What should I do if my son tells me his arm hurts after he throws?
Stop him from throwing that day. Then check for signs that require a physician immediately: a pop during a throw, numbness or tingling, visible swelling, or loss of motion. If none are present, identify where the pain is, whether it happens during or after the throw, and how long it lasts before deciding anything else.
Step one: stop throwing today
Not for two weeks. Not for the season. Today.
The purpose is not rest for its own sake. It is to stop adding to the problem while you find out what it is. A young thrower who keeps throwing on a painful arm is doing the one thing most strongly associated with the injury that follows, and he is also making the arm harder to read.
Take him out and tell him he did the right thing by telling you. That second part matters more than it sounds. If reporting pain reliably produces a shutdown and visible worry, he learns to stop reporting, and the next thing you hear about will be worse.
Step two: check for the signs that need a doctor now
- A pop, snap, or sudden sharp pain during a throw
- Numbness or tingling in the hand or fingers
- Visible swelling, redness, or heat around the joint
- Loss of the ability to fully straighten or bend the elbow
- Pain that persists beyond several days of complete rest
- Any of the above in an athlete who is still growing, because growth plate injuries require imaging that no coach or physical therapist can substitute for
A still-growing athlete's elbow and shoulder contain open growth plates. An injury that presents like a ligament problem may be a growth plate problem, and the two are managed very differently. That determination requires a physician and imaging, not a judgment call from the stands.
Step three: read the pain
If none of those signs are present, three questions tell you most of what you need to know.
Where is it? Have him point with one finger, not a wave at the whole arm. Discomfort in the belly of a muscle behaves differently from discomfort at a specific joint line. Pain on the inside of the elbow, right at the point of the bone, or at a discrete spot in the shoulder, points toward structures rather than tissue that has simply been worked.
When does it happen? During the throw, or after? Pain during the throw itself is the more concerning report, because it means a structure is being loaded in the moment rather than tissue recovering afterward.
How long does it last? Ordinary post-throwing soreness appears the next day and is gone within about 48 hours. Discomfort still present at 72 hours has moved out of that category, whatever anyone is calling it.
Then have him rate it from zero to ten, where zero is nothing and ten is completely debilitating. Write the number down. A rating recorded after each outing gives you a trend, and a trend is what actually reveals a developing problem. A yes or no never will.
One caution about the word soreness. It is where problems go to hide. The moment an athlete has permission to file something under just sore, he stops mentioning it, and he is motivated to file it there because sore is acceptable and pain gets you taken out. In our practice, any sensation other than normal is called pain. Use the three questions to decide what to do. Do not use the word soreness to decide whether to pay attention.
What not to do
Do not change his mechanics on your own. This is the most common well-intentioned mistake a parent makes. Altering a delivery without knowing which contributor you are addressing usually adds a problem rather than removing one.
Do not reflexively bucket the arm in ice. The belief that post-throwing soreness comes from lactic acid does not hold up. Studies dating to 1992 and repeated in 2004 found no increase in blood lactate after seven innings of pitching, and the hallmarks of acute inflammation, severe pain, redness, swelling and heat, are rarely present after a normal outing. What is actually happening is microtrauma, microscopic disruption in the fibers of muscle, tendon and ligament, and it repairs through blood flow. Ice restricts blood flow. Dr. Gabe Mirkin, who introduced the RICE protocol in 1978, has since said publicly that both ice and complete rest may delay healing rather than help it. Acute injury with real swelling or trauma is a different situation, managed under your physician's direction.
Do not let him talk you out of it. Listen for the substitute words: tight, weak, dead, fatigued, sore, heavy. Treat all of them as the same report.
Do not let him pitch again to finish a game or a tournament. Of everything on this page, this carries the strongest evidence behind it.
Why rest alone usually isn't the answer
Most families do the reasonable thing. They rest the arm for two or three weeks, the pain goes away, and everyone moves on. Then it comes back, often in the same place, sometimes worse.
Rest works on the symptom. It does nothing to the contributors that produced it.
Arm pain in a young thrower rarely has one cause. It usually reflects several things stacking together: physical restrictions, an inefficient movement pattern, inadequate preparation or recovery, training errors, a workload spike, and poor sleep or nutrition. Rest removes the load for a while. It does not restore hip rotation, change a movement pattern, or fix a schedule where two coaches each see half of his throwing.
So rest him, get him evaluated, and then find out which contributors are actually driving it. That is the difference between the pain going away and the pain staying away.
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