Overhead throwing is an extremely complex movement that places significant stress on the shoulder joint of a pitcher. The shoulder is a hypermobile joint that is susceptible to injury from the repetitive high stress of pitching. Upper extremity injuries comprise more than half of all baseball injuries, the majority of which are shoulder injuries and affect pitchers more than position players. Physical therapy can effectively treat baseball-related shoulder injuries and help pitchers prevent injury through a throwing mechanics assessment and pre-season conditioning program. A successful rehabilitation program is multi-phased, gradually re-introducing the functional demands of the pitcher’s position for a safe return to sport.

Shoulder impingement syndrome develops due to chronic, repeated compression of the rotator cuff tendons and bursa under the acromion, causing pain, swelling, and movement issues. Shoulder impingement can result from repetitive overhead movements such as throwing the baseball, but may also occur due to a fall, muscle weakness in the shoulder joint, or postural abnormalities. Physical therapy can decrease shoulder impingement-related pain and improve shoulder motion and strength through targeted strengthening of the shoulder and upper back.