Throwing injuries

The repetitive action associated with throwing athletes makes them susceptible to injuries in and around the shoulder and elbow joints. These injuries can occur as a result of muscle overuse, improper technique or both.  A variety of throwing athletes can succumb to shoulder and elbow injuries however baseball pitchers are most often affected due to the repetitive action and the tensile forces placed on their upper extremities. The number of pitches, speed of pitches, height, weight and pitching mechanics can potentially play a role in causing injury.

In order to understand these types of injuries we need to understand more about the throwing action itself. There are 6 phases of throwing: they are the wind up, early cocking, late cocking, acceleration, deceleration and the follow through.

The whole movement takes around 2 seconds to complete and pitches can be released at speeds of up to 150km/hr. During throwing the shoulder and elbow joints move at speeds of up to 7000 degrees/second, 6 and 2300 degrees/seconds respectively which places huge forces on the structures designed to protect them. The most significant forces act on shoulder and elbow during late cocking, acceleration and deceleration phases. Knowing the phases of throwing can be important in identifying the injury.


Differential diagnosis

There are a wide variety of possible injuries associated with the throwing athlete to both the shoulder and elbow. Common shoulder injuries are SLAP tears, biceps tendonitis, rotator cuff tears, impingement, instability, glenohumeral internal rotation deficit (GIRD) or shoulder blade motor control issues know as SICK scapula. It is possible to differentiate these types of injuries by a few common signs and symptoms. If the athlete feels pinching when they raise their arm it is possible they have some impingement, if they experience catching or locking then a SLAP tear could be the cause. Feeling unstable or apprehensive of movement are signs of instability, difficulty with putting the hand behind the back can indicate GIRD and a loss of throwing power, speed and accuracy could point to rotator cuff pathology.

The main injuries to the elbow include flexor tendonitis (Little Leaguer's Elbow), ulnar collateral ligament (UCL) injury, valgus extension overload or an olecranon stress fracture. A loss of throwing speed and ball control could point to a chronic UCL injury where as pain with a pop and paraesthesia in the ulnar nerve distribution could indicate an acute UCL injury. Locking, catching or pain associated with ball release (full elbow extension) may indicate valgus extension overload and a decrease in elbow extension, pain with elbow extension/resisted triceps muscle test and posterior tenderness are indicative of an olecranon stress fracture.



 A variety of different treatment options exist to treat shoulder and elbow injuries ranging from tendon offloads, pain management strategies, rest or modifications to pitching mechanics (frequency and volume). After determining the type and extent of the injury your physiotherapist can aim to treat it in 3 phases. The first phase aims to reduce the amount of pain the athlete is in through rest, isometric strengthening and stretching with the therapist performing more passive techniques. In order to avoid total deconditioning the athlete can still perform lower extremity exercises. The second phase involves ‘active rest’ where the athlete is allowed to participate in a limited capacity but no throwing can be performed. The goal of this phase is to restore full and functional motion and improve the stability of the injured joint. The third phase looks to restore/improve terminal range of motion, maintain the stability of the joint throughout the activity, improve the endurance and power of the athlete and progressively return them to full play.


When it comes to sorting your shoulder, elbow, or other injuries, come and see our highly skilled physiotherapists. Here at Thornleigh Performance Physiotherapy, we can give you an accurate diagnosis and treatment, as well as advice on the best course of action for your condition to get you back in action sooner than you could’ve imagined.  We have an expertise in musculoskeletal physiotherapy and are conveniently located near Beecroft, Cherrybrook, Hornsby, Normanhurst, Pennant Hills, Wahroonga, Westleigh, West Pennant Hills, and West Pymble. So give us a call on (02) 8411 2050 to get started on a journey to a better you. 



  • Anderson MW, Alford BA. Overhead throwing injuries of the shoulder and elbow. Radiol Clin North Am. Nov 2010;48(6):1137-1154.
  • Khan K, Brukner P. Brukner & Khan's Clinical Sports Medicine. McGraw-Hill Education; 2011.
  • Patel NB, Thomas S, Lazarus ML. Throwing injuries of the upper extremity. Radiol Clin North Am. Mar 2013;51(2):257-277.
  • Pujalte G, Zaslow T. A Practical Guide to Throwing Injuries In the Throwing Athlete. J Fam Practice. 2013;62(4):175-180.
  • Shanley E, Thigpen C. Throwing Injuries in the Adolescent Athlete. Int J Sports Phys Ther. 2013;8(5):630-640.
  • Jancosko JJ, Kazanjian JE. Shoulder injuries in the throwing athlete. Phys Sportsmed. Feb 2012;40(1):84-90.
  • Kancherla VK, Caggiano NM, Matullo KS. Elbow injuries in the throwing athlete. Orthop Clin North Am. Oct 2014;45(4):571-585.