Baseball and softball place extreme demands on the throwing arm, with pitchers generating ball velocities exceeding 90 mph through a complex kinetic chain. The repetitive nature of throwing creates predictable injury patterns that players, coaches, and parents should understand. At M.O. Therapy in Markham, we help baseball and softball players prevent and recover from arm injuries.
Understanding Throwing Injuries
The throwing motion creates tremendous stress on the arm:
- Elite pitchers can throw over 90 mph
- Shoulder rotation during throwing reaches 7,000-8,000 degrees per second
- Elbow valgus stress during throwing exceeds body weight
- Professional pitchers throw millions of pitches over their careers
- Youth players are at increasing risk due to year-round play
These forces explain why arm injuries are so common in throwing athletes.
Elbow Injuries
UCL Injuries (Tommy John)
The ulnar collateral ligament (UCL) stabilizes the elbow against valgus stress during throwing. UCL injuries have become epidemic, particularly among young players.
What Causes UCL Injuries:
- Repetitive throwing stress
- Excessive pitch counts
- Throwing through fatigue
- Year-round play without rest
- Poor throwing mechanics
- Insufficient rest between outings
Symptoms:
- Pain on inside of elbow during throwing
- Decreased velocity
- Loss of control
- Pop or tearing sensation (acute tear)
- Difficulty gripping ball
- Numbness in ring and small fingers
Risk Factors:
- Pitching more than 8 months per year
- Throwing with fatigue
- Pitching for multiple teams
- Playing catcher when not pitching
- Using breaking balls at young age
- Previous elbow injury
Treatment Options:
Non-Surgical:
- Rest from throwing
- Physical therapy
- Platelet-rich plasma (PRP) injections
- Gradual return to throwing
Surgical (Tommy John Surgery):
- UCL reconstruction with tendon graft
- 12-18 month recovery
- 80-90% return to prior level
- Requires extensive rehabilitation
Little League Elbow
Little League elbow refers to growth plate injuries in young throwers, typically affecting 9-14 year olds.
Types:
- Medial epicondyle apophysitis (most common)
- Osteochondritis dissecans of the capitellum
- Little League shoulder (growth plate injury)
Symptoms:
- Pain on inside of elbow
- Decreased throwing distance and accuracy
- Swelling and tenderness
- Pain that worsens with throwing
Prevention:
- Follow pitch count guidelines
- Avoid breaking balls until physical maturity
- Ensure adequate rest between outings
- Limit year-round play
- Proper mechanics from young age
Flexor-Pronator Strain
What It Is:
- Strain of muscles on inside of forearm
- Often accompanies UCL stress
- Can occur acutely or gradually
Treatment:
- Rest from throwing
- Ice and anti-inflammatory measures
- Gradual strengthening
- Address throwing mechanics
- Slow return to throwing
Shoulder Injuries
Rotator Cuff Problems
Internal Impingement:
- Most common shoulder problem in throwers
- Occurs during cocking phase of throw
- Rotator cuff gets pinched against labrum
- Causes posterior shoulder pain
Rotator Cuff Tendinopathy:
- Develops from repetitive throwing
- Usually involves supraspinatus
- Pain with overhead activities
- May progress to partial or complete tears
Symptoms:
- Pain during or after throwing
- Decreased velocity
- Loss of control
- Night pain
- Weakness with arm elevation
SLAP Tears
What It Is:
- Superior labrum anterior-posterior tear
- Common in throwing athletes
- Results from repetitive stress or acute injury
- Affects shoulder stability and function
Symptoms:
- Deep shoulder pain
- Clicking or catching
- Pain during late cocking phase
- Decreased velocity and endurance
Treatment:
- Physical therapy for mild cases
- Arthroscopic repair for significant tears
- 9-12 month return to throwing after surgery
Shoulder Instability
Types:
- Subtle instability (common in throwers)
- Anterior instability
- GIRD (Glenohumeral Internal Rotation Deficit)
GIRD:
- Loss of internal rotation
- Compensatory gain in external rotation
- Common in throwers
- Can lead to other problems if not addressed
Prevention Strategies
Pitch Count Guidelines
Following evidence-based pitch count limits is essential:
Youth Baseball (9-10 years):
- 50 pitches per game maximum
- 4 days rest after 66+ pitches
Youth Baseball (11-12 years):
- 75 pitches per game maximum
- 4 days rest after 66+ pitches
Youth Baseball (13-14 years):
- 75 pitches per game maximum
- 4 days rest after 76+ pitches
High School (15-18 years):
- 95-105 pitches per game maximum
- Monitor total weekly innings
Off-Season Rest
Recommendations:
- Minimum 2-3 months completely off from throwing
- Continue general conditioning
- Address mobility and strength deficits
- Mental break from competitive play
Strength and Conditioning
Essential Exercises:
Rotator Cuff:
- Side-lying external rotation
- Prone T's, Y's, W's
- 90/90 external rotation
- Rhythmic stabilization drills
Scapular Stability:
- Low rows with squeeze
- Wall slides
- Push-up plus
- Serratus punches
Core and Hip:
- Pallof press
- Medicine ball rotational throws
- Single-leg exercises
- Hip mobility work
Proper Throwing Mechanics
Key Points:
- Full body involvement in throw
- Good hip-shoulder separation
- Efficient arm path
- Proper foot placement
- Balanced follow-through
Red Flags:
- All-arm throwing
- Short-arming the ball
- Excessive elbow dropping
- Landing with foot open
- Poor trunk rotation
Warm-Up Protocol
Before Throwing:
- General cardiovascular warm-up
- Dynamic stretching (especially shoulders and hips)
- Arm circles and shoulder preparation
- Progressive throwing (long toss to mound)
- Gradually increasing intensity
Treatment at M.O. Therapy
Physiotherapy
Our physiotherapists specialize in throwing injuries:
Assessment:
- Throwing motion analysis
- Shoulder and elbow screening
- Strength and mobility testing
- Return-to-throw clearance
Treatment:
- Manual therapy techniques
- Soft tissue mobilization
- Exercise prescription
- Throwing program design
- Mechanics recommendations
Massage Therapy
Our RMTs help baseball players:
- Address arm and shoulder tension
- Recovery between starts
- Season maintenance
- Pre-game preparation
Chiropractic Care
Chiropractic benefits throwing athletes through:
- Spinal and extremity assessment
- Joint mobility optimization
- Soft tissue treatment
- Performance optimization
Return-to-Throwing Programs
Post-Injury Progression
Phase 1: Recovery (2-6 weeks)
- Complete rest from throwing
- Pain resolution
- Restore range of motion
- Begin strengthening
Phase 2: Interval Throwing (4-8 weeks)
- Flat ground throwing at increasing distances
- Start at 30 feet, progress to 120+ feet
- Monitor symptoms at each stage
- Build arm strength gradually
Phase 3: Mound Progression (2-4 weeks)
- Return to mound
- Gradual increase in pitch count
- Add off-speed pitches slowly
- Full velocity progression
Phase 4: Return to Competition
- Simulated games
- Pitch count limits initially
- Full return when symptoms-free
- Continued maintenance
Frequently Asked Questions
What is Tommy John surgery recovery time? Full recovery from Tommy John surgery typically takes 12-18 months, with return to competitive throwing usually occurring around 12-14 months post-surgery.
When should young pitchers learn breaking balls? Most experts recommend waiting until at least age 14, or when growth plates have closed, to begin throwing breaking balls regularly. Focusing on fastball command and changeup earlier is safer.
How can I prevent arm injuries in baseball? Key prevention strategies include following pitch count guidelines, taking adequate rest between outings, maintaining an off-season break from throwing, using proper mechanics, and doing year-round arm care exercises.
Should I throw through arm pain? Never throw through arm pain. Pain is a warning signal that tissue is being damaged. Stop throwing and seek evaluation. Early intervention prevents minor issues from becoming major injuries.
Book Your Assessment
If you're dealing with an arm injury or want to optimize your throwing health, M.O. Therapy in Markham can help. Our team understands the demands of baseball and provides specialized care for throwing athletes.
Call (905) 201-5827 or book online for your assessment. We offer direct billing and same-day appointments for acute injuries.