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What is Little League ShoulderLittle League Shoulder (LLS), or proximal humeral epiphysitis, is a common overuse injury in youth baseball players, especially pitchers between ages 11 and 16. It results from repetitive overhead throwing that places stress on the growth plate at the top of the humerus (upper arm bone). Early detection, proper treatment, and injury prevention strategies are key to safe return to sport and long-term athlete development.Signs and SymptomsAthletes with LLS typically experience gradual onset of shoulder pain, especially during or after pitching. Symptoms may include:<ul><li>Aching or sharp pain in the upper arm or shoulder</li><li>Decreased throwing velocity or control</li><li>Swelling or tenderness over the upper humerus</li><li>Pain with lifting the arm or resisted shoulder motions (Flexion, Abduction, External Rotation, and Internal Rotation</li><li>Fatigue or a feeling of “dead arm” during games</li><li>In some cases, X-rays reveal widening of the growth plate, a hallmark of this condition.</li></ul>Frequency and Risk FactorsLLS accounts for up to 11% of all shoulder pain in youth baseball pitchers, according to multiple epidemiological studies. A 2020 study in The American Journal of Sports Medicine found that young pitchers who threw over 100 innings per year were 3.5 times more likely to develop shoulder injuries, including LLS.Key risk factors include:<ul><li>High Pitch Volumes: Pitching too often without adequate rest Poor Mechanics: Inefficient movement patterns amplify stress on the shoulder</li><li>Year-Round Participation: Lack of offseason rest</li><li>Early Sport Specialization: Limiting exposure to varied athletic movements delays neuromuscular development</li><li>Inadequate Strength and Mobility: Weakness in the rotator cuff, scapular stabilizers, and core muscles contribute to poor throwing mechanics</li></ul>Diagnosis and ImagingClinical evaluation by a sports medicine physician or physical therapist includes:<ul><li>Detailed history (pitch count, playing frequency, prior injuries)</li><li>Physical examination (ROM, strength, special tests for shoulder stability)</li><li>X-ray imaging, particularly of the shoulder in multiple views, can detect widening or irregularity of the proximal humeral growth plate, confirming the diagnosis.</li><li>MRI may be indicated if symptoms persist or other pathology is suspected.</li></ul>Treatment OptionsLLS is typically managed non-operatively, and the focus is on rest, rehabilitation, and education.<ul><li>Phase 1: Acute Phase (0–6 Weeks) Cessation of throwing for a minimum of 6 weeks Ice and anti-inflammatory measures as needed Begin pain-free range of motion exercises Avoid all aggravating activities</li><li>Phase 2: Rehabilitation (6–10 Weeks) Progress to scapular and rotator cuff strengthening Core stabilization and hip mobility training Biomechanical analysis to correct faulty throwing mechanics Begin general conditioning </li><li>Phase 3: Return to Sport (10–16+ Weeks) Gradual return-to-throwing program Emphasize proper warm-ups, post-throw recovery, and ongoing strength maintenance Monitor pitch counts and intensity levels closely Most cases resolve with no long-term complications if treated early and appropriately.</li></ul>Return to Sport RatesReturn to play is excellent when LLS is managed conservatively and athletes follow a structured rehab program.A 2018 study in Orthopaedic Journal of Sports Medicine found that 92% of athletes returned to sport without recurrent symptoms within 12–16 weeks. Adherence to rehab protocols and correction of faulty mechanics were strong predictors of successful outcomes. In rare cases where symptoms persist or the growth plate closes abnormally, further intervention may be required — but this is the exception, not the rule.Prevention StrategiesPreventing LLS centers around load management, education, and athletic development:<ul><li>Follow USA Baseball and Little League Pitch Count Guidelines</li><li>Ensure at least 2–3 months of rest from overhead throwing per year</li><li>Emphasize multi-sport participation and limit early specialization</li><li>Teach and monitor proper throwing mechanics from a young age</li><li>Incorporate shoulder, scapular, and core strengthening exercises</li><li>Encourage honest communication—athletes should report pain early, not hide it</li></ul>Summary Little League Shoulder is a preventable and treatable condition that arises from overuse in youth baseball. Understanding the early signs, implementing proper treatment protocols, and adopting preventive strategies are essential for keeping young athletes healthy and on the field.With education, load management, and proper mechanics, players can return stronger and safer—continuing to develop their skills and passion for the game.References Heyworth BE, et al. (2013). Proximal humeral epiphysiolysis (Little League shoulder) in adolescent baseball players: clinical presentation and return to play. Journal of Shoulder and Elbow Surgery, 22(11): e1–e5. ➤ This study outlines the clinical characteristics of LLS and reports return-to-sport rates following conservative treatment. Fleisig GS, et al. (2011). Risk of serious injury for young baseball pitchers: a 10-year prospective study. The American Journal of Sports Medicine, 39(2): 253–257. ➤ Found strong correlations between pitching volume and increased injury risk, including shoulder growth plate injuries. Harada M, et al. (2010). Radiographic findings in Little League shoulder: Widening of the proximal humeral physis is a normal finding in adolescent baseball players. Orthopaedics &amp; Traumatology: Surgery &amp; Research, 96(8): 861–865. ➤ Describes how to differentiate normal growth plate widening from pathologic LLS changes using radiographs. Mair SD, et al. (2002). Shoulder injuries in young athletes: evaluation and treatment of overuse throwing injuries. Orthopedic Clinics of North America, 33(4): 527–543. ➤ Provides an overview of overuse shoulder injuries in youth, including mechanisms and treatment strategies. Lyman S, et al. (2002). Effect of pitch type, pitch count, and pitching mechanics on risk of elbow and shoulder pain in youth baseball pitchers. The American Journal of Sports Medicine, 30(4): 463–468. ➤ Emphasizes pitch volume and mechanics as key modifiable risk factors for shoulder and elbow injuries. Davis JT, et al. (2012). Return-to-play outcomes of Little League shoulder in adolescent pitchers: a case series of 11 athletes. Sports Health, 4(5): 466–470. ➤ Reports successful return-to-play outcomes following rest and rehab in youth with Little League Shoulder. USA Baseball &amp; MLB. Pitch Smart Guidelines. https://www.mlb.com/pitch-smart ➤ Offers age-based recommendations for pitch counts, rest, and workload management to reduce injury risk.

Little League Shoulder

What Is Little League Elbow? Little League Elbow is an umbrella term for medial (inside) elbow pain resulting from repetitive valgus stress on the immature elbow. Specifically, it involves traction apophysitis of the medial epicondyle, where the growth plate becomes inflamed due to overuse.This condition can range from minor inflammation to avulsion fractures or more serious medial epicondyle separation.Signs and Symptoms Early recognition of symptoms can prevent more serious injury. Common signs include:Medial elbow pain during or after throwing Decrease of throwing velocity or control/accuracy Tenderness over the inside of the elbow Swelling or stiffness Loss of range of motion, specifically extension/straightening&nbsp; Change in pitching mechanics, due to pain Parents and coaches should be particularly cautious when young athletes report persistent pain or decreased performance.Treatment Options Most cases of Little League Elbow are treated non-operatively:Conservative Management (Physical Therapy)&nbsp; Immediate rest from throwing (typically 4–8 weeks) Ice and NSAIDs for pain and inflammation Physical therapy focused on shoulder, rotator cuff, forearm, and core strength, flexibility, and kinetic chain efficiency (lower body)&nbsp; Gradual throwing program before returning to pitching. We customize a specific throwing progression for all of our athletes. Provided on our app with specific instructions on number of throws, distance and intensity.&nbsp; In rare, more severe cases involving avulsion fractures or nonunion, surgical intervention may be necessary.Return to Sport Return to sport timelines vary by severity, but most athletes return to play within 6 to 12 weeks with proper rehab. According to a study by Lyman et al. (2002), players who underwent structured rehab and complied with pitch count guidelines had a significantly reduced risk of reinjury.Rehab Protocol&nbsp;<ul><li>Phase 1: Acute Phase (0–6 Weeks) Cessation of throwing for a minimum of 6 weeks Ice and anti-inflammatory measures as needed Begin pain-free range of motion exercises Avoid all aggravating activities</li><li>Phase 2: Rehabilitation (6–10 Weeks) Progress to scapular and rotator cuff strengthening Core stabilization and hip mobility training Biomechanical analysis to correct faulty throwing mechanics Begin general conditioning</li><li>Phase 3: Return to Sport (10–16+ Weeks) Gradual return-to-throwing program Emphasize proper warm-ups, post-throw recovery, and ongoing strength maintenance Monitor pitch counts and intensity levels closely Most cases resolve with no long-term complications if treated early and appropriately.</li></ul>Prevention Tips Adhere to pitch count and rest guidelines Avoid year-round high intensity throwing (rest/deload at least 9-12 weeks off from throwing per year) Strengthen the shoulder, scapular stabilizers, and core Use proper throwing mechanics.&nbsp; Educate players, coaches, and parents on early signs of injuryReferences Fleisig, G. S., et al. (2011). Risk of serious injury for young baseball pitchers: A 10-year prospective study. The American Journal of Sports Medicine, 39(2), 253–257. Olsen, S. J., et al. (2006). Risk factors for shoulder and elbow injuries in adolescent baseball pitchers. The American Journal of Sports Medicine, 34(6), 905–912. Mair, S. D., et al. (2002). Clinical findings and treatment of medial epicondyle fractures in young throwing athletes. Journal of Shoulder and Elbow Surgery, 11(4), 376–382. Lyman, S., et al. (2002). Effect of pitch type, pitch count, and pitching mechanics on risk of elbow and shoulder pain in youth baseball pitchers. The American Journal of Sports Medicine, 30(4), 463–468. MLB &amp; USA Baseball. Pitch Smart Guidelines. Retrieved from: https://www.mlb.com/pitch-smart

Little League Elbow

Pitching is tough on the elbow. With every throw, the elbow experiences stress, especially in the medial (inside) joint, where the ulnar collateral ligament (UCL) plays a huge role in stabilizing the arm. We know that throwing a lot of pitches can lead to temporary changes in the elbow, but how long does it take to recover? We want to share a recent study looked at exactly that. How does the elbow joint react to 100 pitches? How long it takes to recover from the outting?&nbsp;The StudyThe Researchers observed 26 high school pitchers (average age 16) and had them throw 100 pitches (split into 5 sets of 20). They measured three key metrics before pitching, immediately after, and over the next 24 hours:Medial elbow joint width – This indicates how much the elbow joint loosens or tightens. UCL strain ratio – This tells us how much stress the UCL is under. Forearm flexor-pronator muscle (FPM) strain ratio – These muscles help support the elbow during throwing. What They LearnedImmediatly after pitching, the elbow joint loosened slightly (increased width by 0.84 mm). The UCL and forearm muscles showed immediate changes in strain, meaning they were under stress. However, within 24 hours, most of these changes returned to normal. What This Means for PitchersConclusionThe study suggests that after throwing 100 pitches, a pitcher’s elbow joint recovers/stabilizes within 24 hours. This could mean that low-intensity throwing may be okay after a full day of rest. However, recovery isn’t just about the elbow—other parts of the body also need time to recover.Takeaways for Players and CoachesMonitor recovery – If your elbow still feels off after 24 hours, you may need more rest. Strengthen the forearm muscles – Stronger supporting muscles help reduce stress on the joint. Closely monitor workload management – While the elbow may recover quickly, other parts of the body (like the shoulder) may need more time. This study reinforces the importance of proper recovery, smart training, and listening to your body. So, if you’re a pitcher, make sure you’re taking care of your arm so you can stay healthy and keep throwing strong!Source: Hattori H, Okamura S, Hall T, Sakaguchi K, Akasaka K. Recovery of the Medial Elbow Joint in the 24-Hour Period After Repetitive Pitching in High School Players. Am J Sports Med. 2025 Jan;53(1):115-122. doi: 10.1177/03635465241293074. PMID: 39741472.

How Long Does It Take for a High School Pitcher’s Elbow to Recover?

<h2>In-Season Arm Care for Amateur/ High School Baseball</h2>Arm care is a critical component for high school baseball players aiming to maintain performance and prevent injuries during the season. With numerous games and practices, the repetitive motions can strain the arm, particularly the shoulder and elbow. Implementing a consistent arm care routine is essential for longevity in the sport.<h3>Warm-Up</h3>Before any game or practice, a thorough warm-up is necessary. This should include whole body dynamic mobility/stretching exercises that focus on not only the shoulders and elbows but also the entire body. Dynamic mobility consists of repititions of movement/exercises rather static stretching (holding stretches for 20-30 seconds).&nbsp; A proper warm-up should incorporate exercises like arm circles, cross-body reaches, thoracic spine rotations, band resistest exercises, light dumbbells/plyo balls, but also include whole body movements such as squats, lunges, and light jogging to warm-up the lower body and torso/core. Be sure to break a sweat during your warm-up.&nbsp;There is not a specific warm-up which is best for all players. Your warm-up should be specific to your body's needs and include movement similar to the activity/position you are warming up to play. Some examples of dynamic warm-ups, specific to baseball players, are detailed below.&nbsp;Post-activity stretching is equally important. We recommened cooling down with static stretches (holding stretches for 20-30seconds) can help reduce muscle tension and improve recovery time, minimizing the risk of injury over time. Don't over think this. Stretch muscles that are tight or sore following a game or practice.&nbsp;<h3>In-Season Arm Care Exercises</h3>Strengthening the muscles around the shoulder and elbow can provide better support and stability during pitching or throwing. Exercises such as resistance band workouts, light dumbbell lifts, and push-ups are effective in building the necessary strength in these areas.It’s crucial to focus on form rather than weight to avoid unnecessary strain. Proper technique ensures that players are targeting the right muscle groups without overexerting themselves. Feel the burn in your muscles but do not execute exercises at an intensity that results in muscle failure. A general guideline is 2-3sets of 10-20 repitions. "Feel the burn, and move on."&nbsp;A general guidline would include 3-4 days/week consisting of 2-3 mobility exercises and 5-6 strengthening exercises. The key to success is executing exericse which are specific to your body's needs. Consult with your physical therapist regarding which mobility drills and strengthening exercises are best fot you and your arm.&nbsp;<h3>Rest and Recovery</h3>Adequate rest is just as important as physical training. Ensuring players have scheduled rest days allows muscles to repair and grow stronger. Overuse injuries are common in baseball; thus, monitoring pitch counts and adhering to rest guidelines can prevent potential setbacks.Utilizing ice/heat, compression, muscle stimulation products, sauna, cold plunge are all common and beneficial methods to promote recovery. The goal of recovery is to reduce inflammation and soreness, promoting quicker recovery times.<h3>Nutritional Support</h3>Nutrition plays a significant role in an athlete's performance and recovery. A balanced diet rich in proteins, carbohydrates, and healthy fats provides the energy needed for workouts and aids in muscle repair. Staying hydrated is also crucial, as it maintains muscle function and reduces fatigue.Players should consider consulting with a registered diatician/nutritionist to tailor their diet to meet specific athletic needs, ensuring they are getting optimal nutrients to support their training regimen.<h3>Monitoring Arm Health</h3>Regular check-ups with a Physical Therapist can help monitor arm health and catch any potential issues early. Players should be encouraged to report any discomfort or pain immediately rather than ignoring symptoms, which could lead to more severe injuries.Incorporating these essential arm care strategies into a high school baseball player's routine can significantly enhance performance and reduce injury risks. Consistency and attention to detail are key to maintaining healthy, strong arms throughout the season.<h3>Examples of In-season Arm Care Routines&nbsp;</h3><figure id="figure-bdb5g4osym7nn0kun"><img id="bdb5g4osym7nn0kun" src="https://cdn.durable.co/blocks/1aJ5JTZcL54uBjfv6lQNo0SIhyULx6G0mXPGWnz8VLIAs6wfQSFCZXzNjaUZaXcv.png" alt="" title="" class="object-cover bg-gray-100 rounded-sm md:rounded-md lg:rounded-lg" style="aspect-ratio: 1/1; object-position: 55% 55%;" data-corners="default" data-aspect="1:1" data-caption="" data-positionx="55%" data-positiony="55%" data-fullwidth="false" data-mce-src="https://cdn.durable.co/blocks/1aJ5JTZcL54uBjfv6lQNo0SIhyULx6G0mXPGWnz8VLIAs6wfQSFCZXzNjaUZaXcv.png" data-mce-style="aspect-ratio: 1/1; object-position: 55% 55%;"></figure><figure id="figure-fe2yddxr5hm7nn30u6"><img id="fe2yddxr5hm7nn30u6" src="https://cdn.durable.co/blocks/21pUJfw86xkRoPuHwsmJRVf7oScmIkaffHJaZZgKPqnJVmzC6oE3S0ueM07C3Pmb.png" alt="" title="" class="object-cover bg-gray-100 rounded-sm md:rounded-md lg:rounded-lg" style="aspect-ratio: 1/1; object-position: undefined undefined;" data-corners="default" data-aspect="1:1" data-caption="" data-positionx="undefined" data-positiony="undefined" data-fullwidth="false" data-mce-src="https://cdn.durable.co/blocks/21pUJfw86xkRoPuHwsmJRVf7oScmIkaffHJaZZgKPqnJVmzC6oE3S0ueM07C3Pmb.png" data-mce-style="aspect-ratio: 1/1; object-position: undefined undefined;"></figure>Exercise videos can be found on our YouTube Channel.&nbsp;

In-Season Arm Care for Amateur and High School Baseball Players

Mastering Weightlifting Volume for Optimal Gains: A Complete GuideWhen it comes to building strength and muscle, one of the most critical components of a well-designed workout program is volume. But what exactly does weightlifting volume mean, and how can you use it to optimize your gains in the gym?In this blog, we’ll break down the concept of weightlifting volume, how to calculate it, and how to adjust it based on your goals. Whether you're aiming to build muscle, improve performance, or maintain overall fitness, mastering volume assignments can elevate your results.What is Volume in Weightlifting? Volume refers to the total amount of weight lifted in a workout session, typically measured as the total number of reps multiplied by the weight lifted. For example, if you do 4 sets of 10 reps at 100 pounds, your volume for that exercise would be:4 sets x 10 reps x 100 pounds = 4000 pounds of volumeThis volume measurement is crucial because it dictates the overall workload your body needs to adapt to. The higher the volume, the greater the stimulus for muscle growth and strength development.How to Determine the Right Volume The “right” amount of volume depends on your specific training goals and experience level. Here’s how you can tailor volume assignments for different fitness objectives:1. Strength Training If your goal is to build maximal strength, you'll need to lift heavy weights at a higher intensity relative to your one-rep max (1RM), but with fewer repetitions. The goal is to train your neuromuscular system to handle heavier loads.Intensity: ≥85% of 1RM Reps: ≤6 per set&nbsp; Sets: 2-6 per exercise Training with this approach helps you increase your one-rep max and overall power output, but it requires adequate rest and recovery between sets due to the high intensity.Rest Period: 2-5 minutes between each set.2. Power Development For those focusing on power, there are two types of events to consider: single-effort and multiple-effort. These are especially relevant for athletes involved in explosive sports like Olympic weightlifting, sprinting, or jumping.Single-effort event (e.g., Olympic lifts):Intensity: 80-90% of 1RM Reps: 1-2 per set Sets: 3-5 per exercise Multiple-effort event (e.g., team sports, CrossFit)Rest Period: 2-5 minutes between each set.Intensity: 75-85% of 1RM Reps: 3-5 per set Sets: 3-5 per exercise This type of training emphasizes speed and explosiveness, helping athletes maximize their ability to generate force quickly.Rest Period: 2-5 minutes between each set.3. Hypertrophy (Muscle Growth) If your goal is to build muscle size, you’ll want to train with moderate to high volume at a moderate intensity. The rep range here allows for enough time under tension, a critical factor for muscle growth.Intensity: ≥67-85% of 1RM Reps: 6-12 per set Sets: 3-5 per exercise Progressive overload, where you gradually increase volume or intensity, is key for continuing to build muscle over time.Rest Period: 30 seconds-1.5 minutes between each set.4. Muscular Endurance For those aiming to increase muscular endurance, the goal is to lift lighter weights for higher reps. This approach enhances your muscles' ability to perform under prolonged stress, which is essential for long-distance athletes or those looking for greater general fitness.Intensity: Less than 67% of 1RM Reps: ≥12&nbsp; Sets: 2-4 per exercise Training for endurance improves your stamina and ability to perform repetitive movements over an extended period, making it a staple for athletes in endurance sports or anyone looking for enhanced muscular staying power.Rest Period: ≤30 seconds&nbsp;Adjusting Volume Based on Experience Level Your experience level should also dictate how much volume you incorporate into your workouts:Beginners: 2-3 sessions per week. Start with lower volume (8-10 total sets per muscle group per week) to allow their bodies to adapt without overtraining. Intermediate lifters: 3-4 sessions per week. Moderate volume (10-15 total sets per muscle group per week) as their muscles become more accustomed to the stress of lifting. Advanced lifters: 4-7 sessions per week. Higher volume (15-20+ total sets per muscle group per week) to continue progressing as their bodies have adapted to lower volumes. The Importance of Rest and Recovery Increasing volume is a great way to build muscle and strength, but it’s crucial to balance it with adequate recovery. Overtraining can lead to fatigue, injury, and stalled progress. Incorporate rest days, ensure proper sleep, and fuel your body with the right nutrition to maximize the benefits of your training.Final Thoughts Understanding and mastering volume assignments in weightlifting can significantly boost your results, whether you're looking to gain muscle, improve strength, or enhance endurance. By tailoring your workout volume to your specific goals and experience level, you can create a program that pushes you towards consistent progress.Start tracking your volume today and watch your gains skyrocket!

Weightlifting Volume for Optimal Gains

Throwers often seek ways to improve their performance. One effective method is through weighted ball programs. These programs are designed to enhance strength, range of motion, throwing mechanics, and accuracy.<h2>Understanding Weighted Ball Programs</h2>Weighted ball programs involve the use of balls that are heavier or lighter than the standard ball used in the sport. These variations in weight help athletes develop different muscle groups and improve their throwing mechanics.Coaches and athletes must choose the appropiate weights and dose/volume (number of throws) to avoid injury. It is important to follow a structured program and understand the risks involed.&nbsp;<h3>Risks of Weighted Ball Programs&nbsp;</h3>While weighted ball programs can be beneficial, below are the risks.&nbsp;<ul><li>Increasing stress/strain on the shoulder and elbow.</li><li>Increase in injury rates of the shoulder/elbow.</li></ul><h3>Benefits of Weighted Ball Programs</h3>What does a weighted ball program actually do? Research has shown immediate effects of weighted ball programs include:&nbsp;1. Increased shoulder external rotation range of motion2. This increased shoulder external rotation/layback is correlated to an increase in velocity. Not an increase in shoulder strength.This increase in shoulder external rotation range of motion has a direct correlation to increasing velocity. But again, with the increased risk of increased stress/strain on the shoulder and elbow.&nbsp;<h3>Our Recommendations:&nbsp;</h3>Weighted ball programs much be stratigically utilized while understanding the risks involved.&nbsp;1. Consult with your instructor/coach, trainer and therapist, prior to initiating a weighted ball program.&nbsp;2. Understand your specific musculoskeletal limiations and mechanical faults prior to initiating a weighted ball program. Do you need more external rotation/layback? Are there other range of motion, strength, or mechanical faults contributing to lack of velocity?&nbsp;3. Determine the appropriate weight, volume, and dose (number of throws) specific for you.&nbsp;4. Have a clear understanding that there is an increased risk of injury.&nbsp;<h3>Conclusion</h3>We are not recommending cesation of weighted ball programs. There are situations in which they can be beneficial to increasing your performance. The utilization of wieghted balls should be overseen by a professional as well as initiated after consulting with your coach, instructor and therapist in order to ensure safe utilization and execution.&nbsp;

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Little League Shoulder

Little League Elbow

How Long Does It Take for a High School Pitcher’s Elbow t...

In-Season Arm Care for Amateur and High School Baseball P...

Weightlifting Volume for Optimal Gains

Optimizing Performance with Weighted Ball Programs for Th...