Little League Elbow

Pitcher.Little league elbow is an injury to the growth plate on the inside of the elbow caused by:

  • Repeated overhead throwing with improper mechanics
  • Lack of muscle strength and endurance
  • Throwing breaking pitches too early
  • Pitching too much
  • Pain to inner elbow with pitching or throwing. In severe cases, your child may have pain at rest, which continues for days after throwing.
  • Swelling
  • Decreased elbow motion
  • Decreased throwing speed

A doctor will examine the athlete. An X-ray may also help the doctor see how much damage there is to the growth plate in the elbow.

Little league elbow is an overuse injury caused by too much throwing using improper mechanics. Because the growth plate is not solid bone, it can widen, become swollen and cause pain. The most common ways for this to happen include:

  • Improper pitching mechanics
  • Throwing too much
  • Not resting between throwing sessions
  • Weakness of the muscles that support the shoulder and shoulder blade during throwing
  • Playing multiple positions that require different throwing mechanics
  • Playing in more than one league in a season 

The risk of developing little league elbow increases when an athlete:

  • Throws a curveball or slider before growth plates have closed
  • Does not have the proper strength and endurance of the shoulder muscles

Since little league elbow is a bone-related injury, rest is needed to allow the injury to heal. After the bone injury is healed, the athlete works on strengthening the shoulder and back muscles.  This will help increase the shoulder’s ability to withstand the strain placed through the arm during the throwing motion.

Throwing and pitching are total body activities, and weakness in one area will increase the stress through others.  An athlete will need to work on strengthening core muscles, as well as the legs and hips.  Video analysis of the athlete throwing may help find any mechanical faults that increase the stress in the elbow or shoulder.

A return-to-throwing program is developed once the athlete is cleared to return to throwing.  This allows the athlete to slowly increase the forces and demands through the arm that are necessary for return to full competitive play.

Little league elbow has a low risk of permanent injury. There is a small chance of early growth plate closure or a fracture of the growth plate requiring casting or surgery. Little league elbow will often heal completely with rest, and the athlete will not lose any functional ability.

The athlete can usually return to full play following 6-8 weeks of rest. During that rest period, it is important to look at issues that may cause future problems:

  • Lack of strength and endurance
  • Faults in the athlete’s throwing mechanics

While no injury can be completely prevented, proper mechanics, rest and strengthening can reduce the risks of injury. USA Baseball has developed guidelines for young players to help reduce the risk of injury.

Recommended pitch counts by age and associated rest periods:

Age of Athlete

Pitch Limits per Day









Number of Pitches Thrown

Days of Rest









(Courtesy of Little League Baseball)

Parents need to also be aware of any reports of pain, fatigue or changes in throwing motions as these are often warning signs that if ignored may lead to more serious injury.

Last Updated 04/2012