6 Key Benchmarks Before Returning to Throw After an Arm Injury – Lewis Physical Therapy & Sports Rehab

What You’ll Learn in This Blog

When a pitcher is recovering from an arm injury, the question is always the same:
“When is it safe to start throwing again?”

In this post, Dr. Jeff Lewis, owner of Lewis Physical Therapy & Sports Rehabilitation in Point Pleasant, NJ, shares the six essential benchmarks every baseball player must meet before returning to throwing — and how rushing the process can lead to re-injury.

🎥 Watch the Full “6 Key Benchmarks” Breakdown on YouTube

Don’t risk re-injury by rushing your throwing progression.
▶️ Watch Now on YouTube:

1. Regain Full, Pain-Free Range of Motion

Before picking up a baseball, the athlete must demonstrate pain-free shoulder and elbow range of motion — both actively and passively.
Dr. Lewis checks for:

• Full shoulder external and internal rotation

• Full elbow flexion and extension

• No pain with overpressure testing

If any stiffness or hesitation remains, the arm isn’t ready for throwing stress yet.

2. Rebuild External-to-Internal Strength Ratios

Throwing places huge demands on the shoulder’s rotator cuff, especially during the deceleration phase.
That’s why Dr. Lewis measures the external-to-internal rotation strength ratio using a handheld dynamometer.

• The minimum acceptable ratio is 0.69 (69%) before throwing begins.

• The goal by bullpen work is 0.80 or higher (1.1-1.2) to protect the shoulder from breakdown.

Without this balance, the stronger internal rotators overpower the stabilizing cuff muscles — increasing injury risk.

3. Restore Grip Strength Symmetry

Grip strength reflects the arm’s total kinetic chain readiness.
Dr. Lewis tests grip strength in both arms, in multiple positions (arm at side and overhead).
The goal: Equal strength on both sides or a return to pre-injury baseline.

A deficit in grip strength signals incomplete recovery of forearm and shoulder musculature — a red flag before throwing resumes.

4. Tolerate Push-Pull Strength Training

Before throwing, pitchers must handle a pain-free upper-body training routine that includes:

• Dumbbell floor presses

• Row variations

• Landmine or overhead pressing

They don’t need to lift maximal loads yet — but they should tolerate progressive resistance through a full range of motion without discomfort.

5. Control Speed and Movement Across Planes

Throwing is a high-speed, multi-planar movement.
That’s why athletes must demonstrate control and coordination through both slow eccentrics and fast explosive motions.
This ensures that not just the arm, but the entire kinetic chain — trunk, hips, and scapular stabilizers — is ready for the dynamic demands of pitching.

6. Pass Plyometric Readiness Drills

Finally, before returning to throw, pitchers must tolerate lower-level plyometric work such as:

• Medicine ball chest passes

• Rotational throws

• Plyo ball rebound and catch drills

These drills replicate the speed, elasticity, and endurance demands of throwing. If these can be performed pain-free and with good mechanics, it’s a green light to begin a structured throwing progression.

Key Takeaway

Rushing a return-to-throw program before meeting these six benchmarks can undo months of progress.
Every athlete’s timeline is different — some may take a week, others six or more — but the process must be individualized and data-driven.

Meeting all six readiness tests ensures pitchers return stronger, more durable, and less prone to re-injury.

🎙 Listen to This Episode on The Lewis Physical Therapy & Sports Rehab Podcast
Catch the full breakdown of the Return-to-Throw Benchmarks and how to rebuild throwing strength safely.

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

⚡ Build Strength, Speed & Arm Durability with the Triple Threat 12-Week Program

This program helps high school baseball players:

• Increase throwing velocity

• Build lower-body and rotational power

• Reduce arm overuse and shoulder fatigue

👉 Get started here: https://www.lewisptsr.com

🩺 Struggling with Arm Pain or Shoulder Tightness?

If throwing pain is limiting your performance, we can help.
Schedule a discovery call today with our baseball rehab specialists at Lewis Physical Therapy & Sports Rehab in Point Pleasant — where we help athletes throw pain-free and return stronger than ever.