Little League Elbow Syndrome: What you Should Know

Orthopaedic & Spine Center

Image of Dr. Boyd HaynesBoyd W. Haynes III, MD

Many of us grew up playing on a Little League baseball or softball team and cherish those memories of daily ball practice, camaraderie with teammates, incredible wins and crushing losses during the spring and summer days on the field.  Even if you’ve never played, you may have seen the movie Bad News Bears and understand how playing Little League ball can be an all-encompassing and extremely competitive sport, for the kids and sometimes more so for their parents!

Little League Elbow Syndrome (LLES) is simply an overuse injury that happens after repetitive throwing, such as that seen on a ball field.  It only happens to kids and teens whose growth plates in the elbow have not fused.  Every long bone in a child’s body has a growth plate at each end, which determines the shape, size and length of the bone when it matures.  These growth plates are softer and weaker than normal bone, and can even be weaker than the attached ligaments and tendons.

When stress is applied over and over to the growth plate of the elbow by throwing a ball, it can become sore to the touch, ache or throb with a sharp pain, and swell on the inside of the elbow.  Some kids feel a pop and a pain while throwing. It is important to have your child seen by a physician if they start complaining of pain in the elbow.  Early treatment is key and can prevent a myriad of problems down the road. When this condition is untreated, children can eventually develop small fractures, bone spurs, loose bone chips, early on-set arthritis and bone deformity.

Little League Elbow Syndrome is most commonly seen in pitchers.  It usually causes pain during the acceleration phase of the pitch. It typically develops gradually with pitching, but can soon cause pain even when simply throwing the ball.  Outfielders and catchers are also susceptible to this condition, as their positions require them to make hard throws that must go long distances.

If you bring your child to see me for a diagnosis, I will ask a lot of questions about their activities, when the pain started, when it is better or worse, etc.  I am also going to order x-rays of the elbow and arm.  That way, I can see if there are bone abnormalities, growth plate irregularities, spurs, chips or arthritis that will need to be dealt with during the treatment period.  Often, the elbow looks perfectly normal on x-ray, but it is still painful.

Treatment involves rest.  Whaaat?  You mean no pitching or throwing?  That’s right.  Ice and NSAIDS are commonly prescribed to get the inflammation and pain under control. Typically, this happens in a matter of weeks IF the athlete stops throwing completely, but can take much longer if Junior is non-compliant.  Physical Therapy is a very important component of the treatment plan and should be specific to the needs of each adolescent. PT should focus on increasing strength of the core, upper body and arms, as well as increasing the range of motion in the elbow.

When the pain and inflammation are gone and strength and range of motion have increased, the young athlete can return to the game S-L-O-W-L-Y.  It is recommended that they start in non-throwing positions (designated hitter) and slowly progress through positions back to pitching.  As there is a direct correlation to LLES and the number of pitches thrown, these should be carefully monitored, as well as practice throwing and pitching, to ensure the kid doesn’t exceed the recommended number of throws per day.

As with many overuse injuries, prevention of LLES is certainly preferable to having to treat it.  Here are some tips for parents with children playing Little League ball:

  1. Make sure that the coach and team strictly follow pitching guidelines for youth.  Many say they do, but when the competition heats up, those guidelines fly out the window.  If that happens, find another team for your child. Guidelines can be found at or ASMI Position Statement for Youth Baseball Pitchers.
  2. Kids younger than 14 are limited to pitching fast balls and change ups. After age 14, they can throw curve balls. Only after the age of 16 should sliders be added to their pitching repertoire.
  3. Keep your child active and physically fit year-round with a variety of sports and activities that build strength, flexibility and stamina, not just during ball season.
  4. Help your child to understand that playing through and ignoring pain while pitching can greatly decrease their long-term prospects of playing ball.  Getting medical attention to address pain early on is the best way to keep your child in the game for years to come.