Shoulder Pain from Throwing? New Research Shows Which Exercises Actually Build a Stronger Shoulder
Written by Dr Julian Simpson — Chiropractor with 15+ years of experience, Board Member of the Chiropractic Australia Research Foundation, and author/reviewer of 800+ health articles.
Shoulder Pain from Throwing? New Research Shows Which Exercises Actually Build a Stronger Shoulder
Whether you're playing cricket in Sunbury, tennis in Melton, or simply throwing a footy with the kids, shoulder pain doesn't have to keep you on the sidelines.
If you've ever felt a sharp twinge when bowling, serving, pitching or even reaching overhead, you're certainly not alone.
Shoulder injuries are among the most common problems seen in overhead athletes—and they don't just affect professionals. Weekend cricketers, social tennis players, baseball players, handball athletes and active adults all place enormous demands on their shoulders every time they throw, serve or hit.
Here in Sunbury and Melton, we regularly help patients whose shoulder pain has developed after years of sport, repetitive work, or even long days driving between home and Melbourne along the Calder or Western Highway. Often, the pain isn't simply coming from the shoulder itself—it reflects how the entire body is moving together.
Exciting new research has taken a closer look at one of the world's most popular shoulder rehabilitation programmes and discovered which exercises genuinely strengthen the muscles that matter most—and where many rehabilitation programmes may be falling short.
Why Throwing Places So Much Stress on Your Shoulder
Throwing appears simple, but it's actually one of the most complex movements the human body performs.
Rather than relying solely on the shoulder, efficient throwing depends on the kinetic chain—a sequence of coordinated movements beginning at your feet before transferring force through:
The legs
The hips and pelvis
The core
The trunk
The shoulder blade
The shoulder
The arm
The wrist and hand
When one link in this chain isn't working efficiently, another part has to compensate.
Researchers call this the "catch-up phenomenon."
Instead of force being shared across the whole body, extra load is placed on the shoulder—greatly increasing the risk of injury.
The study highlighted just how widespread shoulder injuries are in overhead sports.
Researchers reported:
44–75% of elite handball players have experienced shoulder pain.
Around 68% say shoulder pain affects their training.
Shoulder injuries account for 25–47.7% of all tennis injuries.
Approximately 23% of English county cricketers develop shoulder injuries in their throwing arm.
In American college baseball, 16.1% of all injuries involve the shoulder, with 18.5% occurring during pitching.
These numbers reinforce one important message:
Healthy shoulders require far more than simply strengthening the rotator cuff.
What Did This New Study Investigate?
Researchers recruited 33 male overhead athletes, including baseball, cricket and handball players.
The group consisted of:
17 healthy athletes
16 athletes with previous shoulder injuries, including:
Rotator cuff problems
Shoulder instability
Each athlete completed exercises from the well-known Advanced Throwers Ten (ATT) rehabilitation programme.
Using sophisticated electromyography (EMG) equipment, researchers measured muscle activity across 16 different muscles, including:
Rotator cuff muscles
Trapezius muscles
Deltoids
Serratus anterior
Chest muscles
Latissimus dorsi
Core muscles
Hip muscles
Leg muscles
This allowed them to identify exactly which exercises produced enough muscle activation to build strength.
Which Exercises Worked Best?
The findings were surprisingly clear.
Only three exercises consistently produced strengthening-level muscle activity (greater than 40% of maximal voluntary contraction) in the muscles most responsible for shoulder stability.
These were:
✅ T-Raises
Excellent for activating:
Posterior deltoid
Infraspinatus
Lower trapezius
In injured athletes:
Posterior deltoid reached 40.1% MVC
Lower trapezius reached 43.1% MVC
Infraspinatus reached 42.7% MVC
✅ Y-Raises
This exercise produced some of the highest activation levels in the study.
Lower trapezius activation reached:
54.2% MVC in healthy athletes
58.4% MVC in injured athletes
The lower trapezius is essential for maintaining healthy shoulder blade movement during throwing and overhead activities.
✅ Prone Row into External Rotation
Another standout performer.
Researchers recorded:
Healthy athletes:
Lower trapezius: 41.8% MVC
Supraspinatus: 43.5% MVC
Injured athletes:
Lower trapezius: 44.2% MVC
Infraspinatus: 40.6% MVC
This exercise appears particularly valuable because it strengthens multiple stabilising muscles simultaneously.
Some Popular Shoulder Exercises Didn't Do What People Expected
Many rehabilitation programmes include exercises such as:
Wall circles
Standing low rows
Seated external rotation
Full can raises
Side-lying external rotation
While these exercises certainly have a place during rehabilitation, researchers found most only produced low to moderate muscle activation.
In other words:
They help with:
Movement control
Joint stability
Early rehabilitation
But they may not provide enough stimulus to significantly build strength in many of the muscles required for powerful overhead sport.
The Biggest Surprise: The Core Barely Worked
Perhaps the most unexpected finding involved the core.
Despite many exercises being performed on stability balls, activation of the:
abdominal muscles
gluteals
hamstrings
quadriceps
calf muscles
was generally below 11% of maximum muscle activity.
That's well below the level typically required to develop meaningful strength.
This matters because previous research has shown throwing athletes generate:
75–100% muscle activation through the abdominal muscles during throwing.
The rehabilitation exercises simply weren't challenging these muscles enough.
Why a Whole-Body Approach Works Best Successful shoulder rehabilitation isn't just about treating the painful shoulder. The latest research shows the shoulder performs best when the entire kinetic chain is functioning efficiently—from the feet and hips, through the core, into the shoulder blade and finally the arm. Combining targeted shoulder strengthening with spinal mobility, core conditioning, hip stability, movement retraining and hands-on care often provides a more complete pathway back to sport, work and everyday activities.
What About the Rotator Cuff?
The rotator cuff remains one of the most important muscle groups for shoulder health.
Its job is to:
Keep the shoulder centred in its socket
Control movement
Resist unwanted joint translation
Protect the shoulder during high-speed throwing
The study found exercises such as:
T-Raises
Y-Raises
Prone Row into External Rotation
were the best options for activating these important muscles.
For injured athletes, the infraspinatus consistently worked harder than in healthy athletes, suggesting the body recruits additional stabilising muscles after injury.
The Advanced Throwers Ten Programme
The study evaluated selected exercises from the Advanced Throwers Ten (ATT) rehabilitation programme.
The standard protocol includes:
10 primary exercises (with several variations)
3 sets of 10 repetitions
Gradual progression through bilateral and unilateral movements
Controlled movement using a metronome at 60 beats per minute
Light 1 kg dumbbells for shoulder exercises
Resistance tubing for rowing movements
Stability ball exercises to challenge balance and posture
Approximately 2 minutes of rest between exercises
Exercises assessed in the study included:
Seated Full Can
Seated Lateral Raise
Side-Lying External Rotation
T-Raises
Y-Raises
Prone Row into External Rotation
Seated External Rotation
Seated Extension into External Rotation
Seated Extension into 45° External Rotation
Standing Low Row
Wall Circles (clockwise and anti-clockwise)
The researchers concluded that while the programme is valuable for shoulder rehabilitation, additional core, hip and lower limb strengthening exercises should be included to better prepare athletes for returning to throwing sports.
What Does This Mean If You Have Shoulder Pain?
Whether you're:
Playing cricket on weekends
Serving in tennis
Throwing a baseball
Coaching junior sport
Working in a physically demanding job
Regularly lifting overhead
it's important to remember that shoulder pain rarely has a single cause.
Modern rehabilitation should assess:
Shoulder strength
Shoulder blade control
Neck and upper back mobility
Core strength
Hip stability
Overall movement patterns
Treating only the sore shoulder often misses the bigger picture.
How Chiropractic Care Can Help
At Health Wise Chiropractic, we assess how your entire body moves—not just where it hurts.
Your care may include:
Comprehensive movement assessment
Spinal and joint mobility evaluation
Chiropractic adjustments where clinically appropriate
Shoulder mobility assessment
Rotator cuff strengthening advice
Core stability exercises
Hip and pelvic mobility work
Individualised rehabilitation programmes
Return-to-sport guidance
Our goal is to help restore efficient movement throughout the entire kinetic chain, reducing unnecessary stress on the shoulder while helping you return to the activities you enjoy.
How Chiropractic Care May Help
At Health Wise Chiropractic, we take a comprehensive approach to posture-related care.
Treatment may include:
We focus on addressing both the symptoms and the underlying biomechanical stress contributing to neck dysfunction.
About the Author
Dr Julian Simpson is an Australian chiropractor with over 15 years of experience in musculoskeletal healthcare and rehabilitation.
He is a Board Member of the Chiropractic Australia Research Foundation and has reviewed and written more than 800 evidence-based health articles focused on spinal health, rehabilitation, sports injuries and conservative care approaches.
His treatment focus includes:
Chiropractic adjustments
Sports chiropractic
Massage therapy
Shockwave therapy
Laser therapy
Non-surgical spinal decompression
Dr Simpson provides patient care through Healthwise Chiropractic, serving communities including Sunbury, Melton, Diggers Rest and surrounding regions.
Reference
Owens LP, Coyles G, Khaiyat O. Whole Body Kinetic Chain Muscle Activity during selected Rehabilitation Exercises in Healthy and Injured Overhead Throwing Athletes. Int J Sports Phys Ther. 2026 Jun 1;21(6):531-544. doi: 10.26603/001c.162098. PMID: 42245754; PMCID: PMC13232157.
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