Rehabilitation of Throwing Shoulder

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Top Contributors -Wataru Okuyama

Introduction

Throwing disorder is a complaint of throwing pain with little or no interference with daily life. Rehabilitation is an important part of the treatment, as it must lead to the stage where he can pitch without pain. When a player presents to us with a complaint of pitching pain, there are no abnormalities in joint range of motion measurements, manual muscle strength measurements, or neurological examinations performed for general orthopedic diseases. Manual examinations of shoulder labral and rotator cuff injuries are scattered, but are not conclusive enough to warrant surgery.

We would like to describe the examination method, including 11 physical findings that are easy to obtain and convincing to the player, and conservative therapy with emphasis on rehabilitation of these findings.

The Pathology of the Throwing Disorder

The concept of muscle wasting (fatigue): Overthrowing, insufficient stretching, and poor functional balance between the lower and upper limbs have been shown to cause throwing problems in the shoulder. In particular, players are often unaware of the weakness of the rotator cuff and peri-scapular muscles. Throwing disorder is caused by the functional imbalance between the two. During the throwing motion, the inner muscles, which are the external rotators, are required to contract centrifugally from the release of the ball to the follow-through. It is thought that microdamage to the muscle fibers is caused by traction. Atrophy of the infraspinatus muscle, often resulting in differences in appearance between right and left sides. The muscle thickness of the infraspinatus muscle was studied by ultrasound in 144 players with throwing disorders. The results showed that the average thickness of the muscles on the throwing side was 13.9 mm and that of the non-throwing side was 14.9 mm. There was a tendency for the subspinous muscles on the pitching side to have less muscle thickness. It was suggested that throwing the ball puts a lot of stress on the shoulder joint.

Pathophysiology from the perspective of the kinetic chain: Let's think about a series of throwing motions, from wind-up, to ball release, and then follow through. The process of energy transfer from the lower limb to the trunk, from the trunk to the upper limb, and then to the ball is considered as a kinetic chain. When energy is not transferred from one segment of the body to the next during a throwing motion, the other segments compensate for it, leading to an obstacle in that segment. At the time of examination, it is possible that the symptom may not be caused by the true location of the problem, but somewhere else.

The concept of causing a glenoid labrum injury:

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