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Fitness & Training: Thrower's Elbow

By Andris Dikmanis, Photos by Ellen Schuerger, 07/01/10, 1:34AM EDT


Johnnie LaRossa, St. Dominic High School

It’s the “dog days of summer,” you have just finished playing a double header, your body is tired, your uniform is covered in dirt from making incredible diving catches. You say to yourself as you sit on the bench in the dugout, “if I can continue to play like this, there will be no problem making the “Big team” come tryouts next time.” You reach for your glove and it hits you; a sharp pain from your elbow radiating down to your wrist.

What is it?

Commonly known as “Thrower’s Elbow,” elbow tendinitis occurs when there is damage to the bones, muscles, tendons and ligaments around the elbow joint and forearm. The typical throwing motion of a baseball causes the structures of the medial side (inside) of the elbow to stretch, while at the same time compressing the structures on the lateral side (outside). Over time this constant compression on the lateral side can result in micro-fractures in the arm bones and can eventually lead to bone spurs and bone chips. Conversely the constant stretching on the medial side can result in severe ligament strain. Eventually the damage causes a restriction of movement, inflammation and pain increase. This leads to the formation of scar tissue, possible bone spurring and calcium deposits. If left untreated, the damage can put a lot pressure on the muscles and nerves, which can cut off the blood flow and pinch the nerves responsible for controlling the muscles in the forearm.

What causes it?

Typically this injury is caused from overuse. Whenever a motion is performed repetitively for a prolonged period of time, strain on the forearm/elbow complex, coupled with inadequate recovery/rest time, will produce enough strain and overwork those muscles of the complex. On another note physical contact, such as falling or accidentally hitting the area could also trigger the symptoms. Throwing technique is another possible reason for developingthis injury. For novice players of the game it is very important to follow the directions of your coaches and maintain proper throwing mechanics, especially when increasing power and speed. It is important to maintain a general level of good physical fitness to help prevent and decrease your chances of developing this type of injury.

Signs & Symptoms

Pain on both sides of elbow due to motion.

Pain/discomfort may radiate down to wrist or hand.

Weakness, stiffness or general restrictive movement in the throwing elbow.

Numbness/tingling sensation down the arm, maybe felt due to inflammation around the joint capsule.

Prevention Techniques

Warm-up: Participating in a 10-15 minutes structuredthrowing/stretching program can decrease your likely hood of irritating the structures around the elbow and throughout the rest of the arm.

Throwing Technique: It is crucial that you maintain proper biomechanical/technically appropriate throwing motion. Over time, bad habits and incorrect technique can lead to strain on the structures of the elbow, which could lead to injury. It is very important to learn and maintain proper technique from the start to decrease the likelihood of injury.

Cooldown/Rest: After your practice or workout, participatingin 10-15 min stretching program can help to properly maintain muscle and tendon  flexibility.

It may additionally help to decrease any inflammation developed during the session. Applying the R.I.C.E. prevention concept (Rest, Ice, Compression, Elevation) can also decrease any inflammation developed by the soft tissue during your workout session.

Treating Thrower’s Elbow

This particular injury is a soft tissue injury of the muscles and tendons around the elbow joint and should be treated like any other soft tissue injury. Like any other soft tissue injury, the R.I.C.E. regime should be employed. As mentioned above Rest, Ice, Compression, and Elevation should be implemented to decrease the acute symptoms after injury. Additionally, referral to an appropriate professional for an accurate diagnosis is advised. It is critical that the R.I.C.E./referral regime be implemented for at least the first 48 to 72 hours. This will give you the best possible chance of a successful recovery.

Treatment after 48 to 72 hours involves a number of specific techniques, which can be provided by a physical therapist. Since every injury has a different level of complexity, it is hard to tell what treatment application will be used. Commonly the use of heat and massage is one of the most effective treatments for removing scar tissue and speeding up the healing process of the muscles and tendons.

After most of the inflammation and pain has been reduced, it is time to focus on the rehabilitation phase of treatment. The main objective of this phase is to regain and increase the strength, power, endurance and flexibility of the muscles and tendons that have been injured.

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References: Kevin E. Wilk, Michael M. Reinold, James R. Andrews. Rehabilitation of the thrower’s elbow. Clinics in Sports Medicine - October 2004 (Vol. 23, Issue 4, Pages 765-801, DOI: 10.1016/j.csm.2004.06.006)

Brad Walker. “Throwers Elbow, Elbow Tendonitis and Elbow Pain A Guide to the Treatment and  Prevention of Throwers Elbow.” The Stretching Institute™ Copyright © 2010.