My Doctor told me that I have “Little League Elbow.” What does this mean and can I play through it?
Little League Elbow, also known as medial epicondyle apophysitis, is a common overuse injury in young athletes, particularly those involved in throwing sports like baseball. It occurs when repetitive stress is placed on the growth plate on the inside of the elbow, leading to inflammation and pain. This condition typically affects children and adolescents between the ages of 8 and 15, during the critical years when their bones and joints are still developing.
Growth plates are areas at the end of certain bones that are soft, similar to cartilage early in our lives. They are soft and have a “gap” between the end and the rest of the bone in order to accommodate how our body changes as we grow. When we reach a certain age, typically puberty, growth plates turn into hard bone and these growth plates close. Once the plates are completely ossified (hardened), bone growth in length stops,
Why does Little League Elbow Develop?
1. Poor Throwing Mechanics
Bad habits like "opening up" too early, excessive trunk lean, or an inefficient arm path can increase torque across the elbow. Poor mechanics put additional stress on the elbow, specifically structures on the inside. If some of the terms used above are unfamiliar to you (opening up, trunk lean), it is probably best that you reach out to a pitching coach to have them take a look.
2. Overuse and Inadequate Rest
One of the biggest risk factors is simply throwing too much. Whether it’s games, practices, bullpen sessions, or backyard play, excessive throwing volume without sufficient rest doesn’t give the developing elbow a chance to recover. Pitchers who continue throwing despite being tired are at 3.5 times greater risk for arm injury.
⚠️ Studies show that pitchers who throw more than 75 pitches in a game or more than 600 pitches in a season have a significantly higher risk of elbow injury.
3. Specialization at a Young Age
Year-round baseball and early sport specialization are now common. Playing only one sport—especially one with a repetitive motion like pitching—prevents athletes from developing balanced musculature and increases their exposure to overuse injuries. I discussed the important points to consider when specializing in a sport here.
4. Throwing Breaking Balls Too Early
There’s still some debate, but many coaches and clinicians believe that throwing curveballs and sliders before the athlete has fully matured can increase stress on the elbow. The torque required for these pitches—especially when thrown with immature mechanics—can contribute to injury. Take a look at this blog post for more information.
5. Poor Strength, Mobility, or both
Deficits in shoulder range of motion, scapular stability, or core strength can lead to compensations that overload the elbow. A weak kinetic chain means the elbow ends up doing more than it should. Here is a great exercise that can help add strength in areas that are susceptible.
Determining whether you can play through Little League Elbow is complex. In some cases, you may be able to simply use pain as your guide. However, in other situations continuing to throw can exacerbate the injury and potentially lead to more serious complications, such as permanent damage to the growth plate, placing excessive stress to the UCL (aka the Tommy John Ligament), and in turn jeopardizing your baseball career. It is very important to remember that this area that becomes sore in Little League Elbow is the anchor for the ulnar collateral ligament (UCL). That is why it is very ill-advised to push through this pain without understanding what the repercussions of your actions may be. Early diagnosis and appropriate treatment, which may include rest, physical therapy, and a gradual return to activity, are crucial for recovery. A structured rehabilitation program and throwing program under the correct guidance is essential for young athletes to heal properly and return to their sport safely.
At the Training Room Physical Therapy, all overhead athletes will receive a “head-to-toe” evaluation. This is because the process of evaluating an athlete with this issue is complicated. The evaluation starts with observing how the athlete uses their entire body during a throw. This includes analyzing the hip rotation, spine alignment, and lower body stability. The hips generate much of the power in a throw, while the spine helps transfer this energy up through the torso and into the arm. Any dysfunction or weakness in these areas can place excessive stress on the elbow, increasing the risk of injury. Core stability is a critical component of a successful throw as a weak core can result in an inefficient transfer of energy, leading to an increase of strain on the arm. Then, strength and mobility of the arm is performed. While we recognize that no overhead athlete is perfectly symmetrical, it is important to view the athlete’s body as one unit. While Little League Elbow may seem like a straight forward injury, there are potentially a lot of underlying issues that need to be addressed - or this problem will most likely return.
Please feel free to watch the video below from Dr. James Andrews, a world renowned orthopedic surgeon. He stresses that the major risk factors for elbow pain is excessive pitching and throwing while fatigued. While this may seem obvious, there are still many skeletally immature kids who throw against this advice. In order to tackle this problem I firmly believe that education for our coaches is the best solution.
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