Article Text

Download PDFPDF

Exercise prescription for overhead athletes with shoulder pathology: a systematic review with best evidence synthesis
  1. Alexis A Wright1,
  2. Eric J Hegedus1,
  3. Daniel T Tarara2,
  4. Samantha C Ray3,
  5. Steven L Dischiavi1
  1. 1 Department of Physical Therapy, High Point University, High Point, North Carolina, USA
  2. 2 Department of Exercise Science, High Point University, High Point, North Carolina, USA
  3. 3 Department of Physical Therapy, Duquesne University, Pittsburgh, Pennsylvania, USA
  1. Correspondence to Dr Alexis A Wright, High Point University, One University Parkway, Drawer 67 High Point, NC 27262, USA; awright{at}


Objective To produce a best evidence synthesis of exercise prescription used when treating shoulder pathology in the overhead athlete.

Design A systematic review of exercises used in overhead athletes including case studies and clinical commentaries.

Data sources MEDLINE, PubMed, SPORTDiscus and CINAHL from database inception through July 8, 2016.

Methods We examined data from randomised controlled trials and prospective cohort (level I–IV evidence) studies that addressed exercise intervention in the rehabilitation of the overhead athlete with shoulder pathology. Case studies and clinical commentaries (level V evidence) were examined to account for expert opinion-based research. Data were combined using best evidence synthesis and graded (A–F) recommendations (Centre for Evidence-Based Medicine).

Results There were 33 unique exercises in six level I–IV studies that met our inclusion criteria. Most exercises were single-plane, upper extremity exercises performed below 90o of elevation. There were 102 unique exercises in 33 level V studies that met our inclusion criteria. These exercises emphasised plyometrics, kinetic chain and sport-specific training.

Conclusions and relevance Overall, evidence for exercise interventions in overhead athletes with shoulder pathology is dominated by expert opinion (grade D). There is great variability between exercise approaches suggested by experts and those investigated in research studies and the overall level of evidence is low. The strongest available evidence (level B) supports the use of single-plane, open chain upper extremity exercises performed below 90° of elevation and closed chain upper extremity exercises. Clinical expert pieces support a more advanced, global treatment approach consistent with the complex, multidimensional nature of sport.

  • Shoulder
  • sports rehabilitation programmes
  • athlete
  • exercise rehabilitation

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors All named authors assisted with the idea, development, data synthesis and analysis, writing, and revision of the submitted manuscript.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.