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Throwing Injuries 1

I often get young athletes in the clinic with shoulder pain from throwing. Pain in this population can be from a number of different factors but is very often due to overuse. Kids as young as eight or nine years old start training in the winter and play ball through the end of July. Throwing for so much of the year is too much for these athletes and leads to overuse injuries in the shoulders and elbows. 

Coaches and parents need to be aware of this risk of injury, and should carefully monitor their players. Employing pitch counts for pitchers and instructing players in good pitching mechanics are good ways to keep players safe. Being able to notice the signs of fatigue can prevent further overuse, and prevent a loss in playing time due to an arm injury. 

A tired pitcher:

  • Does not finish his throw. This means he is staying upright at release. A full follow through is very important to slow the arm and the body down. When a player gets fatigued he may be unable to consistently finish his pitches, placing him at risk for injury.
  • Has a drop in velocity.  When used during a game, radar guns can allow coaches to quantitatively determine a pitcher’s fatigue. Even without a radar gun, a coach should be looking at pitch velocity with the naked eye to assist in the assessment of pitcher fatigue.

Caution: Radar guns can lead to kids overthrowing in an effort to compete with friends or reach a certain MPH, so use sparingly

  • Struggles to throw strikes.  Fatigue impacts a pitcher’s ability to throw using proper mechanics. This can lead to trouble consistently finding the strike zone. (If they struggle to find the strike zone, to begin with, you may not be able to use this sign reliably).
  • Tells you he is tired. Coaches, you need to listen to your players.  He may still be pitching well and can help you win, but if he tells you he is tired, he needs to be done. Winning a game is not worth the injury that can be caused.


Common throwing injuries include rotator cuff tendinopathy/strain, labral tears, instability, and ulnar collateral ligament tears. Recovery time can vary depending on the type of injury and can have a player shut down anywhere from 4 weeks to a year or more. Many of these injuries can be treated by a physical therapist by a variety of treatments. 

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