Shoulder pain when you throw usually comes from the repeated stress of the late cocking and follow-through phases, which OrthoInfo identifies as the parts of the throw that put the greatest force on the shoulder. Common results are internal impingement of the rotator cuff, labral (SLAP) tears, rotator cuff tendinitis, gradual looseness at the front of the joint and a loss of inward rotation known as GIRD. A physical therapist measures rotation, cuff strength and shoulder blade control, looks at the legs and trunk that power the throw, and then rebuilds throwing in planned steps.
Last reviewed By the Monon Therapy Collective editorial team
- Highest-stress phases
- Late cocking and follow-through
- Early warning of looseness
- Pain and lost velocity, not a feeling of slipping
- Youth pitch limits
- Pitch Smart: 95 a game at 13 to 16, 105 at 17 and 18
- First step
- Rest from throwing plus a full shoulder and kinetic chain exam
Where in the throwing motion does shoulder pain usually start?
Most throwers feel it in late cocking, the moment the arm is fully wound back, or in follow-through as the arm decelerates. OrthoInfo explains that throwing at speed demands extreme outward rotation, which gradually stretches the front of the shoulder while the back of the shoulder tightens; over seasons that imbalance raises the risk of labral and rotator cuff tears.
Where the pain sits and when it appears are useful clues, summarized below. None replace an exam, and pain in a growing athlete always deserves one, because the growth plates near the shoulder are still open.
| Likely cause | What it tends to feel like | Where to read more |
|---|---|---|
| Internal impingement | Pain at the back of the shoulder with the arm cocked; cuff tendons are pinched between the ball and socket | Shoulder impingement |
| SLAP or labral tear | Deep pain in late cocking, with catching or locking | Shoulder labral tear |
| Rotator cuff tendinitis or partial tear | Pain spreading from the front of the shoulder to the side of the arm, during throwing and sometimes at rest | Rotator cuff injury |
| Gradual instability | Pain and a drop in velocity rather than an obvious slip or dislocation | Shoulder instability |
| Biceps tendon irritation | Ache at the front of the shoulder, often alongside a labral problem | Biceps tendinitis |
What is GIRD and why does it matter to pitchers?
GIRD stands for glenohumeral internal rotation deficit: the throwing shoulder loses inward rotation compared with the other side. OrthoInfo describes it as a natural result of the soft tissues at the back of the shoulder tightening while the front loosens, and links the loss to a higher risk of labral and rotator cuff tears.
A therapist measures it with you lying on your back, the arm out to the side and the elbow bent, comparing how far each forearm rotates forward. Total arc of rotation matters as much as the internal rotation figure, because throwers normally gain outward rotation. Stretching the back of the shoulder, such as the sleeper or cross-body stretch, is common, but only once the cause of the pain is clear.
What does a therapist test in a thrower’s shoulder?
Expect three parts: the shoulder itself, the shoulder blade, and everything below it. The shoulder exam covers rotation range on both sides, cuff strength in several positions, and provocation tests that recreate the cocked position to see whether the pain is at the back (impingement) or deep inside (labrum).
OrthoInfo also highlights scapular dyskinesis, poor control of the shoulder blade, which often shows as a drooping throwing shoulder and pain at the front near the collarbone. The therapist watches the blade as you raise and lower the arm, then checks hip rotation, single-leg balance and trunk rotation, because a stride or hip that leaks power makes the arm work harder. A throwing video from practice is worth bringing.
How long before I can throw again with a sore shoulder?
It depends on the cause, but the path is the same: a break from throwing while range and strength return, then an interval throwing program that adds distance, volume and intensity in steps. Pain-free strength and range come first; the calendar does not decide.
OrthoInfo notes that most throwing shoulder injuries are first treated without surgery, with activity changes, physical therapy for posterior tightness and front-of-shoulder strength, and a look at mechanics. Exercises such as banded external rotation and the prone Y, T and W usually feature early. Before returning to games, many athletes do formal return-to-sport testing.
How do pitch counts protect young throwing arms?
Pitch counts limit how much the arm throws when tired. MLB and USA Baseball’s Pitch Smart guidelines set daily maximums by age, for example 95 pitches for ages 13 to 16 and 105 for 17 and 18, with required days of rest that rise as the count climbs.
Spring and summer seasons around Carmel often overlap with travel ball and tournaments at Grand Park in Westfield, so one player can pitch for several teams in a week. Parents should track the combined total. For families looking for help, see physical therapy for baseball and softball players; for anyone under 18, a parent or guardian completes the shoulder questionnaire and attends visits.
When a throwing shoulder needs a doctor now
Stop throwing and see a physician promptly if you have:
- A pop with sudden loss of strength, or the shoulder visibly out of place
- Numbness, coldness or a color change in the hand or fingers while throwing
- Swelling of the whole arm, which can mean a clot in the upper arm vein
- Pain at rest or at night in a young thrower, or pain that persists after a week off
- Pain on the inside of the elbow as well, which can mean an elbow ligament injury
If you think it is an emergency, call 911.
