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Overhead Athlete Kinetic Chain Assessment and Treatment

Original Editor - Ari Kaplan

Top Contributors - Ewa Jaraczewska and Jess Bell  

Introduction

The kinetic chain refers to the coordinated sequence of body segments working together to transfer energy from the ground through the trunk to the throwing arm.[1] [2]

In overhead sports, disruptions in the kinetic chain can cause athletes to adopt compensatory patterns that impact performance and increase the risk of an upper extremity injury.[3][4] To understand the impact of these changes on overhead athletes, this article discusses four components of the kinetic chain: thoracic rotation, pelvic rotation, pelvic tilting, and combined thoracic extension with hip extension and shoulder flexion.

Thoracic Rotation

Thoracic rotation is paramount to generating rotatory forces.  When throwing, the pelvis rotates first, with the shoulders lagging behind. This lag creates potential energy through the core and thoracic spine. This energy is converted into kinetic energy, sequentially building velocity. This can be observed during the throwing motion by looking at hip-shoulder separation. If there is a limitation in thoracic range of motion, we will see reductions in the ability to separate. This limits velocity and potentially increases stress on the arm.[5]

Thoracic Rotation Assessment

Thoracic rotation can be assessed with the athlete sitting with their legs crossed.[5] This position isolates the thoracic spine, eliminating movement at the hip and lumbar spine.

Normal Movement Patterns

During the assessment, the clinician looks for symmetric rotation to the left and right sides.[5] The athlete should maintain an upright position throughout the movement, with comparable rotation on each side. They should not hunch forward or side-bend, and rotation should originate at the thoracic spine—not from the hips, lumbar spine, or shoulders.[5]

Dysfunctional Movement Patterns

Athletes with thoracic rotation restrictions may demonstrate several compensatory patterns, including scapular protraction and shoulder elevation, excessive thoracic kyphosis, and trunk side-bending.[5]

Impact of Dysfunctional Movement Patterns

Reduced hip-shoulder separation can result in premature trunk opening. This breakdown in timing forces the arm to generate power that would normally come from the trunk and lower body, creating excessive demands on the shoulder and elbow.[3]

Limited thoracic rotation creates increased stress on the anterior shoulder structures as athletes use compensatory strategies to achieve the external rotation necessary for effective throwing. These athletes may experience posterior shoulder impingement as they struggle to achieve a layback position without adequate thoracic spine rotation.[6]

Pelvic Rotation

The lumbopelvic region provides dynamic stability and connects the upper and lower extremities.[7] Kinetic chain disruptions in this region can increase forces on the shoulder and medial elbow.[5][8][9]

Pelvic Rotation Assessment

Pelvic rotation can be assessed with the athlete standing and their arms crossed over their chest. The athlete is instructed to rotate their pelvis while keeping their shoulders still. The clinician observes the athlete's ability to dissociate their pelvis from their upper body.

Normal Movement Patterns

The athlete will ideally be able to achieve isolated pelvic rotation while the shoulders remain still. Left and right pelvic rotation should be symmetrical. The movement should appear controlled, without excessive compensatory movements at the thoracolumbar junction or upper extremity.[5]

Dysfunctional Movement Patterns

Athletes with pelvic rotation restrictions may develop various compensatory patterns, including excessive shoulder and trunk movement during pelvic rotation. They may also develop asymmetric rotation.

Observed limitations may stem from range of motion limitations, especially in the lumbar or lower thoracic region, or even hip internal or external rotation. However, an athlete may have adequate range of motion, but still have an impairment in pelvic rotation due to a lack of motor control.

Impact of Dysfunctional Movement Patterns

In pitching or overhead throws, athletes ideally lead with their lower body and pelvis—this is followed by movement at the thoracic spine and shoulders. When pelvic rotation is reduced, the entire kinetic chain can be disrupted.[10][11][12] Athletes who cannot disassociate may struggle at this phase of the throw, which can cause increased stress on the anterior shoulder and medial elbow, and posterior shoulder impingement.[5]

Pelvic Tilt

Assessing an athlete's pelvic tilt is important as pelvic tilt restrictions can create a mechanical disadvantage for power generation. As an athlete moves through the throwing motion, they generate power from multiple regions of the body. In the late cocking phase, we should see a significant anterior pelvic tilt, which helps position the lumbar spine into lordosis and places the thoracic spine into extension, as well as the arm into maximal external rotation. The entire body should then whip forward, from the ground up, with the athlete moving from an anterior tilt to a posterior tilt and generating sagittal plane power from the core, which drives the arm to move forward. This anterior-to-posterior pelvic tilt in the sagittal plane movement is similar to the transverse plane force generation of the pelvis and thoracic rotation. Athletes who struggle with pelvic tilt often also struggle with pelvic rotation, as they are frequently stuck in an anterior tilt position.

Pelvic Tilt Assessment

Pelvic tilt can be assessed in standing. The athlete is asked to move from an anterior to a posterior pelvic tilt position. The clinician observes the athlete's ability to move through range.

Normal Movement Patterns

An overhead athlete should be able to smoothly transition between positions without excessive compensation from the lumbar spine or hips. During an anterior tilt, the pelvis tilts forward and the lumbar lordosis increases. During a posterior tilt, the pelvis tilts backward and the lumbar spine moves toward neutral or slight flexion. The average range of motion in healthy males has been found to be 13.0 ± 4.9° for anterior pelvic tilt and 8.9 ± 4.5° for posterior pelvic tilt.[13]

Dysfunctional Movement Patterns

Athletes may develop increased or reduced movement in either direction.[5] Often, this is seen in standing, where an exaggerated anterior tilt stems from reduced mobility in the hip flexors or lumbar musculature. An exaggerated posterior tilt can occur from limited hamstring mobility. Anteriorly tilted positions are often associated with reduced strength or activation of the lower abdominals, gluteals, or hamstrings. Even if mobility impairments are not present or they have been corrected, an athlete may still struggle if they don't retrain the movement pattern.[14][15][5]

Impact of Dysfunctional Movement Patterns

Athletes need to be able to achieve a sufficient anterior tilt when they're moving into a layback or maximally externally rotated position. Reduced anterior tilt can cause the trunk to start flexing too early. This reduces the amount of functional shoulder external rotation,[16] which increases strain on the shoulder and can create a valgus stress at the elbow.[5][17] It can also affect power generation during a throw.[18] [19] Reduced posterior pelvic tilt is more likely to limit performance than increase injury risk. It can limit the velocity of a throw and disrupt follow-through.[15]

Thoracic Extension with Hip Extension and Shoulder Flexion

Combining thoracic extension with hip extension and shoulder flexion allows the clinician to evaluate multiple components important to throwing, particularly baseball pitching, as this position mimics the extreme positions required during pitching.

Combined Thoracic and Hip Extension with Shoulder Flexion Assessment

This combined movement can be assessed with the athlete in a lunge position. The athlete's back leg (the trail leg) is extended at the hip, they extend their thoracic spine, and they reach both arms overhead into shoulder flexion.

Normal Movement Patterns

Ideally, the athlete will achieve full range of hip extension, thoracic extension, and shoulder flexion without compensatory movements from adjacent segments. The athlete should be able to maintain the lunge position while looking up and maintaining an extended position through their spine. The clinician will ideally be able to see the patient's ear when viewing from the side.[5]

Dysfunctional Movement Patterns

Athletes with restrictions might have reduced thoracic extension or excessive thoracic flexion. They might move into lumbar hyperextension or have reduced shoulder flexion range.

Impact of Dysfunctional Movement Patterns

Any reduction in the range of motion of these movements can increase stress on the shoulder and elbow and reduce the velocity of the throw.[20][21][5]

Three-Phase Approach to Treating Kinetic Chain Impairments in Overhead Athletes

Treatment for kinetic chain impairments can be broken down into three phases. Phase one focuses on mobility, flexibility and motor control. Phase two focuses on strengthening and stability. Phase three focuses on integration and functional movement.[5]

Phase One: Mobility, Flexibility and Motor Control

The initial treatment phase focuses on restoring range of motion and establishing proper movement patterns. This phase addresses tissue restrictions and introduces basic activation patterns for mobility. Key interventions during this phase target the specific kinetic chain impairments identified during assessment.[5] Treatments include manual techniques, soft tissue mobilisation, and specific stretching protocols.

Phase Two: Strengthening and Stability

Once adequate mobility is achieved, the focus is on developing strength and stability. Strengthening exercises focus on dissociating movements, enabling athletes to learn to control different segments of their kinetic chain independently (e.g., rotating the pelvis while maintaining a stable torso, or rotating the torso while maintaining a stable pelvis).[5]

Phase Three: Integration and Functional Movement

The final phase focuses on integrating the mobility and strength gains into sport-specific movement patterns at progressively increasing speeds and complexities. These techniques ensure that the treatment gains are maintained under competitive demands.[5]

Resources

References

  1. ↑ Adeel M, Lin BS, Chaudhary MA, Chen HC, Peng CW. Effects of strengthening exercises on human kinetic chains based on a systematic review. Journal of Functional Morphology and Kinesiology. 2024 Jan 17;9(1):22.
  2. ↑ Owens LP, Coyles G, Khaiyat O. Alterations to the Kinetic Chain Sequence After a Shoulder Injury in Throwing Athletes. Orthopaedic Journal of Sports Medicine. 2024 Nov;12(11):23259671241288889.
  3. ↑ 3.0 3.1 Jones Jr SD, Safran MR. Current concepts: the hip, core and kinetic chain in the overhead athlete. Journal of Shoulder and Elbow Surgery. 2024 Feb 1;33(2):450-6.
  4. ↑ da Silva Barros BR, de Barros AC, da Silva Júnior N, Cavalcanti IB, de Oliveira Sousa C. Motor alterations along the kinetic chain in amateur volleyball and handball athletes with shoulder pain: An observational comparative study. Journal of Bodywork and Movement Therapies. 2024 Jul 1;39:364-72.
  5. ↑ 5.00 5.01 5.02 5.03 5.04 5.05 5.06 5.07 5.08 5.09 5.10 5.11 5.12 5.13 5.14 5.15 5.16 Kaplan A. Overhead Athlete Kinetic Chain Assessment and Treatment Course. Physiopedia Plus, 2025.
  6. ↑ Liaghat B, Pedersen JR, Husted RS, Pedersen LL, Thorborg K, Juhl CB. Diagnosis, prevention and treatment of common shoulder injuries in sport: grading the evidence - a statement paper commissioned by the Danish Society of Sports Physical Therapy (DSSF). Br J Sports Med. 2023 Apr;57(7):408-416.
  7. ↑ Gilmer GG, Washington JK, Dugas JR, Andrews JR, Oliver GD. The Role of Lumbopelvic-Hip Complex Stability in Softball Throwing Mechanics. J Sport Rehabil. 2019 Feb 1;28(2):196-204.
  8. ↑ Lintner D, Noonan TJ, Kibler WB. Injury patterns and biomechanics of the athlete's shoulder. Clin Sports Med. 2008 Oct;27(4):527-51.
  9. ↑ Ellenbecker TS, Aoki R. Step by Step Guide to Understanding the Kinetic Chain Concept in the Overhead Athlete. Curr Rev Musculoskelet Med. 2020 Apr;13(2):155-163.
  10. ↑ Wang SM, Chen SH, Chen HY, Huang JH, Wu YR, Hsu WL. Pelvic Control and Pelvic-Trunk Coordination as Key Determinants of Pitching Velocity in Baseball Pitchers. Orthop J Sports Med. 2025 Jul 24;13(7):23259671251350302.
  11. ↑ Moiroux-Sahraoui A, Mazeas J, Delgado N, Le Moteux C, Acco M, Douryang M, Bjerregaard A, Forelli F. Prevention of Overhead Shoulder Injuries in Throwing Athletes: A Systematic Review. Diagnostics (Basel). 2024 Oct 30;14(21):2415.
  12. ↑ Lobbos BS, Essa MMM, Khaireldin A, Gamal El-Din MY, Rizkallah P, Samy HA. Influence of pelvic position on shoulder range of motion. BMC Musculoskelet Disord. 2025 Jan 17;26(1):60.
  13. ↑ Takaki S Ms Pt, Kaneoka K PhD Md, Okubo Y PhD Pt, Otsuka S Ms, Tatsumura M PhD Md, Shiina I PhD Md, Miyakawa S PhD Md. Analysis of muscle activity during active pelvic tilting in sagittal plane. Phys Ther Res. 2016 Nov 29;19(1):50-57.
  14. ↑ González-de-la-Flor Á, Cotteret C, García-Pérez-de-Sevilla G, Domínguez-Balmaseda D, Del-Blanco-Muñiz JÁ. Comparison of two different stretching strategies to improve hip extension mobility in healthy and active adults: a crossover clinical trial. BMC Musculoskelet Disord. 2024 Oct 26;25(1):853.
  15. ↑ 15.0 15.1 Ludwig O, Dindorf C, Kelm S, Kelm J, Fröhlich M. Muscular Strategies for Correcting the Pelvic Position to Improve Posture-An Exploratory Study. J Funct Morphol Kinesiol. 2024 Jan 29;9(1):25.
  16. ↑ McMullen J, Uhl TL. A kinetic chain approach for shoulder rehabilitation. J Athl Train. 2000 Jul;35(3):329-37.
  17. ↑ Nishino K, Yamamoto N, Okamura N, Sekine H, Tanaka Y, Nishizawa T, Tanaka M, Edama M, Omori G. Pitching Kinematics and Kinetics Related to the Elbow Joint Load in Young Female Baseball Players: A Comparison With Young Male Baseball Players. Orthop J Sports Med. 2025 Jun 16;13(6):23259671251343795.
  18. ↑ Trasolini NA, Nicholson KF, Mylott J, Bullock GS, Hulburt TC, Waterman BR. Biomechanical Analysis of the Throwing Athlete and Its Impact on Return to Sport. Arthrosc Sports Med Rehabil. 2022 Jan 28;4(1):e83-e91.
  19. ↑ Gauthier ML, Unverzagt CA, Davies GJ. Evaluation and Treatment of Baseball Pitchers: There's More to Assess than the Arm. Int J Sports Phys Ther. 2025 Jan 1;20(1):113-126.
  20. ↑ Yoshimi M, Maeda N, Komiya M, Fukui K, Tashiro T, Kaneda K, Arima S, Tsutsumi S, Abekura T, Urabe Y. Effect of thoracic expansion restriction on scapulothoracic and glenohumeral joint motion during shoulder external rotation. J Back Musculoskelet Rehabil. 2022;35(6):1399-1406.
  21. ↑ Zaremski JL, Zeppieri G Jr, Tripp BL. Sport Specialization and Overuse Injuries in Adolescent Throwing Athletes: A Narrative Review. J Athl Train. 2019 Oct;54(10):1030-1039.
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