Movement Medicine

Return-to-Throwing Checklist

Eric Nichols
May 08, 2025By Eric Nichols


Our Systematic Approach for all Overhead Athletes Recovering from Shoulder or Elbow Injuries

Our goal is to provide a simplified and direct approach to return to throwing. This systematic approach ensures all variables are accounted for to ensure elite results. 

This checklist is intended to help clinicians, coaches, and athletes determine when a player is ready to begin a structured interval throwing program following rehab from any upper extremity throwing injury (e.g., SLAP tear, UCL sprain, posterior impingement, rotator cuff strain, flexor mass strain, etc.).

Step 1: Clinical Clearance 

  • Injury-specific pain-free range of motion (active and passive)
  • No pain with palpation of affected structures (labrum, UCL, flexor mass, etc.)
  • No clicking, locking, or instability reported by athlete
  • Symmetrical Shoulder total arch of motion (with a goal of 150-160 degrees)
  • Shoulder Flexion PROM of greater than 150 degrees 
  • Shoulder Horizontal Adduction of greater than 20 degrees 
  • Thoracic Spine Rotation of greater than or equal to 60 degrees 
  • Negative or normalized provocative orthopedic tests (e.g., O’Brien’s, valgus stress, posterior impingement)
  • No night pain or post-activity soreness that lasts >24 hours
  • Physician or rehab provider has cleared return to throwing

Step 2: Strength & Stability

  • Greater than or euqal to non-domanate isometric strength scores
    • Tested with out force plate technology:  
      • Shoulder Flexion 
      • Shoulder Abduction 
      • Shoulder I, Y, and T tests 
      • Shoulder Internal Rotation 
      • Shoulder External Rotation 
      • Bicep and Tricep 
      • Pronation/Supination 
      • Wrist Flexion/Extension
      • Grip strength 
  • Normal Scapular-Humeral Mechanics and Neuromusular Controll
  • Normal Glenohumeral and Scapulothoracic Stability 

Step 3: Kinetic Chain Readiness

  • Functional hip and thoracic spine mobility 
  • Single leg balance within 90% of opposite side 
    • Objectively measured on our motion capture and force plates 
  • Motion Capture Functional Movements all within normal values 
    • Squat 
    • Single Leg Squat 
    • Lunge 
    • Single Leg Balance 

Step 4: Plyometric and Movement Preparation

  • Complete a progressive plyometric drill program 
    • Double arm medicine ball throws
    • Single arm mechcine ball throws
      • Visit our youtube channel for examples 

Step 5: Throwing-Specific Readiness

  • Mentally confident and motivated to begin throwing
  • Understands and agrees to interval throwing progression and soreness rules
  • Completed education on:
    • Arm care
      • Pre-throw routine  
      • Recovery strategies
      • Pain monitoring
  • Athlete can demonstrate:
  • Proper throwing mechanics at submaximal effort
  • Trunk and scapular sequencing in dry throws or shadow drills
  • No fatigue, loss of control, or “dead arm” during mock or light-velocity drills

Additional Benchmarks we regularly assess to determine readiness 

  • Shoulder ER/IR ratio: >66% on dynometer testing 
  • Core rotational strength 
  • SL squat mechanics/form 
  • Hip ER > 40 degrees 
  • Hip IR > 30 degrees 

Final Notes

  • Use daily readiness logs or soreness monitoring to guide progression.
  • Athletes must remain symptom-free during and 24 hours after each session.
  • If pain, loss of mechanics, or fatigue occurs—pause, regress, and reassess.
  • A supervised interval throwing program is strongly recommended.