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Return to play for the throwing athlete: How much should we really limit throwing?

Baseball pitcher ready to throw ball
Jeff Peach

Jeff Peach

Jeff Peach is a CAT(C) and CSCS that is currently the Program Director for Webber Academy Wildcats Baseball. He specializes in shoulder and elbow rehabilitation in throwing and other overhead athletes. Jeff has been working as an athletic therapist for the last six years after graduating from the University of Calgary, and has been a baseball coach for the last 12 working with both youth and professional athletes.

As a baseball coach, I have encountered a few different return to play and rehab approaches with athletes who have recently worked with a health care professional. Injury severity dependent, many involve shutting down throwing completely while some off field rehab exercises are done, and then having them return to play if they feel symptom free.  While this follows the textbook progression of return to play for most injuries, in the throwing shoulder, I have often felt that we should adjust our rehab progression to include throwing in some capacity right from the start or very close to it. 

Elite throwing athletes take advantage of the physiological asymmetries that come with the throwing shoulder, such as increased external rotation. For many, a reduction in this metric can often lead to injury throughout the fascial chain as forces are distributed into other parts of the arm and shoulder complex (often this can be one of the original causes of the primary injury).

When we take away the normal stress that throwing imposes on the shoulder and it’s surrounding tissues, those tissues will adapt to the new (or rather lack thereof) stress. Therefore, when we re-introduce throwing, we are re-introducing stress into not only the injury site, but the entire fascial chain, and hoping that it responds appropriately. 

Many throwing related injuries are often intensity or volume related; a forearm flexor strain will often only be noticeable at a certain level of effort or arm slot, or an impingement/rotator cuff injury will be asymptomatic until a certain volume threshold is approached. As throwing is such a highly sequenced chain of movement, it can be challenging for athletes to re-capture proper throwing mechanics right away especially if they have not been required to call upon that particular motor pattern for a long time. 

Anecdotally, off-season throwing programs typically require athletes to have 1-2 weeks of ramp-up for every week that they take off from throwing. Some professional throwing athletes often choose not to take a break from throwing, but rather drop their volume down to a point where they can maintain their feel for their mechanics without elevating their chronic work load to unsafe levels. For these reasons and many more, I find myself having athletes get into throwing or modified throwing exercises ASAP. I feel it not only reduces chances of re-injury, but can also help drive more patient compliance and a return to previous performance level.

Do you have a forearm flexor strain?

Here is an exercise I recommend to aid in recovery:

  • Lie on your back with a small (5-10lb) dumbbell in hand while your arm is abducted and elbow flexed to 90 degrees
  • Turn your pelvis away from the raised arm (to mimic a horizontal throwing position) and begin performing finger curls and wrist flexes
  • You want a high number of repetitions for this, and try to relax the elbow so that you can feel the exercise in the flexor tendon as you contract and relax

Are you recovering from a recent or chronic injury? An Athletic Therapist can help.

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