What is Little League Elbow?

Little League elbow is one overload damage to the elbow caused by repeated throwing. Most cases occur in pitchers, but any young athlete who throws a lot can get the condition.

What are the signs and symptoms of Little League Elbow?

Children with Little League elbow have pain on the inner part of their elbow. At first, the elbow may only hurt during or just after throwing. But without treatment, the elbow can start to hurt all the time. The pain usually starts gradually, but can occur after a throw if the athlete has often made the same movements.

What Causes Little League Elbow?

Little league elbow is an overuse injury (also called a repetitive stress injury). Overuse injuries occur because the same movement is repeated over and over.

In Little League elbow, repetitive throwing injuries a growth plate in the elbow. A growth plate is a layer of cartilage near the end of a bone where most of the bone’s growth occurs. It is weaker and more prone to injury than the rest of the bone.

Who Gets Little League Elbow?

Little League elbow happens most often in pitchers. But anyone who throws a lot, including catchers, infielders and outfielders, can get it.

Most cases are in children and teenagers aged 8-15 years. They are still growing, so their bones still have growth plates. Bones that have finished growing do not have growth plates. Elbow pain after this age is probably not Little League elbow.

How Is Little League Elbow Diagnosed?

Health care providers diagnose Little League elbow by:

• asking about sports and activities
• makes an examination of the elbow, observes range of motion and performs strength tests
• sheep X-rays (X-rays may be normal in Little League elbow, but may show other problems in the elbow)
• compare the affected elbow with the unaffected elbow

How is Little League Elbow treated?

Children with Little League elbow should take a break from all throwing for about 6 weeks. For pain and swelling, they may:

• Place ice or a cold pack on the elbow every 1-2 hours for 20 minutes at a time. Place a thin towel between the ice and the skin to protect it from the cold.
• Take ibuprofen (Advil, Motrin, or store brand) or naproxen (Aleve, Naprosyn, or store brand) if the health care provider says it’s OK. Follow the package directions for how much to give and how often to give it. Children should always take medicine with food.

When pain and swelling subside, health professionals usually recommend physiotherapy or another training program. Before returning to play, some kids may find it helpful to work on how they throw with a pitching coach or physical therapist.

When Can Kids With Little League Elbow Go Back to Throwing?

After a period of rest and physical therapy or another exercise program, athletes with Little League elbow can slowly return to pitching if they:

• don’t have elbow pain
• has full strength in the arm
• can fully bend and straighten their elbow

Athletes with Little League elbow must work with their health care provider and trainer to create a return to pitching program. The program must:

• slowly increase the number, distance and intensity of pitches over 6-8 weeks
• say how many squares can be thrown per day
• say what distance it is OK to throw

They should not go back to throwing until their healthcare provider says it is OK. Going back too soon can permanently damage the elbow.

Can Little League Elbow be Prevented?

To prevent Little League elbow, young athletes should:

• Take a break from throwing for 3-6 months a year. They may play another sport that does not involve throwing, such as soccer or swimming.
• Make sure they throw correctly.

They should also follow pitching guidelines that specify:

• how many seats are OK for each age
• what kind of seats are OK for each age
• how much rest is needed between practice and games

You can find information online about pitching guidelines at:

How can parents help?

To help children with Little League elbow:

• Make sure they follow the health care provider’s recommendations for rest and exercise.
• Make sure they don’t go back to throwing up until the doctor says it’s OK. Throwing too early can cause permanent damage to the elbow.
• When they are back to pitching, make sure the pitching guidelines are followed. Someone from the team should keep track of the lanes. If no one does, you may need to do it yourself.
• Teach your child that if something hurts during practice or a game, they should stop playing immediately. If pain persists, your child should be checked by a coach, trainer and health nurse before returning to play.