Four Measures to Prevent Little League Elbow

Elbow injuries are typically seen in baseball and tennis players because of repetitive throwing or swinging motions. The problem arises in these athletes from the inflammation and deterioration of ligaments and tendons because of repetitive stress and or kinetic chain weak links. This can ultimately lead to pain, tenderness, stress fractures, ulnar collateral ligament (UCL) injuries or permanent growth plate damage.


Several injuries we see in the little league population are little league elbow and medical epicondyle avulsion fractures.

  • Little League Elbow
    • Overuse injury to the medial epicondyle apophysis.
    • Caused by frequent forces (such a pitching) that overload the area.
    • A common case involves a youth baseball pitcher who is throwing in too many innings, throwing inappropriate pitches for his/her age or trying to throw too hard.
  • Medical Epicondyle Avulsion Fractures
    • Progressive Inflammatory condition involving the growth plate of the humerus, near the inner elbow at the medial epicondyle.
    • Growth plates are only found in individuals that are growing, thus this condition is isolated to skeletally immature children and adolescents.
    • The growth plate is an area of relative weakness, and injury to it occurs due to repeated stress or vigorous exercise.
    • Causes
      • Repeated stress on the growth plate results in inflammation which is the biological process that results in pain, tenderness, warmth, redness, and swelling
      • If stress is continuous and severe across the growth plate, small fractures (breaks) in the growth plate may occur.
      • Avulsion will ultimately occur where the growth plate separates from the medial epicondyle.  Surgical fixation is often required depending on the degree of separation.

Injury prevention strategies and youth baseball league education is required to educate coaches, parents and athletes on the severity of these conditions.  The following measures should be taken to prevent injuries:

  1. Limit pitch counts per the ASMI guidelines.
  2. Do not allow athletes in this age group to play on multiple teams.
  3. Do not allow athletes to play catcher and pitcher in same game or same day.
  4. Do not encourage athletes to throw as hard as they can.

Want more guidance on this topic? Join me for Advanced Concepts for the Overhead Athlete, a two-day course where you’ll learn how to implement a throwing and injury prevention program for your local athletes. It’ll be held May 14-15 in Falls Church, Virginia and July 16-17 in Colorado Springs, CO.

AngelaGordonAngela T. Gordon PT, DSc, MPT, COMT, OCS, ATC

Co-Founder Advanced Kinetics Physical Therapy and Sports Performance

Certified Orthopedic Manual Therapist

Board Certified Orthopedic Specialist

Certified Athletic Trainer


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