Wilk Kevin E, Meister Keith, Andrews James R
HealthSouth Rehabilitation Corporation and American Sports Medicine Institute, Birmingham, Alabama 35202, USA.
Am J Sports Med. 2002 Jan-Feb;30(1):136-51. doi: 10.1177/03635465020300011201.
The overhead throwing motion is an extremely skillful and intricate movement that is very stressful on the shoulder joint complex. The overhead throwing athlete places extraordinary demands on this complex. Excessively high stresses are applied to the shoulder joint because of the tremendous forces generated by the thrower. 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. We refer to this as the "thrower's paradox." This balance is frequently compromised, which leads to injury. Numerous types of injuries may occur to the surrounding tissues during overhead throwing. Frequently, injuries can be successfully treated with a well-structured and carefully implemented nonoperative rehabilitation program. The key to successful nonoperative treatment is a thorough clinical examination and accurate diagnosis. Athletes often exhibit numerous adaptive changes that develop from the repetitive microtraumatic stresses observed during overhead throwing. Treatment should focus on the restoration of these adaptations during the rehabilitation program. In this article, the typical musculoskeletal profile of the overhead thrower and various rehabilitation programs for specific injuries are discussed. Rehabilitation follows a structured, multiphase approach with emphasis on controlling inflammation, restoring muscle balance, improving soft tissue flexibility, enhancing proprioception and neuromuscular control, and efficiently returning the athlete to competitive throwing.
过顶投掷动作是一种极其熟练和复杂的动作，对肩关节复合体造成很大压力。过顶投掷运动员对这个复合体有极高的要求。由于投掷者产生的巨大力量，肩关节会承受过高的压力。投掷者的肩部必须足够松弛以允许过度的外旋，但又要足够稳定以防止出现症状性肱骨头半脱位，因此需要在活动度和功能稳定性之间达到微妙的平衡。我们将此称为“投掷者悖论”。这种平衡经常受到破坏，从而导致受伤。在过顶投掷过程中，周围组织可能会发生多种类型的损伤。通常，通过精心构建和认真实施的非手术康复计划，损伤可以得到成功治疗。成功进行非手术治疗的关键是全面的临床检查和准确的诊断。运动员经常会表现出许多适应性变化，这些变化是由过顶投掷过程中反复出现的微创伤应力所导致的。治疗应着重于在康复计划中恢复这些适应性变化。在本文中，将讨论过顶投掷者典型的肌肉骨骼特征以及针对特定损伤的各种康复计划。康复采用结构化的多阶段方法，重点是控制炎症、恢复肌肉平衡、改善软组织柔韧性、增强本体感觉和神经肌肉控制，并有效地使运动员恢复到竞争性投掷状态。
