Overhand throwing motions trigger high torque and also fuel powerful acceleration forces that can cause significant stress on the shoulder joint. Whether you are a professional athlete or just playing catch with your kids in the backyard, pain or discomfort when throwing can be linked to abnormal shoulder function.

The Motion of Throwing

The motion of throwing comprises four different phases: (1) wind up, (2) cocking, (3) acceleration, and (4) deceleration. Because the shoulder is a mobile joint, different forces, velocity and stress can be generated during each phase. However, there must be a balance between the laxity of the shoulder joint needed to achieve the first two phases and stability to execute the second two phases.

motions of throwing ball

When this balance is improper, damage to the ligaments, muscles and joints of the shoulder is common. Because the phases of throwing occur so rapidly, it may be difficult for athletes to determine which phase of this chain is broken and thus causes pain. To add to the complexity of the problem, 50-60% of the strength generated from throwing comes from the core and lower extremities. Problems in these areas can compound shoulder disorders.

Signs of a Problem

Shoulder problems may be associated with a plethora of symptoms but all symptoms should be evaluated by an orthopedic specialist. These symptoms can include aching pain that often goes down one’s upper arm, a sudden sharp pain during throwing that leads to a “dead arm” feeling, clicking or catching in the shoulder, and a loss of velocity and performance.

Treatment Options

Patients who are bothered by sudden or intermittent painful episodes after throwing a ball may recover after a conventional treatment plan based on rest, physical therapy and exercises designed specifically for overhand athletes. It is important to identify specific biomechanical problems associated with injuries in overhand throwing so therapy can be directed to correct these problems. Not all therapy is the same, and undirected care typically is no better than rest.

Patients who don’t improve from therapy may consider further diagnostic testing specific for injuries in the overhand athlete shoulder. The two most common significant injuries in overhand athletes are tears in the superior aspect of the labrum and partial tears of the rotator cuff. Both of these injuries may only be well seen with an MR arthrogram. This is a test where the shoulder joint is injected with dye prior to an MRI to better elucidate the injury. Many of these problems are not well seen with a conventional MRI. Surgical treatment may be needed depending on the MRI findings and especially in patients who have failed conservative therapy.


Dr. Charles Ruotolo is a renowned shoulder expert and the President of Total Orthopedics and Sports Medicine in Long Island.  He has published several clinical papers on shoulder injuries in overhand athletes, including “Loss of Total Arc of Motion in Collegiate Baseball Players” and “Shoulder Pain and the Overhand Athlete“.  Dr. Ruotolo and the team at Total Orthopedics and Sports Medicine are experts in treating athletes of all levels using a range of options from Physical Therapy to Arthroscopic Surgery.  If you are experiencing shoulder pain, or any muscle or joint injury, contact us today to schedule an appointment in one of our 6 locations in Long Island, Manhattan and the Bronx.