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Sore Arms: What You Need To Know* - 10/15/2007


“My son/daughter has a sore (elbow or shoulder).
What’s the best way to handle this?”

          With more games being played, due, at least in part, to the expansion of travel ball and fall leagues, arm problems for young ball players are becoming more prevalent. According to Dr. Glenn Fleisig of the American Sports Medicine Institute ( there are two major “thresholds” where he sees more arm problems:

  • With pitchers who play for 8 months per year, or more

  • With pitchers throwing 85 mph or harder

            Major League Baseball starts in mid-February (pitchers), and, except for teams in the playoffs, ends by October.  A total of about 6 months. A LOT of games in those months, but a lot of downtime thereafter.

          Are the number of games your kids are playing approaching that of these highly skilled, physically mature adults?

          As for throwing 85+ mph, well, of course, we want pitchers to throw this hard, and harder. At this level of velocity, however, the structures of the arm undergo greater forces and stress. If not properly cared for, problems are inevitable.

          There are three primary causes of arm pain/problems:

  1) Overuse – too many practice sessions and games, too many innings pitched. All of which adds up to insufficient recovery time.

  2) Improper mechanics - Overhand throwing is a bio-mechanically un-natural act, even when done with what are considered to be good mechanics.  When things are not being done properly, problems increase dramatically.

  3) Poor conditioning - Proper strength and flexibility work can help prevent arm problems by “toughening” the ligaments, tendons, and muscles thereby making them more injury resistant. Ultimately, though, excessive and incorrect use will overwhelm even the best conditioned arm.

  Arm Injuries

          There are a number of maladies that can afflict overhand throwers, especially pitchers. Listed here are several of the more common ones that many ball players will experience during the course of their career:

  Bursitis - Bursae (plural; singular is bursa) are fluid-filled sacs that cushion areas of friction between tendon and bone or skin. Bursitis is the inflammation of one or more bursa.

  Tendinopathy - Any disease or dysfunction of a tendon. Refers to two conditions that can occur together: tendon inflammation, known as tendinitis, and tiny tears in the connective tissue in or around the tendon, known as tendinosis.

  Tendinitis – inflammation of a tendon. The white areas on each end of the muscle are its tendons, which connect muscle to bone. Considered to be a rare condition. [1]

  Tendinosis a more serious condition characterized by degeneration (not inflammation) of the collagen fibers in the tendon due to excessive wear and tear. More common, and more difficult to treat, than tendonitis.

Comparing Tendinosis To Tendinitis


Very Common


Very Rare

Takes longer to heal - months/years

Quick to heal - 14 days or less

Treated with therapeutic exercise

Aggravated by exercise

Irritated by NSAIDs

Helped by NSAIDs

Shows up black on an MRI (T1)

Shows up white on an MRI



Usually feels better after proper training

Hurts to move at all

Responds well to electric stimulation
and heat

Irritated by heat

Irritated by ice

Responds well to ice

  Impingement Syndrome - the diagnosis given for shoulder pain that is the result of tissues that get "pinched" or "impinged." This pinching occurs when the shoulder joint no longer stays centered in the socket as the arm is raised, as in the overhead throwing motion of a baseball or softball player. Can be caused by imbalances of strength and flexibility between various muscles in the shoulder.

    Medial epicondylitis – also known as pitcher’s elbow, golfer's elbow, and tennis elbow.  Caused by damage to the tendons that bend the wrist toward the palm (flexion). The most common symptom of ME is pain along the palm side of the forearm, from the elbow to the wrist, on the same side as the little finger.

  Can be caused by inflammation from too much repetitive activity, like throwing, or from a breakdown of tendon fibers known as tendonosis (see above).

  Pain vs. Soreness

            When is pain serious? When you can no longer perform your normal activity - like throwing - and/or the pain causes you to adjust from your normal mechanics to compensate for the pain.

          Post-activity pain, such as that which is ordinarily felt after training or competition, should dissipate within 24-48 hours. Pain persisting beyond this time should be referred to appropriate medical authority.  At this point, trying to "tough it out" can lead to more serious injury.

  Basic Recovery Regimen

          When arm problems occur, this is the course that will likely have to be followed:

1) Stop any activity causing pain. Recovery time will vary; can take weeks to months.

2) When pain is gone, begin appropriate strength and conditioning work to re-hab the structures involved.

3) After a minimum of 6-8 weeks of S & C work, begin activity (throwing) again.

          There are NO shortcuts through this process. It is better to err on the side of extra recovery time rather than rushing back prematurely and risking re-injury. The good news is that appropriate strength and conditioning can help ball players to both prevent as well as recover from most throwing injuries.



1.  Khan KM, Cook JL, Taunton JE, Bonar F. Overuse tendinosis, not tendonitis. The Physician & Sports Medicine 2000;28(5):38-48.

          *This report is not intended to diagnose or treat a medical condition.  It is presented for informational purposes only. If you are experiencing arm pain/problems, seek the advice of appropriate medical authority.

(C) 2007 Baseball Fit, LLC. All Rights Reserved. Short quotations with attribution permitted. Cite source as Steve Zawrotny's BASEBALL FIT  Hitting & Pitching Conditioning