by Jason Ryan, Senior Physiotherapist, Director & Throwing Sport Expert (Leeming & Palmyra clinics)
If you’re a baseball player, cricketer or anyone who throws for sport, you’ve probably heard the old advice for elbow pain: stretch it out, rest and it will settle down. While not without merit—because yes, your pain will probably ease up a bit—this isn’t a long-term remedy as it fails to address the root cause.
As former state league baseballers (and general sports tragics), we’ve been working with throwing athletes for 10+ years, from professional athletes to weekend players, and often see same pattern. This being: pain is coming from the elbow, yet the cause is rarely just the elbow.
Stretching Alone Won’t Fix Thrower’s Elbow
A good stretch is the first thing most people try, and it does have a place in treatment. But if stretching is all you’re doing you’re just managing symptoms.
Here’s a fact that often surprises people: around 50% of the force you generate in a throw comes from your lower body and trunk. When that system is slow, weak or poorly timed, your arm picks up the slack. So, when your arm is carrying more load than it should, your elbow pays the price.
Stretching isn’t going to fix a weak hip or stiff thoracic spine, it will possibly just delay your next flare-up.
You Need To Build Force From the Ground Up
When we treat throwers, we assess the full kinetic chain (AKA the whole chain of movement in your body), not just the pain source. Why? Because if your legs and hips aren’t contributing properly to throwing the force has to come from somewhere – usually your elbow.
This is why we prioritise leg and hip training alongside upper body strength in our throwing programs. Exercises like single-leg Romanian deadlifts, split squat patterns, and rotational lower body work all play a role in protecting your arm long-term. Strong legs don’t just make you throw harder, they make you throw safer.
The Flexor-Pronators: The Underrated Key to Medial Elbow Health
The flexor-pronator group is a set of muscles on the inner forearm that act as dynamic stabilisers for the medial (inner) elbow, particularly during the late cocking and ball release phases of throwing.
When these muscles are weak or undertrained, stress gets transferred onto passive structures like your ligaments and UCL (ulnar collateral ligament), which is often where things start to break down.
Flexor-pronator rehab/strengthening exercises:
- Forearm curls (wrist flexion and grip work)
- Band pronation for controlled rotation strength
- Shoulder internal rotation (with wrist pronation for kinetic chain control)
- Plyometric pronation to train high-speed deceleration
Aim for 20 reps of each, two rounds through, either as a warm-up or as part of your gym program.
How Elite Throwers Protect Their Arm
Throwing hard from fence to fence isn’t just about arm speed. It’s about what happens after ball release, and what your body can absorb and control under load. Here’s what we prioritise with our throwing athletes:
- Build the decelerators
Strengthening the muscles that control and slow down your movements is critical. Eccentric barbell work and drop catch variations (including with a plyo ball) teach your body to absorb force properly. If you can’t decelerate, your shoulder pays for it.
- Strengthen the rotator cuff properly
Overhead band work and 90/90 press variations matter more than light bands done in easy positions.
- Train your lower body
Power starts from the ground. As outlined earlier, weak legs mean an overloaded arm.
- Own your rotation
Controlled trunk rotation and upper back strength allow force to transfer efficiently through the throw (instead of being muscled through the arm).
- Clean up your mechanics
Trunk position, chest drive, release point and follow-through all influence how much stress lands on your structures. Good mechanics reduce load before strength comes into play.
Athlete Case Study: A Left-Handed Pitcher
Here’s a recent example from one of our baseball patients. A left-handed pitcher came in with pain through the elbow and shoulder with occasional pins and needles into the fingers. On assessment we found limited thoracic spine rotation and extension (which directly affects scapular position), and he was 20% weaker on the throwing side. (Accurately tested using our state-of-the-art VALD strength testing equipment).
Despite this, after starting targeted mobility work in his first session, he had no pain. We were cautious about calling that a fix, because when pain drops we usually say it’s a good start, not that it’s solved. We monitored him over the following weeks, retested his strength and progressed his program from there.
3 Simple Exercises Every Throwing Athlete Should Do
These exercises are evidence-based, effective and appropriate for almost any throwing athlete. Aim for 3 sets of 8–12 reps.
Side-lying external rotation: Lie on your non-throwing side and rotate the shoulder outward under control. Builds posterior rotator cuff strength.
Prone T (rear delt raise): Lying face down, raise both arms out to the side in a T position. Targets the mid-back and posterior shoulder.
Prone external rotation: Lying face down with the arm hanging off a bench, rotate the shoulder outward through range. A staple for rotator cuff health in throwers.
As always, you’re aiming for consistency.
Work With Us – Perth’s Throwing Sports Physio
We work with throwing athletes across baseball, cricket and other throwing sports across Perth. If your elbow or shoulder keeps flaring up, or you want to build a proper arm care program, we’d love to help.
Pop in and see us at either clinic or follow along on Instagram @perth_baseball_physio for more evidence-based arm care content. You can also check out our Meet the Team page to learn which physios are experts in this area.
