Pitching Shoulder Pain… Strength, Mobility, Mechanical or Overuse

Anterior Shoulder Pain Top

It seems that just about every pitcher, these days, has experienced pain at various points of their pitching career. For a pitcher or a position player, pitching shoulder pain can be a result of one or a combination of three things, lack of strength/mobility, mechanical disconnects and/or overuse.  Does the following scenario sound familiar?

    • Pitcher’s arm hurts
    • He goes to Physical Therapist (PT)
    • PT shuts him down for 6 weeks
    • Pain goes away
    • Pitcher starts throwing again
    • Pitcher’s arm hurts again…

Now, this is not a blog meant to make light of physical therapy. There are many forward thinking PTs out there that understand the concept in which we’re about to embark on.  As a matter of fact, I apply many of their concepts to my own programming.  The question is “are we really fixing the problem or just relieving the symptoms?” I mean, obviously if we stop throwing, the pain will go away but we need to find out what is causing the pain to begin with.  Otherwise we’re just stuck in a revolving door (not to mention giving away a ton of cash to PTs who are merely bringing the arm back to neutral and not addressing the cause).

This is what strength Coach Mike Boyle refers to as “treating the pain site, not the pain source” and in the next series of blogs, I’m going to show some examples of this phenomenon, in the form of pitching mechanics. Today’s pain site is the…


Anterior shoulder pain is generally caused by anterior and superior migration of the humeral head (arm) in the glenoid (socket), a relatively common problem among pitchers.  This occurs during the throwing motion, anywhere from the stride position up to the point of ball release.

Anterior Shoulder Pain Middle 1

Anterior Shoulder Pain Mariano

We’re going to look at some common lower body mechanical disconnects (pain source) that could be causing pain in the anterior shoulder (pain site).  These are many times overlooked by pitching coaches who do not possess an in depth knowledge of functional anatomy and bio-mechanics and often focus on the late arm action instead of everything leading up to that point.

(Lower Half Tutorial)

So although this delivery still looks pretty athletic, it’s the mobility and sequencing issues of the lower half (pain source) that are causing the athlete to experience pain in the anterior shoulder (pain site).  This is directly due to the arm flying open early as well as being responsible for supplying most of the power in the throw due to front knee leakage.

Giving this athlete some good hip mobility work and throwing correctives to help him be more aware of his landing will go a long way in preventing the arm from flying open prematurely. By the same token, giving him specific throwing correctives to help engage the lower half, and teaching him to create a more “hip dominant” back leg, will allow him to put more force into the ground while coming down the mound.  The net result of all this will create lower half leverage in the delivery and take much of the stress off of the anterior shoulder by lowering the work load of the upper body and arm.

Pain doesn’t have to be a cycle.  If you have pain you need to find the pain source.  Chances are it’s either a lack of strength, mobility/stability or mechanical disconnects.  PT prescribed shutdowns and pitching lessons alone aren’t going to address the issue long term.

Stay tuned for next time when we’ll talk about medial elbow pain.

See ya’ in the gym…

By Nunzio Signore (BA, CSCS, CPT, NASM, FMS)

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