The Complete Guide to Return-to-Throw Programs After an Injury
- undefeatedptandper
- Nov 2, 2025
- 3 min read
By Dr. Carmen Jansante, PT, DPT, CSCS
Undefeated Physical Therapy and Performance
Step 1: Remove the Cause to Allow Healing
If throwing caused the injury, we have to remove throwing — at least temporarily. That means eliminating the very activity that created the stress on the tissue in the first place.
Whether the injury is post-operative or being treated conservatively without surgery, we need to give the tissue time to heal before adding stress back in.
During this period, the goal is for the athlete to be pain-free at rest and pain-free with daily activities before we begin any throwing or high-velocity work.
Step 2: Identify and Correct Imbalances
While we’re resting the throwing arm, we focus on restoring range of motion, flexibility, and strength.
At Undefeated PT, we evaluate each athlete individually to find specific imbalances. One common finding in throwers is an internal rotation deficit, but it’s important to understand this in context.
We don’t just look at internal rotation in isolation — we assess the total arc of motion (internal + external rotation) on both the throwing and non-throwing sides.
A slight internal rotation loss on the throwing arm is normal and expected. Forcing it can actually create an impingement effect in the shoulder. So, we only address true deficits — not natural adaptations that come from throwing.
Step 3: Build Strength and Control
Once we’ve identified imbalances, we spend time rebuilding strength, stability, and control throughout the shoulder and arm complex.
This stage is slower and more controlled — focused on tissue healing and foundational strength before we reintroduce speed or power.
Step 4: Introduce Power and Plyometrics
After the tissue has healed and strength is restored, we transition into power and plyometric training.
Throwing is a fast, high-velocity movement — so to prepare the arm, we must train explosively.
We begin with two-handed plyometric drills, such as wall push-offs:
Start with hands on the wall in a push-up position.
Push away as fast and powerfully as possible, extending the elbows quickly.
Perform 3–5 reps at a time with maximum intent.
Start at 50% effort and gradually build to 100%.
This phase is about speed and intensity, not heavy weight.
Step 5: Progress to One-Handed Plyometrics
Next, we isolate the throwing arm with single-arm plyometric work — but without mimicking a full throwing motion just yet.
A great example is a high pull drill:
The athlete starts in a half-kneeling position to limit lower-body involvement.
From a high arm position, drive the elbow back and extend the shoulder forcefully.
Again, keep reps low (3–5) and focus on quick, explosive movement.
As strength and tolerance improve, we move to more throwing-like movements such as reverse throws or push-press motions.
Step 6: Begin the Return-to-Throw Program
Once the athlete can tolerate plyometric and sport-specific drills without pain, we start a graded return-to-throw program.
The key word here is graded — meaning gradual and progressive.
Soreness is okay and expected.
Pain means we’ve done too much and need to scale back.
For pitchers, that progression might look like:
Short-distance flat-ground throws
Increasing distance and intensity
Gradual reintroduction to mound work
For position players, we focus on building distance, accuracy, and velocity before returning to full game intensity.
Final Thoughts
Return-to-throw programs aren’t rocket science — but they must be systematic, patient-specific, and guided by how the body responds.
At Undefeated Physical Therapy, we help athletes safely bridge the gap between rehab and performance. Our goal is simple: make sure you’re not just pain-free, but ready to perform at your best.
If you’re an athlete dealing with a throwing-related injury, we’d love to help you get back to the field stronger than before.
📱 Text or call Dr. Carmen Jansante at (412) 627-2131
💪 Undefeated Physical Therapy & Performance
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