Why Return-to-Throwing Programs Fails: 8 Common Mistakes in Baseball Rehabilitation
Kathy Ryan-Ceisel, PT MHS | Algonquin Sports PT
Overhead Throwing Expert-Athletic Edge and Wellness Edge
Returning to Throwing Is More Than Following a Timeline
Returning a baseball or softball athlete to throwing after an injury is much more complicated than simply following a calendar or protocol. An athlete may be pain-free, have full range of motion, and look strong in the clinic—but that does not necessarily mean the athlete is ready to tolerate the demands of throwing.
Throwing is a high-speed, highly coordinated movement that requires the entire body to work together. The legs, hips, pelvis, trunk, scapula, shoulder, elbow, wrist and hand all contribute to producing and transferring force. When one part of that system is not ready, another area may be forced to compensate.
This is why a successful return-to-throwing program should be more than a series of throws that gradually increase in distance and intensity. It should be a criteria-based progression that rebuilds strength, endurance, movement quality, workload tolerance, throwing mechanics and confidence.
The goal is not simply to get an athlete throwing again. The goal is to prepare the athlete to throw repeatedly, efficiently and confidently at the demands required by their position and level of competition.
So Why Do Return-To-Throwing Programs Fail?
Here are eight common gaps that can contribute to unsuccessful return-to-throwing.
1. Clearing Athletes Without Objective Readiness
One of the biggest problems in rehabilitation is relying on time-based progression instead of criteria-based progression.
Reaching a certain number of weeks after an injury or surgery does not automatically mean an athlete has regained the strength, endurance, mobility, motor control and workload capacity necessary for throwing.
An athlete can:
Look good in the clinic
Have minimal or no pain
Have full or near-full range of motion
Demonstrates acceptable isolated strength
Completes basic rehabilitation exercises
…BUT still lacks the capacity to tolerate repeated high-velocity throwing. This creates a mismatch between clinical readiness and sport-specific capacity.
A systematic review of UCL reconstruction rehabilitation found that 96.97% of studies used time after surgery as a return-to-sport criterion, but there was substantial variability in recommended timelines. The authors specifically called for more comprehensive functional and performance-based criteria.
What Should Be Assessed Before Throwing?
Depending on the athlete's diagnosis and stage of rehabilitation, readiness may include:
Strength
Muscular endurance
Range of motion
Joint stability
Scapular control
Trunk and pelvic control
Lower-extremity strength
Movement quality
Throwing mechanics
Workload tolerance
Fatigue response
Psychological readiness
Being pain-free is important—but pain-free is not the same as performance-ready. A better return-to-throwing process asks:
Does the athlete have the capacity to handle the next level of demand?
2. Inadequate Kinetic Chain Restoration
Return-to-throwing programs can become too focused on the injured arm.
But throwing is not an arm-only activity.
Force is generated and transferred through the entire kinetic chain:
Legs → hips → pelvis → trunk → scapula → shoulder → elbow → wrist → ball
If an athlete has inadequate lower-body strength, poor pelvic control, inefficient trunk rotation or impaired scapular mechanics, the arm may become the compensator.
The Clinical Failure Pattern
The shoulder or elbow feels good.
The athlete begins throwing.
Then symptoms return.
Sometimes the problem isn't simply that the injured tissue wasn't healed. The athlete may not have restored the movement system that supports throwing.
A comprehensive rehabilitation program should therefore address:
Pelvic control
Hip mobility and strength
Lower-extremity strength
Trunk control and rotation
Scapular mechanics
Shoulder mobility and strength
Arm acceleration and deceleration capacity
Muscular imbalance
The arm should not have to do the job of the entire body.
3. Poor Workload and Throwing Progression Design
Throwing is a form of high-speed loading.
How far an athlete throws matters.
How hard they throw matters.
How many throws they perform matters.
How often they throw matters.
And how much recovery they receive matters.
One common problem is relying too heavily on subjective intensity.
For example:
“Throw at 50%.”
The problem is that 50% effort is not necessarily 50% of the mechanical stress of a maximal throw. Research has consistently shown, perceived effort is not an accurate representation of forces at the shoulder and elbow.
Athletes may unintentionally throw harder than instructed—particularly when they feel good, become competitive, or begin trying to regain their previous velocity.
A better return-to-throwing program considers:
Throwing volume
Throwing distance
Throwing intensity
Throwing frequency
Recovery between sessions
Velocity factors when appropriate
Position-specific demands
Previous workload
Current workload tolerance
The goal is not simply to increase throwing.
The goal is to progressively increase the athlete's capacity to tolerate throwing.
4. Progressing Before Tissue and Neuromuscular Recovery
Fatigue is often underestimated during return to throwing.
An athlete may look excellent during the first portion of a throwing session and then demonstrate subtle changes as fatigue develops.
These changes may include:
Reduced velocity
Loss of command
Changes in arm slot
Altered trunk position
Poorer timing
Reduced lower-body contribution
Increased reliance on the shoulder or elbow
Changes in throwing mechanics
Throwing fatigue can affect movement quality, coordination and the athlete's ability to consistently control the throwing motion. This is why rehabilitation should develop capacity and workload tolerance—not just peak strength.
The athlete needs to be prepared for what happens:
Late in a practice
Late in a bullpen
Late in a game
During a high-volume throwing week
During high stress situations
When recovery time is limited
A strong athlete is not necessarily an capacity-ready athlete.
5. Using the Same Return-to-Throwing Protocol for Every Athlete
There is no single return-to-throwing program that is appropriate for every athlete.
✔️Diagnosis matters.
✔️Surgical procedure matters.
✔️Age matters.
✔️Position matters.
✔️Level of competition matters.
✔️Previous workload matters.
✔️And the athlete's response to throwing matters.
A youth infielder returning from an growth plate injury should not necessarily follow the same progression as a college pitcher returning from UCL reconstruction.
Likewise, a catcher may have different throwing demands than an outfielder.
Position-Specific Throwing Matters
A return-to-throwing program should eventually reflect the demands of the athlete's position.
A position player may need to progress toward:
Routine positional throws
Throwing across the diamond
Throws from different body positions and arm slots
Long-distance throws
Increased throwing frequency
Game-speed throws
A pitcher has additional demands.
Pitchers must eventually progress toward:
Flat-ground throwing
Mound progression
Bullpens
Increasing pitch volume
Increasing pitch intensity
Different pitch types
Pitch sequencing
Game-like situations
Competitive innings
Long toss when appropriate
A pitcher isn't ready simply because they can throw from the mound.
They must progressively demonstrate the ability to tolerate the volume, intensity, recovery demands and performance requirements of pitching.
There is research showing meaningful differences in return-to-play outcomes between pitchers and position players, and even between different position players. For example, professional catchers have demonstrated lower return-to-play rates than infielders and outfielders following UCL reconstruction.
6. Ignoring Throwing Mechanics During Rehabilitation
Throwing is not simply conditioning. It is a highly skilled movement performed under significant force and speed. An athlete can complete every prescribed throw while developing mechanical compensations that increase stress on the recovering tissues. Identifying factors in the throwing and pitching that may have contributed to the athlete's initial pain and symptoms is crucial. Failing to address these factors can lead to the recurrence of symptoms.
Mechanical factors that may need to be monitored include:
Foot and lower-body position
Pelvic control
Trunk rotation
Hip-shoulder separation
Scapular movement
Arm slot
Timing
Front-side control
Follow-through
Mechanical problems that appear at low intensity may become more significant as throwing intensity and as fatigue increase. This is why mechanics should not only be evaluated when the athlete is fresh.
Can the athlete maintain efficient mechanics as workload increases?
That is a much more important question. Early identification of mechanical problems also provides an opportunity to address them before the athlete reaches higher throwing intensities.
An Overhead Video Assessment is highly advised by a qualified pitching coach to identify disconnects in throwing.
7. Poor Communication Across the Performance Team
Return to throwing is rarely successful when everyone is working from a different plan. The athlete may have:
An orthopedic surgeon
A physical therapist
An athletic trainer
A strength and conditioning coach
A pitching coach
A head coach
A parent or guardian
Everyone involved needs to understand the current restrictions, progression and warning signs.
For example:
A physical therapist may clear an athlete for a controlled throwing progression while a coach unknowingly increases throwing volume or intensity much faster than intended.
The athlete may also feel good and decide to throw more than prescribed.
That is not simply a rehabilitation problem.
It is a communication problem.
Everyone Should Know:
What can the athlete do?
How much can they do?
How hard can they do it?
When can they progress?
What symptoms should stop progression?
A successful return-to-throwing program requires communication between the athlete, family, medical team and coaching staff.
8. Return to Play Does Not Equal Return to Performance
Perhaps the biggest blind spot in rehabilitation is defining success as simply getting the athlete back onto the field.
Return to play ≠ return to performance.
An athlete may technically return to competition but still have:
Reduced velocity
Poor command
Decreased endurance
Reduced throwing volume tolerance
Altered mechanics
Loss of confidence
Fear of reinjury
Increased fatigue
This is especially important for pitchers. A pitcher who can complete an inning is not necessarily ready to pitch a full game. A position player who can make several throws is not necessarily ready for the volume and intensity of a complete game.
The goal of rehabilitation should extend beyond:
“Can you play?”
The better question is:
“Can you repeatedly tolerate the demands of your position at the level required for performance?”
That is the difference between return to play and return to performance.
What Actually Causes Return-to-Throwing Failure?
A recurring theme in the return-to-throwing literature is the need to match an athlete's developing capacity with the demands of throwing.
1. Capacity vs. Demand
An athlete may have enough strength for an isolated exercise but not enough endurance for repeated throwing.
2. Objective vs. Subjective Progression
“Throw at 50%” can mean something very different to an athlete than it does to a clinician or to a pitching coach.
3. Local vs. Global Rehabilitation
The shoulder or elbow may be ready, but the remainder of the kinetic chain may not be.
4. Clearance vs. Readiness
Being medically cleared does not automatically mean an athlete is prepared for unrestricted competition. Throwing a medicine ball into a trampoline 20x does not clear an athlete for throwing.
5. Rehabilitation vs. Performance
Returning to the field is one milestone.
Returning to previous—or required—performance is another.
A 2026 MLB position-player study found that although more than 80% returned to play by 1.5 years, players demonstrated declines in some performance/value measures even after returning to play.
What Should a Better Return-to-Throwing Program Include?
A comprehensive return-to-throwing program should progressively rebuild the athlete's ability to tolerate the demands of throwing. That includes more than simply increasing distance.
A complete progression should consider:
💪Mobility
Does the athlete have the mobility required to efficiently perform the throwing motion? This is not just at the shoulder, but the spine, hips, and ankles.
💪Strength
Can the athlete generate and absorb the forces required for throwing?
💪Endurance
Can the athlete maintain strength and movement quality over repeated throws?
💪Movement Quality
Can the athlete efficiently use the entire kinetic chain? How does the athlete squat and lunge?
💪Throwing Mechanics
Can the athlete maintain efficient mechanics as distance, intensity and fatigue increase? Are there disconnects in throwing mechanics that may contribute to pain and poor performance.
💪Workload
Can the athlete tolerate increasing throwing volume and frequency?
💪Intensity
Can the athlete progressively tolerate higher throwing speeds and game-like effort?
💪Recovery
Can the athlete recover appropriately between throwing sessions?
💪Confidence
Is the athlete mentally ready to throw without fear or hesitation?
💪Sport-Specific Demand
Does the progression eventually reproduce what the athlete will actually be required to do in competition?
The Return-to-Throwing Progression
A return-to-throwing program should generally progress from controlled, lower-demand throwing toward the specific demands of the athlete's sport and position. However, there is no universal distance, number of throws, or intensity that applies to every diagnosis. The athlete's physician and rehabilitation team should determine the appropriate progression.
Phase 1: Reintroduce Throwing
Early throwing is typically focused on:
Appropriate distance
Controlled volume
Comfortable effort
Consistent mechanics
Monitoring symptoms during and after throwing
The objective is to reintroduce throwing without exceeding the athlete's current capacity.
Phase 2: Progress Distance
As the athlete demonstrates an appropriate response, throwing distance can gradually increase. This may eventually lead toward longer-distance throwing or long toss, when appropriate for the athlete and diagnosis.
Long toss should not automatically be considered the next step for every athlete.
The question should be: Has the athlete demonstrated enough strength, endurance, mobility, control and tolerance to handle the additional demand?
The appropriate timing depends on the athlete's injury, age, position, throwing history and medical restrictions. Long toss requires different mechanical stress on the arm.
Phase 3: Progress Intensity
Distance and intensity are separate variables.
An athlete may be able to throw farther without being ready to throw harder.
Likewise, an athlete may be able to throw at higher intensity at a short distance before being ready for high-intensity long-distance throwing.
Progression should therefore consider both:
How far? and How hard?
Subjective effort can be useful, but objective measures such as throwing velocity with radar guided tools can provide additional information when available and appropriate.
Phase 4: Position-Specific Throwing
The athlete now begins moving toward the demands of their actual position.
This may include:
Throws from different field positions
Throws on the run
Throws from different arm slots
Increased throwing frequency
Game-speed throws
Position-specific distances
The objective is to bridge the gap between rehabilitation throwing and actual baseball or softball.
Phase 5: Pitcher Progression
Pitchers require another layer of progression.
A pitcher may progress through:
Flat ground → increased distance/intensity → mound work → bullpen → increased pitch volume → increased intensity → game-like situations → competitive innings
Pitchers may also need gradual exposure to:
Fastballs
Breaking pitches
Changeups
Pitch sequencing
Higher velocity
Increased pitch counts
Shorter recovery intervals
Multiple innings
The exact progression should be individualized based on the diagnosis, surgery, physician recommendations, age, previous workload and current tolerance.
Returning to the mound is not the same as returning to pitching performance.
Soreness and Symptom Monitoring
Some athletes may experience mild muscular soreness as they progress through a return-to-throwing program. However, symptoms should always be interpreted within the context of the athlete's specific diagnosis and medical restrictions.
A progression may be appropriate when:
Symptoms remain minimal and stable
Symptoms return to baseline within an appropriate recovery period
No swelling develops
Expected range of motion is maintained
Throwing performance remains consistent
Velocity and command do not meaningfully deteriorate
Mechanics remain controlled
Consider repeating or modifying the previous step when:
Symptoms increase
Soreness persists longer than expected
New stiffness develops
Throwing performance changes
Mechanics begin to deteriorate
Recovery between sessions becomes more difficult
Stop throwing and communicate with the medical team if:
Sharp or increasing pain develops
Significant pain occurs
Swelling develops
Range of motion decreases
Numbness or tingling develops
There is a significant or unexplained drop in velocity
Command suddenly deteriorates
Throwing mechanics substantially change
These are general monitoring principles and are not a substitute for the athlete's physician-specific or surgery-specific return-to-throwing instructions.
Return to Throwing Should Be a Process—Not a Date
A successful return to throwing is not about checking a box on a calendar.
It is about determining whether the athlete has developed the capacity to meet the demands of throwing. The athlete needs to be ready for more than the first few throws.
They need to be ready for:
Distance.
Intensity.
Volume.
Fatigue.
Position-specific demands.
Game-speed performance.
Ready to Return to Throwing?
Whether your baseball or softball athlete is returning from surgery, recovering from an arm injury, or struggling to regain velocity, command, endurance or throwing confidence, a comprehensive evaluation can help identify the factors limiting their return to performance.
At Athletic Edge and Wellness, our goal is not simply to get athletes back on the field but get back to high level performance. We look beyond the injured joint to evaluate the athlete as a complete movement system. Strength, mobility, kinetic-chain function, movement quality, throwing mechanics, workload and sport-specific demands all play a role in preparing a baseball or softball athlete to return safely and performing at their best.
Schedule a comprehensive evaluation with Athletic Edge and Wellness and develop a return-to-throwing strategy based on the athlete—not just the calendar. Call us today at 224-505-3343.
Research & References
Da Silva AZ, Connelly JW, Chalmers PN. Return to Play Throwing Programs. Clinics in Sports Medicine. 2025;44(2):273-289.
Wilk KE, et al. Rehabilitation and Return to Sport Criteria Following Ulnar Collateral Ligament Reconstruction: A Systematic Review.
Hones KM, et al. Variable Return to Play and Sport Performance After Elbow Ulnar Collateral Ligament Reconstruction in Baseball Players: A Systematic Review. Arthroscopy. 2024.
Mastroianni MA, et al. Return to Performance After Ulnar Collateral Ligament Surgery in Major League Baseball Pitchers. American Journal of Sports Medicine. 2025.
Factors that Increase Elbow Stress in the Throwing Athlete: A Systematic Review of Biomechanical and Motion Analysis Studies of Baseball Pitching and Throwing.
Following Ulnar Collateral Ligament Reconstruction, Professional Baseball Position Players Return to Play Faster Than Pitchers, But Catchers Return Less Frequently.
Return-to-Play and Competitive Outcomes After Ulnar Collateral Ligament Reconstruction Among Baseball Players: A Systematic Review.
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