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Throwing Injuries

by Chris Orlando, A.T.C.

Baseball season is getting ready to
start and players from little league to the majors are getting ready
for the season. This is also a time to prevent injuries before they
occur. Stretching, cardiovascular training, and slowly working into
sport-specific skills, etc. will decrease the likely-hood of injuries.

Throwing or pitching a baseball
requires a combination of strength, balance, and flexibility. A ball
properly thrown is a transfer of energy from the legs through the
body. This energy transfer starts at the legs, to the hips, to the
trunk, to the shoulder through the elbow, and being released at the

When a young child tries to throw a
ball for the first time, this endeavor seems to be very awkward and
unnatural. Mechanically, the Arm/Shoulder Complex was not anatomically
designed for overhead throwing. Only with proper coaching and
reinforcing sound body mechanics does throwing become proficient.

Throwing a ball has five phases: 1) A
Wind-up phase 2) A cocking phase 3) A delivery phase 4) A release
phase and 5) A deceleration phase. When a ball is throw in this order,
all major muscle groups help propel the ball not just the arm/shoulder

Injuries: Shoulder complex injuries,
especially to the rotator cuff are very common. The rotator cuff is
comprised of four muscles the Supraspinatus, the Infraspinatus, the
Teres Minor and the Subscapularis.

Also, these muscles act as
decelerators for the arm/shoulder complex. In other words they slow
the arm down after the ball has been released. These control the
arm./shoulder complex. It is these muscles that influence the velocity
of the thrown ball.

Another common area for a throwing
injury to occur is on the inside or medial aspect of the throwing
elbow. This injury is commonly known as Little League Elbow. These
muscles are the inside of the elbow are stressed when the ball is
being released, because they are responsible for the action of the
ball e.g., curveball, slider, cutter, sinker, etc.

Injuries to the rotator cuff and elbow
are mostly due to overuse which cause tears to form in the stressed
areas of these muscles and tendons. These tears start out as
microtears. If they continue to be stressed, they will grow larger
similar to reopening a wound.

Little League Elbow can be potentially
serious to a youngster who is not fully matured. This injury affects
the growth plate, a soft area of immature bone at the end of
the upper arm. The muscles which originate in this area could pull off
a piece of the growth plate if enough stress is applied.

Injury Management: When an athlete
complains of pain in these areas, they should be instructed to ice for
twenty minutes, three – five times a day, take aspirin for
inflammation, and rest until pain and swelling subside. If the
symptoms continue to persist the athlete should be followed-up by a

After a pitcher is through throwing
for the day, ICE should be applied to the shoulder and elbow. If the
pitcher is a starter, at least three days rest should follow before
the next start. If a pitcher is struggling, the coach should find out
why. Many outside factors could negatively influence throwing
mechanics, such as blisters on fingers and toes, ingrown toe nails,
wounds on throwing hand and fingers are a few examples. Throwing
correctly involves the whole body. Using a pitch count cold be
beneficial because not al pitchers can throw 100 plus pitches in a
game. Some pitchers may only be able to throw 75 pitches before they
have to come out; pushing them beyond that cold cause an injury as
well as jeopardize a game.

Injury Prevention: WARM UP TO THROW –
DO NOT THROW TO WARM UP. Doing calisthenics, running, and stretching
are appropriate warm-ups. When a light sweat has been attained, then
throwing should begin. Throwing should start out easy and close
together, as the arm and shoulder loosen up, throwing may be harder
and further apart. A pitcher can now work in his repertoire. At this
point, the coach should check pitching mechanics.

A good drill for ensuring proper
throwing techniques is to put a thin piece of electrical tape across
all four seams of the ball, when the ball is thrown properly the tape
should spin concentrically. This drill should be especially conducted
at the beginning of camp, or the season.

Remember that throwing involves the
whole body, not the arm/shoulder complex. Do not ignore shoulder and
elbow pain, especially if the athlete is less than 17 year old; the
growth plates could be affected. Pitchers should ice after every
outing, and starters should wait at least three days before the next

If you have any questions about the
above topic, call the Division of Sports Medicine at Northeast
Rehabilitation Health Network at (603) 893-2900 x606.