs, pelvis, trunk, and out the shoulder through the elbow and hand. Athlete shoulder control in the overhead throwing a new. Rehabilitation of the elbow in the throwing athlete kevin e. Throwers ten workout program for baseball pitchers upmc. Current concepts in the evaluation and treatment of the. Player starts at a distance of 15 steps, 23 sets of 25 throws on a line with 5 minutes recovery between sets. Here ill give you 6 supraspinatus exercises that will help rehab your shoulder and improve your form.
Internal rotation at 90 degrees abduction stand with shoulder abducted to 90 degrees, externally rotated 90 degrees and elbow bent 90 degrees. Arthroscopic debridement of type i and iii slap lesions. Although nonoperative treatment is frequently successful in treating these conditions, surgical management may be necessary for the athlete to return to their sport. Return to throwing program boston shoulder institute. Our mission is to provide a rehabilitation and prevention program to minimize the risk of injury, and develop more power and stabilization throughout the throwing motion. Current concepts in the evaluation and treatment of the shoulder in overhead throwing athletes, part 2. To establish a total body awareness and control of his throwing movement before being allowed to return to normal pitching duties. Internal impingement is a commonly described cause of shoulder pain in the overhead athlete, particularly in tennis players. Rotator cuff and shoulder conditioning program introduction 1 additional notes. Therefore, any return to throwing after injury must include attention to the entire body. This chapter provides an indepth introduction to the biomechanics of the shoulder and how they are impacted in the overhead throwing athlete. In addition, all exercises included are specific to the.
The shaver is alternated with a probe to verify the depth and stability of the posterior superior labrum fig 9. The chance for reinjury is lessened by a graduate progression of interval throwing. It is important to understand the mechanics of the shoulder in order to be able to restore the important components that improve performance and facilitate the rehabilitation of the athlete. Injuries to the shoulder of the overhead athlete can be generally classified into three groups.
Additionally, we present basic science contributions in this area, princi ples of shoulder rehabilitation, and a comprehensive rehabilitation program for the symptomatic or. The elbow is placed next to the side and is flexed at 90 degrees think of this elbow as being a hinge on a gate. The throwers ten is meant to be doable any time and any place, whether that be the dugout or at home. Dugas, md, of andrews sports medicine and orthopaedic center. Return to sport program for the javelin thrower a return. Prompt diagnosis and treatment hinges on asking some targeted questions and doing the proper inoffice tests.
The association between abnormal scapular positions and motions and glenohumeral joint pathology has been well established in the literature, whereas studies investigating the. Wilk, pt, dpt,fapta 2017 whats new throwers shoulder new rehab concepts gird assessment assessment of humeral retrotorsion. Sep 12, 2017 thrower s ten exercise program usw pgdip sem, module 4 management and rehabilitation planning of sports and exerciserelated injuries reference. Mission bay campus san francisco, ca 94158 appointments. Excessively high stresses are applied to the shoulder joint because of the tremendous forces generated by the thrower. The programs goal is to be an organized and concise exercise program. Most shoulder injuries in the overhead thrower can be successfully treated nonoperatively to allow the athlete to return to competition.
Arthroscopic labral repair protocol, ii, iv, and complex tears. Nonoperative and postoperative rehabilitation for injuries. Simplifying management options has been challenging and recommendations continue to evolve. West point axillary view demonstrating a posterior inferior glenoid rim osteophyte or throwers exostosis arrow. Rehabilitation after surgical management of the thrower. Throwers shoulder key points pitchers sustain injuries at the highest rate 61% of all team injuries pitchers compared position players 72% of all pitchers injuries are to their shoulderelbow specific risk factors increases injuries pitching when fatigued, or pitch too much volume, improper. The sick scapula, scapular dyskinesis, the kinetic chain, and rehabilitation stephen s. Rafael f escamilla, department of physical therapy, california state university, sacramento, sacramento, ca, usa dr james r andrews, andrews institute, gulf breeze, fl, usa. Recent research, however, has demonstrated a pivotal role for the scapula in shoulder function, shoulder injury, and shoulder rehabilitation. When one structure such as the ligament system becomes weakened due to repetitive stresses, other structures must handle the overload. Credit for these exercises goes to credit for these images goes to handout created by jl zaremski 2015. Feet are shoulder width apart and the knees are slightly flexed. Current concepts in the rehabilitation of the overhead.
Arthroscopic labral repair protocoltype ii, iv, and complex tears. Return to throwing program 6 pitchers post injury throwing program goal. Rehabilitation following ucl kevin e wilk, pt, dpt,fapta. Shoulder injuries in the throwing athlete orthoinfo aaos. The intent of this protocol is to provide the clinician with a guideline of the postoperative rehabilitation course of a patient that has undergone an arthroscopic labral repair. In addition, all exercises included are specific to the thrower and are designed to improve strength, power, and endurance of the shoulder musculature. Jan 16, 2014 new from oakstone publishing and course directors e. The throwers shoulder, particularly in overhand pitchers, is a common site of injury and requires a unique, dynamic, and aggressive rehabilitative approach in order to facilitate the return of the athlete to competition following injury or surgery. An extension to the standard thrower s ten exercise programme has been proposed by wilk et al 2011 youtube video demonstrating the throwers ten exercise programme. The scapula functions as a bridge between the shoulder complex and the cervical spine and plays a very important role in providing both mobility and stability of the neck shoulder region. Sports performance orthopedic rehab team specialists sports 18662057270 throwers ten exercise program 3. Rehabilitation guidelines for slap lesion repair the anatomic configuration of the shoulder joint glenohumeral joint is often compared to a golf ball on a tee.
Interval throwing program for baseball players phase i. 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. Rehabilitation uclr throwers rehabilitation 4 phases program rehabilitation following ucl repair with internal brace ajsm 2016 ucl repair internal brace rehab week 1. If shoulder pain is throwing off your game, its likely that one muscle of your rotator cuff is to blame. As a result, a wide range of shoulder injuries can occur in the throwing athlete. A variety of shoulder er strengthening exercises are reported, including those. Throwers ten exercise program the throwers ten program is designed to exercise the major muscles necessary for throwing. Request pdf rehabilitation after surgical management of the thrower. The thrower s shoulder has long been a topic of debate among shoulder specialists.
This stretches the posterior shoulder and is particularly important for throwers and overhead athletes. Specific exercises for the throwing shoulder kevin e. It provides stability and strength for the shoulder joint, anchoring the humerus upper arm bone to the scapula shoulder blade so that movements of the arm can occur in a. The overhead throwing motion is an extremely skillful and intricate movement that is very stressful on the shoulder joint complex. Strengthening the muscles that support your shoulder will help keep your shoulder joint stable. Always be sure to ice your shoulder after you complete your exercises. Throwers ten exercise program david andrew parker, md the throwers ten exercise program has been designed to exercise the major muscles necessary to return to throwing. The programs goal is to be an organized and precise exercise program specific to the thrower to improve strength, power, and endurance of the shoulder musculature. Taking the cord in the hand, set the shoulder blade and move the hand toward the belly as far as it feels comfortable, or to where the endpoint of pain limits you. Request pdf current concepts in the assessment and rehabilitation of the throwers shoulder at the elite level, pitching has been reported as one of the fastest human movements, occurring at. Overhand throwing places extremely high stresses on the shoulder, specifically to the anatomy that keeps the shoulder stable. Throwers shoulder key points pitchers sustain injuries at the highest rate 64% of all team injuries pitchers compared position players 73% of all pitchers injuries are to their shoulderelbow specific risk factors increases injuries pitching when fatigued, or pitch too much volume, improper. Shoulder rehabilitation treatment includes activity modification, stretching, and strengthening the affected limb.
In addition, all exercises included are specific to the thrower and are designed to improve strength, power and endurance of the shoulder complex musculature. In addition, all exercises included are specific to the thrower and are designed to improve strength, power, and endurance of the shoulder. Reinold introduction specific strengthening and flexibility exercises play a vital role in the ultimate function and injury prevention in the overhead throwing athlete. Rehabilitation of the elbow in the throwing athlete.
The throwing shoulder acquires increased external rotation compared to the contralateral shoulder 33,41,42,48 and demonstrates altered strength profiles with increased strength of the humeral internal rotators compared to the external rotators. Throwers ten program toss, stretch, play catch 3045 feet 5. A practical guide to shoulder injuries in the throwing. Evaluation and management of scapular dyskinesis in. The player must be painfree, throw with good arm mechanicsfootwork, and have good accuracy 75% of throws must hit in the center chest area before the athlete may progress to the next step. Understanding the difference between necessary and adaptive changes and pathologic findings is critical when making treatment decisions. Injectionrehabilitation program throwers shoulder day activity minimal exercise stretch, mild strength 4. Whats new in the rehabilitation of the overhead thrower. Throwers ten exercise program university of florida.
Thrower s ten exercise program usw pgdip sem, module 4 management and rehabilitation planning of sports and exerciserelated injuries reference. Request pdf the advanced throwers ten exercise program. He was an intern athletic trainer for the houston astros organization in 2004 and served as a staff physical therapist at the steadmanhawkins clinic of the carolinas spartanburg, south carolina and consultant for the boston red sox minor. In this article, we discuss the rehabilitation overview in the thrower. Cross body adduction use the opposite arm to pull your affected arm as far as possible across your body. The rotator cuff and labrum are the shoulder structures most vulnerable to throwing injuries. The throwers shoulder program can be customized to fit audiences of various ages, from individualized sessions to sessions that include an entire team. Nonoperative and postoperative rehabilitation for injuries of the throwing shoulder kevin e. Shoulder ucsf sports medicine rehab resource guide. General rehabilitation guidelines rehabilitation following elbow injury or elbow surgery follows a sequential and progressive multiphased approach. The throwing shoulder and the rehabilitation of baseball.
Wilk whats new in the rehab of the overhead thrower 2017 chicago sports medicine 1 whats new in the rehabilitation of the overhead thrower. The throwers ten exercise program is designed to work out the major muscles necessary for pitching and throwing in baseball as well as any other throwing sport. Throwers shoulder program medstar national rehab network. The most significant challenge facing the clinician physical therapist, athletic trainer, strength and conditioning coach is the achievement of a. The thrower s shoulder must be lax enough to allow excessive external. Repeatedly throwing a ball can take a toll on an athletes shoulder. Pdf nonoperative and postoperative rehabilitation for injuries of. Current concepts in the assessment and rehabilitation of the throwers shoulder kevin e. The rotator cuff is made up of four muscles supraspinatus, infraspinatus, subscapularis, and teres minor and their tendons. This radiographie view was obtained with the patient prone, shoulder abducted to 90, and the xray beam directed at the axilla, angled 25 medially and anteriorly. The ultimate goal of elbow rehabilitation is to return the athlete to the previous functional level as quickly and safely as possible. Rehabilitation of the overhead throwing athlete squarespace. Recent advances in the evaluation and treatment of the shoulder.
Three shoulder dysfunctions, often correlated with internal impingement symptoms, require attention in the rehabilitation strategy of internal impingement in the tennis player. Ryan graduated with his masters degree in pt from walsh university north canton, ohio in 2006. Wilk et al describes the throwing athletes predicament by defining the thrower s paradox. Rehabilitation after surgical management of the throwers sh. Rotator cuff sprain and strains university of california. A new exercise series for enhanced dynamic shoulder control in the overhead throwing athlete. Although advances in surgical techniques have allowed surgeons to address the. Nonoperative and postoperative rehabilitation for injuries of the throwing shoulder. This knowledge will help the physician to provide more. This balance is frequently compromised and believed to lead to various types of. The advanced throwers ten program is designed to be used in the later stages of rehabilitation, after the throwers ten program. Arthroscopic debridement of the throwers shoulder is initiated with a 4.
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