How Baseball Players Should be Training to Prevent Elbow Injuries

As a physical therapist who primarily works with baseball players, I see a ton of elbow injuries. Those injuries can range from mild soreness with pitching to needing Tommy John surgery. There are many reasons for elbow injuries increasing including: greater velo, more games, and pitching throughout the year, but I wanted to talk about modifiable factors from my perspective. I see so many physical therapists complaining about baseball players with too long of a schedule. I have coached high school baseball in Northern Virginia where our tryouts began at the end of February. Pitchers need to train before the season starts, so most are throwing in January at the latest. After the high school season, the summer season is important for getting noticed by colleges or at least playing high level competition. The fall may be a bit less strenuous, but there are still many showcases during this time. The fall season might end at the end of October or later depending on your individual schedule. There are no reasonable gaps in that timeframe if you are a high-level player who wants to make it to college. Physical therapists can rant and rave about baseball players doing too much, but the system is set up that way and one person is not going to change that.

Instead of complaining about factors out of an individual athlete’s control, I want to focus on what you can do to prevent elbow injuries. Getting stronger is something every athlete can do and it pays huge dividends regarding injury prevention. A prime example of this is the focus on shoulder strengthening in baseball players. Shoulder injuries used to be much more common in pitchers, but now they are much rarer. I believe that a lot of this is due to shoulder strengthening. There are a million shoulder programs for baseball pitchers online, but it is difficult to find exercises to strengthen the elbow. I am hoping to change that, so let’s talk about elbow injuries, their causes, and how to prevent them.

What Causes Elbow Injuries in Baseball Players?

Before you talk about how to treat elbow injuries in baseball players, it is important to discuss the causes of these injuries. There are two common mechanisms for injury in the elbow: acute trauma and fatigue. Acute trauma involves an injury from one movement. This could be a poor warmup where you throw with maximal effort before you are ready. This could also come from trying to throw a little harder on the mound and causing an injury. Regardless, these result from a lack of force absorption for a singular event. In other situations, poor control of fatigue and repetitive stress can result in an injury. This occurs when you have thrown a complete game and your elbow cannot handle the load of the 100th pitch. Many injuries are related to acute and chronic stress. An example might be a pitcher who has thrown 3 days in a row, causing a high baseline fatigue, who then goes on the mound and tries to throw at max effort without a proper warmup.

If the injury is clearly due to acute or chronic trauma, then I may tailor exercises to address the injury cause. More than likely, I will train the athlete to handle fatigue and spikes of stress to make them as well-rounded and resilient as possible. The key to preventing elbow injuries is to strengthen the muscles crossing the elbow joint. This includes the upper arm muscles (biceps and triceps) along with the forearm muscles. I will focus more on the forearm muscles because those are often neglected in my experience.

Exercises to Strengthen the Elbow in Baseball Players

First I want to focus on exercises to improve endurance of the muscles around the elbow. The simplest exercise that I give to patients involves squeezing a tennis ball. In recently injured clients, this is an easy way to increase volume of forearm strengthening in a simple way. 50 tennis ball squeezes a few times a day is a great way to begin strengthening the forearm with minimal stress or equipment.

Once exercises like ball squeezes become too easy, we need to add weight. Farmer’s carries are a great way to scale forearm strengthening. You can play around with weight, time spent walking, or even the fingers that you use to grip the weight. I often have my athletes avoid using their thumb during farmer’s carries due to the thumb muscles not crossing the elbow joint and also playing a minimal role in throwing. You are not typically stressing your thumb when pitching, so it can be helpful to force the other muscles to work harder by avoiding the thumb. Farmer’s carries are the easiest way to strengthen forearm endurance if you want to change the weight or time spent performing the exercise.

Finally, hangs are the most difficult but most beneficial way to build forearm strength. You can hang from a pull-up bar if you are able to handle it. You can also utilize a barbell that is secured on a rack to hang in different positions. This is a good entry point if you are not able to hang from a pull-up bar for more than a few seconds. Hangs are another great exercise due to many progressions including single arm, bar position, etc. but there is a high barrier of entry. If you cannot hang for more than a few seconds, then I would utilize farmer’s carries to progress to hangs.

Training for acute stress can be difficult to conceptualize until you realize that throwing a baseball is a plyometric movement in the same way as running. We train people to jump when working with runners because we know that helps with joint health and strength. With throwers, we act as if it is so different when it is actually very similar. The first exercise that I utilize with athletes is simply flipping the ball in the air. You can progress to heavier plyo balls to force yourself to handle more weight as you are stronger. The key is to practice flips at different speeds, but especially rapid flips to teach your body to quickly absorb stress and utilize it. Your elbow absorbs a ton of stress in the layback position, but it quickly needs to exert stress with throwing. Train in a way that mimics the stress on the mound by absorbing and generating force.

My next progression for training elbow power is biceps catches. This involves performing a biceps curl and dropping the weight from the top to catch it at the bottom. The weight goes up significantly from ball flips, but you are able to scale it based on the weight of your bar and if you wish to add weight. For a bonus: this movement really strengthens the biceps in addition to the forearm muscles which can help with elbow pain.

In a similar vein to the hangs, using your body weight for plyometric activity is typically the most difficult but the most rewarding. Inverted rows on a barbell allow you to play with letting go and catching yourself. Instead of the force coming from a ball or weight, it is coming from your entire body. There is a high barrier to entry, similar to hangs, but the results are great.

These are just some sample exercises that I use with clients. There are many other examples of forearm strengthening movements online that work just as well. Find something that works for you and you can gradually progress to continue getting stronger.

Recovery for the Elbow Muscles

I would be remiss to not mention the importance of recovery for muscle stress. Recovery takes many forms, but I want to focus on manual therapy. Stressed and strained muscles can lead to increased elbow pain and discomfort. If you are able to decrease the stress of the muscular tissue through scraping, cupping, trigger point dry needling, or massage, it is important to do so. You will recover faster which will decrease injury risk as well as allow you to increase your exercise intensity to allow for more strength. Do not wait until you are injured to seek out a recovery plan for your arm.

How to Prevent Elbow Injuries in Baseball Players

In summary, the most effective way to prevent elbow injuries is to make your surrounding muscles as strong as possible. You should take a look at your workload and try to make tweaks, but building stronger support for the elbow is the best idea in my opinion. Try and target endurance and plyometric training to make your muscles well-rounded. The best way to prevent elbow injuries is to do something preventatively, but especially if you are feeling any pain. You should not have pain with throwing and you need to see someone if you have any elbow pain with throwing. Once you have your workload and strength training in order, utilizing recovery tools including manual therapy can be huge. Allowing the muscles to rest and recover can lead to less pain and greater gains.

Give these exercise ideas a try. The off-season is a great time to make huge gains. Do not forget to strengthen the smaller muscles of your forearm that directly protect your elbow. Hopefully you found this helpful and please share it with someone if you did. If you are in the Sterling, Virginia area and interested in an assessment and individualized plan, please reach out!

Interested in hearing Dr. Danny discuss this topic in video form? Check out our YouTube video with full demonstrations of each exercise here!