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. Rehabilitation uclr throwers rehabilitation 4 phases program rehabilitation following ucl repair with internal brace ajsm 2016 ucl repair internal brace rehab week 1. 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. 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. A new exercise series for enhanced dynamic shoulder control in the overhead throwing athlete.
Rehabilitation following ucl kevin e wilk, pt, dpt,fapta. 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. Throwers ten exercise program university of florida. To establish a total body awareness and control of his throwing movement before being allowed to return to normal pitching duties. Excessively high stresses are applied to the shoulder joint because of the tremendous forces generated by the thrower. Current concepts in the evaluation and treatment of the. 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.
The chance for reinjury is lessened by a graduate progression of interval throwing. Nonoperative and postoperative rehabilitation for injuries. Nonoperative and postoperative rehabilitation for injuries of the throwing shoulder kevin e. Most shoulder injuries in the overhead thrower can be successfully treated nonoperatively to allow the athlete to return to competition. Throwers shoulder program medstar national rehab network. The ultimate goal of elbow rehabilitation is to return the athlete to the previous functional level as quickly and safely as possible.
Arthroscopic debridement of type i and iii slap lesions. Return to throwing program 6 pitchers post injury throwing program goal. In this article, we discuss the rehabilitation overview in the thrower. The player shoulder be going through this program, 2 days on, 1 day off. 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. The tremendous forces produced during the throwing motion coupled with the compilation of the pathology encountered in the thrower s shoulder have generated a complex treatment algorithm. Wilk whats new in the rehab of the overhead thrower 2017 chicago sports medicine 1 whats new in the rehabilitation of the overhead thrower.
Simplifying management options has been challenging and recommendations continue to evolve. Reinold introduction specific strengthening and flexibility exercises play a vital role in the ultimate function and injury prevention in the overhead throwing athlete. Whats new in the rehabilitation of the overhead thrower. The sick scapula, scapular dyskinesis, the kinetic chain, and rehabilitation stephen s. Rehabilitation after surgical management of the thrower. This program is designed to help overhead throwing athletes strengthen and support the.
Wilk et al describes the throwing athletes predicament by defining the thrower s paradox. This knowledge will help the physician to provide more. A practical guide to shoulder injuries in the throwing. The rotator cuff is made up of four muscles supraspinatus, infraspinatus, subscapularis, and teres minor and their tendons. West point axillary view demonstrating a posterior inferior glenoid rim osteophyte or throwers exostosis arrow. Rehabilitation of the overhead throwing athlete squarespace. Although nonoperative treatment is frequently successful in treating these conditions, surgical management may be necessary for the athlete to return to their sport. 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. 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. In addition, all exercises included are specific to the thrower and are designed to improve strength, power, and endurance of the shoulder. As a result, a wide range of shoulder injuries can occur in the throwing athlete. Start with your arm straight at your side and palm facing your leg. The throwers ten exercise programme is a long sanding series of exercises designed to prepare the shoulder for throwing related videos and pdfs. Understanding the difference between necessary and adaptive changes and pathologic findings is critical when making treatment decisions.
Player starts at a distance of 15 steps, 23 sets of 25 throws on a line with 5 minutes recovery between sets. Credit for these exercises goes to credit for these images goes to handout created by jl zaremski 2015. Specific exercises for the throwing shoulder kevin e. Nonoperative and postoperative rehabilitation for injuries of the throwing shoulder. 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. Evaluation and management of scapular dyskinesis in. The throwers ten program is designed to exercise the major muscles necessary for throwing. Therefore, any return to throwing after injury must include attention to the entire body. 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. Andrews, md3 ehabilitation following an injury to the elbow is a common occur rence in orthopaedic. Ryan graduated with his masters degree in pt from walsh university north canton, ohio in 2006. This is because the articular surface of the round humeral head is approximately four times greater than that of the relatively flat shoulder blade face glenoid fossa1 figure 1. Interval throwing program for baseball players phase i.
Shoulder rehabilitation treatment includes activity modification, stretching, and strengthening the affected limb. Overhand throwing places extremely high stresses on the shoulder, specifically to the anatomy that keeps the shoulder stable. Wilk, pt, dpt,fapta 2017 whats new throwers shoulder new rehab concepts gird assessment assessment of humeral retrotorsion. It can be done in the early postoperative period or soon after a fracture. Rotator cuff and shoulder conditioning program introduction 1 additional notes.
Throwers ten workout program for baseball pitchers upmc. The advanced throwers ten program is designed to be used in the later stages of rehabilitation, after the throwers ten program. The rotator cuff and labrum are the shoulder structures most vulnerable to throwing injuries. Rehabilitation after surgical management of the throwers sh. Rafael f escamilla, department of physical therapy, california state university, sacramento, sacramento, ca, usa dr james r andrews, andrews institute, gulf breeze, fl, usa. General rehabilitation guidelines rehabilitation following elbow injury or elbow surgery follows a sequential and progressive multiphased approach. A variety of shoulder er strengthening exercises are reported, including those. Throwers exostosis in a collegiate pitcher journal of. Rehabilitation of the elbow in the throwing athlete. 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. Current concepts in the rehabilitation of the overhead. Cross body adduction use the opposite arm to pull your affected arm as far as possible across your body. Additionally, we present basic science contributions in this area, princi ples of shoulder rehabilitation, and a comprehensive rehabilitation program for the symptomatic or.
Rehabilitation principles a nonoperative rehabilitation program is designed based on the patient. This stretches the posterior shoulder and is particularly important for throwers and overhead athletes. Keep arm straight with palm forward toward ground until you are at shoulder level. Sports performance orthopedic rehab team specialists sports 18662057270 throwers ten exercise program 3.
Strengthening the muscles that support your shoulder will help keep your shoulder joint stable. Arthroscopic labral repair protocoltype ii, iv, and complex tears. Sep 12, 2017 thrower s ten exercise program usw pgdip sem, module 4 management and rehabilitation planning of sports and exerciserelated injuries reference. This chapter provides an indepth introduction to the biomechanics of the shoulder and how they are impacted in the overhead throwing athlete. Shoulder injuries in the throwing athlete orthoinfo aaos. 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. The programs goal is to be an organized and concise exercise program. Athlete shoulder control in the overhead throwing a new.
In addition, all exercises included are specific to the. Arthroscopic labral repair protocol, ii, iv, and complex tears. 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. The throwing shoulder and the rehabilitation of baseball. 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. The most significant challenge facing the clinician physical therapist, athletic trainer, strength and conditioning coach is the achievement of a.
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. Rehabilitation following selected shoulder surgery kevin e wilk, pt, dpt, fapta champion sports medicine birmingham, al i. The throwers ten is meant to be doable any time and any place, whether that be the dugout or at home. Three shoulder dysfunctions, often correlated with internal impingement symptoms, require attention in the rehabilitation strategy of internal impingement in the tennis player. 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. The thrower s shoulder has long been a topic of debate among shoulder specialists. Keeping shoulder abducted, rotate the shoulder back, keeping elbow at 90 degrees. The advanced throwers ten exercise program peter n. Recent advances in the evaluation and treatment of the shoulder. Current concepts in the scientific and clinical rationale. Request pdf the advanced throwers ten exercise program. Dugas, md, of andrews sports medicine and orthopaedic center. 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 musculature.
Injuries to the shoulder of the overhead athlete can be generally classified into three groups. The shaver is alternated with a probe to verify the depth and stability of the posterior superior labrum fig 9. In throwing athletes, these high stresses are repeated many times and can lead to a wide range of overuse injuries. Internal rotation at 90 degrees abduction stand with shoulder abducted to 90 degrees, externally rotated 90 degrees and elbow bent 90 degrees. 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. Shoulder ucsf sports medicine rehab resource guide. Make sure to rest from all painful activities until swelling subsides. Feet are shoulder width apart and the knees are slightly flexed. Current concepts in the assessment and rehabilitation of the throwers shoulder kevin e. 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. Return to throwing program boston shoulder institute. Mission bay campus san francisco, ca 94158 appointments. Jan 16, 2014 new from oakstone publishing and course directors e.
Internal impingement is a commonly described cause of shoulder pain in the overhead athlete, particularly in tennis players. Thrower s ten exercise program usw pgdip sem, module 4 management and rehabilitation planning of sports and exerciserelated injuries reference. Current concepts in the assessment and rehabilitation of the. The association between abnormal scapular positions and motions and glenohumeral joint pathology has been well established in the literature, whereas studies investigating the. The overhead throwing motion is an extremely skillful and intricate movement that is very stressful on the shoulder joint complex. Arthroscopic debridement of the throwers shoulder is initiated with a 4. 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. When one structure such as the ligament system becomes weakened due to repetitive stresses, other structures must handle the overload. This balance is frequently compromised and believed to lead to various types of. 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. Here ill give you 6 supraspinatus exercises that will help rehab your shoulder and improve your form. Rehabilitation of the elbow in the throwing athlete kevin e.
The thrower s shoulder must be lax enough to allow excessive external. Pdf nonoperative and postoperative rehabilitation for injuries of. Prompt diagnosis and treatment hinges on asking some targeted questions and doing the proper inoffice tests. 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 overhead throwing athlete places extraordinary demands on this complex. Always be sure to ice your shoulder after you complete your exercises.
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. The throwers shoulder program can be customized to fit audiences of various ages, from individualized sessions to sessions that include an entire team. Throwers ten program toss, stretch, play catch 3045 feet 5. Injectionrehabilitation program throwers shoulder day activity minimal exercise stretch, mild strength 4. Recent research, however, has demonstrated a pivotal role for the scapula in shoulder function, shoulder injury, and shoulder rehabilitation.633 555 1445 1022 977 782 1320 1031 887 78 1369 1512 798 319 711 880 910 597 1255 555 1025 793 1372 541 1271 775 316 387 352 1210 975 1514 1228 1132 1262 1205 508 1539 371 283 1085 1034 533 525 769 465 809 624 941 544 740