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Overuse Injury- Little League Shoulder

What Coaches Should Know About Little League Shoulder

Little league shoulder is an overuse injury caused by stress to the arm bone (humerus) at the shoulder. This stress causes widening of the growth plate, resulting in pain. It most commonly occurs in youth athletes (boys > girls) between ages 11 and 16.

Factors that contribute to injury:

  • Repeated throwing without adequate rest
  • Throwing with improper or inefficient mechanics
  • Lack of strength in the shoulder, shoulder blade, and elbow/forearm muscles

If untreated, the condition can worsen. Activities outside of baseball may become painful like simple daily tasks or even pain at rest. There is a small chance for a significant growth plate injury like a stress fracture or even worse, closure of the growth plate. However, when treated appropriately, little league shoulder will often heal completely with rest and a dedicated rehabilitation program.

Little League Shoulder Injuries are on the Rise

There has been and increasingly high rate of little league shoulder injuries in the past decade. These injuries are occurring in younger athletes and often linger year after year if the source of the problem is not addressed.  

The factors that contribute to the increase in little league shoulder injuries:

  • Overuse—not monitoring appropriate pitch counts
  • Throwing or pitching when fatigued
  • Pitchers that play multiple positions in the same game
  • Year-round single sport specialization
  • Participation on multiple teams in a season 

How Do I Know If My Player Has Little League Shoulder?

Symptoms of little league shoulder include:

  • Pain in the shoulder or upper arm when throwing
  • Pain in the shoulder at rest or when raising the arm
  • Decreased throwing speed and/or accuracy

The diagnosis and severity of little league shoulder can usually be made with X-ray imaging from your primary care doctor or pediatrician. Less often, more advanced imaging may be needed. If you suspect that your athlete might be suffering from little league shoulder, it’s important to seek attention from a medical professional quickly.

How is Little League Shoulder Treated?

Once the diagnosis of little league shoulder is made, the most common form of treatment is rest from throwing and beginning an individualized rehabilitation program.

Conservative treatments should include:

  • Rest – avoid repetitive reaching, lifting, or throwing activities.
  • Ice – to decrease swelling and pain in the shoulder.
  • Physical therapy – sport-specialized physical therapists can create individualized exercise prescriptions consisting of strengthening and stretching routines for the athlete. These regimens often focus on improving the strength and stability of the shoulder and arm muscles. Additionally, they will emphasize strength and mobility of the core, legs, and hips to enhance stability and the overall ability to throw.
  • Video throwing analysis – Trained physical therapists can perform video analysis of the throwing motion. These therapists are trained with the biomechanical knowledge to break down the phases of throwing to find deficiencies and identify inefficient mechanics.
  • Return-to-throwing program – once cleared to return to throwing, the athlete will progress through a staged throwing program that slowly increases the demands on the arm and shoulder. As the athlete gradually develops an increased throwing tolerance, they will be able to return to competitive play.

How Can I Help Prevent Little League Shoulder?

While no injury can be completely prevented, proper mechanics, rest and strength can reduce the risk of injury. Before returning to play, injured athletes should have their throwing mechanics assessed. Coaches need to be aware of any reports of pain, fatigue, or changes in throwing motions. These are often warning signs that, if ignored, may lead to more serious injury.

Additionally, USA Baseball in partnership with major league baseball (MLB) has developed guidelines for young pitchers to help reduce the risk of injury.

Age

Daily Max (Pitches in Game)

0 Days Rest

1 Days Rest

2 Days Rest

3 Days Rest

4 Days Rest

5 Days Rest

7-8

50

1-20

21-35

36-50

N/A

N/A

N/A

9-10

75

1-20

21-35

36-50

51-65

66+

N/A

11-12

85

1-20

21-35

36-50

51-65

66+

N/A

13-14

95

1-20

21-35

36-50

51-65

66+

N/A

15-16

95

1-30

31-45

46-60

61-75

76+

N/A

17-18

105

1-30

31-45

46-60

61-80

81+

N/A

19-22

120

1-30

31-45

46-60

61-80

81-105

106+

 

Web pages for more information:

MLB.com/pitch-smart

 www.littleleague.org

Erika Sandell-Savor DPT, SCS- Physical Therapist
Erika Sandell-Savor DPT, SCS- Physical Therapist

 

 

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Arm Care Starts with the Legs

 

 

Photo Courtesy of University of Utah®
Photo Courtesy of University of Utah®
Photo Courtesy of Cincinnati Children’s®
Photo Courtesy of Cincinnati Children’s®
Youth Sports Done Right