Health Matters 8/2: Injuries throw athletes a curve ball

By Barbara Kutch, P.T.

Throwing a ball may look fairly easy to the average person, but there is more involved in the action than just the arm.

And when the mechanics of throwing start to break down because of overuse or tiredness, injuries can occur.

Princeton Rehabilitation, a unit of Penn Medicine Princeton Health, offers sports specific rehabilitation programs designed to improve flexibility, joint stability, endurance and conditioning, so patients can get back in the game.

Common throwing injuries

To throw a ball correctly requires almost your entire body, from your feet and legs to your hips and core and finally to your elbow and shoulders.

When any one of these areas is weak or tired, a breakdown can occur, which may affect the quality of your throw and may also lead to shoulder and elbow injuries.

Although throwing injuries most often occur in baseball pitchers, any athlete who participates in a sport that requires overhand motions is at risk.

Moreover, young athletes who play a single sport throughout the entire year are especially susceptible to injury.

Common throwing injuries, according to the American Academy of Orthopaedic Surgeons, include:

  • Medial apophysitis, commonly known as “Little Leaguer’s elbow.” This injury occurs when repetitive throwing creates an excessively strong pull on the tendons and ligaments of the elbow. Little Leaguer’s elbow can be serious if it becomes aggravated. Repeated pulling can tear ligaments and tendons away from the bone, pulling tiny bone fragments with them, which can disrupt normal bone growth. This can cause elbow pain, restricted range of motion and locking of the elbow joint.
  • Osteochondritis dissecans. Another source of elbow pain caused by excessive throwing is a condition called osteochondritis dissecans. This occurs when the muscles on either side of the elbow compress the joint and smash immature bones together, which can loosen or fragment the bone and cartilage in the elbow.
  • SLAP (superior labrum anterior to posterior) tears. The labrum is strong, fibrous tissue in the shoulder that helps stabilize the joint and serves as an attachment point for many of the shoulder ligaments as well as the bicep tendons. A SLAP tear occurs when the top part of the labrum – where the bicep tendon attaches – is injured extending from the front (anterior) to the back (posterior). Typical symptoms are a catching and locking sensation, and pain with certain shoulder movements.
  • Bicep tendinitis and tendon tears. Repetitive throwing can cause the bicep tendon to become irritated and inflamed, resulting in pain and weakness in the front of the shoulder. Occasionally, the damage caused by tendonitis can result in a bicep tear.
  • Rotator cuff tendinitis and tears. The rotator cuff is a group of muscles and tendons that form a covering around the head of the upper arm bone where it fits into the socket in your shoulder blade. When the muscles are overworked, they can become inflamed, resulting in tendinitis. Over time, the rotator cuff may begin to fray and ultimately tear. Early symptoms include pain that radiates from the front of the shoulder to the side of the arm. Pain can occur during throwing, other activities and at rest.
  • During a throw, the rotator cuff tendons can get pinched between the upper arm bone and the shoulder socket. This can cause a partial tearing of the rotator cuff and may also damage the labrum.

Treatment and rehabilitation

Treatment for throwing injuries ranges from conservative measures such as ice and rest to surgery for serious cases.

In addition, physical therapy can help improve range of motion in the shoulder and strengthen muscles that support the joint, and help evaluate and correct throwing mechanics.

Princeton Rehabilitation, a unit of Penn Medicine Princeton Health, provides specialized physical therapy services for adults and children with throwing and other sports related injuries.

Patients (with a prescription from their doctor) receive an initial evaluation and individualized plan of care that includes strengthening and corrective exercises specific to their unique needs.

Preventing injury

To help prevent injury, proper conditioning and strength training are critical, as is adequate recovery time after a game.

For younger athletes, the American Academy of Pediatrics offers the following tips:

  • Maintain a good fitness level during the season and the offseason. Preseason training should allow time for general and sport-specific conditioning.
  • Athletes should avoid specializing in one sport before late adolescence.
  • Athletes should take at least one day off per week from organized activity to recover physically and mentally.
  • Cross-train. Athletes should vary their endurance workouts to include multiple different activities.
  • Follow general guidelines for how many pitches a child should throw each week.

Learn more

Penn Medicine Princeton Health, through its Community Education & Outreach Program, will host a discussion titled “Throwing: More Than Just the Arm” from 7-8 p.m. on Wednesday, Aug. 7 at the Plainsboro Library, 9 Van Doren St., Plainsboro.

To register for the free session or for more information visit call 888-897-8979.

To find a physical therapist with Penn Medicine Princeton Health, call 609-853-7840 or visit

Barbara Kutch, P.T. is physical therapist and certified strength and conditioning specialist with Princeton Rehabilitation, a unit of Penn Medicine Princeton Health.