Young pitchers are reporting to baseball fields all across Louisville and Southern Indiana. Learn about Little League elbow, an overuse injury that affects baseball pitchers as well as softball and tennis players, and what parents can do to help children prevent it.

Published: May 27, 2019 | Updated: October 12, 2020

Spring is officially here — and that means young pitchers and catchers are reporting to baseball fields all across Louisville and Southern Indiana. Youth baseball is a fun and healthy spring and summer sport for boys and girls. But as youth sports get more competitive and kids specialize in a single sport or position at younger ages, overuse injuries such as Little League elbow, clinically known as medial epicondyle apophysitis, become more common. What is this condition — and how can you make sure your kids are playing smart this spring and summer?

What is Little League elbow?

Medial epicondyle apophysitis is an injury to the inside of the elbow joint caused by stress due to overuse from pitching and throwing. The condition happens in children and teens with open growth plates, which are flexible cartilage new bone growth near the ends of bones in growing children. It’s more common in kids who are overhand pitchers, however, kids who play other baseball positions, softball and tennis can be at risk for the condition.

How do kids get Little League elbow?

Several things can contribute to a child experiencing this and other baseball overuse injuries, including:

• Repetitive overhead throwing motion without proper rest and stretching
• Pitching and throwing too much
• Pitching and throwing without using proper technique
• Pitching while another part of the body is injured
• Pitching on back-to-back days
• Lack of shoulder muscle strength
• Throwing inappropriate pitch types for the child’s age (throwing curveballs and sliders at a young age)
• Throwing too many pitches during a game or over the course of the entire season or year
• Using a radar gun to measure pitch speed

What are Little League elbow symptoms?

Symptoms may include:

• Decreased ability to throw with usual accuracy or speed
• Difficulty with extending the elbow completely
• Pain in the inner elbow with movement; child hearing a “pop” during a hard throw
• Swelling in the inner elbow

If the condition remains untreated, it can get worse and may lead to bone and/or ligament damage. There is also a small chance that the growth plate could close prematurely or fracture, which may need casting or surgery.

How is Little League elbow treated?

The condition often will heal with a combination of rest, ice and anti-inflammatories for pain. Typically, a child will need to stop throwing for six weeks. After this rest period, he or she can begin working with a specially trained physical therapist — not a pitching coach — on a progressive throwing program. This program focuses on proper throwing mechanics with the arm and highlights core and leg strengthening, as these help with throwing strength and endurance. A child is cleared to return to practice and games when the pain is gone.

How to prevent overuse injuries

Any overuse injury can be prevented by encouraging overall health and proper training. Major League Baseball (MLB) and USA Baseball partnered to create Pitch Smart, a comprehensive guide for parents and young athletes to understand safe pitching practices. Pitch Smart was developed with an advisory council of physicians from the American Sports Medicine Institute and various MLB franchises. Pitch Smart includes pitch count limits and required rest recommendations for youth pitchers by age group. In addition, here are some other tips to help prevent overuse injuries in children and teens:

• Keep an eye on pitching type for younger ages. Breaking pitches, such as curveballs and sliders, can have an increased risk of injury for younger pitchers. This is because these pitches put more stress on the elbow than others. There are age recommendations available for certain pitches, but parents should work with their child’s primary care provider to understand if their child is ready for advanced pitches. A child may be ready for these advanced pitches at a younger or older age due to their stage of development. Starting these advanced pitches can start a child on a path to pitch more frequently, which also can lead to overuse.
• Maintain overall fitness. A child should have a fitness routine appropriate for his or her age and the sport he or she plays. Resistance training, aerobic conditioning and strength training all can be part of a well-rounded fitness routine.
• Play other sports in the offseason. Children are specializing in one sport at younger and younger ages. Playing a different sport in an offseason can give a child a needed period of “active rest” from throwing. Playing a non-throwing sport can give a child three to six months of recovery time for his or her throwing arm.