By Dr. Shayne Kelly, DO — Fellowship-Trained Sports Medicine Surgeon · Tri-City Orthopedics, Kennewick, WA
The graded throwing progression Dr. Kelly uses to return athletes to the mound and the field after injury or surgery.
This is the published Interval Throwing Program developed at the American Sports Medicine Institute (ASMI) by Kevin Wilk, DPT, Mike Reinold, DPT, and Dr. James Andrews — the standard graded return to throwing used across sports medicine. Do NOT start or advance this program on your own: your starting stage and pace depend on your injury or surgery, and Dr. Kelly or your physical therapist will set them for you.
• Throw every OTHER day — never on consecutive days.
• Warm up first: jog or bike to a light sweat, stretch, then begin with easy shorter warm-up throws before each set.
• Use a crow-hop and throw on an arc with a relaxed motion — no flat-footed max-effort throws.
• Every stage must be completed WITHOUT pain before you advance. Mild muscle soreness that resolves is acceptable; joint pain in the shoulder or elbow is not — if it appears, stop, rest, and drop back a stage.
• Keep doing your arm-care work (the Thrower's Ten Program) on the schedule Dr. Kelly gave you.
Work through each distance in order. At each distance, the goal is roughly 75 pain-free throws, built up across 2–3 sessions, before moving to the next distance.
| Stage | Distance | Goal before advancing |
|---|---|---|
| 1 | 45 feet | ~75 pain-free throws across 2–3 sessions |
| 2 | 60 feet | ~75 pain-free throws across 2–3 sessions |
| 3 | 90 feet | ~75 pain-free throws across 2–3 sessions |
| 4 | 120 feet | ~75 pain-free throws across 2–3 sessions |
Research behind the ASMI program shows the arm stress at 120 feet is similar to pitching off a mound — so pitchers move to Phase II after completing 120 feet. Position players continue the same pattern out to 150 and 180 feet before returning to position-specific throwing.
| Step | What you throw |
|---|---|
| 1 | Fastballs only at 50% effort |
| 2 | Fastballs at 75% effort |
| 3 | Fastballs at 100% effort |
| 4 | Breaking pitches added last, once fastballs are full-effort and pain-free |
Dr. Kelly or your therapist will set your pitch counts and the pace between steps. Full strength and confidence in the arm come before game innings.
Stop throwing and call Dr. Kelly’s office at (509) 460-5588 for any sharp pain in the elbow or shoulder during throwing, pain that returns at a stage you had already passed, or new numbness or tingling in the arm or hand. For chest pain or trouble breathing, call 911.
Dr. Kelly sees patients at Tri-City Orthopedics in Kennewick.
Request an AppointmentThere is no single, perfect return-to-throwing program. The right program is individualized — built around your injury or surgery, your position, your season, and how your arm responds along the way. What stays constant is the progression:
Long toss → flat-ground pitching → mound throwing → live batting practice → game play
…advancing only when each stage is pain-free and your mechanics hold. When available, we use technology-assisted workload tracking — radar-gun effort control and throwing-workload monitoring — to guide the progression objectively rather than by guesswork. The ASMI program below is the framework; your plan is set with Dr. Kelly and your rehab team.
This page summarizes the Interval Throwing Program developed at the American Sports Medicine Institute (ASMI) by Kevin Wilk, DPT, Mike Reinold, DPT, and Dr. James Andrews — the standard graded return to throwing used across sports medicine. It begins only after Dr. Kelly clears you to throw, and it runs under the supervision of your rehab team. There is NO set timetable: every step must be completed without pain before you advance, and progression varies athlete to athlete.
• Jog or bike until you develop a light sweat, then stretch systematically — legs, trunk, back, and arm.
• Do a light set of rotator-cuff warm-up work before throwing (your Thrower's Ten exercises).
• Begin each throwing set with easy warm-up throws at a comfortable short distance before moving to the day's target distance.
• Every throw uses the crow-hop — hop, skip, then throw — on an arc, with only enough effort for the ball to travel the target distance. Flat-footed throwing stresses the arm and is not allowed.
• Throw every OTHER day, with a rest day between steps, unless Dr. Kelly tells you otherwise. Some athletes need every third or fourth day — listen to your arm.
• Perform each step at least TWICE without pain before moving to the next step.
• A dull, diffuse muscle ache during recovery is normal. Sharp pain — especially in the shoulder or elbow joint — means stop all throwing until it settles, and call the office if it continues.
• Keep up your strengthening (high-repetition, low-weight, with emphasis on the back of the rotator cuff) on throwing days, AFTER you throw — the day between is for flexibility and recovery.
Phase I moves through graduated distances in numbered steps. Each step is built from sets of about 25 throws, separated by warm-up throws and 3–5 minute rests. The goal at each distance is 75 pain-free throws before moving on.
| Phase | Steps | What it looks like |
|---|---|---|
| 45 ft | 1–2 | Two, then three, sets of ~25 throws |
| 60 ft | 3–4 | Same pattern at 60 ft |
| 60–75 ft | 5–6 | 75 ft introduced and built up alongside 60 ft |
| 75–90 ft | 7–8 | Mixed-distance sets stepping up to 90 ft |
| 90–120 ft | 9–10 | Mixed-distance sets stepping up to 120 ft |
| Flat-ground pitching | 11–12 | Mixed distances plus 20–30 throws at 60 ft on flat ground using your normal pitching mechanics |
Position players work the same pattern out to 150 and 180 feet, then return to position throwing simulating game situations at 50% → 75% → 100% effort. Exact throw counts for every step are in the official ASMI document linked below — Dr. Kelly or your therapist will mark your starting step.
Phase II starts after Phase I is complete and pain-free. All mound work is done in the presence of your pitching coach to keep mechanics right — a radar gun helps keep effort honest.
| Stage | What you throw |
|---|---|
| 1 | Fastballs only at 50% effort, building session volume, then blending in 75% effort |
| 2 | Fastballs at 75% effort, with batting-practice throwing gradually added |
| 3 | Breaking balls introduced gradually alongside batting practice, finishing with simulated games that add about 15 throws per workout under a pitch count |
Returning to batting is its own progression — dry swings → tee → soft toss → live pitching — on the timeline Dr. Kelly sets for your injury.
This page summarizes ASMI's Interval Throwing Program (V3, revised 2019). The complete step-by-step tables are ASMI's copyrighted material — download the full official document free from the American Sports Medicine Institute: ASMI Interval Throwing Program for Baseball Pitchers (PDF). Also published in: Reinold MM, Wilk KE, Reed J, Crenshaw K, Andrews JR. Interval Sport Programs: Guidelines for Baseball, Tennis, and Golf. J Orthop Sports Phys Ther. 2002;32(6):293–298. Use the official document alongside the schedule Dr. Kelly gives you.
Stop throwing and call Dr. Kelly’s office at (509) 460-5588 for any sharp pain in the elbow or shoulder — especially in the joint — during or after throwing, pain that returns at a step you had already passed, or new numbness or tingling in the arm or hand. For chest pain or trouble breathing, call 911.
Dr. Kelly sees patients at Tri-City Orthopedics in Kennewick.
Request an Appointment