Little League Elbow

By Kurtis Mullaney PT, DPT, ATC/L

Pitch Count Recommendation By Age

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Little League Elbow

Although often applied to any condition that causes pain in a young thrower, Little League elbow most accurately describes medial epicondylar apophysitis. Medial epicondylar apophysitis is a traction injury to the medial epicondylar apophysis most often related to the repeated elbow valgus force associated with throwing. In individuals approaching skeletal maturity, the medial epicondyle apophysis may fail to close. In more mature athletes, the apophysis may close and injury may occur in the UCL substance or attachment sites.


Management of medial epicondyle apophysitis includes cessation of pitching activities for 4–6 weeks. In the early stages of recovery, ice, and NSAIDs can be useful. If patients present with a flexion contracture, an elbow extension brace can be beneficial. Other strength and conditioning activities should be performed. Occasionally, symptoms return, usually from an inadequate recovery period. In these cases, a splint may be used to more definitively rest the elbow. After the 4- to 6-week rest period, when symptoms have abated, a progressive throwing program is instituted over a 4- to 8-week period. Players typically return to full effort throwing by 12 weeks.

Pitchers may elect a position change such as first base, which allows continued participation but with decreased stress to the elbow to avoid recurrence in the same season. If symptoms recur after a trial of non-operative treatment, then cessation of play for a complete season is indicated.


Prevention is the key to treatment for elbow injuries in the young athlete. Prevention can be accomplished by rules limiting the number and type of pitches allowed in youth baseball along with education of Little League coaches, parents, and throwers.

Steps to Prevention:

  • Follow the pitch count regulations set by the American Sports Medicine Institute, Little League baseball, or USA Baseball
  • Do not begin throwing screwballs, curveballs, or slides before 14 years of age
  • Consult your local sports medicine specialist and have him analyze your throwing mechanics in order to prevent mechanical related injuries

JOI Rehab

JOI Rehab has biomechanical software (Dartfish) that can conduct a video analysis of a thrower’s mechanics and evaluate their deficiencies. JOI’s goal is to help improve the performance of athletes to reduce the risk of injury or re-injury. All 12 of our rehab centers are certified to assist in throwing performance as well as our sports center. If your baseball team is interested in a custom throwing session to improve your mechanics and techniques, call (904) 858-7045

JOI has 12 physical therapy clinics conveniently located in Jacksonville and Northeast FL who specialize in orthopedic rehab. Our JOI team has the expertise and technological advances to get you back to your ideal level of function.

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