With the baseball season in “full swing”, doctors and physical therapist see an alarming increase in the number of elbow injuries in adolescent baseball players. With an increasing number of children participating in Little League baseball, so is the epidemic of overuse elbow injuries. “Little Leaguer’s elbow”, also known as medial apophysitis, is one of the most common overuse injuries experienced in adolescent baseball players.
Medial apophysitis refers to chronic inflammation of the growth plate. In adolescent baseball players who are still skeletally immature, repetitive overhand throwing of the baseball can cause pain located on the inside or medial aspect of the elbow. With too much repetitive throwing of a baseball, the growth plate along the medial elbow becomes inflamed through cumulative and repeated traction stresses placed on the inside of the elbow.
Little Leaguer’s elbow should be suspected in the adolescent baseball player, usually between the ages of 9-14 years old, who complains of medial elbow pain. They will usually complain of medial elbow pain while throwing and this pain will frequently be increased with the more innings pitched or games played. They may have pain and tenderness with palpation of the medial aspect of the elbow and if acute, can have a loss of motion in either the flexed or extended position of the elbow. There may be a recent increase in the number of games played or innings pitched by these adolescent athletes leading up to their complaint of pain.
Initial treatment for this overuse injury is rest. Complete rest from throwing for a minimum of 4 to 6 weeks should be undertaken with no throwing of any kind strictly adhered to. Along with rest, ice and non-steroidal anti-inflammatories can be used to reduce soreness and inflammation. If symptoms persist and/or the baseball player is lacking a full-joint range of motion it is important that an orthopedic surgeon is consulted for further examination with x-ray or MRI if necessary.
Once the rest period is over and pain and full range of motion has been restored, adherence to a strict throwing rehabilitation protocol designed by a physical therapist should be implemented. An interval based return to throwing program lasting for a minimum of 6-8 weeks should be completed in an effort to restore full arm strength and velocity. Ideally, this throwing program would be done under the supervision of someone with a sound understanding of the overhead throwing mechanics to help discern and correct any form or technique issues that the thrower may have. If at any point during the throwing program pain is encountered, the throwing program should be halted or slowed down to allow for optimal tissue healing. Lastly, a total-body conditioning program, including hip, back, and lower extremity strengthening, flexibility and mobility should be combined with their rehabilitation program to help optimize a player’s biomechanics and reduce strain on the upper extremity.
Recovery from Little Leaguer’s elbow should take 12-14 weeks to return to competitive throwing in a game type situation. Prevention or to stop this injury from occurring again should focus on the number of pitches and the types of pitches thrown by the young adolescent pitcher. Pitches that place a high level of stress to the elbow, like the breaking ball and the curveball should be avoided until the pitcher reaches the appropriate age and skeletal maturity. In addition, a complete strengthening program that focuses on the core, lower extremities, and the throwing shoulder should be continued year-round to maintain and further develop strength and neuromuscular control.
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References
Can We Reduce the Epidemic of Elbow Injuries in Youth Throwers? Padaki, AS, Ahmad CS, J Orthop Sports Phys Ther. 2018;48(5):354-357
Little league elbow. Benjamin HJ, Briner WW Jr. Clin J Sport Med. 2005 Jan;15(1):37-40.
Effect of pitch type, pitch count, and pitching mechanics on risk of elbow and shoulder pain in youth baseball pitchers. Lyman S, Fleisig GS, Andrews JR, Osinski ED. Am J Sports Med. 2002 Jul-Aug;30(4):463-8.
Little league elbow: valgus overload injury in the paediatric athlete. Klingele KE, Kocher MS. Sports Med. 2002;32(15):1005-15.
Little League Baseball. www.littleleague.org
American Sports Medicine Institute. www.asmi.org
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