Little League Elbow

What Is Little League Elbow?

Little League elbow is an overuse injury to the elbow caused by repetitive throwing. Most cases happen in pitchers, but any young athlete who throws a lot can get the condition.

What Are the Signs & Symptoms of Little League Elbow?

Kids with Little League elbow have pain on the inner part of their elbow. At first, the elbow may hurt only during or right after throwing. But without treatment, the elbow can start hurting all the time. The pain usually starts gradually, but can happen after one throw if the athlete has been making the same motions often.

What Causes Little League Elbow?

Little League elbow is an overuse injury (also called a repetitive stress injury). Overuse injuries happen because the same motion is repeated over and over again.

In Little League elbow, repeated throwing injures 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 happens. It's weaker and more at risk for 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 kids and teens 8–15 years old. They're still growing, so their bones still have growth plates. Bones that are done growing don't have growth plates. Elbow pain after this age likely is not Little League elbow.

How Is Little League Elbow Diagnosed?

Health care providers diagnose Little League elbow by: 

• asking about sports and activities
• doing an exam of the elbow, observing range of motion and doing strength tests
• getting X-rays (X-rays can be normal in Little League elbow but can show other problems in the elbow)
• comparing the affected elbow with the unaffected elbow

How Is Little League Elbow Treated?

Kids with Little League elbow must take a break from all throwing for about 6 weeks. For pain and swelling, they can:

• Put ice or a cold pack on the elbow every 1–2 hours for 20 minutes at a time. Put 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. Kids should always take the medicines with food.

When pain and swelling ease, health care providers usually recommend physical therapy or another exercise program. Before returning to play, it might help some kids 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 rest period and physical therapy or another exercise program, athletes with Little League elbow can slowly return to pitching if they:

• do not have any elbow pain
• have full strength in their arm
• can bend and straighten their elbow fully

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

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

They shouldn't go back to throwing until their health care provider says it's OK. Going back too early can permanently damage the elbow.

Can Little League Elbow Be Prevented?

To help prevent Little League elbow, young athletes should:

• Take a break from throwing for 3–6 months a year. They can play another sport that doesn't involve throwing, like soccer or swimming.
• Make sure they throw correctly.

They also should follow pitching guidelines that specify:

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

You can find information online about pitching guidelines at:

• American Sports Medicine Institute
• Little League Baseball and Softball

How Can Parents Help?

To help kids with Little League elbow:

• Make sure they follow the health care provider's recommendations for rest and exercises.
• Make sure they don't go back to throwing until the doctor says it's OK. Throwing too soon can cause permanent elbow damage.
• When they're back to throwing, be sure the pitching guidelines are followed. Someone from the team should keep track of pitches. If no one does, you may need to do it yourself.
• Teach your child that if something hurts during training or a game, they should stop playing right away. If the pain continues, your child needs to get checked by a coach, trainer, and health care provider before returning to play.