Anterior Shoulder Impingement in Baseball Pitchers: Understanding the “Front of Shoulder Pinch”

Shoulder pain in baseball pitchers/throwers often brings one diagnosis to mind: impingement. While most people think of the common posterior/internal impingement, anterior impingement is another frustrating and often overlooked condition—especially in throwers experiencing pain during early to late cocking or acceleration phases of the throw.

Let’s break down what anterior shoulder impingement is, how to identify it, and the best steps toward getting back to pain-free throwing.

What Is Anterior Shoulder Impingement?

Anterior impingement syndrome in throwers refers to pinching or compression of soft tissues (most commonly the biceps tendon or subscapularis) between the humeral head and anterior-superior glenoid or acromion.

This often happens due to:

• Poor humeral head control
• Capsular tightness (especially posterior/the back)
• Over-dominant anterior musculature
• Weakness in the scapular stabilizers and rotator cuff
  In pitchers, it often shows up during:
• Late cocking phase (when max external rotation is reached)
• Early acceleration (as the arm drives forward)
• Ball release/Follow-through 

Common Symptoms

• Deep, localized pain in the front of the shoulder
• Sharp or pinching sensation during the throw (esp. arm-cock or follow-through)
• Pain with horizontal adduction or internal rotation (arm accross body)
• Soreness with push-up or bench press movements
• Decreased velocity or throwing accuracy
• Pain with biceps loading or resisted flexion

Contributing Factors in Pitchers

• Posterior capsule tightness: Forces humeral head forward during cocking phase
• Poor scapular control: Limits upward rotation and posterior tilt
• Biceps overuse: Compensation for rotator cuff or scapular weakness
• Overhead volume: High workloads lead to anterior shoulder overload
• GIRD (Glenohumeral IR Deficit): Alters throwing mechanics and increases anterior stress
  

How we diagnose

• Clinical exam: Pain with Neer’s, Hawkins-Kennedy, Yocum, and Speed’s test
• Palpation over biceps groove or anterior joint line
• Pain with resisted shoulder flexion and horizontal adduction
• MRI (in severe cases) may show biceps tendinopathy, subscap strain, or labral fraying
  

Evidence-Based Rehab & Treatment Plan

Phase 1: Calm Down the Irritation

• Reduce throwing volume or pause completely
• Manual therapy to posterior shoulder (sleeper stretches, soft tissue release)
• Address scapular positioning (manual retraction assist, wall slides)
• Laser therapy over anterior capsule and biceps
• Pain-free isometrics and light resistance for rotator cuff and scapular stabilizers
  

Phase 2: Build Strength & Mobility

• Restore posterior shoulder mobility (sleeper stretch, cross-body stretch)
• Strengthen lower trap, serratus, rotator cuff
  • Side-lying ER, prone Y’s, wall slides, IR strength
• Rhythmic stabilization drills: rhythmic ball taps, body blade
• Begin eccentric biceps control: tempo curls, eccentric forearm pronation

Phase 3: Dynamic Control & Plyo Prep

• Integrate med ball throws (2-hand → 1-hand → diagonals)
• Thrower-specific drills: reverse throws, step-backs, recoil decel
• Address deceleration mechanics + scapular control under speed

Phase 4: Return to Throwing

• Begin interval throwing program once:
• Pain-free with full ROM
• Scapular and rotator cuff control under load
• Tolerates eccentrics and plyos
• Monitor arm soreness 24–48 hours post-throwing
  

Return to Sport Timeline

• Mild
  • Return to throwing: 2-3 weeks
  • Return to prior level of performance: 4-6 weeks
• Moderate 
  • Return to throwing: 3-5 weeks
  • Return to prior level of performance: 6-8 weeks
• Severe (Labral involvement)
  • Return to throwing: 6-8 weeks
  • Return to prior level of performance: 8-12+ weeks

Prevention Tips for Pitchers

• Maintain posterior shoulder mobility (GIRD prevention)
• Integrate posterior chain & scapular strength into arm care
• Limit push-up and bench press volume during heavy throw periods
• Monitor throwing loads and build gradually (ACWR 0.8–1.3)
• Prioritize deceleration drills and eccentric training

Final Thoughts

Anterior shoulder impingement in throwers often flies under the radar but can have a major impact on velocity, confidence, and overall shoulder health. With a well-structured program addressing scapular mechanics, cuff strength, and throwing control, most athletes make a full return — and come back more durable than ever.

References
Wilk KE et al. (2015). Rehabilitation of the Overhead Throwing Athlete.
Kibler WB et al. (2008). Scapular dysfunction in overhead athletes. Sports Med.
Laudner K et al. (2006). Posterior shoulder tightness in throwers. J Athl Train.
Reinold MM et al. (2008). Shoulder adaptations in the overhead athlete.
Shanley E, et al. (2011). Biomechanical mechanisms of shoulder injuries in throwers.