Experts Warn About Elbow Injury in Little Leaguers

Pitching more than 100 innings per year increases likelihood of pain 

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ALEXANDRIA, VA, August 2, 2011 — Talented, young baseball players from around the world are gearing up for the 65th Little League Baseball World Series, August 18-28 in South Williamsport, Pennsylvania. While the focus is on winning, the game-plan for many coaches and parents also aims to protect players from a painful injury caused by excessive throwing known as Medial Epicondyle Apophysitis or Pitcher's Elbow. The American Physical Therapy Association (APTA) warns that millions of little leaguers are putting themselves at risk for injury in their attempt to throw the fastest and farthest.

"It has been estimated that 2.2 million children between the ages of 4 and 16 are participating in baseball annually," said APTA member Kevin Wilk, PT, DPT, a leading authority in sports injury rehabilitation. "Kids between the ages of 9 and 14 who throw breaking balls, pitch in showcases to display their skills and fundamentals, or, more importantly, pitch too frequently without adequate rest, are the most vulnerable to injury."

Pitcher's Elbow is a chronic inflammation of the growth plate on the elbow joint, which manifests itself as pain and swelling inside the elbow. Approximately 50% of little leaguers ages 9 to 14 will experience elbow pain.[i] Pitchers in this same age group who pitch more than 100 innings a year experience a 3 to 4 times greater risk of elbow or shoulder injury.[ii] Those who continue to pitch through the pain can eventually cause the growth plate to separate from the joint, requiring surgery to re-attach it.

Routinely players will go from a game in one league to a practice or game in another league and pitch on back-to-back days. If coaches on both teams are unaware of the fact that the pitcher just pitched for another league, there will be a misrepresentation of league pitch counts and a subsequent increase to one’s risk for injury.

APTA member Mike Mullaney, PT, DPT, an expert on throwing injuries said, "It is up to the player and the player's parents to monitor pitch count, understand the designated pitch counts for their age group, and respect them."

These risk factors contribute to elbow pain in youth baseball players: 

  • Age. Youth baseball players are at greater risk because their elbow joint (bones, growth plates, and ligaments) are not fully developed and are more susceptible to overuse injuries. 
  • Pitching too many games.The number of games pitched should be carefully monitored and follow the league's pitch count rules (.pdf). If pain occurs before the pitch count limit is reached, then the player should stop immediately. Rotating pitchers during games is a good idea to ensure adequate rest is given to each pitcher.
  • Curveballs and breaking pitches. Both of these types of pitches appear to put more stress on the growth plate than other types of pitches.
  • Improper mechanics. Proper throwing mechanics decreases forces on the elbow joint.

Physical therapists, as experts in restoring and improving motion in people's lives, can help players prevent overuse injuries by educating them on proper throwing mechanics and through preventative programs that focus on stretching and strengthening the arm. Wilk recommends a combination of good mechanics, being physically fit, not being fatigued when you throw, adhering to pitch count guidelines, and not playing the positions of pitcher and catcher for a team to decrease one's risk. Mullaney added that a strengthening program focused on the posterior shoulder may also minimize risk.[iii] 

In March 2011, the American Sports Medicine Institute, where Wilk is the director of rehabilitative research, updated its "Position Statement on Youth Baseball Pitchers," which includes 10 recommendations for preventing injuries in youth baseball pitchers:

For more information about Pitcher's Elbow and how a physical therapist can help prevent or treat the condition, click here.

About the American Physical Therapy Association  

The American Physical Therapy Association (APTA) represents more than 77,000 physical therapists, physical therapist assistants, and students of physical therapy nationwide. Learn more about conditions physical therapists can treat and find a physical therapist in your area. Consumers are encouraged to follow us on Twitter (@moveforwardpt) and Facebook.


[i] Lyman S., Fleisig GS, Andrews JR, Osinski, ED. Effect of pitch type, pitch count, and pitching mechanics on risk of elbow and shoulder pain in youth baseball pitchers. Am J Sports Med. 2002;30(4):463-468.

[ii] Fleisig GS, Andrews JR, Cutter GR, Weber A, Loftice J, McMichael C, Hassell N, Lyman S. Risk of serious injury for young baseball pitchers: a 10-year prospective study. Am J Sports Med. 2011; 39(2):253-257.

[iii] Trakis, JE, McHugh, MP, Caracciolo, PA, Busciacco, L, Mullaney, M, Nicholas, SJ. Muscle strength and range of motion in adolescent pitchers with throwing-related pain: Implications for injury prevention. Am J Sports Med. 2008;36:2173.

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