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Upon completion of this chapter the student should be able to demonstrate the following competencies and proficiencies concerning the overhead athlete:

  • Understand the role of the scapula in the overheard athlete

  • Describe and implement scapular exercises

  • Describe the throwing motion

  • Be familiar with the similarities and differences of the overhead motion in overhead sports

  • Describe and implement exercises for the posterior shoulder muscles and rotator cuff muscles

  • Be able to implement throwing programs for the overhead athlete

  • Design and implement an athlete-specific therapeutic exercise and throwing program for the overhead athlete


The rehabilitation of the overhead athlete requires the sports medicine professional to have a thorough understanding of the biomechanics of the shoulder complex as it relates to the specific action involved. The shoulder complex is comprised of a combination of bones, muscles, and ligaments that function around the glenohumeral, scapulothoracic, acromioclavicular, and sternoclavicular joints. It is the coordinated movement of these structures that allows the overhead athlete to function. The overhead athlete needs a combination of shoulder mobility and stability to meet the demands of their respective sport. Athletes involved in repetitive overhead activities place unique demands on the shoulder girdle.1 Overhead activities such as throwing, playing tennis, or playing volleyball place the athlete at considerable risk of overuse injuries.2,3

Clinical Pearl 23-1

The overhead athlete needs a balance of shoulder mobility and stability to avoid injury.

All overhead athletes should not be treated the same because of the varying mobility, stability, and functional demands4 associated with each sport (pitchers, volleyball, quarterback, swimmer, etc.). From a biomechanical perspective baseball, tennis, football, and volleyball players are similar in that their shoulders go through repetitive overhead motions that are noncontinuous and ballistic in nature.4 In these activities, the arm is powerfully propelled forward from maximal or near-maximal external rotation (ER) to internal rotation (IR) and requires the posterior rotator cuff musculature to act eccentrically to decelerate or "brake" the arm as it rotates and horizontally adducts across the body. Contrarily, freestyle swimming requires a more continuous and repetitive bilateral motion during the submersion phase, where the arms are used to propel the body forward during rotation or "rolling" of the humeral head on the "pull through" phase.3,5 During the corresponding "recovery" phase, the arm is lifted out of the water and brought over the body in preparation for hand entry and the next stroke cycle. This type of activity produces less stress and eccentric loading to the joint; however, the continuous nature of the technique permits less opportunity for muscular recovery and a greater risk of fatigue-induced microtrauma to the joint.3,5 Whereas water polo represents a unique combination of both forceful throwing and swimming.6

Several intrinsic and extrinsic risk factors can be modified or controlled in most overhead ...

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