The Most Common Throwing Injuries (And Why They Happen)

Whether you're a baseball pitcher, cricket fast bowler, javelin thrower, softball player, or compete in another overhead throwing sport, throwing places significant demands on the shoulder and elbow.

In fact, the shoulder can rotate at over 7,000 degrees per second during elite throwing, while the elbow experiences substantial valgus forces with every throw. Over time, these repetitive loads can contribute to pain or injury if the body's capacity doesn't match the demands being placed upon it.

At SportsFit Health and Rehab Five Dock, we regularly assess and treat throwing athletes of all ages. Understanding the most common throwing injuries is the first step towards preventing them and returning safely to sport.

Rotator Cuff-Related Shoulder Pain

The rotator cuff is a group of four muscles that help stabilise the shoulder while allowing it to move at extremely high speeds.

Contrary to popular belief, the rotator cuff doesn't simply become "weak." In many athletes, shoulder pain develops because the demands of training, throwing volume or competition exceed the capacity of the tissues.

Symptoms often include:

• Pain during or after throwing

• Reduced throwing velocity

• Shoulder fatigue

• Pain when sleeping on the affected side

Management typically involves identifying why the shoulder became overloaded and progressively rebuilding strength, endurance and throwing tolerance rather than simply resting indefinitely.

Ulnar Collateral Ligament (UCL) Overuse Injuries

The ulnar collateral ligament (UCL) is one of the primary stabilising ligaments on the inside of the elbow. During throwing, it experiences exceptionally high forces, particularly during the late cocking and acceleration phases.

While complete UCL ruptures are well known in professional baseball, many athletes experience gradual irritation or partial injury due to repetitive overload rather than a single traumatic event.

Common symptoms include:

• Pain on the inside of the elbow during throwing

• Reduced throwing speed

• Loss of accuracy

• A feeling of instability during harder throws

Early assessment is important, as many overuse injuries respond well to appropriately managed rehabilitation before they become more significant.

Medial and Lateral Elbow Tendinopathy ("Golfer's" and "Tennis" Elbow)

Although commonly associated with racquet sports, both medial and lateral elbow tendinopathy can occur in throwing athletes.

The repetitive gripping, wrist stabilisation and force transfer required during throwing can overload the tendons around the elbow, particularly when throwing volume increases rapidly.

Athletes often notice:

• Pain when gripping

• Tenderness around the elbow

• Discomfort during throwing or strength training

• Symptoms that gradually worsen over time

Successful management usually involves progressive loading rather than complete rest, while also addressing the factors that contributed to the overload.

Biceps Tendinopathy

The long head of the biceps tendon plays an important role in helping stabilise the shoulder during overhead movement and assists in slowing the arm during the follow-through phase of throwing.

Repeated high-speed throwing can irritate this tendon, particularly if the shoulder is managing excessive load elsewhere.

Symptoms may include:

• Pain at the front of the shoulder

• Discomfort during the late cocking or follow-through phase

• Tenderness over the biceps tendon

• Pain when lifting or carrying objects

Because several shoulder structures can produce similar symptoms, an accurate assessment is important before beginning treatment.

SLAP Tears

A SLAP (Superior Labrum Anterior to Posterior) tear involves the cartilage around the top of the shoulder socket.

Throwing athletes can develop labral injuries due to the repetitive traction and rotational forces experienced during overhead throwing.

However, it's important to know that MRI findings don't always explain shoulder pain. Many pain-free throwing athletes have labral changes that never cause symptoms.

Potential symptoms include:

• Deep shoulder pain

• Clicking or catching sensations

• Pain during the cocking phase of throwing

• Reduced throwing performance

Treatment depends on the athlete's symptoms, goals and examination findings—not simply the MRI result.

Shoulder Instability

Some athletes experience excessive movement of the shoulder joint, either because of previous injury, naturally increased joint laxity or repetitive throwing.

When the muscles surrounding the shoulder cannot adequately control this movement, instability-related pain may develop.

Symptoms may include:

• A feeling that the shoulder is "slipping"

• Pain during high-speed throwing

• Reduced confidence when throwing

• Recurrent episodes of shoulder discomfort

Rehabilitation usually focuses on improving dynamic stability, strength and sport-specific control.

Not Every Throwing Injury Is Caused by the Shoulder

Although pain is often felt in the shoulder or elbow, the contributing factors may exist elsewhere.

Limited hip mobility, reduced trunk rotation, lower limb weakness, poor force transfer and rapid increases in throwing volume can all increase stress on the arm.

Training load is one of the biggest contributors to throwing injuries. Sudden spikes in throwing volume, intensity or frequency can overwhelm the body's ability to adapt, even in well-conditioned athletes. Monitoring workload and increasing throwing demands progressively is an important part of both injury prevention and rehabilitation.

This is why assessing the entire kinetic chain—and not just the painful area—is essential.

Technical Coaching and Throwing Progressions Matter

Recovering from a throwing injury isn't just about getting stronger—it also involves gradually exposing the arm to the specific demands of throwing again.

For many athletes, working with an experienced throwing coach can be invaluable. Technical coaching may help improve throwing mechanics, optimise force transfer through the body, and identify movement patterns that may be contributing to excessive stress on the shoulder or elbow. While every athlete throws differently, efficient technique can often improve both performance and resilience.

Equally important is following a structured return-to-throwing program. Rather than returning straight to full-intensity throwing, rehabilitation should gradually rebuild throwing volume, intensity and distance in a controlled manner. This progressive approach allows the shoulder and elbow to adapt to increasing loads while monitoring symptoms along the way.

A well-designed throwing progression isn't just for athletes returning from major injury—it can also help those recovering from smaller overuse problems or periods away from sport.

Early Assessment Can Keep You Throwing

Many throwing injuries begin gradually. Athletes often notice fatigue, reduced velocity or mild discomfort before pain becomes significant.

Seeking advice early may allow small issues to be addressed before they develop into longer-term problems.

At SportsFit Health and Rehab Five Dock, we assess throwing athletes using an evidence-informed approach that considers shoulder function, elbow health, throwing mechanics, workload and the entire kinetic chain. Where appropriate, we work alongside coaches to help athletes return to throwing safely and efficiently through an individualised rehabilitation and graded return-to-throwing program.

Whether you're recovering from injury, managing increasing throwing loads or aiming to perform at your best, our physiotherapists can help you build the strength, confidence and throwing capacity needed to get back on the field.