Understanding Little League Shoulder: Causes, Symptoms, and Treatment Options

Kathy Ryan-Ceisel, PT MHS

Owner, Athletic Edge and Wellness

Overhead Throwing Specialist

💪Shoulder pain in young baseball and softball players should never be dismissed as “just growing pains.” One of the most common overuse injuries in youth throwers is Little League Shoulder — an inflammation or stress injury to the growth plate of the upper arm bone caused by repetitive throwing. This condition is most often seen in athletes between ages 9 and 16, when bones are still developing and most vulnerable to overuse. Recognizing the early signs and understanding the causes of Little League Shoulder can make all the difference in preventing long-term injury and ensuring a safe return to play.

1. Overuse and High Throwing Volume

Repetitive overhead throwing without adequate rest places stress on the shoulder’s growth plate. Recent research (Orthopaedic Journal of Sports Medicine, 2023) shows that total throwing workload—including warm-ups, bullpen sessions, and infield throws—is more predictive of injury than game pitch counts alone.

2. Inadequate Rest and Recovery

Young athletes who play on multiple teams or throw year-round don’t give their growth plates enough time to heal. Sports medicine experts recommend 3–4 months off from pitching or overhead throwing each year to allow for full recovery and bone remodeling.

3. Workload & pitch count issues

A 2023 Orthopaedic Journal of Sports Medicine study found that pitch count limits alone aren’t enough — cumulative workload across positions and lack of rest days also contribute to growth plate injuries.

Multiple-team participation (e.g., travel + school ball) significantly increases risk.

4. Weakness or Imbalance in the Kinetic Chain

Deficits in shoulder, scapular, core, or hip strength lead to poor energy transfer during throwing. A 2024 study in The American Journal of Sports Medicine found that decreased hip rotation and poor trunk stability significantly increase the rotational stress placed on the shoulder.

5. Faulty Throwing Mechanics

Improper mechanics—such as early trunk rotation, dropping the elbow, or over-rotating the shoulder—amplify torsional load on the growth plate. Fatigue and poor coaching feedback can worsen these issues over time.

6. Rapid Growth and Development

During growth spurts, bone length often increases faster than muscle flexibility and coordination. This temporary imbalance can alter throwing motion and increase stress on the shoulder joint.

7. Early Sport Specialization

Focusing solely on baseball or softball from a young age increases overuse risk. Studies show that multi-sport athletes have fewer overuse injuries and develop better total-body coordination compared to those who specialize early.

8. Poor Warm-Up and Conditioning Habits

Skipping a structured warm-up, band routine, or post-throw recovery can reduce shoulder readiness and lead to tissue fatigue.

COMMON SYMPTOMS IN LITTLE LEAGUE SHOULDER

🛑Pain and discomfort: Athletes with little league shoulder experience pain in the shoulder region. The pain is often felt during or after overhead activities, such as throwing a baseball or softball.

🛑Limited range of motion: The affected shoulder may have reduced flexibility and limited range of motion. Athletes may find it challenging to fully extend or rotate their shoulder.

🛑Weakness: Little league shoulder can cause weakness in the shoulder muscles, making it difficult to generate power and control during throwing or other activities.

🛑Tenderness and swelling: Athletes may experience tenderness when pressure is applied to the affected area, sometimes swelling may occur.

Decreased performance: As a result of pain, limited range of motion, and weakness, athletes may experience a decline in their throwing or overhead performance.

*Pain during throwing motion:  Pain can be aggravated during the throwing motion, making it uncomfortable and challenging for the athlete to throw with the same force and accuracy as before.

*Decreased throwing distance: The pain and limited range of motion can result in a decreased throwing distance. Athletes may find it difficult to generate enough power in their throws, leading to reduced velocity and a shorter distance covered by the ball.

*Altered throwing mechanics: To compensate for the pain and limitations, athletes with little league shoulder may unknowingly alter their throwing mechanics. These changes can negatively impact their throwing technique, accuracy, and overall performance. Improper mechanics can also put additional stress on other parts of the arm and lead to further injuries.

*Difficulty with follow-through: Little league elbow can affect an athlete's ability to complete the full throwing motion and follow-through. This can result in a less fluid and natural throwing motion, affecting the overall efficiency and effectiveness of their throw.

* Decreased control and accuracy: Pain and limitations in the shoulder joint can make it challenging for athletes to maintain control and accuracy in their throws. The lack of stability and discomfort can lead to erratic and inconsistent throws, affecting their ability to hit their intended targets.

🧪DIAGNOSIS OF LITTLE LEAGUE SHOULDER

Follow up with sports medicine physician and Xrays are indicated. 

X-ray findings of Little League shoulder may include:

1. Widening of the growth plate: X-rays may show widening or irregularity of the growth plate in the upper arm bone (humerus). This is a result of stress and strain on the growth plate due to repetitive throwing motions.

2. Fragmentation or irregularity of the growth plate: X-rays may also reveal fragmentation or irregularity of the growth plate, indicating damage and stress on the bone.

3. Bone sclerosis: X-rays may show areas of increased density or sclerosis in the bone, which is a response to stress and injury.

4. Soft tissue swelling: X-rays can help identify any soft tissue swelling or fluid accumulation around the shoulder joint.

It is important to note that X-rays alone may not be sufficient for a definitive diagnosis of Little League shoulder. Other imaging tests such as MRI or ultrasound may be needed to evaluate the soft tissues and to confirm the diagnosis.

⚾Treatment for Little League Shoulder typically involves rest, physical therapy, and modifying throwing techniques to prevent further injury.

🎯Rest and activity modification: The first step in treating little league shoulder is to rest the affected shoulder and avoid activities that exacerbate the pain. This may involve a temporary break from throwing or participating in overhead sports.

🎯Physical therapy: A physical therapist can provide exercises to stretch and strengthen the shoulder muscles, improve range of motion and strength and promote proper shoulder mechanics. They may also use modalities such as heat or ice to reduce pain and inflammation.

🎯Gradual return to activity: Once the pain has subsided and the shoulder has regained strength and flexibility, a gradual return to throwing or overhead activities is recommended. This should be done under the guidance of a healthcare professional or physical therapist to prevent re-injury.

🎯Technique correction: Athletes may need to modify their throwing or overhead technique to reduce stress on the shoulder joint. Proper mechanics and throwing form can help prevent future episodes of little league shoulder.

🎯Prevention strategies: Coaches, parents, and athletes should prioritize injury prevention strategies such as proper warm-up and cool-down exercises, regular strength training, and monitoring workload to avoid overuse injuries.

🎯Return-to-throwing protocols:  Evidence supports criterion-based progression — pain-free ROM, symmetric strength, and controlled mechanics before resuming throws. A typical timeline is 3 months minimum of rest followed by a graduated throwing program under physical therapy supervision.

Little League Shoulder is a warning sign that the body is being pushed beyond its limits — but with early intervention, rest, and a guided return-to-throw program, athletes can make a full recovery. Early intervention and proper management can promote healing, prevent further damage, and allow athletes to return to their sport safely. 

At Athletic Edge & Wellness, our sports medicine and physical therapy team specializes in youth arm care, throwing mechanics, and safe return-to-sport programs for baseball and softball players. If your athlete is experiencing shoulder pain, schedule an Arm Care Assessment with us today to identify the cause, correct movement patterns, and build a stronger, healthier throwing arm for next season.

Contact us today at 224-505-3343 or visit us at www.edge360wellness. come