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 7,250 degrees per second. The repetitive nature of overhead throwing can lead to numerous adaptations in the glenohumeral, scapulothoracic, and hip joints. Due to these unique changes, a comprehensive and sequential rehabilitation program is dependent upon a through examination. The rehabilitation program should consist of an individualized plan of care which 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 which commonly occur to the thrower's shoulder are described, and strategies to address them will be discussed. A sequential, multi-phased rehabilitation program is outlined which addresses restoration of motion, strength, endurance, and power. 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 throwing shoulder. A four phase approach, each with specific criteria that directs progression to the next phase are discussed.