Can a 16-year-old be cleared for sports while undergoing physical therapy (PT) for arm pain?

Sports Clearance for 16-Year-Old with Arm Pain in Physical Therapy

A 16-year-old can be cleared for sports participation while undergoing physical therapy for arm pain only after completing a structured rehabilitation program, demonstrating pain-free range of motion and strength, and successfully completing a progressive return-to-throwing program without symptoms. 1

Initial Assessment Requirements

Before any clearance decision, the following must be evaluated:

• Determine the underlying cause of arm pain through physical examination focusing on focal weakness, decreased range of motion during abduction with external or internal rotation, and tenderness over the proximal humerus or rotator cuff 1
• Rule out serious pathology including proximal humeral epiphysiolysis (Little League shoulder), rotator cuff tears, or labral injuries that are common in adolescent throwers 1
• Assess for warning signs requiring medical consultation including discomfort during throwing that persists, inability to complete activities without pain, or symptoms that worsen with continued participation 1

Rehabilitation Phase Requirements

The athlete must progress through four distinct phases before sports clearance 1:

Phase 1: Acute Phase

• Complete rest from throwing until asymptomatic 1
• Modalities include cryotherapy, stretching of posterior shoulder muscles, and rotator cuff/scapular stabilization strengthening 1
• No throwing is performed during this phase 1

Phase 2: Intermediate Phase

• Continue stretching, specifically internal rotation and horizontal adduction 1
• Progressive isotonic strengthening and core/lower extremity strengthening 1
• Athlete must demonstrate pain-free motion and strength before advancing 1

Phase 3: Advanced Strengthening Phase

• Initiate plyometric program and endurance drills 1
• Begin short-distance throwing program only after pain-free motion achieved 1

Phase 4: Return-to-Activity Phase

• Progressive interval throwing program lasting 1-3 months depending on injury severity 1
• Must complete program without evidence of symptoms before competition clearance 1

Specific Return-to-Sport Criteria

The athlete can only be cleared when ALL of the following are met:

• Complete absence of pain both at rest and with throwing activities 1
• Full range of motion restored compared to non-throwing arm 1
• Normal strength in rotator cuff and scapular stabilizers 1
• Successful completion of age-appropriate interval throwing program without symptom recurrence 1
• For 16-year-olds specifically, this requires progression through steps 1-16 of the data-based interval throwing program, advancing no more than one step every 3 days for moderate injuries 1

Critical Pitfalls to Avoid

Never clear an athlete who:

• Still experiences arm pain during or after throwing, as this indicates incomplete healing 1
• Has not completed a structured throwing program, as premature return increases risk of re-injury 36-fold 1
• Shows signs of over-exercising including inability to finish activities, inability to converse during activity, or faintness/nausea after exercise 1

Special Considerations for Adolescents

• Adolescent throwers have unique vulnerabilities including open growth plates and weaker rotator cuff muscles compared to adults 1
• Arm pain is common but not normal - 74-80% of youth players report arm pain, but this should not be dismissed as acceptable 2
• Psychosocial pressure exists - 46% of youth players report being encouraged to play despite pain, which must be resisted 2
• Athletes with prior overuse injuries are at higher risk and require more conservative management 2

Documentation and Monitoring

• Record symptoms, rating of perceived exertion, heart rate, and blood pressure during initial supervised activities 1
• Monitor for recurrence of symptoms at each stage of progression 1
• If symptoms return at any stage, athlete must return to previous asymptomatic level and restart progression after resolution 1

The decision to clear must prioritize long-term shoulder health over short-term competitive goals, as premature return significantly increases risk of chronic injury and surgical intervention 1