Little League Elbow: Symptoms, Causes, Treatment & Recovery

Reviewed by the Physiotherapy Team at Waterloo Sports Medicine Centre 

Little League elbow is an overuse injury that can cause pain on the inside of the elbow in young athletes who participate in throwing sports/activities (not just baseball!). It can be frustrating for young athletes who want to continue playing their sport. The good news is that with appropriate activity modification, rehabilitation, and a gradual return-to-throwing program, many young athletes can safely return to their sport. 

What Is Little League Elbow? 

Little League elbow, medically known as medial epicondyle apophysitis, is an overuse injury affecting the developing growth plate on the inside of the elbow. Children and adolescents are particularly susceptible because their bones and growth plates are still developing. Repetitive throwing places significant valgus stress and traction on the medial elbow, which can irritate the growth plate over time.  

What Causes Little League Elbow? 

Little League elbow usually develops gradually rather than from one specific injury. Repetitive throwing can repeatedly stress the developing structures of the elbow, particularly when the amount or intensity of throwing exceeds what the athlete's body can tolerate. Risk factors can include: 

• Throwing frequently or for long periods  

• Excessive pitching or throwing volume  

• Rapid increases in training load  

• Playing on multiple teams or leagues  

• Year-round throwing without adequate rest  

• Poor throwing mechanics  

• Returning to throwing too quickly after an injury  

• Early sport specialization  

Overuse injuries are common among young throwing athletes, and following age-appropriate throwing and rest guidelines can help reduce injury risk.  

What Are the Symptoms of Little League Elbow? 

The most common symptom is pain on the inside of the elbow, particularly during or after throwing. 

• Tenderness over the bony prominence on the inside of the elbow  

• Swelling  

• Elbow stiffness  

• Reduced ability to fully straighten the elbow  

• Pain with throwing  

• Decreased throwing performance  

• Pain that gradually becomes more frequent or occurs with less activity  

Elbow pain in a young throwing athlete should not simply be considered normal soreness. Persistent symptoms can indicate an overuse injury that requires assessment.  

How Is Little League Elbow Diagnosed? 

A physiotherapist or physician will typically ask about the athlete's throwing history, training volume, symptoms, and recent changes in activity. A physical examination can assess elbow range of motion, strength, tenderness, and other potential sources of pain. 

X-rays may be recommended to evaluate the growth plate and look for changes such as widening or fragmentation. Ultrasound or MRI may be used in certain cases when additional information is needed.  

This assessment is important because not every case of youth elbow pain is Little League elbow. Other conditions, including medial epicondyle fractures, ulnar collateral ligament injuries, and other overuse injuries, can cause similar symptoms.  

How Can Physiotherapy Help Little League Elbow? 

The first step in treatment is usually removing the activity that is aggravating the growth plate, particularly throwing. Rehabilitation can then focus on restoring mobility, strength, and movement control before gradually returning to throwing. Your physiotherapist may work on: 

Restoring Mobility 

Pain and irritation can cause elbow stiffness. Your physiotherapist can help restore comfortable elbow and upper-extremity mobility while monitoring symptoms. 

Strengthening the Entire Kinetic Chain 

Throwing involves much more than the elbow. Rehabilitation may include strengthening the: 

• Forearm and wrist  

• Elbow  

• Shoulder and rotator cuff  

• Scapular muscles  

• Core  

• Hips and lower body  

Addressing the entire kinetic chain can help the athlete develop the strength and movement control needed for throwing.  

Improving Throwing Mechanics 

As the athlete progresses, physiotherapy can address movement patterns and throwing mechanics that may contribute to excessive stress on the elbow. 

Gradual Return to Throwing 

Once the athlete has regained pain-free mobility and adequate strength, throwing should be reintroduced gradually rather than returning immediately to full-effort pitching. 

A supervised progression may begin with light throwing and gradually increase distance, volume, and intensity before returning to competitive pitching.  

Helpful strategies include: 

• Following age-appropriate pitch-count and rest recommendations  

• Taking regular breaks from throwing  

• Avoiding year-round specialization in one throwing sport  

• Gradually increasing throwing volume  

• Avoiding throwing through elbow pain  

• Maintaining strength and mobility throughout the body  

• Using appropriate throwing mechanics  

• Communicating with coaches when pain develops  

When Should You See a Physiotherapist? 

Consider having your child assessed if they experience: 

• Persistent pain on the inside of the elbow  

• Pain during or after throwing  

• Elbow swelling or stiffness  

• Loss of elbow motion  

• A noticeable decline in throwing performance  

• Pain that continues despite rest  

• A sudden “pop” or sharp pain while throwing  

 Looking for Little League elbow treatment or pediatric sports physiotherapy in Waterloo or Kitchener-Waterloo? Book an appointment with Waterloo Sports Medicine Centre to help your young athlete recover and safely return to throwing.