A Pitch Too Many: Little League Elbow

January 5th, 2021
Little League elbow

In talking to friends and family about my job, they always ask me what kind of patients that I see. They are interested in the variety of diagnoses that we see including the complex surgical and non surgical cases. They are always surprised, though, when I tell them the ages of the patients that come. They seem shocked that some of my patients can be as young as 9 to 11 years old. 

These patients do present with the common fractures and sprains from various sports and just being kids. However, we also see a fair amount of patients this age range that are having problems due to overtraining and overuse. One sport that we can see this in is baseball.

There are a variety of overuse injuries that occur in baseball involving multiple joints. Today I would like to talk about Little League Elbow.

There is a general consensus that the injury rate in children is increasing. I have seen this in my time as a physical therapist over the past 8 years.  One reason that this has occurred is more sport specialization earlier on in a child’s athletic career. This means that instead of playing anywhere from 2-4 different sports a year, they are playing the same sport, on multiple teams, for the entire year. This can result in overuse, and not enough variability in how a child moves or stresses his/her body. This then can lead  to stress related overuse injuries. 

Little League elbow describes a “lesion to the medial aspect of the elbow” (1) and is usually caused secondary to excess stress placed across the elbow during the early phases of throwing including the cocking phase. The elbow can be both impacted on the inside aspect due to a distracting force or the outside of the elbow due to a compression force. Therefore, symptoms can prevent itself in a variety of ways.  

An efficient evaluation and exam is required to ensure appropriate diagnoses and imaging is often performed. Depending on the athlete’s age they may present with apophysitis (inflammation of the growth plates) or an epicondylar avulsion fracture where the ligament pulls part of the bone away from the main structure (2)

Whenever a young throwing athlete complains of medial elbow pain, Little League Elbow will be considered more likely. The earlier this is spotted and addressed, the better the throwers prognosis is with a reduced risk of functional limitations or damage (1)

Physical therapy is an effective tool in recovering from Little League Elbow. It is important, as it is an overuse injury, to remove the aggravating factor, which is typically throwing for at least 4-6 weeks (2). The goal of physical therapy is to restore normal motion, improve the athletes core and shoulder strength, improve the throwers understanding of how to use more than just their arm to throw, and educate the parents and coaches on how to prevent these types of injuries.

How does one prevent these types of injuries? Encouraging good throwing mechanics at a young age is a key part of reducing the likelihood of these types of injuries (1). Following a specific pitch count and not throwing fatigued is also an important aspect of minimizing the effects of overuse. The physicians and physical therapist should not be the only one responsible for the health and well being of these young athletes. Coaches and parents need to take on this responsibility as well and recognize when their athletes and kids are showing signs of discomfort, fatigue, and poor mechanics.

If you have a child or an athlete that has been suffering with elbow pain contact our physical therapy office today at Chicago, North Center, Lincoln Square, Lincoln Park, Roscoe Village, IL. We will set up an evaluation for you so you can get started on your road to recovery. At The Fit Institute (TFI), our physical therapists are dedicated to helping you return to your sport as quickly as possible!

Here is a good reference to determine the appropriate pitch count and rest requirements for different ages of little league players:



  1. Klingele K, Kocher M. Little league elbow: valgus overload injury in the paediatric athlete. Sports Medicine [serial online]. December 2002;32(15):1005-1015. Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed November 19, 2011
  2. A clinical and roentgenographic study of little league elbow. American Journal Of Sports Medicine [serial online]. 2004 Jan-Feb 2004;32(1):79-84. Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed November 19, 2011