"It hurts when I'm throwing. What's the problem, and when can I throw again?"
Even though the athletes might not immediately ask the "what" and "when" questions out loud, it's almost certain that they are thinking exactly that.
I have had the privilege of working with overhead athletes, particularly handball players, for over two decades. The shoulder of an overhead athlete, especially that of a thrower, is highly complex and presents numerous challenges in diagnosis and managemen
Overhead athletes and especially throwers, from handball players to baseball pitchers, rely heavily on their shoulders for optimal performance. However, with repeated use, these athletes are particularly prone to shoulder injuries, which can sideline them for extended periods. I've have for the past couple of years been asked to write book chapters and articles on different aspects of shoulder problems - prevention, diagnosis, rehab, return to sport - in overhead athletes and several of these book chapter and articles I've written with my partner in crime Dr. Rod Whiteley, sports physio and . If you haven't already, make sure to follow @RodWhitely on X and if you ever at a conference and you see his name in the program, that is the session you should lock in. You will not get disapointed!
This series builds on the works the Rod and I have done and will delve into the most prevalent shoulder conditions affecting throwers, focusing on practical approaches to diagnosis, rehabilitation, and return to play.
To answer the "when" question, we first need to address the "what" question. In this series—"My Shoulder Hurts: When Can I Play Again?"— I will go through the most common diagnoses seen in handball players and, generally, in most athletes who perform overhead throwing. Since most shoulder injuries in handball and among throwers develop gradually, pinpointing a specific tissue is often difficult, and in many cases not necessary for a successful return to sport, even though it is important to rule any severe injury that perhaps need non-conservative treatment. Instead of a tissue-focused approach, we will use a more straightforward, function-focused approach based on signs and symptoms. For example, we'll consider how the pain started, when it occurs during the throwing motion, whether there are any other symptoms (such as instability or neurological signs), and where the pain is located. However, if you're someone who prefers a tissue-focused approach, don't worry—we will still highlight the most common or likely tissues or anatomical structures involved in the different diagnoses.
Each part of this series will present a hypothesized diagnosis based on the patient's history, relevant physical examination, and clinical reasoning. From there, we will discuss overall strategies from the acute/initial phase through the intermediate and late phases, leading up to the return to sport. This series is not intended as a prescription or solution for every shoulder injury, but rather as a foundation to support your clinical reasoning when providing value-based care that centers on the individual’s preferences, expectations, and needs.
In the next part of our series, we’ll explore deceleration-related shoulder pain — the most common issue faced by overhead athletes. We’ll look at how to recognize it, manage it, and ultimately overcome it to return to sport and top performance.