by Drs. Neil and Wendi McKenna, DPT, Center for Optimal Movement
During Little League Baseball season, we at Center for Optimal Movement experience an uptick in questions about and challenges with shoulder, arm, and elbow pain. Some parents want to prevent injuries in their young athletes, some are managing the first signs and symptoms, and some are wondering about best practices for post-injury rehab, return to play guidelines and continued protection. All want to help keep their kids playing.
Unfortunately, research currently shows that the number of complaints from soreness to medical diagnosis of Little League Elbow and Little League Shoulder is on the rise. As many as 20% to 40% of baseball athletes ages 9-12 report elbow pain. This means that up to two in every five children who play baseball may experience soreness and pain that could lead to significant injury and time away from the game they love.
From preventing injury to continued protection afterwards, it’s important to look at throwing. Whether your child is experiencing muscle fatigue, ligament sprains or muscle and tendon strains and inflammation, throwing mechanics, throwing intention, repetitive throwing, and intentional recovery are key components to optimizing arm health. The good news about these challenges is that we as a medical community are acutely aware of them and have great information, resources, and solutions for parents, coaches and athletes to keep kids playing safely with optimal performance, both now and in the long run.
Let’s Dive In:
What are “Little League Elbow” (Medial Epicondyle Apophysitis) and “Little League Shoulder” (Proximal Humeral Epiphysitis)?
Both LLE and LLS are irritations at the growth plate, which is active, open and responsible for bone growth. The activity is also precisely what makes it more vulnerable to injury. Growth plates within the bone are not as strong as the more mature bone around them and have less tensile strength than the attached ligaments and tendons attached. Therefore, the growth plate is one of the first structures that gets irritated and ultimately fails with overuse.
The injuries bear the names Little League Elbow and Shoulder because they are common during Little League ages (9 – 12 years), and are uncommon once the growth plates are closed and growing is complete. For girls, this occurs sometime between 13-16 years of age; for boys, between 15-17. Because everyone starts and completes puberty at different times, it may also be later for both genders.
How do Little League Elbow (LLE) and Little League Shoulder (LLS) occur?
There are several intertwined factors for throwing-related arm pain. The primary contributing factors are overuse and throwing when fatigued. **NOTE: Your child might not FEEL fatigued.** Fatigue is primarily driven by pitch and long-throw counts, no matter how strong or how much endurance your young athlete has. Tracking throws per day, per week, per season, and per year is a great start. Also essential is being committed to specific and intentional rest and recovery on “off” days in season and active recovery and foundation-building during the off-season.
Several other factors contribute to increased overuse injuries like LLE and LLS:
- Trying to gain velocity aggressively,
- Poor pitching mechanics, and
- Throwing breaking balls which include supination of the arm. Supination is the motion where your hand rotates in a palm up direction, and typically produces the spin for effective curveballs and sliders. Changeups are regarded to be safer on the arm with the pronation motion that occurs (palm rotating down).
What are the symptoms and signs of overuse? Symptoms are what an athlete internally feels and experiences. Signs are an outward expression noticed by the athlete and/or coaches and parents.
The symptoms are often not clear. It could start with a feeling of general arm fatigue, but an athlete may not be aware of any impending problem until they feel a sudden pain at the inside of the elbow or top of shoulder or hear/feel a pop or a crack when executing a throw.
First signs are more clearly defined, but will most likely be noticed by a coach or parent, not the athlete. Signs include a reduction in throwing velocity, altered throwing mechanics, or loss of ball-placement control to the intended target. If pain is present, you may also notice swelling and tenderness at the inside elbow or top of shoulder.
Be particularly on alert for any pain or soreness that lasts longer than 24 hours.
What to do if my child experiences throwing-related pain?
If your child is experiencing prolonged arm soreness or location-specific pain, stop throwing and seek medical consultation. Ice can help to manage the pain and inflammation acutely, however the underlying impairment and contributing factors are not addressed with ice.
Further investigation is advised with your pediatrician or pediatric orthopedist and then a physical therapist who specializes in youth athletes. After it is clear where your athlete is in symptom/sign management or rehab for a diagnosed injury, physical therapy is usually indicated to address strength, range of motion, stabilization, and foundational posture and movement mechanics. Return to play and continued protection guidelines are also discussed with you and your child.
How can I prevent this as a parent?
- Adherence to the Pitch Smart guidelines created in conjunction with Team USA Baseball is our first recommendation. Since overuse throwing injuries do not occur solely with pitchers, we recommend taking note of how many days your child is throwing a baseball per week, and include intentional down time from throwing between practices and games.
- A throwing consultation with a baseball coach may help to identify mechanical inefficiencies.
- An evaluation by a physical therapist who specializes in orthopedics and youth athletes can also identify and address impairments in posture and movement patterns, speed, agility, range of motion, strength, and stabilization. When these areas are assessed and addressed, particularly in the context of sport-specific needs, injuries can be prevented and performance on the field enhanced.
It is possible to keep ‘em playing. With knowledge, solid foundational posture and movement patterns, intentional practice, and scheduled recovery we can all work together to make sure our youth athletes are healthy today and in the long run. We look forward to being a resource for you.
Drs. Neil and Wendi McKenna, both Doctors of Physical Therapy, are a husband and wife team working together to address the increasing needs for the growing youth athlete population. Youth sports is growing rapidly, competition is getting steeper, and pressure to perform is increasing, sometimes to the detriment of our athletes’ physical, emotional and mental health. Injuries are up, burnout is high, and kids are losing their passion for the games they once loved. Neil and Wendi empower athletes, parents, and coaches with knowledge, skills and tools to keep physical performance optimized, fun meter high, and leadership strong through intentional training, recovery, mindset, and emotional intelligence practices.
Let’s work together to keep ‘em playing.
We currently have a clinic in Solana Beach and can be reached at (858) 704-4464.