What is Little League (or Little Leager's) elbow?
Little league elbow is a common overuse injury that is caused by irritation of the growth plate of the humerus (arm bone), specifically the medial apophysis. The growth plate is near the attachment site of the muscles in the forearm that are in charge of flexing and rotating the wrist and forearm. Repetitive throwing creates an overload stress on the area.
If not treated or managed properly, ligament damage, tendon tears, avulsion fractures, growth plate fractures, and potential deformity may occur.
What are the risk factors for little league elbow?
The strongest correlation to injury is amount of pitching. This is assessed at the micro and macro levels:
- number of pitches per game
- innings pitched per season
- months pitched per year
- fatigued pitching
- pitching on multiple teams with overlapping seasons
Other risk factors include increased intensity or competition levels at a younger age.
Throwing breaking pitches is NOT a risk factor based on clinical, epidemiological, and biomechanical analysis.
What are current pitching guidelines?
Pitching guidelines for youth can be found here:
- Age <8: https://www.mlb.com/pitch-smar...
- Age 9-12: https://www.mlb.com/pitch-smar...
- Age 13-14: https://www.mlb.com/pitch-smar...
- Age 15-18: https://www.mlb.com/pitch-smar...
- Age 19-22: https://www.mlb.com/pitch-smar...
- Watch and respond to signs of fatigue (eg, decreased ball velocity, decreased accuracy, upright trunk during pitching, dropped elbow during pitching, or increased time between pitches). If a youth pitcher complains of fatigue or looks fatigued, rest is recommended.5
- No overhead throwing of any kind for at least 2 to 3 months per year (4 months is preferred). No competitive baseball pitching for at least 4 months per year.
- Do not pitch more than 100 innings in games in any calendar year.
- Follow limits for pitch counts and days rest.
- Avoid pitching on multiple teams with overlapping seasons.
- Learn good throwing mechanics as soon as possible. The first steps should be (1) basic throwing, (2) fastball pitching, (3) changeup pitching.
- Avoid using radar guns.
- A pitcher should not also be a catcher for his team. The pitcher-catcher combination results in many throws and may increase the risk of injury.
- If a pitcher complains of pain in his elbow or shoulder, discontinue pitching until evaluated by a sports medicine physician.
- Inspire youth pitchers to have fun playing baseball and other sports. Participation and enjoyment of various physical activities will increase the youth’s athleticism and interest in sports.
How important are pitching biomechanics?
Throwing mechanics can reduce stress on the elbow and shoulder by promoting better force transfer from the ground up through the ball. Common inneficiencies are seen in the leg, hip, and core causing increased force production needed in the shoulder, elbow, and arm.
What are the best treatment options for little league elbow?
1. Fleisig, G. S., & Andrews, J. R. (2012). Prevention of elbow injuries in youth baseball pitchers. Sports health, 4(5), 419–424. https://doi.org/10.1177/194173...