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Increase in Little League Elbow

Marketplace Physical Therapy Treats Children with Little League Elbow

Marketplace Physical Therapist, Dr. Courtney Ellstrom, has seen a sharp increase in Little League Elbow. The medical term for Little League Elbow is Medial Epicondylar Apophysitis. Little League elbow is an injury that usually affects pitchers from 9 to 14 years old, thus the name. It can also occur to children in other sports who throw a lot like football, water polo, and volleyball. Pain is caused by an increased amount of pressure on a growth plate in the forearm. Remember that phrase “Practice Makes Perfect”, we might want to rethink that.

Anatomy of the forearm and elbow

Why does it occur?

With Sports Stars notoriety and salary increasing significantly, parents and children are pushing harder than ever for success. In simple terms, children do not have the muscle or ligament structure to support a major league work load. If you want a more technical version: The medial epicondyle is where the forearm muscles attach to the bone and is the ligament that stabilizes the elbow in the throwing motion. In children the medial epicondyle contains a growth plate of immature cartilage cells, which is significantly more likely to be injured compared to mature bone. You must be extremely careful with this injury because if ignored the growth plate can actually tear off from the upper arm.

This is a great example of the pressure placed on the elbow during a throw.

Symptoms of Little League Elbow

Symptoms can present themselves during sports and non-sports activities. The patient will experience pain on the side of the elbow when throwing which can result in a decrease in speed or accuracy. One of the Pitchers on my son’s baseball team started demonstrating symptoms when he was writing in class or doing homework. You might think they are just trying to get out of class work, but any movement involving the forearm can cause pain.


Ignoring this injury is a recipe for disaster and can limit your child’s future in their sport. Our Doctors of Physical Therapy recommend seeing a Physical Therapist immediately. You can schedule a free consultation at any of our locations in Chino, Riverside, Corona, Redlands or Beaumont.

Here are some recommendations depending on the severity of the injury.

  1. Ice the elbow three times a day for 15 minutes each.
  2. Treat the injury with Interferential Stimulation and Ultrasound
  3. Develop a strength and conditioning program to increase the endurance and capacity of the forearm muscles.
  4. If the injury is severe, your Physical Therapist could recommend cessation of the sport for a maximum of 6 weeks.
  5. Referral to a Physician for an X-Ray to determine severity.
  6. Forearm braces to immobilize the arm.

As always Pitchers should have rest days between high throwing days.

Here is the schedule we followed for my son’s baseball team.

For pitchers age 7 to 16

Pitches in a day Rest time
61 or more 4 days
41-60 3 days
21-40 2 days
1-20 1 day

For pitchers age 17 to 18

Pitches in a day Rest time
76 or more 4 days
51-75 3 days
26-50 2 days
1-25 1 day

Please contact us if you have any questions.


Michael Rappaport

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Published on: August 9th, 2011

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