Little League elbow is an overuse injury affecting the inside part of the overhead athlete’s elbow. The injury occurs in youth athletes 8 to 13 years old with open growth plates. In these youth baseball players, the growth plate is much weaker than the ligaments and muscles surrounding it. Once the growth plates fuse, athletes are more likely to injure soft tissues such as the ulnar collateral ligament (UCL). Little League elbow is most common in baseball pitchers but can also occur in any position player, softball players, or tennis players.
During the late cocking and acceleration phases of throwing, the shoulder and elbow are subjected to very high forces. The repetitive stress of throwing can lead to pain, swelling, and tenderness in this area. The youth baseball player may also show signs of decreased throwing velocity and accuracy. If untreated, there is a small chance for early growth plate closure or fracture, which could require surgery. Little League elbow will often heal completely with 2 to 4 months of rest and an individualized physical therapy program. Below are 5 things parents and coaches should know to prevent Little League elbow in youth baseball players.
#1: Elbow injuries are more common in those who play year-round
The repetitive stress of throwing a baseball subjects the growing elbow to excessive forces. The growing bones of youth athletes need time away from throwing. Youth baseball players should take 3 to 4 months off from throwing each year. This period should be devoted to playing other sports in order to develop overall athleticism. This is also the ideal time to perform resistance exercise to build strength in the lower body, core, and arm. Players who throw year-round or in multiple leagues are often plagued by arm fatigue. Throwing with fatigue is the number one risk factor for shoulder and elbow injury in youth baseball players.
#2: Little League elbow is common in both pitchers and catchers
A 2004 study in the American Journal of Bone and Joint Surgery found 70% of youth catchers demonstrate signs of Little League elbow on x-rays. In comparison, 63% of pitchers demonstrated these findings. Approximately half of these pitchers and catchers complained of elbow pain. The other half were not experiencing pain. However, catchers complained of elbow soreness more often than pitchers. During a game, catchers and pitchers may perform an almost equal number of throws. Also, catchers often throw from a squat or semi-squat position. Without the ability to generate force from the lower body, this position may place additional stress on the catchers elbow. It may be advantageous for catchers to throw from a standing position whenever possible. In any case, parents and coaches should closely monitor catchers and pitchers during the course of a season. Any signs of altered throwing or complaints of pain by the athlete should prompt a medical evaluation.
#3: Taller players are more likely to develop Little League elbow
Overall height and a recent increase in growth have been shown to be risk factors for developing Little League elbow. During the growth spurt it is believed that the rate of bone length growth exceeds the rate of bone strength development. Therefore, the growing bone and growth plate may be more susceptible to those who are experiencing rapid changes in height. Taller players are also more likely to throw at greater velocities which subject the elbow to greater stress. Therefore, the stress associated with these developmental factors, along with throwing excessively at increased velocities, may predispose the taller baseball player to elbow injury. Parents and coaches should keep a close eye on these taller players and be on the lookout for any early warning signs of arm pain or fatigue.
#4: Little League elbow is more common in players working with private coaches
A recent study investigating Little League players in the United States found two factors associated with positive elbow MRI findings. These two factors were year-round play and working with a private coach. Additionally, a history of arm pain was also associated with year-round play and working with a private coach. This is not to say that youth baseball players should not work with private coaches. Private coaches can be instrumental in improving throwing mechanics thus potentially improving performance and reducing injury risk. However, working with pitching coaches can contribute to throwing excessively or even year-round. Baseball players should be encouraged to work with coaches to improve their skills and love for the game. However, it is extremely important that these players get ample rest from throwing so they do not jeopardize their long-term playing career.
#5: Strengthening and stretching exercise can reduce the risk for developing elbow injuries
Muscle imbalances and poor movement patterns during and following growth spurts predispose youth athletes to overuse injuries such as Little League elbow. Modifiable risk factors for injury relate to improving shoulder flexibility and total arm strength. A recent study in the American Journal of Sports Medicine showed youth baseball players can significantly reduce their risk for elbow injury by engaging in a regular stretching and strengthening program. These exercises should target the trunk and arm musculature to address factors shown to be associated with injury risk. Strengthening the shoulder blade and rotator cuff muscles us often emphasized in overhead athletes. Athletes should be instructed in individualized programs based on their own unique needs. There is no one size fits all program for baseball players. Below are a few exercises which are useful for some overhead athletes.
Little League elbow is becoming increasingly more common as youth baseball players are throwing more often and at greater velocities. It is more important than ever for parents and coaches to closely monitor all youth baseball players for excessive amounts of throwing and the early signs of arm fatigue. Also, pitchers, catchers, taller players, and those with private coaches may be at an increased risk for injury thus requiring close observation. Youth baseball players who adhere to regular stretching and strengthening exercise can reduce their risk for injury. Therefore, preventing Little League elbow requires a team approach involving the player, parents, coaches, trainers, and the medical staff.
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- Yukutake T, Kuwata M, Yamada M. A preseason checklist for predicting elbow injury in Little League baseball players. Orthop J Sports Med. 2015;3(1):1-7.