By: Dr. Nick Whittaker

Tommy John injuries have become increasingly common in baseball over the last decade. What was once viewed as a career-altering injury seen mostly in professional pitchers is now affecting athletes at younger ages and across every position on the field.

While pitchers are still at the highest risk, catchers, infielders, outfielders, and other overhead athletes can all develop elbow injuries from repetitive throwing stress.

The good news is that many Tommy John injuries are preventable.

Most elbow injuries don’t happen because of one single throw. They develop over time due to a combination of high throwing volume, poor movement mechanics, mobility restrictions, strength deficits, and inadequate recovery. That’s why prevention strategies need to focus on the entire body, not just the arm itself.

What Leads to Tommy John Injuries?

The ulnar collateral ligament (UCL), located on the inside of the elbow, experiences significant stress during throwing, especially during the acceleration phase of pitching.

Several factors can increase stress on the elbow and raise the risk of injury:

-Repetitive Valgus Stress on the Elbow

Every throw places valgus stress across the inside of the elbow. Over time, repeated high-velocity throwing without proper recovery can overload the ligament and surrounding tissues.

-Poor Shoulder and Scapular Control

The shoulder blade (scapula) plays a major role in force transfer during throwing. If the scapular muscles are weak or poorly coordinated, the elbow often absorbs more stress than it should.

-Limited Thoracic Mobility

A stiff upper back limits rotational movement and forces the shoulder and elbow to compensate during throwing mechanics.

-High Throwing Volume Without Recovery

Year-round throwing, excessive pitch counts, inadequate sleep, and poor recovery strategies all contribute to tissue overload and increased injury risk.

Common Mistakes Baseball Players Make

-Only Focusing on the Arm

Many players think elbow pain is strictly an arm issue. In reality, throwing is a full-body movement that relies on efficient force transfer from the ground up.

-Ignoring Total Body Strength

Lower body and core strength are critical for generating power and reducing stress on the arm. Weak hips, poor trunk control, and limited leg drive can increase elbow load.

-Skipping Recovery Work

Mobility work, soft tissue care, sleep, hydration, and proper workload management are essential components of staying healthy during a season.

-Throwing Year-Round Without Breaks

More isn’t always better. Without periods of rest and structured progression, tissues lose their ability to recover and adapt.

5 Key Exercises for Tommy John Injury Prevention

1. Scapular Stability Work

Strong and coordinated scapular muscles help position the shoulder correctly during throwing and improve force transfer through the kinetic chain.

Examples:

Wall slides

Rows/pulling exercises

Serratus punches

A-T-Y exercises

Focus on quality movement and control rather than heavy resistance.

2. Rotator Cuff Strengthening

The rotator cuff helps stabilize the shoulder during high-speed throwing motions. Weakness or fatigue in these muscles can increase stress on the elbow.

Examples:

Side-lying external rotations

90/90 external/internal rotation

Scaption

Body blade

Rhythmic stabilization drills

The goal is endurance and control, not maximal loading. Think of light weight, high reps.

3. Thoracic Mobility Drills

The thoracic spine needs adequate rotation and extension to allow efficient throwing mechanics.

Examples:

Open books

Quadruped thoracic rotations

Foam roller extensions

Thread-the-needle

Improving thoracic mobility can reduce compensatory stress on the shoulder and elbow.

4. Lower Body Strength Training

The legs and hips generate much of the force used during pitching and throwing. If lower body strength is lacking, the arm often works harder to create velocity.

Examples:

Front or back squats

Deadlifts

Lunge variations

Single-leg RDLs

Developing lower body strength improves power production while reducing unnecessary stress on the arm.

5. Core Rotational Control

Efficient energy transfer through the trunk is critical for throwing performance and injury prevention.

Examples:

Pallof presses

Medicine ball rotational throws

Cable chops/lifts

Dead bugs

A strong, coordinated core improves control and reduces energy leaks throughout the throwing motion.

How to Build an Injury Prevention Plan

Step 1: Find Underlying Issues

Every athlete is different. A proper assessment should evaluate:

Shoulder mobility

Scapular control

Thoracic mobility

Hip strength and stability

Core control

Throwing mechanics

Training and recovery habits

Identifying the true weak link is the first step toward reducing injury risk.

Step 2: Fix the Problem

Once deficits are identified, training should target the areas that place excessive stress on the elbow.

This may include:

Improving mobility restrictions

Building strength and endurance

Cleaning up movement patterns

Managing throwing workload

Optimizing recovery strategies

The goal is to improve the entire kinetic chain—not just treat symptoms.

Step 3: Perform and Prevent

An effective prevention program should integrate seamlessly into a player’s throwing schedule and strength training routine.

Consistency matters more than intensity. Small improvements performed regularly over time can dramatically reduce injury risk and improve long-term performance.

Summary

Tommy John injuries are often the result of accumulated stress and poor movement efficiency—not just bad luck.

Prevention requires more than basic arm care exercises. Baseball players need:

Total body strength

Good mobility

Efficient mechanics

Proper recovery

Structured workload management

When athletes build resilient movement patterns and stay consistent with training, they significantly reduce their risk of injury while improving performance on the field.

How to Find a Baseball Physical Therapist in the Portland, Maine area for Baseball Injury and Tommy John Prevention

Not all rehab or training programs are designed specifically for baseball athletes.

When looking for a sports physical therapist, find someone who understands:

Overhead athletes and throwing demands

Baseball-specific movement patterns

Strength and conditioning principles

Return-to-throwing progressions

Performance-based programming

Collaboration between the athlete, therapist, coaches, and strength staff is often the best approach for keeping players healthy and performing at a high level.

At Infinite Capacity Physical Therapy we help baseball players improve strength, mobility, throwing capacity, and overall durability through individualized performance and injury prevention programs.

Whether you’re a pitcher, position player, or parent looking to keep your athlete healthy, we can help build a plan designed to keep you on the field. Schedule a FREE Discovery Call to start the process!

Click Here to Book Your Free Discovery Call