3 Common Causes (other than overuse) of Arm Pain in Baseball and Softball Players By Greg Crossman, DPT

This time of year, we see many baseball and softball players coming into the clinic with arm pain.  Overuse is the most common reason cited by research and doctors for arm pain in overhead athletes. There are some great resources out there with information on how to avoid overuse injuries including recommendations offered by PitchSmart and the American Orthopedic Society for Sports Medicine.  Today, however, I’d like to discuss three additional causes of injury in overhead athletes, not directly related to overuse.  

Loss of range of motion and strength.  Research shows us that overhead athletes lose motion in the shoulder and elbow as well as rotator cuff strength in the shoulder after throwing.  Wilk, Reinold, et al. in The American Journal of Sports Medicine in 2008 showed deficits in both shoulder rotation and elbow motion directly following and 24 hours after throwing.  This deficit likely gets even worse as the season progresses.  Lack of shoulder and elbow motion has been shown, in several studies, to contribute to both shoulder and elbow injury.  Gagnon et al in the Journal of Strength and Conditioning Research in 2023 showed decreased rotator cuff strength as the season progressed in college baseball players, and Laudner et al in Clinical Journal of Sport Medicine in 2013 showed loss of strength around the shoulder blade in both pitchers and position players.  Strength deficits around the shoulder are a major risk factor for both shoulder and elbow injury.  

Throwing mechanics.  Though “proper throwing mechanics” are much debated among coaches, research has shown a direct relationship between throwing mechanics and injury.  The American Sports Medicine Institute has done extensive research in this area and found that lack of hip/shoulder separation, hand position at front foot strike, and front knee position at ball release, all relate to injury.  Identifying these key areas in the throwing motion and correcting deficits can help reduce the likelihood for injury and improve performance.  

Recovery.  Fatigue has been shown to be the single greatest predictor of injury in youth pitchers.  Fleisig et al in The American Journal of Sports Medicine in 2006 showed a 36X increased risk for injury in adolescent baseball pitchers who pitched regularly while fatigued.  A focus on proper recovery can help reduce fatigue and the likelihood for injury.  Getting proper sleep, nutrition, and hydration is the first step in proper recovery.  There are additional tools that can be used to aid in recovery, including compression, cryotherapy and electric stimulation.  Several published studies including those in Journal of Athletic Training and Journal of Strength and Conditioning Research have shown that using these modalities regularly can reduce pain, improve range of motion, and decrease fatigue.

In short, to prevent injury and improve performance, overhead athletes can focus on three areas:  maintaining range of motion and strength, proper mechanics, and reducing fatigue.  At Complete Game, we offer an Arm Care Program for overhead athletes.  Each athlete undergoes one-on-one clinical assessment as well as 3D motion analysis using our markerless 3D motion capture system.  Using that data, we provide each athlete with an individualized arm care program that they can perform as part of their pre-game and pre-practice warm up.  One-on-one follow up sessions with our injury prevention specialists ensure that each athlete has proper form with all exercises, and can progress exercises when appropriate. 

For more information about our Arm Care Program call us at 978-710-7204 or email Sara at scarpenito@completegamept.com.