Baseball Interval Throwing Program: Start your Pre-Season throwing Program to Prevent Shoulder and Elbow Injuries.

By John R. Mishock, PT, DPT, DC

Approximately, 3-4 million children and adolescence between the ages of 4 and 17 participate in organized baseball throughout the country. Unfortunately, many of these young athletes will develop elbow and or shoulder pain and be seen in physical therapy clinics and orthopedic surgeon’s offices this year.

Little leaguers (9-13 years of age) have greater than a 50% chance of experiencing elbow or shoulder pain in a given season. (American Journal of Sports Medicine, 2011)

From youth to professional there are more than 50, 000 injuries per year. Most of the injuries in baseball involve the pitchers throwing arms. (Conte S, Am J Sports Med.) The highest injury rate during the season is in the month of April. The high injury rate is most likely due to overuse (excessive throws) secondarily to the arm not being properly conditioned in the pre-season. This overloading of the shoulder and elbow coupled with inadequate rest and recovery leads to injury and pain.

In 2015 the Major League Baseball (MLB) spent over $665 million on injured players who were on the disabled list. With the ever escalating expense on injured players at all levels, the MLB future draft pick may be chosen not on talent alone but on physical health and throwing utilization as a youth star. It’s not only ability but durability that will allow the player to reach the highest levels in baseball. Prevention starts at youth level baseball, were we parents and coaches can protect our kids from throwing injuries by following well established guidelines for prevention and training.

The first step to prevention is a pre-season interval throwing program. Baseball interval throwing programs have been part of baseball conditioning and rehabilitation for decades. Scientific evidence clearly indicates that a progressive build-up of intensity and volume of throws best prepares the muscles, tendons and ligaments for the rigors of a long throwing season.

Our interval throwing program should be used as a guide to gradually build the player’s throwing capacity and endurance when returning from the off-season, in hopes of minimizing the risk of injury and optimize throwing performance. Prior to starting any throwing program it is essential follow certain principles:
1. All arms are unique to the individual.
2. Always “listen” to the throwers arm allowing it to dictate what is needed day to day. If there is tightness, soreness or pain don’t throw.
3. Throw more not less, but do it with gradual progression allowing adequate amount of rest and recovery.
The first step in the pre-season interval throwing program is to determine when the season will start (first team practice). Once the estimated date is determined count back 4 weeks for position players, 6 weeks for youth and adolescent pitchers and 10 weeks for the high school, college or pro pitcher.

Please visit our website for an example pre-season throwing program.

A complete outline of the program can be found in Dr. Mishock’s book “The Rubber Arm” at

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