Sports Medicine

Physical Therapy for Little League Shoulder and Elbow

Our Pediatric Sports Medicine team put together these videos to provide information for you.

Ryan Ross, ATC/L

Little League Shoulder and Elbow are overuse injuries usually caused by too much throwing using improper mechanics.

The most common ways for this to happen include:

  • Improper pitching mechanics
  • Excessive throwing
  • Not resting between pitching sessions
  • Playing multiple positions that require different throwing mechanics
  • Playing in more than one league in a season
  • Weakness of the muscles that support the shoulder and shoulder blade during throwing; in addition to core weakness and tightness causing improper mechanics

The risk of developing little league elbow increases when an athlete:

  • Throws a curveball or slider before growth plates have closed
  • Does not have the proper strength and endurance of the shoulder muscles or core

Physical therapy is an important component in all stages of recovery. Because throwing and reaching activities are total body activities, weakness or tightness in one area will increase the stress through the other areas of the body. For this reason, your physical therapist will perform a comprehensive evaluation not only of the shoulder and elbow but also of the trunk and lower extremities. This will include a biomechanical analysis to help determine not only the faulty movement patterns, but also areas of weakness and/ or tightness contributing to dysfunction. Video analysis of the athlete’s throwing can assist the physical therapist in finding mechanical faults that increase the stress in the shoulder or elbow.

Since Little League Shoulder and Elbow are bone-related overuse injuries, it is important to rest the affected growth plate, bone, and muscles attached which will allow healing to occur. In this first phase of recovery (the “acute” phase) physical therapy will focus on decreasing the pain and inflammation in the affected joint. Following the biomechanical analysis, physical therapy will address the core, spine, and/or leg weakness or tightness. This will allow the athlete to maintain his or her strength and endurance in unaffected body areas and allow the physical therapist to correct the mechanical faults causing the stress to the shoulder or elbow.

The second phase of recovery emphasizes strengthening of the muscles in the shoulder, elbow, shoulder blades, and upper back. These muscle groups provide the stability needed to keep the shoulder and elbow in place during the deceleration (slowing down) phase of throwing and absorb the stress created from the legs, spine, and core muscles during the first three phases of throwing (acceleration phase).

Once the athlete is cleared by their doctor to return to throwing, the physical therapist and athletic trainer will begin the third phase of recovery: the return-to-sport phase. In this final phase, the physical therapist will design a return-to-throwing or return-to-sport program. This program will integrate the individual components addressed in the first two phases: retraining the legs, core, spine, and arms to work together to maintain the normal body biomechanics during the athlete’s movements. This is important to maintain equal stress through the joints generated from the feet, through the legs, spine, arm, and out through the hand during the throwing movement.

When this final phase is complete, the athlete will have re-trained his or her body to move more efficiently, gaining strength, accuracy, and speed. Small biomechanical faults that were corrected will help to prevent future injury. Review of correct warm-up, throwing mechanics/pitch count, and cool-down techniques will ensure a healthy, balanced athlete able to continue playing long beyond high school.

Sports rehabilitation physical therapy provided at Johns Hopkins All Children’s Outpatient Care is provided in a one-on-one setting with gyms designed for the active athlete. Emphasis is placed on positive attitude, hard work, and fun activities to keep the teenage athlete engaged in his or her therapy. All Children's Hospital Sports rehab helps athletes get back into the game, better than before!