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Health & Exercise Forum

Little League Elbow is No Little Problem

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May 24, 2010

Dr. Mackarey's Health & Exercise ForumSpring has arrived and baseball season is around the corner. It is hard to believe that a healthy young little leaguer has to worry about injuries. They seem so flexible, agile, strong, and fast. Unfortunately, because their bones are not fully developed, they are vulnerable to “Little League Elbow.” Little league elbow is an injury to the growth plate on the inner aspect of the elbow. The growth plate, where the muscles of the wrist and forearm attach, is also called the medial epicondylar apophysis. This undeveloped and immature boney area is greatly stressed in sports and activities that require repetitive throwing motions.

Causes of Little League Elbow

Repetitive throwing is the most common cause of little league elbow. The two phases of the throwing motion that stress the growth plate most are the early acceleration phase and the release phase. During the early acceleration phase, when the thrower changes from windup to throwing, the muscles of the forearm and wrist pull a traction force through the growth plate. In the release phase, a powerful inward and downward snap of the wrist cause the muscles and ligaments to pull on the growth plate. The growth plate in the elbow is vulnerable to injury because it is made up growth cartilage. The cartilage is immature and softer than bone, muscles, tendons or ligaments. As the thrower continues to repeat the trauma without enough rest, the cartilage weakens and develops small cracks. Eventually, it may pull away from the bone.

Symptoms of Little League Elbow

Pain on the inner aspect of the elbow is the most significant sign of little league elbow. The pain can occur as a sudden sharp pain after a hard throw or a gradual onset from repeated trauma over the season. In addition to pain the thrower may experience tenderness to touch, swelling, redness, and warmth on the inner aspect of the elbow.

Treatment of Little League Elbow

  • Rest- stop throwing
  • Ice – ice packs 15-20 minutes 3-5 times per day
  • Compression – compression bandage or sleeve
  • Minor Problem - If caught early separation of the growth plate may be minimal and the above  treatment may be sufficient.
  • Physician Visit – if pain persists for more than a few days, a visit to your family physician is important to determine the extent of the injury. An X-ray of the growth plate may be necessary.
  • Stop Throwing Period – may take 4-6 weeks to allow proper healing
  • Position Change – in minor cases, or following 4-6 weeks of rest, the athlete may continue to play if the player is moved to a position in which very little throwing is required, such as first base or second base.
  • Severe Problem – on rare occasions, the growth plate is separated enough to require casting. Even more rarely, the problem requires surgical intervention.
  • Treatment Once Healed – involves a slow and gradual return to throwing, at first from short distances, then advancing to 50 pitches from the mound.
  • Orthopedic & Sports Physical Therapy Consultation – will assist and expedite your return to activity.
  • Long-Term Outcome - With proper management, this problem will heal completely and will not have any negative long-term effects. On rare occasions, the cartilage will degenerate and tiny loose bodies can break off and get lodged inside the elbow joint. This may require surgical removal.

Prevention of Little League Elbow

Do What the Big Leaguers Do:

  • Warm-Up – heat, massage, light and short-distance throwing before pitching
  • Cool-Down – ice elbow and shoulder after throwing
  • Pitch Count – college and professional pitchers DO NOT count innings, nor should little leaguers. Count Pitches.
    • 9-10 year olds: 50 per game 75 per week, 1000 per season
    • 11-12 year olds: 75 per game, 100 per week, 1000 per season
    • 13-14 year olds: 75 per game, 125 per week, 1000 per season.*

*American Journal of Sports Medicine

  • Do Not Over Throw at Practice or Playground – throwing when not playing organized baseball still stresses the elbow. Don’t throw at pick-up games or gym class and play infield when not pitching,
  • No Curves or Breaking Pitches (until age 14)– last year, Little League Magazine, recommended only two pitches required to be effective in little league baseball: fastball and change-up.
  • Stop – Stop – Stop – pitching at the first sign of elbow pain, rest, ice and compress.
  • Stretch – maintain shoulder motion year round by turning shoulder in (behind back), turn shoulder out (behind head), and bring shoulder across chest (hugging).
  • Off-Season Rest – Major league pitchers often take off 2-3 months from pitching. They stretch, weight train, play other sports (golf, run, tennis) and use other muscles.
  • Practice Technique – get instructions from a professional on proper throwing technique. Learn to throw from your legs not your arms.

Visit your doctor regularly and listen to your body.

Read about preventing youth baseball injuries.

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email:

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an affiliated faculty member at the University of  Scranton, PT Dept.