How to Avoid Tommy John Surgery Part III: 5 Necessary Exercises to Avoid Injury

Now that you know the risk factors and improper pitching mechanics that can lead to excessive valgus stress at the elbow, you are probably wondering what exercises you can do to strengthen the elbow to combat this stress.

If you remember back to part I of this blog, we talked about the tensile strength of the medial ulnar collateral ligament and how it can withstand approximately 33 Nm of force, but professional pitchers often generate upwards of 64 Nm of valgus torque. This means that muscles and other soft tissue structures around the elbow need to make up the difference in force generation to prevent ligament injury. There are many exercise programs designed for pitchers, including the “throwers ten” and “ballistic six”, but we will cover the five necessary exercises that are specific for providing stability against valgus forces at the elbow.

                According to Werner et al., the muscles that help support the elbow during valgus forces include the wrist flexors/pronators, triceps, and anconeus. However, other muscles that can help reduce stress at the elbow indirectly include the scapular stabilizers, rotator cuff muscles, and biceps to prevent elbow extension during the throwing motion. All of these muscles are strengthened using the following five exercises:

  1. Wrist flexor roll-ups
  2. Wrist pronation/supination
  3. Bicep curls
  4. External/internal rotation at 90/90
  5. Prone W to Y’s

#1. Wrist Flexor Roll-Ups

Wrist flexor roll-ups require a weight (3-8 lbs) be tied onto the center of a dowel. Pitchers should stand with arms straight out in front of them and palms facing up while they grab the dowel with the weight hanging below. Quickly take turns flexing each wrist so that the string rolls around the dowel until the weight is brought up to arm height, slowly lower the weight rolling the dowel in the opposite direction, and repeat for 3 sets x 15 reps.

#2. Wrist Pronation/Supination

For wrist pronation/supination exercise, the pitcher should be standing or sitting with forearm supported and holding onto a short dowel with 3-5 lbs tied to the end. Slowly rotate the forearm so that the palm goes from facing up to facing down and then return to the starting position. The key is to move slowly and keep the shoulder and arm stable while only the forearm rotates for 3 sets x 15 reps.

#3. Bicep Curls

Bicep curls are a very familiar exercise for most athletes and gym goers, but to make this exercise more specific for baseball pitchers, it should be modified and performed in a pitching position. Pitchers should get into a throwing position with shoulder and arm in the 90/90 position. Using an appropriate weight, slowly extend the elbow until it is straight and then return to the starting position, while ensuring the shoulder stays stable by pulling them back and down. Perform 3 sets x 15 sets.

#4. External/Internal Rotation

External/internal rotations with bands or weights are one of the most common exercises that baseball pitchers are given to strengthen the rotator cuff muscles, but many times they are performed with elbow down at the side. In order to make this exercise more effective and pitching specific, they should be performed with shoulder abducted and elbow flexed to 90 degrees like a pitching position. Pitchers should stand in a pitching position with shoulder and arm in the 90/90 position and a band tied to something solid. Keep the shoulder stable by pulling them back and down and let nothing else move while rotating the arm backwards. Repeat for 3 sets x 15 reps, and then turn around so you can pull the band forwards.

#5. Prone W’s and Y’s

One of the most important muscle groups that are often neglected in pitchers are the scapular stabilizers, specifically the lower and middle trapezius. The scapular muscles help provide a strong and stable base from which the other arm muscles can use during a throw. Without a stable base, pitchers will lose efficiency, power, and introduce abnormal forces into the shoulder and elbow. A good exercise to work on the scapular stabilizers is lying on your stomach with an exercise ball or bosu ball under the hips to elevate the body off the ground, and bring your arms up into a W position by pinching the shoulder blades back and down. Then keeping the shoulders pinched and down, slowly raise the arms up overhead into a “Y” position and return them back into a “W” position. Add weight to make the exercise harder and perform 3 sets x 10 reps.

This concludes our three part serious on avoiding Tommy John surgery, and I hope it was informative to learn the risk factors for medial ulnar collateral ligament injury, proper and improper pitching mechanics, and exercises pitchers can perform to strengthening the shoulder and elbow to help reduce the risk of injury.

We are dedicated to helping athletes improve their performance while minimizing risk of injury at Competitive Edge Physical Therapy. Continue to check out our website at for more great blogs and come visit our state-of-the-art clinic here in San Jose, CA if you need help returning to your sport after injury or just want to improve performance!


  1. Hi, I would like to have Parts 1 and 2of this topic sent to my email address. Also, I would like to be put on to your email list for more articles about pitching mechanics and injuries. Thank you

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