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Preventing Arm Injuries as a Pitcher

If you’re reading this, you probably already know the stats. So the obvious question among pitchers is this: how can pitchers prevent arm injuries in the first place?

You might be thinking it’s:

  • An arm care routine
  • Strength training
  • Shoulder flexibility
  • Good throwing mechanics
  • Cold plunge/ice packs
  • Pitch counts
  • Dry needling
  • Blood Flow Restriction Training (BFR)

Even though we do plenty of that with pitchers at PRO Athlete Physical Therapy in Denver, none of those are the answer in isolation. After spending years as a physical therapist with the Minnesota Twins, my answer is clear: start with the basics.

I’ve seen it time after time - athletes who focused on the basics performed the best and stayed the healthiest. Does that mean focusing on the fundamentals prevents injuries 100% of the time? Of course not. However, it's the best place to start.

Pro Pitcher After Arm Injury Rehab

Preventing Arm Injuries: The Basics

So what are the basics?

  1. Sleep/Nutrition/Hydration
  2. Mental Health/Communication
  3. Workloads/Training
  4. Arm Care/Maintenance
  5. Coaching/Performance

In this 3 part series, we’ll take a deep dive in this order:

  • Part 1: Sleep/Nutrition/Hydration and Mental Health/Communication

  • Part 2: Workload management for throwing/swinging/training 

  • Part 3: Arm care and maintenance (slightly touching on coaching and mechanics)

Here’s the truth: unless you’re a top prospect or big league pitcher already (spoiler, if you’re reading this, you probably ain’t that guy yet, pal) these are the principles you should adhere to to prevent arm injuries. Don’t reinvent the wheel. This isn’t Instagram.

Pitcher Needs

There’s a concept in psychology called Maslow’s Hierarchy of Needs which lays out all of the basic needs humans require to survive and thrive. After years of rehabbing and maintaining pitchers’ injuries and healthy arms, I’ve adapted the hierarchy of needs and apply it with athletes here at PRO Athlete PT:Blue and White Funnel Chart Presentation

Other healthcare providers can (and likely will) pick knits at this “model” but you’ll have a hard time convincing me that following scientific principles doesn’t help prevent pitchers from sustaining arm injuries.

You’re probably wondering when I’ll get into fancy exercises and cutting edge maintenance programs. That will come. But I can't emphasize enough how often I see pro athletes who need a crash course on this stuff first. Let’s dive in.

Sleep, Nutrition, and Hydration

These needs are the building blocks to preventing injuries in pitchers (and every athlete, really).


Disclaimer: Nutrition is a topic that can depend on many factors. If you’re reading this, please check with your doctor before applying these principles.

When it comes to nutrition and hydration, the principles are straight forward. While training, a general recommendation for athletes is to eat between 1.5 and 2 grams of protein per kilogram of body weight. Carbohydrates and fats in things like whole grains/vegetables and nuts/avocados are important as well. However protein is paramount to development and growth. 

Here’s an example for a 19 year old pitcher who weighs 160 lbs and training regularly:

→ 160lbs/2.2 = 73 kilograms

→ 73x1.5 = 110 grams of protein per day


As far as hydration goes, the general rule of thumb for water is to drink at least 1 cup for every 20 minutes of exercise. Also make sure to eat plenty of fruits and vegetables and a well balanced diet to maintain electrolyte balance. Generally speaking, drinks like gatorade and electrolyte supplements can be reserved for extreme heat training and/or training sessions longer than 90 minutes. 

For more absolutely killer (and FREE) nutrition advice, I recommend Wendi Irlbeck who is a Registered Dietician and certified sports nutritionist. Below is an example of her advice.

Wendi Irlbeck Advice


Here are the scientific facts:

  • 7-9 hours of sleep is recommended for adults 18-25

  • Sleeping fewer than 7 hours per night increases an athlete’s injury risk by 1.7x

  • The average amount of sleep elite athletes get is 6.7 hours

  • Sleep influences mental processing/appetite/mood/reaction time and so much more

Here’s what to do. Track your sleep for a period of a week and change nothing else about your training or habits. Journal it. At the end of the week rate how rested you feel on a scale from 1-6 with 6 being very rested. Then rate how satisfied you are from 1-10 with 10 being very satisfied and adjust from there. 

The biggest competitive edge almost no athlete is exploiting is sleep. Want to prevent injury? The answer isn’t just in foam rolling, postural exercises or massage. Those things have a place but a good night’s sleep is absolutely essential for any of your training to matter. Just ask Usain Bolt.

Usain Bolt on Sleep

Mental Health and Communication

Mental Health

Here’s the bottom line: If the grind doesn't stop, neither does your brain. 

Mental health is a vague buzzword but the reality for athletes is that facing adversity in sport becomes way harder when your nervous system is overloaded before you step foot in the gym or on the field/court. Things like family troubles, financial stress, making the roster and other life stressors are going to happen. 

But the goal is not and should not be to eliminate these completely. Instead, finding healthy coping strategies and communicating with your coaches/support staff is absolutely key. If there are enough stressors in your life that sports aren’t in the cards at this moment, that’s okay. Find a trained mental health professional that can help you come to that conclusion.

Contact: 988 if you’re in crisis.


Want 2 truths about performance and preventing arm injuries as a pitcher?

  1. Closed mouths don’t get fed. 
  2. “The single biggest problem in communication is the illusion that it has taken place”. - George Bernard Shaw

A Pitcher’s Arm Injury Story

The best way to drive this section home is with a story.

During my time in pro ball, I helped rehab a pitcher after Tommy John Surgery. We spent a ton of time together and he eventually confessed to me that his elbow didn’t feel right…for months

Then he blew out.

He had been feeling pain and tightness after every outing. Did he communicate with his athletic trainer about this? 

Not once.

Now, could this have saved him from a year plus of rehab? It’s impossible to say. But the bottom line is that despite having every resource at his fingertips to stay healthy and give himself a fighting chance, it didn’t happen. Why?

Because closed mouths don’t get fed.

Don’t wait until you’re in pain. Talk to your athletic trainer and/or a physical therapist you trust. Communicate to your skill coaches how much you think you can do. Talk to your S&C coaches about modifications. Take initiative and understand you need to have the long game in mind.

Pro Pitcher After Arm Injury Rehab

Part 1 Takeaway

In this 3 part series on preventing arm injuries as a pitcher, I can’t emphasize enough how important sleep and nutrition are as a foundation. Even pro athletes need this education at times. So if you aren’t a professional pitcher yet, congratulations! You’re already ahead of the game. 

To prevent arm injuries as a pitcher, here’s where to start:

  1. Sleep enough. Generally, at least 8 hours a night is where to start.

  2. Eat a balanced diet with enough protein (1.5 - 2 grams of protein per kilo of body weight)

  3. Understand your mental load outside of just ball and talk to a professional if needed

  4. If you start to feel physically off do not ignore it. Talk to your athletic trainer or give us a call for free at (720) 248-7515 to see if we can be of assistance.

Remember this is just part 1 of this series. Next week we’ll discuss workloads, how to structure training and why a routine is important. Then in part 3 we’ll finally address mobility and strength and a proper arm care routine to prevent injuries as a pitcher. 

In the meantime, stay safe out there.

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arm injuries
Edwin Porras
Post by Edwin Porras
Feb 29, 2024 3:57:01 PM