Shouldering the Burden of Overuse
Combine fast-growing children and baseball and you have the classic ingredients for the most common cause of shoulder pain. Parents, coaches or young athletes may shrug off the pain, but it's often a sign of an overuse injury and time to call on physicians and physical therapists for help, says Eric Wall, MD, orthopedic surgeon at Cincinnati Children's Hospital Medical Center.
Football, basketball, wrestling and other high-impact sports cause their fair share of shoulder injury – most often dislocations. Swimming, and less often volleyball and tennis, can also lead to chronic shoulder problems. But it's baseball, or more specifically pitching, says Dr. Wall, that's to blame for the majority of shoulder overuse injuries.
Despite the growth of fast-pitch softball for girls, that sport rarely produces shoulder injuries, he says. It's the overhand motion of pitching that causes so many shoulder problems in hardball – hence the name "Little League shoulder."
Vulnerable Growth Plates
"The number one cause of overuse pain in the shoulder is a stress fracture through the growth plate of the highest arm bone," Dr. Wall says. Such stress fractures, and related pain, are most likely when a boy hits a growth spurt, usually within a year or two of age 14.
"The body is laying down bone so quickly then that it doesn't have time to solidify," he says. "It's like building on wet cement. Once that process slows, boys are much less likely to get that stress injury." Girls have similar growth spurts around age 12, but they don't get injured because they don't pitch overhand.
Youngsters, used to hearing about adult sports injuries, are likely to believe they have a rotator cuff injury or impingement when they feel shoulder pain, Dr. Wall says. A rotator cuff injury is a tear or other damage to the ring of muscles that keeps the ball of the shoulder joint in place. Impingement happens when the humerus rubs against the top of the shoulder socket. "Those are extremely rare in young people," he says, "though older high school players occasionally get rotator cuff injuries."
Fortunately, shoulders are far more forgiving than knees and elbows, Dr. Wall says, and rarely require surgery for overuse injuries. The best treatment usually is rest, followed by a gradual return to full-speed activity.
Rx for Physical Therapy
Physical therapy can play a major role both in recovery from and prevention of overuse injuries, he says. Physical therapists recommend exercises to build up muscles in the back, abdomen and other parts of the body so shoulder muscles don't have to work as hard.
"We have swimmers and pitchers strengthen the muscles they never use in order to help balance the shoulder muscles," Dr. Wall says. "This requires high-level, specialized exercises that aren't in books. You need to be supervised to do them properly."
Parents can find such specialized exercise programs at the Sports Medicine Biodynamics Center at Cincinnati Children's. There, for example, a young pitcher's throwing motion may be videotaped with multiple cameras to analyze strength deficits that the exercises can target.
Limiting pitch counts for young pitchers is another way to avoid overuse that can lead to shoulder injuries, Dr. Wall says. But, he notes many leagues rely on limiting innings or mandating days of rest, which don't provide as much protection. Youngsters who pitch in multiple leagues or practice at full speed between games may also circumvent limits that could prevent injuries.
