Why Does My Elbow Hurt After Throwing? What It Actually Means.
- undefeatedptandper
- Aug 2
- 5 min read
If you’re a baseball or softball player, chances are you’ve felt soreness after throwing at some point. The question is:
Is it normal… or is it the start of an injury?
At Undefeated Physical Therapy & Performance, one of the most common complaints we evaluate in throwers is elbow pain after throwing. Over the past month alone, we’ve seen a significant increase in athletes dealing with medial (inside) elbow pain, prompting this discussion.
Many athletes assume elbow pain is “just part of baseball.”
It isn’t.
Knowing the difference between normal fatigue and abnormal pain could be the difference between finishing your season healthy or ending up with months of rehab—or even surgery.
Fatigue Is Normal. Pain Is Not.
Let’s clear up one of the biggest misconceptions in baseball.
After a normal throwing session, it’s completely expected to feel:
General arm fatigue
Muscle tiredness
A decrease in velocity late in a throwing session
Overall body fatigue after a high-volume day
Those are normal training responses.
What is not normal is experiencing:
Pain on the inside of your elbow
Sharp pain during throwing
Pain after every throwing session
Pain that lingers into the next day
A “dead arm” feeling
Loss of velocity because your arm hurts
Pain that progressively worsens throughout the season
If you’re experiencing any of these consistently, your body is telling you something.
Ignoring it rarely makes it better.
Why Does the Elbow Hurt During Throwing?
Throwing a baseball is one of the fastest and most stressful motions the human body can perform.
During the acceleration phase of pitching, tremendous forces travel from the ground, through your legs and trunk, into your shoulder, and finally through your elbow before the ball leaves your hand.
The elbow acts like the middle link in a chain.
If something higher up the chain isn’t doing its job, the elbow often pays the price.
Understanding the Structures Around the Elbow
Many athletes immediately think of a UCL tear when their elbow hurts.
While the ulnar collateral ligament (UCL) certainly receives a tremendous amount of stress during throwing, it is far from the only structure that can become painful.
The elbow contains several important muscle groups responsible for:
Wrist flexion
Wrist extension
Forearm pronation (turning the palm down)
Forearm supination (turning the palm up)
Elbow flexion
Elbow extension
These muscles work continuously throughout every throw to stabilize the elbow and transfer force efficiently.
In addition, several ligaments provide stability, with the UCL being the primary restraint against valgus stress—the force that attempts to stretch open the inside of the elbow during throwing.
Understanding whether pain is coming from muscle tissue or ligament tissue is one of the first priorities during an evaluation.
The Elbow May Not Actually Be the Problem
This is one of the biggest concepts we teach our athletes.
Just because your elbow hurts doesn’t necessarily mean your elbow is the problem.
At our clinic, we always evaluate the body from the top down.
Why?
Because the shoulder, thoracic spine, hips, and trunk all influence how much stress ultimately reaches the elbow.
If these areas are not moving well or producing force efficiently, the elbow is forced to compensate.
That’s why we never simply treat the site of pain.
We identify why the pain developed in the first place.
The Shoulder Is Often the Missing Piece
One of the first things we assess is shoulder mobility.
Research consistently shows that deficits in shoulder motion can significantly increase stress placed on the medial elbow during throwing.
We specifically evaluate:
Shoulder Flexion
Limited overhead mobility changes arm position during the throwing motion and often forces additional stress into the elbow.
Internal Rotation
Loss of internal rotation is extremely common in throwers.
While some adaptation is normal, excessive loss can alter throwing mechanics and increase valgus stress.
External Rotation
Throwers naturally gain external rotation over time.
However, what matters most isn’t one motion by itself.
We evaluate the athlete’s total rotational arc—the combination of internal and external rotation—and compare the throwing arm to the non-throwing arm.
When total rotational motion is significantly reduced, elbow stress often increases dramatically.
Is It Muscle Pain or Ligament Pain?
One of the biggest goals during an examination is determining which tissue is actually irritated.
Muscle-related pain often hurts when:
Resisting wrist flexion
Resisting wrist extension
Pronation
Supination
Gripping
Contracting the forearm muscles
These muscles work incredibly hard during throwing and can become overloaded.
Ligament-related pain is often characterized by:
Pain directly over the inside of the elbow
Pain during late cocking or acceleration while throwing
Pain with valgus stress testing
Pain that increases with higher throwing intensity
Decreased throwing velocity because of discomfort
A proper examination helps determine which structures are involved so treatment can be directed appropriately.
Restoring Elbow Motion Is Critical
One thing we commonly see after throwing is athletes losing full elbow extension.
Even small losses in extension can change throwing mechanics and increase stress throughout the arm.
One of our early treatment priorities is restoring:
Full elbow extension
Normal forearm mobility
Healthy soft tissue mobility
Blood flow to irritated tissues
Depending on the athlete, treatment may include:
Instrument-assisted soft tissue mobilization (IASTM)
Cupping therapy
Dry needling
Joint mobilization
Manual therapy
Targeted mobility exercises
These treatments are combined with progressive strengthening—not used as standalone fixes.
Strength Matters—But So Does Mechanics
Simply strengthening the elbow is rarely enough.
We also examine:
Throwing mechanics
Scapular control
Rotator cuff strength
Core stability
Hip mobility
Lower-body force production
Workload management
Throwing volume and recovery
The body works as one kinetic chain.
If one link breaks down, another structure has to absorb the stress.
More often than not, that’s the elbow.
Don’t Wait Until It’s a UCL Injury
Many serious throwing injuries don’t happen overnight.
They develop over weeks or months as small issues accumulate.
Addressing elbow pain early can often prevent:
Chronic tendinitis
Flexor-pronator strains
UCL injuries
Time away from baseball
Surgical intervention
The earlier we identify the true cause, the faster we can develop a plan to keep you on the field.
Final Thoughts
If your elbow hurts every time you throw, your body is giving you valuable information.
Pain isn’t something to push through.
It’s a signal that something in your throwing system isn’t functioning the way it should.
Whether the issue is shoulder mobility, strength deficits, workload, mechanics, or irritation of the muscles or ligaments around the elbow, finding the true cause is the key to long-term success.
At Undefeated Physical Therapy & Performance, we specialize in evaluating baseball and softball athletes to determine exactly why pain is occurring—not just treating the symptoms.
Healthy athletes throw harder, recover faster, and stay on the field longer.
Contact Us Today
If you’re dealing with elbow pain after throwing, don’t wait until it becomes a bigger problem.
Undefeated Physical Therapy & Performance Pittsburgh, Pennsylvania
Text: (412) 627-2131
Instagram: @undefeated_pt
Email: carmen@undefeatedpt.com
Whether you’re a Little League player, high school athlete, college pitcher, or professional baseball player, we’d love to help you get back to throwing pain-free.
References
Wilk KE, Macrina LC, Fleisig GS, et al. Deficits in Glenohumeral Passive Range of Motion Increase Risk of Elbow Injury in Professional Baseball Pitchers.
Fleisig GS, Andrews JR. Biomechanics of Overhand Throwing with Implications for Injuries.
American Sports Medicine Institute (ASMI). Baseball Pitching Mechanics and Injury Prevention.
Reinold MM, Wilk KE, et al. Current Concepts in the Evaluation and Treatment of the Throwing Athlete.
Kibler WB, Sciascia A. The Role of the Scapula in Overhead Throwing Mechanics.
Ellenbecker TS, Wilk KE. Rehabilitation of the Overhead Athlete.
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