Current Concepts in the Assessment and Rehabilitation of the Thrower's Shoulder

At the elite level, pitching has been reported as one of the fastest human movements, occurring at angular speeds of 7250°/s. The repetitive nature of overhead throwing can lead to numerous adaptations in the glenohumeral, scapulothoracic, and hip joints. Owing to these unique changes, a comprehensive and sequential rehabilitation program is dependent on a thorough clinical examination. The rehabilitation program should consist of an individualized plan of care that focuses on shoulder mobility, scapular posture and strength, dynamic stability and neuromuscular control of the shoulder complex, as well as core and lower extremity strength. In this article, the adaptations that commonly occur to the thrower׳s shoulder are described and strategies to address them are discussed. A sequential, multiphased rehabilitation program that addresses restoration of motion, strength, endurance, and power is outlined. It is essential to consider the kinetic chain and involvement of the core and lower extremities with throwing and that these regions should not be ignored in the evaluation and treatment of the thrower׳s shoulder. A 4-phase approach, with specific criteria that direct progression to the next phase, is discussed.