Sports Therapy

Little League Elbow

On December 5, 2016
By Dr. Nekessa Remy | 0 Comments

mississauga chiropractorWhat is Little Leaguer’s Elbow?

Little leaguer’s elbow is an overuse condition seen in adolescent baseball player’s, hence the name, that can be a cause of pain located on the inside of the elbow (medial). With too much repetitive throwing of a baseball the growth plate on the inside of the end of the elbow, known as the medial epicondyle, becomes inflamed. Little leaguer’s elbow is known as an apophysitis which refers to chronic inflammation of the growth plate. In adolescents, the growth plates are the weak link in the elbow during the throwing motion as opposed to the ligaments as in adults. Elbow pain in general in the adolescent pitcher is not uncommon and occurs in up to 40% of throwers.

How do you get Little Leaguer’s Elbow?

Repetitive overhand throwing of a baseball, most commonly seen in little league adolescent pitchers, can lead to cumulative traction stress being placed on the inside of the elbow. During the overhand throw, the inside of the elbow (medial) has traction placed on it while the outside of the elbow (lateral) has compression placed on it. This repeated traction on the medial elbow pulls at the growth plate and it becomes irritated and inflamed.

Who is most susceptible to Little Leaguer’s Elbow?

Little leaguer’s elbow most commonly occurs when an adolescent baseball pitcher throws too many pitches in games and does so on too often days. This leads to a cumulative number of throws that exceeds the forces that the growth plate on the medial side of the elbow can withstand.

What are the recommended pitch counts to decrease the chances of Little Leaguer’s Elbow occurring in the first place?

The USA Baseball Medical and Safety Advisory Committee makes the following recommendations for earliest age at which pitchers should begin throwing each pitch type: fastball, age 8; change-up, age 10; curveball, age 14; knuckleball, age 15; slider, age 16; forkball, age 16; splitter, age 16; screwball, age 17. Breaking pitches should not be thrown until skeletal maturity (growth plates are closed) is reached.

The recommended per game pitch counts are: 8 to 10 years, 50 pitches; 11 to 14 years, 75 pitches; 15 to 16 years, 90 pitches; 17 to 18 years, 105 pitches. Furthermore, pitchers should not compete more than 9 months per year and should avoid all overhead activities during those 3 months of rest. In addition, pitchers should be not participate in more than 1 league during overlapping seasons. Pitchers of all ages should be involved in year-round conditioning to promote endurance, core strength, neuromuscular control, and proper throwing mechanics.

How is Little Leaguer’s Elbow initially treated?

The patient should undergo a period of complete rest from throwing for 4 to 6 weeks at a minimum. During this period throwing of any kind is strictly prohibited. Laser therapy, acupuncture and soft tissue therapy can be used to reduce inflammation and help manage pain. A strengthening and endurance program should be initiated to maintain cardiovascular fitness and to focus on overall core strength. Often adolescent aged athletes have poorly developed core strength and overall body control which can make them susceptible to poor throwing mechanics and injury. Regular icing and anti-inflammatory medication should be used early on when the patient is symptomatic.

Following the initial 4 to 6 week period of no throwing and only when the patient is completely pain free, a structured throwing program should be initiated over the next 6 to 8 weeks. During this time, the pitcher should be assessed to evaluate and correct their throwing mechanics. Any pain during the rehab period should cause the athlete to temporarily pause their program for a short period until they can throw without symptoms.

What is the typical recovery from Little Leaguer’s Elbow?

Typically it takes about 12 weeks for an injured athlete to return to competitive throwing in a game situation. Special attention should also be paid to the number of pitches and to the types of pitches thrown by the pitcher. Higher stress pitches like a curve ball or breaking ball should be avoided until the pitcher reaches the appropriate age. Also, the athlete’s core and shoulder strengthening program should be continued year round to maintain and further develop their strength and muscle control.


For more information contact Mississauga Chiropractor Dr. Nekessa S. Remy at or 905-820-7746





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