Treating Shoulder Pain When Throwing in Sports

The motion of throwing a ball is complex and requires a healthy functioning shoulder in which muscles, tendons, ligaments, and bone all move in a synchronized and stable pattern. Because of this complexity, subtle abnormalities can lead to shoulder pain and discomfort. 

The Motion of Throwing

The throwing motion is characterized by four distinct phases:

1. Wind-up
2. Cocking
3. Acceleration
4. Follow-through

For effective throwing mechanics, the rotator cuff and other shoulder muscles must sequentially guide these movements. The labrum must stabilize the ball in the socket of the shoulder. The shoulder blade rotation must coordinate with the arm to ensure mobility. 

Abnormalities in any of these functions can lead to pain and even damage inside the shoulder. The pain may come from the:

• Shoulder blade
• Shoulder joint (cartilage and labrum)
• Rotator cuff muscles and tendons
• Nerves that control the function of the muscles

Once the source of the discomfort is identified, treatment can be targeted at the appropriate site of the problem.

The shoulder blade is attached to the chest wall with ligaments, muscles, and tendons. The various muscles and tendons that control movement of the shoulder blade can all impact movements, including throwing.

For this reason, physical therapist often focus on scapular mobility when addressing shoulder joint problems

Symptoms

The throwing motion causes very high torque and acceleration forces that act on the shoulder joint and the muscles, ligaments, and tendons that surround the joint. 

Whether you're a professional baseball pitcher or playing catch with your child in the yard, shoulder-function abnormalities can cause significant pain. Some symptoms of a shoulder problem include:

• Aching pain: Often deep in the shoulder or extending down the upper arm
• "Dead Arm": Lack of strength in the throwing motion
• Night Pain: Pain isn't too bad when throwing but can awaken you from sleep

Diagnosis

When you go to your healthcare provider about shoulder pain when throwing, they'll need to understand exactly where the abnormality is in the throwing motion. It's helpful to find a healthcare provider familiar with throwing mechanics.

Tests to diagnose shoulder pain can be helpful, but only when placed into the context of the symptoms you're experiencing. Often, in young athletes and weekend warriors, abnormalities may be seen on an MRI, but these may or may not be the source of shoulder pain. 

That's where a skilled examiner familiar with shoulder injuries can help to determine if there is a structural abnormality that needs to be addressed.

Treatment

Most people who experience the spontaneous onset of pain with throwing can improve with non-surgical treatments. The earliest phase of treatment is resting the joint and reducing inflammation. Treatments may include:

• Ice
• Anti-inflammatory medications
• Cortisone injection

Once the acute symptoms of inflammation have subsided, a therapist can guide you back to full mobility and strength of the shoulder. 

The most common abnormality is tightness of the posterior shoulder capsule, causing a loss of normal internal rotation of the shoulder (patients may notice when they reach behind their back, they can't reach up as high on the side with the painful shoulder). 

Stretching to improve internal rotation or any other lost motion can help allow a more normal throwing motion.

Strength exercises are often aimed at the rotator cuff, as these muscles are critical to initiating proper shoulder movements and stabilizing the shoulder joint. 

In addition, the periscapular muscles (muscles that attach to the scapula bone) are important to ensure that the scapular movements are coordinated with the throwing motion.

Most cases of shoulder pain when throwing will improve with these steps. 

One of the most common scenarios is a middle-age person who doesn't regularly throw and develops pain after an unusual amount of throwing either for recreational sports or in coaching for a children's program.

These people usually have very poor shoulder mechanics and trying to just pick things up where they left off years before is ineffective. Performing a structured shoulder stretching and strengthening program almost always alleviates the pain in these cases.

A Word From Verywell

The throwing motion is a complex shoulder movement that requires normal mechanics of interconnected muscles, tendons, ligaments, bones, and joints.

Abnormalities of any part of this complex linkage can lead to shoulder dysfunction and ultimately to pain when throwing. 

When the mechanics of the throwing motion are altered, inflammation is often the result, and discomfort is a frequent symptom.

The good news is that noninvasive treatments to improve the mechanics of the shoulder joint are often effective at relieving symptoms of shoulder pain when throwing.