What new research in young pitchers teaches us about all overhead athletes

Shoulder and elbow pain are some of the most common complaints we see in young athletes — not just in baseball, but in softball, volleyball, tennis, swimming, lacrosse, gymnastics, and even CrossFit-style training.

While these injuries are often blamed on the arm itself, emerging research tells a different story: Upper extremity injuries frequently originate from poor control of the core and hips.

A 2025 study published in the International Journal of Sports Physical Therapy examined high school baseball pitchers and found that athletes with poorer lumbopelvic-hip control placed significantly more stress on their shoulder during throwing — even when they were otherwise healthy and pain-free

The Kinetic Chain: Why the Arm Depends on the Body

Overhead sports rely on a concept called the kinetic chain — energy starts at the ground, moves through the legs and trunk, and finally reaches the arm.

When the core and hips are unstable:

• Energy leaks occur
• The shoulder has to generate more force on its own
• Joint stress increases
• Injury risk rises

This is true whether the athlete is throwing a baseball, serving a volleyball, swimming freestyle, or swinging a racquet.

What the Study Found

Researchers evaluated 60 high school pitchers using:

• A single-leg balance test to measure core/hip control
• 3D motion capture to assess joint stress during pitching

They found that:

• Poorer control on the drive leg was associated with higher shoulder loading
• The shoulder was forced to compensate for instability lower in the body
• These patterns appeared even in young, pain-free athletes

This suggests that injury risk may begin developing long before symptoms appear.

Why This Applies to All Upper Extremity Athletes

Although the study focused on baseball pitchers, the findings apply to any athlete who repeatedly uses their arm at high speeds or overhead, including:

• Volleyball players
• Softball players
• Tennis & pickleball athletes
• Swimmers
• Gymnasts
• CrossFit & fitness athletes
• Youth athletes in growth spurts

In all of these sports, poor core and hip control shifts load to the shoulder and elbow, increasing wear and tear over time.

Rethinking Arm Care

Traditional arm care programs focus heavily on:

• Bands
• Rotator cuff strengthening
• Stretching

While important, they are only part of the solution.

True injury prevention requires:

• Single-leg stability
• Core control in athletic positions
• Hip strength and coordination
• Integrated full-body movement training

This is where performance-based physical therapy makes a difference.

The Aureum Physio Approach

At Aureum Physio, we assess how the entire body works together, not just the painful area.

Our goal is to help athletes move more efficiently, reduce unnecessary joint stress, and build long-term resilience — not just get through a season, but thrive across many years of sport.