Rehabilitation Process for Returning Baseball Players to Throwing After an Arm Injury

Recovering from an arm injury can be a challenging journey for baseball players and throwing athletes, but following a structured rehabilitation process is key to safely regaining strength and returning to the game. Here's a step-by-step guide on the process I use to help ensure a full recovery and return-to-play.

1. Regain Full Range of Motion and Control Pain

The first step is to restore full range of motion in the injured area, whether it's the elbow or shoulder. For elbow injuries, it's crucial to regain extension immediately, while flexion can gradually be restored over 2-4 weeks (in post-op cases) as long as it doesn't cause swelling. As a general rule of thumb, pitchers only need 120-125 degrees of elbow flexion to safely throw. Pain management is also a priority—rehab should be pain-free or tolerable to avoid further damage.

2. Initial Strengthening and Stability Work

Once range of motion is restored, the next phase is corrective strengthening exercises. Low-intensity exercises, often incorporating tools like blood flow restriction (BFR) training, help build a foundation of strength without overloading the joint. Stability exercises also play a crucial role in this stage, ensuring that the arm is prepared for more dynamic movements later in the rehab process. During this time, we will also work to improve any deficits along the kinetic chain, such as poor hip/thoracic spine mobility, single leg balance or lower body/core strength.

3. Progressing to Weight Training

Building true strength is vital before reintroducing throwing. This is achieved through functional weight training, including squats, lunges, presses, and pulls in a variety of directions. These compound movements help build overall body strength and stability, which is essential for a successful return to throwing. Neglecting this phase can result in a weak throwing arm or underprepared body, increasing the risk of re-injury when they begin resuming.

4. Plyometric Training

The final stage before returning to throwing is plyometric training. Using medicine balls and other tools, this phase involves explosive, fast movements that simulate the speed and intensity of throwing. By the time the athlete is ready to throw, their body will already be accustomed to the high demands of the sport, making the first throws easier and safer. For this phase, we will progress an athlete from 2-handed throws (i.e. chest passes) to 1-hand throws (i.e. plyo ball wall throws). Also, by this phase athlete's should have full shoulder total range of motion.

By following this structured rehab process, baseball players and throwing athletes can safely return to the field, stronger and pain-free.