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Winning Tips for Preventing Little League Elbow in Young Pitchers

If your child is a baseball pitcher, it’s important to take steps to prevent Little League elbow. Little League elbow strikes children and adolescents who throw a baseball repeatedly. This overuse can cause microtraumas to their growing bones, which leads them to overload the structures on the inside of the elbow.

“Little League elbow is an injury most commonly seen in adolescent pitchers, whose growth plates have not yet fused on the inside of the elbow,” said Ryan Neeley, DO, an orthopedic surgeon specializing in shoulder and elbow treatments at Banner Health in Arizona.

“Kids who develop Little League elbow might notice pain in their throwing arm and decreases in their pitch speed, accuracy and distance,” Dr. Neeley said.

The medical name for Little League elbow is medial apophysitis, and it can result in fractures, muscle strain, ligament injury or inflammation of the growth plate.

The right precautions can keep Little League elbow at bay

The good news is Little League elbow can be prevented. Follow the USA Baseball Medical/Safety Advisory Committee recommendations for pitch counts and rest days for players age 7 to 22.

“It is imperative that parents and coaches of these athletes understand and adhere to recommendations for number of pitches and innings pitched per week based on the age of the athlete,” Dr. Neeley said.

Parents and coaches should also watch for these risk factors:

  • More than eight months of competitive pitching per year
  • More than 80 pitches per game
  • Fastball speed of more than 85 mph
  • Pitching despite arm fatigue and pain
  • Being a starting pitcher
  • Throwing a lot of warm-up pitches
  • Participating in showcases

Here’s what to do if you spot signs of Little League elbow

If a young athlete begins to have pain on the inside of the elbow with throwing, the first step is to decrease the pitching load. If reducing pitch counts and modifying activities don’t alleviate symptoms after four weeks, talk to your child’s doctor.

If young pitchers develop Little League elbow, most recover with active rest, a gradual return to activity with a focus on proper pitching mechanics and core stability and a focus on safe pitching principles.

And athletes don’t have to stay off the field altogether. “Players can often continue to play a different position while recovering and rehabilitating their pitching arm,” Dr. Neeley said.

In rare cases, players might need surgery to treat Little League elbow. But that’s uncommon. “The goal for young players should be to avoid being in the position where surgery is a possibility by diligently taking care of their arms,” Dr. Neeley said.

The bottom line

Young pitchers who overuse their arms are at risk for Little League elbow. By limiting how often they pitch and how many pitches they throw, they can avoid it. If they do develop Little League elbow, it’s easily treatable.

To find a provider near you who specializes in preventing and treating sports injuries, visit

For more information about youth athletes, check out:

Children's Health Parenting Sports Medicine