Little League Shoulder: What Parents & Coaches Need to Know
Author: Dr. Courtney Klueppel, PT, DPT
What is the difference between normal arm soreness and Little League Shoulder?
Little League Shoulder is a condition also known as traction apophysitis of the growth plate of the humeral head. This typically impacts children between the ages of 8 and 14 years old, but it can impact children where growth plates haven’t yet closed. What happens with traction apophysitis is a widening of the growth plate around the upper arm bone (aka the humeral head) that creates inflammation and pain, essentially being classified as a fracture through the middle of the growth plate.
This is more prevalent in overhead athletics with repetitive stress on their shoulders such as baseball, softball, tennis, and volleyball. Over a long summer with high pitch counts, that repetitive pulling creates micro-trauma, widening, and inflammation along the growth plate.
4 Red flags that parents and coaches miss:
- Bony Tenderness: Direct tenderness when touching the bone near the upper arm growth plate.
- Lingering Soreness: Shoulder tightness or discomfort that persists for days after a start and doesn't resolve with rest.
- Velocity Losses: A noticeable drop in pitch velocity, or an athlete altering their arm slot (e.g., dropping their elbow or leaning their trunk laterally) to avoid shoulder pain.
- Pain with Daily Overhead Movement: Discomfort when lifting their arm, reaching into a locker, or putting on a backpack.
What should you do for a Little League Shoulder?
Physical therapy can be beneficial in the ability to resolve other modifiable risk factors such as shoulder strength, core stability, and hip mobility. Return to throwing should be gradual and graded according to player development and time off compared to time available for ramp up. Based on current research, it is recommended that players take at least 3 months off from repetitive stresses such as pitching and throwing to allow the growth plate to heal. During this time, players can still be active with non-painful fielding and hitting.
How can I prevent Little League Shoulder from happening to my child?
There isn’t a 100% way to prevent Little League Shoulder by playing overhead sports like baseball and softball. Ways to mitigate risk of developing shoulder pain or a condition like Little League Shoulder is establishing a good arm care program for while in season and during the off season. Also being aware and mindful of pitch counts and number of throws during a game and throughout a weekend will assist in preserving arm health and durability of shoulder throughout a season. MLB pitchsmart guidelines is a good resource for age related pitch counts and days of rest recommended following pitching outings.
Research is pretty clear on what to look out for when players are pitching. These are huge risk factors for baseball players getting hurt:
Arm Fatigue: Pitching with self-reported arm fatigue is the single biggest risk factor for youth throwing injuries.
Inning Counts: Pitching more than 100 innings in a calendar year increases serious injury risk by 3.5x.
Year-Round Throwing: Throwing competitive pitches for more than 8 months out of the year makes an athlete 5x more likely to suffer a shutdown injury.
Does Little League Shoulder cause permanent damage or stop bone growth?
When allowed to heal through rest and rehabilitation, athletes with LLS heal without long term complications. However, if a player tries to return to play too quickly or is left untreated, it can increase the risk of long term chronic shoulder pain and/or premature closure of the growth plate, which can impact overall bone growth of the upper arm. There is the possibility of recurrence of LLS if return is too quick and throwing mechanics or pitch counts are not closely monitored.
Stop Guessing. Build a Durable Throwing Arm.
If your player is struggling with shoulder pain after pitching at Grand Park, competing in high school conference play, or grinding through travel ball across Westfield, Carmel, Noblesville, or Zionsville, don't wait for a complete shutdown.
At Integrated Performance, our Physical Therapists don't just hand you a bag of ice and tell you to stop playing. We evaluate the entire athlete—from hip mobility and core strength to shoulder mechanics—to resolve pain, rebuild the kinetic chain, and guide you through an objective, step-by-step return-to-throwing program.
Is your athlete dealing with lingering shoulder pain?
Click here to schedule a comprehensive physical therapy evaluation with our sports PT team today!
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