Published by PMR of NY & CT
Whether you pitch, play quarterback or throw from the outfield, few things are more frustrating than a shoulder that aches every time you let the ball go. Shoulder pain when throwing is common because the overhead throw is one of the fastest, most demanding motions the body makes.
Most throwing shoulder injuries build up gradually from repetition rather than a single bad throw, and many respond to rest, targeted rehab and a careful return to throwing.
Why throwing is hard on the shoulder
A throw starts in your legs and trunk, and the shoulder acts like the end of a whip. In the cocking phase, the arm rotates far back. During acceleration, it whips forward at high speed. After release, the muscles at the back of the shoulder must brake the arm in a fraction of a second.
Repeated often, that cycle stresses the rotator cuff tendons, the labrum (the ring of cartilage around the socket) and the biceps tendon. When the legs and core contribute too little, or mechanics break down with fatigue, the shoulder takes on more load.
Common causes of shoulder pain when throwing
Rotator cuff tendinitis and tears
The rotator cuff is a group of four muscles and tendons that keep the ball of the shoulder centered in the socket. In throwers, the tendons can become irritated or develop partial tears, often causing pain during the throw and an ache afterward. Our rotator cuff tear page covers this injury in depth.
Internal impingement
When the arm is cocked back, the rotator cuff tendons can get pinched between the ball of the shoulder and the back edge of the socket. This internal impingement typically causes pain in the back of the shoulder during late cocking. It differs from the more familiar shoulder impingement that causes pain when you raise your arm overhead.
SLAP tear
A SLAP tear is an injury to the top of the labrum, where the biceps tendon attaches. Throwers may feel deep pain, clicking or catching, along with a loss of velocity or control.
Biceps tendinitis
The long head of the biceps tendon runs over the front of the shoulder. Repeated throwing can irritate it, causing front-of-shoulder pain that may travel down the upper arm.
Dead arm
Some throwers describe a sudden dead arm feeling: the arm goes weak or numb mid-throw and velocity drops. It has long been linked to shoulder looseness (instability) and labrum injuries, and it deserves a full exam.
Warning signs to take seriously
Shoulder pain when throwing is worth getting checked if you notice:
- Pain that lingers more than a day or two after throwing
- Pain that changes your throwing motion or makes you hold back
- Clicking, catching or a sense that the shoulder is slipping
- Weakness, a drop in velocity or a dead arm feeling
- Pain at night or at rest
Go to an emergency room if your shoulder looks deformed or won't move after a fall or collision, or your arm or hand turns numb, cold or pale, and see a doctor promptly after a sudden pop with severe pain. Call 911 if shoulder pain comes with chest pressure, shortness of breath or sweating, which can signal a heart attack.
How throwing shoulder injuries are treated
Treatment usually starts without surgery. A typical plan includes:
- A break from throwing. Relative rest lets irritated tissues settle while you stay active in other ways.
- Restoring motion. Many throwers lose internal rotation in the throwing shoulder, and targeted stretching may help restore it.
- Strengthening. Rotator cuff and shoulder blade exercises build control and endurance, especially in the muscles that slow the arm.
- Training the whole chain. Hip, core and leg strength take load off the shoulder.
- Mechanics. A coach or clinician can spot patterns that overload the shoulder as you tire.
Sports medicine and physical therapy at Physical Medicine & Rehabilitation of NY & CT (PMR) can guide this process. Surgery is usually considered only for significant structural damage or when a well-run rehab program hasn’t worked.
Returning to throwing safely
Once you have full, pain-free motion and good strength, most programs use a step-by-step throwing program. You start with short, easy tosses, then add distance, effort and volume over several weeks before returning to the mound or full game speed.
Follow the progression even if you feel ready to skip ahead. Mild soreness that fades by the next session is common; pain during throwing means dropping back a step. Keep doing your strengthening exercises throughout, since fatigue is a common factor in throwing injuries.
Frequently asked questions
Should I throw through shoulder pain?
It's best not to. Pain during throwing is a signal that something is irritated or injured, and pushing through it can turn a minor problem into one that takes months to recover from. Mild muscle soreness the day after throwing is common, but sharp pain, pain that changes your motion or pain that lingers should prompt rest and an exam.
What is the best stretch for a throwing shoulder?
There is no single best stretch, but the sleeper stretch and cross-body stretch are commonly used to restore internal rotation, which many throwers lose over time. Stretch gently, without forcing it or causing pain. A clinician can measure your shoulder motion and tell you whether stretching, strengthening or both should be your focus.
Can young pitchers get shoulder injuries?
Yes. Young pitchers are especially vulnerable because their bones are still growing. Little League shoulder, an overuse injury to the growth plate at the top of the upper arm bone, causes pain with throwing. MLB and USA Baseball's Pitch Smart program advises pitch count limits, several months off from throwing each year and not playing for multiple teams at once.
Request an appointment at PMR
If shoulder pain is holding back your throwing, our team can help find the cause and guide your return to play. Learn more about our shoulder pain care, or request an appointment and we will contact you to schedule a visit.
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