Why Rest Alone Doesn’t Fix Throwing Arm Pain

undefeatedptandper
Jun 28
4 min read

By Dr. Carmen Jansante, PT, DPT, CSCS

Undefeated Physical Therapy and Performance

One of the most common things I hear from baseball players is:

“I took a week or two off throwing, it felt better, but as soon as I got back into it, the pain came right back.”

And honestly—that makes sense.

Rest is important. It’s a very important advantage when it comes to helping an athlete recover from injury because we are temporarily removing the stress from the injured area. For throwers, taking time off from throwing can absolutely help calm symptoms down.

But here’s the truth:

Rest alone rarely fixes the actual problem.

It may reduce pain temporarily, but it doesn’t address why the pain showed up in the first place.

I use this analogy all the time.

Imagine you have a nail stuck in your shoe and every time you walk, it’s poking the bottom of your foot.

It hurts.

So what do you do?

You sit on the couch for a week.

After that week, your foot feels great because you haven’t been standing on it.

But the second you get up and walk again…

That nail is still there.

The pain comes right back.

So what has to happen?

You have to do two things:

Remove the nail (fix the root cause)
Build up the bottom of your foot so it can tolerate more stress

Throwing pain works the exact same way.

When we rest, we remove the painful stimulus—throwing.

That’s important.

But if we don’t address the underlying movement issues, strength deficits, mobility limitations, or tissue capacity problems, the arm is often going right back into the same environment that caused pain in the first place.

What’s Usually Going On?

With throwers, I often see a few common patterns:

They’re extremely dominant through the front side of the body
Tightness in the pec major and pec minor
Limited thoracic rotation
Loss of shoulder rotation or elbow extension
Weakness in the posterior cuff and scapular stabilizers
Poor deceleration strength

Think about it:

Most throwers spend a lot of time producing force.

The front side—the pecs, lats, anterior shoulder—becomes strong and dominant because that’s where they generate power.

But over time, the backside—the retractors, rotator cuff, and decelerators—gets overpowered.

That imbalance changes how the shoulder and elbow accept stress.

And eventually, something starts talking.

Pain is often just the signal.

Step 1: Restore Range of Motion

Before we build, we need to restore.

A lot of throwers lose motion—especially at the elbow and shoulder—because of repetitive high-velocity throwing and poor tissue recovery.

That’s where we start:

Restoring shoulder mobility
Restoring elbow extension
Improving thoracic mobility
Improving rib cage mechanics

And here’s something important:

Strength work can also be mobility work.

If all we do is stretch, we’re missing a huge piece.

Tissues adapt when they are loaded.

Research consistently shows that progressive loading improves tendon health, muscle adaptation, and tissue tolerance far better than passive treatment alone.

Step 2: Strengthen the System

Once mobility improves, we strengthen.

This is where we rebuild capacity.

We strengthen:

Rotator cuff
Scapular stabilizers
Posterior shoulder
Forearm
Core
Lower half

Because throwing is not just an arm movement.

It’s a full-body movement.

The stronger and more efficient the system is, the less stress the arm has to absorb.

Step 3: Power and Plyometrics

This is one of the biggest missing pieces.

Before going back to throwing, we have to train the arm to accept and produce force quickly.

That’s where plyometrics come in.

We start with two-handed plyometrics:

Med ball slams
Scoop tosses
Shotput throws
Rotational throws

Why?

Because both arms share the load.

Roughly 50% on the throwing arm and 50% on the non-throwing arm.

This allows us to train:

Explosive intent
Trunk rotation
Lower half force transfer
Arm speed
Deceleration

Without immediately putting the athlete back into a full throwing position.

Then we progress into single-arm plyometrics where the throwing arm begins taking on more stress independently.

This bridges the gap between rehab and throwing.

Step 4: Patterning and Return to Throw

Only after mobility, strength, and power are rebuilt do we begin:

Patterning drills
Mechanical corrections
Structured return-to-throw progressions

This part matters.

Because returning too early without rebuilding tissue capacity is one of the fastest ways to end up right back where you started.

Rest Is Part of the Plan—Not the Entire Plan

Rest is important.

But rest is just one piece.

If you’re dealing with arm pain, tightness, velocity loss, or recurring soreness every time you ramp up throwing…

There’s usually more going on.

At Undefeated Physical Therapy and Performance, we specialize in helping baseball players and overhead athletes find the real issue and build a plan to fix it.

If you feel like you “just need rest,” you might actually need the missing piece.

Ready to get your arm right?

📞 Call or text: 412-627-2131

📩 Follow us on Instagram: @undefeated_pt

🌐 Contact us here: https://undefeatedpt.com/contact

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. Am J Sports Med. 2014.

Manske RC, Ellenbecker TS. Current Concepts in Shoulder Examination of the Overhead Athlete. Int J Sports Phys Ther. 2013.

Chalmers PN, Erickson BJ, Ball B, Romeo AA. Shoulder and Elbow Injuries in the Overhead Throwing Athlete. Sports Health. 2017.

Reinold MM, Gill TJ. Current Concepts in the Evaluation and Treatment of the Shoulder in Overhead Throwing Athletes. Sports Health. 2010.

Escamilla RF, Yamashiro K, Mikla T, Collins J, Andrews JR. Shoulder Muscle Activity and Function in Common Shoulder Rehabilitation Exercises. Sports Med. 2009.

Fleisig GS, Diffendaffer AZ, Aune KT, et al. Biomechanical Analysis of Weighted Ball Exercises for Baseball Pitchers. Sports Health. 2017.