Preventing Microtrauma with MicroChanges: in Overhead Throwing Athletes

by Stephen G. Linton, PT, DPT

Throwing a baseball is one of the most traumatic forces that is self-inflicted on the body in all of sports. With the upcoming baseball season looming so closely, there are many athletes getting ready to show how good they’ve become in the offseason. “Practice, Practice, Practice Makes Perfect” is the idea that most have in mind when trying to improve. But this overtraining can come at a price.


Baseball players, all over the world, suffer from overhead throwing injuries, such as rotator cuff tears, tendonitis, impingement, and labral tears. These are caused by the high velocity forces that are being exerted on the shoulder girdle, in which static and dynamic stabilizers are not well prepared for. Injuries to the shoulder do not have to be from one traumatic event, but more often originate from repetitive movement that causes a failure in the structure. Coaches, very often, pay close attention to the technique of throwing, without the strength training in order to combat these forces and sustain the athlete’s ability long term. In order to have proper movement syngery within the shoulder and upper extremity when throwing, strength and control of the throwing motion in the acceleration and deceleration phases need to be optimized. These days, it is very common for baseball players to play all year round, leading to an overwhelming number of overuse injuries.


The internal rotators of the shoulder (Teres Major, Subscapularis, Deltoid,Pectoralis and Latissmus dorsi) are used to help generate the forward progression of the arm and slowing down the initial backward cocking back movement during the throwing motion. The external rotators of the shoulder (Teres Minor and Infraspinatus) are used to bring the arm back during the initial phase of the throw, but then are also vital in decelerating the shoulder as the forward motion is progressing. If these muscles are not synergistic in function and control, there can be tears and/or irritation of the muscle and/or tendons in any phase of the throw, with torque occurring at the most externally rotated position coming into internal rotation.

Therapist’s Role

The physical therapist’s role in overhead throwing injuries is in education before the activity begins, prevention when improper mechanics are determined, and treatment as soon as the injury occurs, if it were to occur. The first priority of a therapist is to make sure that the shoulder has the full range of motion needed for the proper throwing mechanics, which is more than the average person. Secondary goals will involve decreasing the irritation that is causing the pain, through the use of modalities and rest. The next goal will be to regain strength in the new pain-free range that has been obtained. And lastly, monitor the progress of the patient’s deficits in order to regain proper mechanics and throwing form, stopping this injury from reoccurring and progressing in their return to sport. It is important to know, and educate our athletes, on the proper neuromuscular technique for throwing, improve the proper mechanics when practicing, and rest when needed/scheduled.

We are not only treating the shoulder, but we are treating the core and lower extremity, which helps to support the continued proper throwing motion. By training these other important bodily entities, we can decrease the pressure and forces required for the throw to occur efficiently, and lower the specific demands on the shoulder and upper extremity.

Do I Need Surgery?

Physical therapy is the first and most effective treatment in overuse injuries and return to sport post treatment. If therapy has been attempted, then surgery may be an option due to the severity of the issue, determined in conjunction with your orthopedic surgeon.

Quick Tips on How to Prevent Injury

Where Can I Go For Help?

The Physical Therapy and Wellness Institute
5 locations – Lansdale, Montgomeryville, Quakertown, East Norriton, Glenside
Call to schedule your evaluation today! (215) 895-9871