How to prevent 'Little League elbow'

"The most mild form of the condition is a tendon injury, but it can also be associated with bony problems in the joint itself, and in the most severe cases, it could be caused by a tear in the ligament that provides significant stability in the elbow of a pitcher" explains David T. Bernhardt, MD, a UW Health primary care sports medicine physician.

Elbow overuse injuries can occur at any age, but it's particularly a problem in young athletes whose bones have not yet matured, making their growth plates more susceptible to injuries. Little League players usually start pitching around age 10 or 11, and some kids' growth plates don't close until ages 14 or 15, he says.

"After the growth plates fuse, the risk of bony problems decreases, although the player is still at risk for overuse injuries" Bernhardt says. "But your body can withstand more force at an older age."

Bernhardt and colleagues have seen a growing number of patients with Little League elbow in recent years.

"We think that's related to kids becoming much more specialized in sports. They're playing baseball year-round, they're playing on travel teams so they aren't getting the rest in between, and coaches may not understand child development or be aware of pitch counts for their own team, let alone if the player is playing for multiple teams," he says. "Kids can also feel peer pressure because they're having fun and experiencing success, so they throw even when their arm is tired or hurting."

Ignoring arm fatigue or pain could lead to lifelong consequences, including the ending of your child's pitching career.

"There are a couple of worst-case scenarios," says Bernhardt. "One is the bony injury doesn't heal and the child ends up with a painful degenerative process in the joint that could bother them for the rest of their life. A tear the ulnar collateral ligament and surgical repair to stabilize the elbow, what's commonly known as Tommy John surgery, is another possibility."

Bernhardt and his colleague, Karl Fry, PT, from UW Health Sports Rehabilitation, share these tips for protecting the young thrower:

Enforce pitch limits

Most leagues have pitch limits based on a child's age for good reason. Make sure to track your child's pitches, including those thrown outside of practice, and communicate with the coach, or coaches, if your son or daughter is on multiple teams before your child exceeds the recommended limit.

Encourage rest

That means checking with your player frequently to see how he or she is feeling. "You shouldn't let your child throw with a weak or sore arm, elbow or shoulder, and you shouldn't let them throw when they say their arm is tired" Bernhardt says.

Seek treatment early

"If your child has vague elbow soreness that is not improving with rest after a week or two, or if every time the kid throws, he or she has elbow problems, see a doctor" he says. Treatment for Little League elbow involves rest and rehabilitation, and Bernhardt recommends seeing a physical therapist who specializes in sports medicine, like the team at UW Health's Sports Medicine Clinic. A sports medicine specialist can analyze your child's throwing mechanics to prevent future injuries and design a "return to throwing" program.

Vary your sports

Take a break after baseball season and encourage your child to play another sport instead of playing baseball year-round. "We're really trying to encourage the multisport athlete and discourage sports specialization to lower the risk of these overuse injuries," Bernhardt says.