Pitching Pain

Pitching Pain

Numerous parts of the shoulder are utilized and strained while throwing: the rotator cuff, the glenoid, the ligaments, the labrum, and the biceps. The biomechanics of pitching or throwing has roughly 6 stages, all of which impact the arm in a different way, and may result in pain or injury following overuse.



Injury Potential

Wind up

Wind up
  • Storage of energy
  • Center of gravity is over the back of the leg
  • Rotation of the upper trunk
  • Begins with the movement of the back leg and completes with the elevation of the lead leg and separation of glove and ball

Rarely a cause of injury

Early Cocking

Early Cocking
  • Begins with the lead leg at max height, ends with the lead foot contacting back with theground
  • Torso and pelvis rotate in opposite directions
  • Transfer of the energy of the lower body into the upper extremity

Shoulder stiffness can result in over and under trunk rotation, creating back or hip pain

Late Cocking

Late Cocking
  • Begins with the lead foot contacting back with the ground and ends with the point of maximal external rotation
  • Maximum valgus torque generated: 64 Nm
  • Equivalent to 40lb of weight in the hand

Pain during this stage of throwing is frequently related to problems with the ulnar collateral ligament (UCL) or an anterior labral tear

Acceleration Phase

Acceleration Phase
  • Between maximum external rotation and ball release
  • Rotation from 175 degrees of external rotation to 100 degrees of internal rotation in 42-58 milliseconds
  • Rotational velocity of 7000-9000 degrees per second

UCL pain typically present during this phase

Pain may also result from early arthritis in the back of the elbow

Deceleration Phase

Deceleration Phase
  • Between ball release and maximum humeral internal rotation and elbow extension
  • Most violent phase of throwing cycle
  • Maximum joint loading
  • Posterior shoulder muscle and biceps/brachialis activity is decelerating the shoulder and elbow

SLAP tears and posterior labral tears are problematic during this phase


  • Body continues to move forward
  • Ends with the player in the fielding position

Unlikely culprit of injury

  • American Academy of Orthopaedic Surgeons Website
  • Arthroscopy Association of North America Website
  • muschealth Website
  • American Shoulder & Elbow Surgeons Website
  • Charleston RiverDogs Website