Why is rehab for the overhead athlete so nuanced—and how much of the answer is hidden below the shoulder? On this episode of BackTable Bone & Sports, Dr. Larry Balle welcomes Corbin Hedt, PT, DPT, SCS, CSCS, to explore upper extremity rehabilitation, fellowship training in sports physical therapy, and the evidence behind advanced throwing programs. Hedt breaks down the kinetic chain from the ground up, explains why only a few accredited fellowships exist for upper extremity athletes, and shares why modern rehab is all about proximal stability leading to distal performance. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction07:43 - Nuances of Upper Extremity Rehab14:22 - Upper Extremity Fellowship Overview21:12 - Barriers to Fellowship Expansion28:15 - Kinetic Chain in Throwing33:03 - Core Control and Movement Quality37:27 - Evaluating the Softball Pitcher44:24 - Blood Flow Restriction Training49:42 - BFR Protocols and Study Findings56:06 - Injury Risk and Workload Research1:03:37 - Imaging Findings in Asymptomatic Throwers1:07:36 - Curveballs, Velocity and Volume1:11:01 - Final Takeaways and Closing Remarks --- More about this episode The discussion covers clinical decision-making for common injuries like rotator cuff tendinopathy and UCL injury, the use of blood flow restriction therapy, and how evaluation and rehab protocols are evolving with new research. They dive into the mechanics of throwing, movement quality, imaging findings in asymptomatic athletes, and what really drives youth arm injuries. The episode closes with practical pearls for trainers and clinicians, including the dynamometer trick for patient buy-in, and why looking at the whole athlete, not just the pain, matters most. --- Resources Lambert BS, Hedt C, Ankersen JP, et al. Rotator cuff training with upper extremity blood flow restriction produces favorable adaptations in Division IA collegiate pitchers: a randomized trial. J Shoulder Elbow Surg. 2023;32(6):e279-e292.https://doi.org/10.1016/j.jse.2023.02.116 Intelangelo L, Lassaga I, Gonzalo E, et al. Is Strength the Main Risk Factor of Overuse Shoulder Injuries? A Cohort Study of 296 Amateur Overhead Athletes. Sports Health. 2025.https://doi.org/10.1177/19417381241298287 Bowen L, Gross AS, Gimpel M, Bruce-Low S, Li FX. Spikes in acute:chronic workload ratio (ACWR) associated with a 5-7 times greater injury rate in English Premier League football players: a comprehensive 3-year study. Br J Sports Med. 2020;54(12):731-738.https://pmc.ncbi.nlm.nih.gov/articles/PMC7285788/ Erickson BJ, Camp CL, D'Angelo J, et al. Musculoskeletal Findings of the Major League Baseball Combine: A Description of the "Normal" Prospective Professional Baseball Player. Am J Sports Med. 2025.https://doi.org/10.1177/03635465251339773 Fleisig GS, Andrews JR, Cutter GR, et al. Risk of Serious Injury for Young Baseball Pitchers: A 10-Year Prospective Study. Am J Sports Med. 2011;39(2):253-257.https://doi.org/10.1177/0363546510384224 Ready To Throw, the free throwing program, rehab protocol and pitching mechanics repository https://www.readytothrow.com/ --- BackTable Bone & Sports is the go-to podcast for orthopedic surgeons, sports medicine docs, pain specialists, and MSK radiologists. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app