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Welcome back, gang! You’re hooked, aren’t you? Learning how to prevent the most common baseball injuries is a never-ending quest. Since arm injuries in baseball don’t rest, neither do we so let’s jump back in.

Over the last two weeks, here’s what we’ve learned to stay healthy as a baseball player:

  1. Get at least 8 hours of sleep

  2. Eat 1.5-2 grams of protein per kilogram of body weight

  3. Drink about 1 cup of water for every 20 minutes of exercise

  4. Find good mental headspace and talk to a professional if you need to

  5. Structure your work week in a way that alternates between low/medium/high intensity

  6. Create a predictable roller coaster-like routine with throwing and swinging


So where does arm care come in? If you remember the pyramid from part 1, congratulations! It’s time to talk about that. 

If Athlete Pyramid of Needs

If you or somebody you know would like a FREE 15 minute phone call to begin an arm care routine, call us today!

The Secret Sauce

Here’s the secret sauce to prevent shoulder pain as a pitcher: there is no secret sauce. An individualized and complete evaluation specific to a baseball player is the goal. 

If you’re going somewhere else other than PRO Athlete for rehab as a baseball player, here are 3 questions to ask your PT or AT to ensure you’re getting the most out of your time:

  1. Will we be looking at shoulder strength today? If so, which ranges?

  2. Will we be looking at shoulder range of motion today? If so, what is your opinion on “GIRD”?

  3. Will we be assessing the rest of my body like my mid back and lower body for issues that could increase my risk of injury? 

Let’s walk through what part of an evaluation at PRO Athlete Physical Therapy looks like with an example. Keep in mind every rehab professional has a different process and there’s not one right or wrong way to do, well, anything. But there is a way that addresses risk factors to reduce the risk of common baseball injuries.

Objective Measures and a Routine is Key



Let’s say that there’s a baseball pitcher named Pete returning for his 2nd visit on a maintenance plan at PRO Athlete. Here are the bare essentials we already know from his previous visit:

  • It is Week 3 of the baseball season

  • Pete’s last outing was four days ago (4 live-game innings) and his next outing is two days from now

  • Pete had medium to high intensity throwing day yesterday along with a heavy lift

  • Pete has no injury or surgery history but says by mid-season he just feels “wound up and tight”

  • Pete has gotten heavy interest from the MLB as a free agent so longevity is his goal

For new pitchers looking to prevent arm injuries, we measure/assess all of the following:

  • Shoulders/Shoulder blades
  • Low back
  • Hips
  • Ankles
  • Trunk
  • Neck
  • Elbows
  • Wrists

For the purposes of this example though, the key areas of focus for Pete due to his history are:

  1. Feeling overall recovered and ready for his next outing 

  2. Total shoulder range of motion on his throwing side

  3. Upper/mid back joint and muscle tightness


The physical exam will include a quick visual scan to see if Pete has any new abnormalities or asymmetries (another spoiler: there probably will be).


What’s normal vs. abnormal range of motion? There are general rules of thumb but the reality is together we’ll find what feels and should be normal for Pete. 

A Quick note on Shoulder “GIRD”

A specific worry for many athletes and coaches is shoulder “GIRD or Glenohumeral Internal Rotation Deficit. There are common myths about GIRD that could be an entire blog series by itself. So in the name of brevity, just know that losing shoulder internal rotation motion after throwing is normal, does not automatically mean you’ll injure your arm and is certainly not a death sentence. For more on “GIRD” myths, shoot me an email at I’ll send some resources to you.

After objectively assessing Pete’s shoulder total arc range of motion of both shoulders (below) with specialized tools and the rest of his body’s mobility, we’ll jump into strength testing. 


 Shoulder Total Arc Range of Motion



What do we measure? 

We use a tool called a dynamometer to see how many pounds of force Pete’s body can utilize and go from there. We’ll start by testing his shoulder internal rotation and external rotation of both arms.

We’ll also measure Pete’s grip strength on both sides now using a handheld dynamometer.


Here’s what we found with Pete:

  • A big decrease in total shoulder range of motion compared to his opposite side and a big loss of internal rotation specifically compared to his last visit

  • A loss of mid back mobility on his left side

  • A big “knot’ and soreness to the back of his shoulder muscles and upper back joints

  • A decrease in grip strength on both sides

Now What?

So, what to do with Pete? One outing and let’s be honest, he’s toast! 

We’ll start by checking in on how he’s sleeping.

You can guess how this is gonna go - since he last pitched he’s been up every night playing Roblox until 1:00AM. Then he gets up at 7:00AM for school, work and training. Otherwise he’s been eating enough protein and “sort of hydrating” but another issue is he hasn’t made time to do his maintenance exercises.

This is not the way to prevent arm injuries as a pitcher.

These are probably the main drivers of why Pete is having a hard time recovering and probably why his grip strength is down. So we remind him how important the basics are and he agrees.

Mobility Work

Next, Pete has had success in the past with the use of dry needling. So to reduce the muscle tightness in the back of his shoulder, that’s where we go:

Shoulder Dry Needling


But we can’t just end on needles - we need to work that new motion. So we load it with this:

Shoulder ER Strength

Shoulder ER Strength


That pesky internal rotation was still limited, though. So now what? We hit ‘em with a few rounds of these:


To address the rest of his mid back joint restriction, we work on Pete's spine with some manual therapy and he learns this drill for upper back stiffness:


Next, he begins diaphragmatic breathing + a thread the needle exercise and after the session, he ends with 15 minutes of medium intensity Airdyne biking.

The Result

Pete’s session is a a grand slam.

After the session Pete reports still feeling tired from not sleeping enough but his grip strength on both sides improved slightly. He also saw a big change in his mid back mobility and his total shoulder arc range of motion is almost back to baseline.

Not every case is this simple but after spending hundreds of hours with elite baseball players, I can nearly guarantee that following the basics can get you these results. 

I hope this series and final example helped tie it all together for you so you can prevent the most common injuries in baseball. If you’re interested in working with us at PRO Athlete, give us a call today!

We'll talk soon.

Edwin Porras
Post by Edwin Porras
Mar 14, 2024 4:10:32 PM