Shoulder Pain When Throwing a Baseball
Shoulder pain is, without a doubt, the most common injury that I’ve seen in baseball players (and softball players alike). Players sometimes experience pain during throwing, while others notice pain or discomfort afterwards. Either way, experiencing shoulder pain when throwing a baseball is common, but not normal. There are many things you can do for shoulder pain, including strengthening, mobility work, coordination training, etc. You may be experiencing pain because of improper mechanics, overuse, improper loading, or shoulder impingement, but each reason is able to be addressed. You do not need to just deal with the pain.
Now, we’re going to discuss some of the reasons why you might be experiencing shoulder pain when throwing a baseball. And then sharing what you can do, or who you can see, to fix it. This isn’t an exhaustive list, but worth mentioning some of the most common reasons I see baseball athletes struggling with shoulder pain during the season.
Potential contributing factors to shoulder pain when throwing:
Improper mechanics
Overuse or overtraining
Improper loading or preparation for the activity
Impingement or structural damage
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Quick Overview of the Shoulder Joint and Rotator Cuff
Throwing is one of those motions that can be "natural" (think softball pitching, as it is underhand, which is similiar to the way we swing our arm when we walk) and it can also go "against" typical motion: overhand throwing.
Throwing motions, while necessary for baseball (and softball), are not natural, which is why we need to ensure that we take care of our bodies if we are doing them regularly so we can prevent injury.
The shoulder joint is composed of 4 rotator cuff muscles and rotator cuff tendons that help your upper arm bone maintain a perfect relationship to what is commonly known as the "socket". In medical terms, it keeps your humeral head inside the shoulder socket, or joint, which is a part of your shoulder blade.
Other areas that may be involved when we talk "shoulder pain" or shoulder injuries are the biceps tendon and superior labrum and common injuries in throwing sports are rotator cuff tears, glenohumeral internal rotation deficit (GIRD), slap tears, and more. Common symptoms are pain, tenderness, generalized ache, excessive soreness, sharp pain, pain with reaching overhead, into the backseat of a car, while lifting, etc.
But just because you have shoulder pain does not mean that you have a true "injury" (one that is mentioned above). I see lots of shoulder pain resolve with anti-inflammatories and specific exercises and treatment options I offer in my clinic.
Improper Throwing Mechanics and Shoulder Pain
Throwing mechanics is usually the first thing I like to address with my baseball athletes.
The best way to assess this is with a video analysis of throwing mechanics.
Get a video of you throwing with a teammate, either at practice or in a game, so that we can review form and identify any potential areas of concern.
I also recommend checking in with your coach, having them evaluate and correct your throwing mechanics in various situations - short distance, long toss, etc. If your coach doesn’t feel comfortable with this assessment, schedule a lesson or evaluation with a throwing coach in your area to get more personalized feedback.
Overuse or Overtraining and Shoulder Pain
Overuse and overtraining are probably the most common reasons that I see baseball players experiencing shoulder pain when throwing.
It usually happens over time with repetition or after a big tournament weekend when the demand for throwing exceeds what the body is trained for or prepared to do.
This can happen in a variety of situations:
Skipping the warm-up or throwing progression to get to “more important stuff”
Lack of gradual ramping of throwing at the start of the season (ex. Jumping back into it)
Lack of in-season strength training
Minimal or nonexistent recovery practices
Honestly, I see these changes happen a lot - perhaps when running late for practice, not feeling like they have enough time to do recovery activities, and not preparing in the off-season.
I get it, we’re all busy and there are a million things on the to-do list every day.
However, it’s important to take care of your body, especially when it comes to performance.
Athletes weren’t made to just dive into baseball season head first, going from throwing maybe once per week to five or six days per week with tournament games on the weekends. That’s when you start to develop overuse injuries and pain, most noticeable when throwing.
An in-season strength training and mobility program is a great way to help take care of your throwing shoulder and reduce risk of injury as well (keep reading for my option).
Inadequate Loading or Preparation for Throwing
Kind of bouncing off the last point of discussion here, since a lack of preparation usually leads to an overuse injury, but it’s worth mentioning and expanding on the topic a bit more.
Preparing for your season (or even your next game) requires more than just packing your bat bag and washing your uniform. With the way baseball seasons are structured, you’re playing in more games than ever before, and the season is spread out over a period of months. Sometimes, school ball and competitive sports are going on at the same time, increasing the demand for your body to keep up.
Strength training and mobility work consistently throughout the year is key to reducing injury risk.
And I should say, having a specific and structured program that is built just for you is crucial.
This includes pre-season lifting and mobility, off-season work, and in-season training to ensure that you’re promoting muscle balance and optimal function. You can certainly go wrong here and overtrain, so having a plan that is guided and monitored by a fitness professional who is experienced in working with baseball players is important.
As I mentioned earlier, it’s important to warm-up before every practice and game. Yep, the boring stuff, the throwing progression starting at the knees, and not rushing through the process just to move on to batting warm-ups.
It’s also important to note that a gradual progression into throwing is helpful, starting a couple months out from your first practice. This is a good way to ease back into it, especially for athletes who play multiple sports and may be coming off the tail end of basketball season when baseball season starts in the spring.
Shoulder Impingement or Structural Damage and Pain With Throwing
In most baseball athletes, addressing one of the aforementioned topics helps significantly to resolve shoulder pain when throwing, but it’s important that you also know when you need to seek additional consultation or imaging.
Seeing a physical therapist is a great place to start, especially if your state allows direct access (like we do in Washington). A physical therapist who is well-versed in treating throwing athletes is your best bet.
Typical reasons you might go to the specialist:
Sharp, stabbing, or burning pain in the shoulder or arm
Numbness and tingling in the arm
Severe or sudden weakness or inability to move the shoulder (decreased range of motion that is severe and noticable)
Hearing a pop or clunk in the shoulder followed by pain
After a specific mechanism of injury or known impact resulting in pain
And if you feel more comfortable starting with the orthopedic doctor/specialist, do it. Trust your gut when something doesn’t feel normal or “right” in your shoulder.
Here’s my policy - if in doubt, get it checked out. Always.
You’ll never regret scheduling an appointment with the orthopedic specialist and getting some imaging. Even if there isn’t anything wrong, it at least gives you peace of mind that something isn’t severely damaged within the shoulder.
You can ask for a physical therapy referral (if you need one) regardless of findings.
Impingement happens when a structure in the shoulder, like a muscle, tendon, or bursa, is getting pinched and compressed with movement, resulting in pain. Usually there is some resulting inflammation in the area and sometimes there will even be partial muscle tears present. However, this is something that we commonly treat in physical therapy with good success!
There can be other structures that are damaged including the bursae (fluid filled sac to assist with cushioning and movement) and also the labrum (which provides additional stability to the joint). Each has different signs and symptoms associated with it. But it all boils down to the same thing - get it checked out if you suspect you might have damaged the shoulder.
What Should I Do If I Have Pain While Throwing a Baseball (or Softball)?
After reading this article, you probably already know what I’m going to say.
If you’re experiencing shoulder pain while throwing a baseball, get it checked out - especially if it’s been over a week with symptoms. Rarely do I see these issues get better with rest and ice alone.
Schedule an appointment with your local sports physical therapist, get an evaluation of the shoulder, and figure out exactly where you need to start in the recovery process. If you feel more comfortable starting with an orthopedic surgeon/specialist, then start there.
It’s important that you don’t just ignore the pain and pray for it to go away. That typically results in longer recovery times, more severe injury to the shoulder, and more time spent on the sidelines due to pain and injury.
Where to Find a Sports Physical Therapist in Kennewick
If you’re local to the Tri-Cities area, my clinic is in Kennewick and I’d be happy to work with you. I specialize in working with baseball players and athletes alike with both injury rehab and recovery care including manual therapy, dry needling, scraping, cupping, and more.
If you’re local to the Kennewick, WA area and want to start with a personalized assessment, call me!
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