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TRAINING ROOM: The Throwing Shoulder

By Bob Smetanka, P.T., A.T.C.

From Spring 1991 issue of HardBall Magazine

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Play ball! In a short time, the traditional yell of baseball will be heard by MSBL leagues across the country. Everyone is eagerly awaiting the start of the season, but eagerness alone will not guarantee a healthy, successful season.

Many players, especially pitchers, spend most of their season fighting a sore shoulder. The shoulder, by design, has great mobility. With so many areas moving and being stressed repeatedly, a number of injuries can occur. The most common injuries seem to occur at the biceps tendon, bursae (lubricating joint sac), infraspinatus muscle (on the lower shoulder blade) and rotator cuff (turns the arm). The rotator cuff is the most common injury site.

Injuries can occur from muscular strength imbalance, weakness, inflexibility or overuse. Poor throwing mechanics at the legs, hips, trunk and shoulder with incorrect alignment, balance or rhythm can lead to injury. Some shoulder soreness may be expected after intense throwing, but it is possible to complete a season with minimal shoulder problems from throwing.

The key to an injury-free season is a well-conditioned athlete prior to the season's start. Good strength, flexibility and muscular endurance can offer a protective "cushion” in fatigue and skill breakdown. General conditioning (running, weight training and stretching) can be helpful, but greater success can occur with a program specific to baseball.

For years, baseball failed to apply exercise principles for performance enhancement. It is now widely recognized that sport-specific conditioning, especially strength training, is essential for successful baseball competition. Pitching involves short-duration, high-intensity muscular contractions followed by extended periods of rest. Training programs that require rapid energy production—weight training and high-intensity, short-duration interval running—must be used. Also important (but to a lesser degree) is flexibility, muscular endurance and cardiovascular endurance.

While it is crucial to strengthen the shoulder and entire upper extremity, a major emphasis must be placed in other areas. Throwing a baseball has been likened to cracking a whip: the force is initiated at the handle, with energy moving towards the forceful "snap” at the tip. The leg push-off leads the explosive rotation of the hip and generation of power to the arm for the throw. Strength development at the quads, hip, abdomen, lower back and trunk rotators is required for the health of the throwing shoulder.

Ideally, prevention of shoulder injuries involves off-season, pre-season and in-season conditioning programs. The difference in programs lies in intensity, weight and repetitions. Free weights, machines or rubber tubing can be used for resistive exercises. A number of publications describe proper techniques and the philosophy of progression.

In the pre-season program, greater emphasis is placed upon skill development while strengthening continues (but at a lesser intensity: approximately 60%-70% of the off-season weight maximum). A 6- to 8-week throwing program should be adequate to prepare the arm. This consists of a progression of easy throws from center field, to shorter distances with greater speed, for up to 20 minutes. Position players may use a similar program with modifications according to their position.

Flexibility exercises are important at the shoulder, but some pitchers may have enough range of motion for the cocking phase. It is necessary to look at each pitcher's mechanics to determine flexibility needs. Most amateur players, however, will probably need to stretch the upper extremity and legs throughout the pre-season and in-season.

Once the season begins, the conditioning program should not be abandoned. Research indicates that most athletes do not play themselves into shape. Throwing injuries can occur if the off-season strength gains are not maintained. One to two sessions per week, along with a modified sprint program, can be adjusted within the context of the pitching rotation and muscle soreness.

Weak shoulder blade muscles are susceptible to injury from their inability to counter the tremendous acceleration forces forward. Strength development of the throwing decelerators (outward rotators) is crucial to the prevention of shoulder problems. Other strengthening exercises to the upper extremity must include the wrist, forearm, elbow, shoulder and shoulder blade.

Methods of preparation for throwing on game day can be as varied as the number of players on a team. A pitcher may use heat, massage, stretching or light resistance. Some throw very little and others may need at least 1-2 hours of total body warm-up and throwing in order to throw effectively and pain free.

Regardless of your present pre-practice and pre-game program, you cannot ignore the aging process. You cannot ignore previous throwing experience, previous injuries, type of pitch, mechanics or amount of tissue elasticity. Some researchers indicate a decreased blood supply to the rotator cuff with aging. Adequate warm-up allows increased blood supply, tissue temperature and tissue extensibility. Adequate warm-up can prevent injuries and allow greater throwing efficiency. Early in the season, a limit should be placed upon the number of pitches. Decisions based upon emotion can lead to injury. Strength and endurance allow you to extend the limit.

After the game, ice the shoulder for 20 minutes. Some may also prefer a massage or stretch to help remove muscular waste products from the intense workout. The goal is to have no soreness 2-3 days after throwing. The recovery of the shoulder continues with the return to the in-season conditioning program of running, stretching and strengthening.

The integrity and efficiency of the throwing mechanism involves more than the shoulder joint and supporting muscles; it requires a total body approach to care and development. We need to pay more attention to conditioning than we did in our younger days. A total program will allow us greater, injury-free enjoyment of baseball for many, many years.

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Additional reading

Shoulder and Arm Exercises for Baseball Players. Marketing Dept., Centinela Hospital Medical Center, 555 E. Hardy Street, Inglewood, CA 90307

The Baseball Player's Guide to Sports Medicine, Pat Croce, P.T., A.T.C. Leisure Press 1987, Champaign, IL.


Bob Smetanka, P.T., A.T.C. is a physical therapist and athletic trainer. In 1991 he was president of the Boise MSBL and played on the Boise MSBL Red Sox.

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