Little Leaguers – Big Problems

Over 10 million people younger than 18 years old play baseball in the world, 2 million of which are right here in the United States of America.  Baseball may not be a contact sport (unless you’re sliding into home), but there is still a high risk for injury among the many youth that play this national past time.  Research has shown that children between the ages of 9-18 years old, that are baseball pitchers, have a high risk of injury for many different factors.  Between these ages, children pitch on multiple teams at one time, multiple games in one day or week, and a high number of pitches, are all contributing to this recurring theme of overuse that’s causing increased arm pain and injuries.

The motion of pitching is an overhead-ackward movement activity and is predominately a male dominated problem.  Most women are more associated with playing softball, which in an underhand throwing motion.  Summer, Fall, Winter, Spring, weekends, and weekdays.  These players are pitching over and over and over again, all year around.  Males normally go through their growth spurt between the ages of 10 to 16 years old.  As their bodies mature, their muscles, bone alignment, and bone density are underdeveloped, which also makes them more prone for injury.  There needs to be a guideline or set of rules in which children and parents should be made aware of that would govern the participation of children who pitch, reducing the risk of injury and long term effects that could develop.

Research on this topic results in the following findings: 40% pitched in a league without pitch counts or limits.  13% of pitchers pitched competitively for more than 8 months of the year.  57% pitched on back-to-back days.  19% pitched more than one game in the same day.  Nearly 33% of these pitchers pitched for more than one team during the same season.  10% also played catcher on the same team.

Little League Shoulder is an overuse injury caused by highly repetitive throwing utilizing abnormal arm movements. Weak musculature and a non-fused growth plates can become torn or inflamed causing pain in the shoulder joint.  Also increased intensities as children age can cause an acceleration of this syndrome.  Common motion loss occurs due to the outward rotation of the shoulder during the throwing motion, so there will be a muscular imbalance or capsule tightness that will develop the longer this pitching frequency occurs.  Tightness and shortening of the shoulder ligament called the posterior-inferior glenohumeral ligament occurs as this throwing form continues on a regular basis. A Physical therapist will be able to identify the specific components of the shoulder in which the injury is occurring and start rehabilitation.  Stretching of the ligament previously mentioned is key to this process or it may become increasingly tighter and more debilitating.  Symptoms may include pain (in the middle phase of throwing when the arm is at its farthest part back before proceeding forward), redness, tenderness to the touch, decreased range of motion, and stiffness.  Pain may begin to resolve with rest and discontinuation of activity, but this is only the first step in an extensive physical therapy rehabilitation process that needs to take place.  Treatment for this condition includes frequent icing, stretching, mobilizations to the shoulder joint, soft/deep tissue manual therapy, ischemic compression of trigger points, modalities (such as electrical stimulation, ultrasound, heat, cryotherapy, and laser), stability therapeutic exercises, and strengthening exercises once the joint is stable.  A home exercise program will be given to enhance the results of the treatment given during the therapy session.  For more information on stretching go to

Little League Elbow is the most common overuse injury caused by the force of the throwing motion resulting in the elbow bending inward repeatedly, which may cause tears/fractures in the cartilage, ligaments, and bones of the elbow.  It causes a compression of outside elbow structures, and a tension of inside structures.  This condition, aside from pain, results in decreased throwing effectiveness and distance. This condition is exclusively pertains to the inside portion of the elbow, different than if you are feeling pain in the front back or outside portions.  Mini stress fractures may also develop on the bone.  Symptoms will include tenderness over the inside portion of the elbow, swelling, redness, pain, stiffness, and decreased range of motion.  Treatment for this condition is very similar in component to the shoulder.

When diagnosing these disorders, X-rays or MRIs may need to be performed.  Once the parent, coach, and/or pitcher have recognized the symptoms, very frequent icing to the area is a must, along with anti-inflammatory medications such as ibuprofen may be prescribed.  The prognosis is dependent on the severity of the injury.  Therapy may be done as a preventative measure, for stabilization, or post-surgical.  The goal is to restore optimal loading of the joint, restore full range of motion, increase strength/stabilization, increase proper coordination, increase endurance, eliminate pain/tenderness, and return athlete to better than original form.

These conditions are named Little League Elbow or Little League Shoulder for a reason.  There are a huge variety of exercises and treatments that can and should be utilized.  Preventative measures need to be taken now before this becomes a major issue debilitating your child or teenager.  Warming up properly is very important and this can be done properly through some light throwing, non-aggressive stretching, and light jogging.  Periodically switching your pitcher to other positions and paying close attention to new pitching regulations by the little league baseball organization listed below.  Stop pitching when pain begins and seek health professional help.  Having an open communication with your child pitcher and their symptoms.  There needs to be an emphasis on controlling the throwing motion and the good mechanics of pitching.  Lastly, choosing the fastball as the main pitch utilized before learning the change-up and then beginning other pitches.

In 2008, Little League Baseball was the first national organization to adopt a pitch count pitching rules to reduce the number of injuries occurring to their players.  Children should be restricted to 2 games per week and between 50 to 100 pitches per game increasing as your child ages.  This is a great step in the detection and prevention of these disorders in children.

Consulting a physical therapist is very crucial in the diagnosis and treatment of these disorders.  When treating the elbow and shoulder injuries, the initial phase of therapy will include range of motion correction and joint mobilizations/stabilizations.  For more information about physical therapy services head to  Then treatments of pain and the inflammation will continue, followed by stretching and strengthening of the elbow and muscles, eventually returning to full level of playing.  A high level fitness and pitching program can be designed for each individual child based on age, body type, and extent of injury.

If you want information on how to prevent this from occurring or treatment of an injury already obtained, call Total Performance Physical Therapy, in North Wales, PA for your initial evaluation and consultation today.  Getting the right answers now and altering your child’s frequency of pitches may be unappealing to the child, but will improve the quality of their muscles, joint, and continued enjoyment of the sport or the rest of their bright futures.


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