Treatment for Brachial Plexus Overuse Symptoms in Throwing Athletes
The treatment for brachial plexus overuse symptoms in throwing athletes should follow a structured rehabilitation protocol with a gradual return to activity, focusing first on rest and activity modification, followed by progressive strengthening and sport-specific training before returning to throwing. 1
Initial Assessment and Management
Rest and Activity Modification:
- Complete cessation of throwing activities during the acute phase
- Avoid positions that exacerbate symptoms (typically overhead positions)
- Modify daily activities that provoke symptoms
Pain Management:
- Non-steroidal anti-inflammatory medications for acute pain
- Application of ice to reduce inflammation
- Consider physical therapy modalities such as ultrasound or electrical stimulation
Rehabilitation Protocol
Phase 1: Acute Phase (1-2 weeks)
- Focus on pain control and protection of the injured structures
- Gentle range of motion exercises within pain-free range
- Light aerobic activity that doesn't involve the affected arm (e.g., walking, stationary cycling at 70% maximum heart rate) 2
- Postural education and correction
Phase 2: Intermediate Phase (2-4 weeks)
- Progressive range of motion exercises
- Begin strengthening of the rotator cuff, scapular stabilizers, and core muscles
- Sport-specific exercises without throwing motions
- Address any biomechanical issues or muscle imbalances
Phase 3: Advanced Rehabilitation (4-6 weeks)
- More complex training drills
- Progressive resistance training
- Sport-specific movement patterns without full throwing
- Neuromuscular re-education
Phase 4: Return to Throwing Program (6+ weeks)
- Gradual progression of throwing distance, intensity, and volume
- Begin with short, low-intensity throws and progress systematically
- Monitor symptoms closely during progression
- If symptoms return, step back to previous level for at least 24 hours before attempting to progress again
Return to Play Protocol
Following the principles established for other sports injuries, return to throwing should follow this stepwise process 2:
- No throwing activity until asymptomatic at rest
- Light aerobic exercise without throwing
- Sport-specific training without throwing (running, fielding)
- Non-contact throwing drills at reduced intensity
- Full-contact practice after medical clearance
- Return to competitive throwing
Each step should take a minimum of 24 hours, with a total minimum of 5 days before full return to competition. If symptoms recur at any stage, the athlete should return to the previous asymptomatic level and attempt to progress again after 24 hours of being symptom-free.
Prevention Strategies
- Throwing Mechanics: Proper evaluation and correction of throwing mechanics
- Training Program: Balanced strengthening of the entire kinetic chain
- Workload Management: Appropriate pitch counts and rest days between throwing sessions
- Equipment: Proper equipment fitting and maintenance
- Warm-up: Comprehensive dynamic warm-up before throwing activities
Special Considerations
- Athletes with recurrent symptoms may require more prolonged rest periods and a slower progression
- Consider imaging (MRI of the brachial plexus) for persistent symptoms to rule out more severe injury 1
- Surgical intervention is rarely needed for overuse injuries but may be considered in cases with structural abnormalities or if conservative management fails after 3-6 months 1
Common Pitfalls to Avoid
- Returning to throwing too quickly before adequate healing
- Focusing only on the symptomatic area rather than addressing the entire kinetic chain
- Neglecting core and lower body strength which contribute to proper throwing mechanics
- Ignoring early warning signs of recurrence during the return to throwing progression
- Failing to address underlying biomechanical issues that contributed to the initial injury
By following this structured approach, most throwing athletes with brachial plexus overuse symptoms can successfully return to their sport with reduced risk of recurrence.