Little League Elbow
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
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)
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)
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.
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
- 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 - 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 - 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.
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.
Educate players, coaches, and parents on early signs of injury
References
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 & USA Baseball. Pitch Smart Guidelines. Retrieved from: https://www.mlb.com/pitch-smart