The Return-to-Throwing Checklist Every Pitcher Needs - Lewis Physical Therapy & Sports Rehabilitation

Returning to throwing after an injury is one of the most critical phases in a baseball player’s career. Yet, it’s also where most athletes—and even some providers—make mistakes.

The biggest issue?

They base return-to-throwing on time… not criteria.

If you want to stay healthy and actually perform when you come back, you need a structured checklist.

🎥 Watch the Video Breakdown

Before we dive in, make sure to watch the full breakdown where I walk through this entire process step-by-step.

Watch on Youtube Here:

⚠️ 1. You Must Have Normal Range of Motion

Before throwing even becomes a conversation, your shoulder and elbow mobility need to be restored.

Key benchmarks:

• Less than 5° difference side-to-side for the following movements

• Total Range of Motion (External Rotation + Internal Rotation)

• Flexion with Scapulae Pinned

• Flexion without Scapulae Pinned

• Cross-body adduction to ~90°

If you’re off by 6-8 degrees? It might not mean you can't throw, but need to be VERY closely monitored. Off by 15-20 degrees? We have some work to do.

💪 2. Strength Ratios Matter More Than You Think

Most athletes focus on “feeling strong.”

That’s not enough.

You need objective data.

A key metric:

• External Rotation (ER) to Internal Rotation (IR) MINIMUM ratio ≥ 67% (I personally prefer this to be closer to .8 to start throwing. However, for some athletes post-TJ or labrum surgery, this is an okay value to clear for throwing, but they must continue to progress closer to .8-.85 before returning to games.

Why this matters:

• Throwing demands high eccentric control

• Weak ER = poor deceleration = higher injury risk

You also need:

• Less than 10% strength asymmetry side-to-side

🏋️ 3. You Need to Tolerate Load in the Gym

Before throwing, your arm needs to prove it can produce & accept forces.

This includes:

• Push movements

• Pull movements

• Overhead patterns

• Carrying/holding heavy weight

If your arm can’t tolerate the gym…

It won’t tolerate throwing.

🔗 4. Closed-Chain Stability Comes First

Before high-speed throwing, we build stability through a wide varieyt of closed-chain drills.

Examples:

• High Plank

• Bear crawls

• Side Planks

This improves:

• Joint control

• Co-contraction of the rotator cuff

• Force transfer by emphasizing the use of the kinetic chain (core/legs working in conjunction with upper body)

⚡ 5. Plyometrics (But Don’t Overdo It)

This is where a lot of programs go wrong.

You don’t need:

• 20 different plyo drills

• Max-effort throws before throwing

Instead:

• Start with extensive (low intensity, high reps)

• Progress to selective intensive work (higher intensity, lower reps)

Focus on:

• Quality

• Control

• Intent

⚾ 6. Sometimes… Throwing IS the Plyometric

One of the biggest mindset shifts:

Throwing itself is a plyometric activity.

In some cases, especially:

• Short layoffs

• Good strength + mobility

You don’t need an extended plyo phase.

You need:
➡️ Smart progression back into throwing

🚨 The Biggest Mistake I See

Athletes returning from elbow injuries…

Without ever testing their shoulder.

Or vice versa.

That’s a recipe for re-injury.

🗓 Ready to Start Throwing Pain-Free? Book Your Evaluation Today

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📘 The Arm Pain Blueprint (FREE Download!)

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⚾ Pitcher’s Mechanical Blueprint (FREE GUIDE)

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🎙 Listen to This Episode on The Lewis Physical Therapy & Sports Rehab Podcast

Catch the full breakdown of return-to-throwing criteria and how to avoid re-injury.

🎧 Listen on Spotify:
https://open.spotify.com/show/4A6iBs0CzkAwSu9rUVPfGX?si=lrea2AaWQSy5USIT90KXhQ