Sports Medicine

Little Leaguers' Elbow

Excerpt from the Fall 2011 issue of On Call, Beth Israel Deaconess Hospital-Milton's bi-annual communnity newsletter:

“Take Me Out of the Ballgame!”
Lack of Rest Poses Arm Risks for Year-Round Ballplayers

Think fall is just for football?  Think again.  Fall and winter youth baseball leagues and clinics have turned the national pastime into a year-round passion for many young athletes.  But without a break in the action, kids may be doing more harm than good to their big-league dreams.

Dr. Benjamin Thompson is a BID-Milton orthopaedic surgeon specializing in arthroscopic surgery and sports related injuries.  While training at the Andrews Institute in Florida, a world-renowned sports medicine research and treatment center, he’s seen ball players as young as 13 years old undergo “Tommy John surgery”, or ulnar collateral ligament reconstruction.  Once considered an aging athlete’s concern, overuse of the elbow among the young has made this kind of surgery more common for kids.

 “It’s becoming an epidemic,” Dr. Thompson said, referring to the growing incidence of elbow overuse injuries in youth baseball players. Specifically, he discussed a medical issue in athletes with growing bones known as “Little Leaguer’s Elbow” or medial apophysitis.  This painful condition is caused by too much throwing, which places stress on the muscles that attach to the inner side of the elbow, the side closest to the body. 

“Children have a soft growth plate in this area of the elbow that bears much of the strain from the muscles during a throwing motion,” Dr. Thompson explained.  “As they grow, the growth plate hardens to form bone.  But while it’s soft, too much throwing can irritate and inflame the growth plate, or even cause it to fracture.

“The same forces from overthrowing which put the growth plate at risk prior to the growth plate hardening can ultimately lead to ligament damage. Far too often, this damage requires surgery and up to a year of rigorous rehabilitation before the athlete can get back on the field,” he said.

Setting limits to the number of pitches thrown and not allowing pitchers to throw breaking balls until puberty are two methods of reducing the risk of injury, but it’s not always that simple.  Year-round conditioning and proper mechanics are crucial.  And, while Little Leaguer’s Elbow and ulnar collateral ligament injuries are mostly associated with pitchers, catchers are also at risk due to their high number of throws each game.  In addition, Dr. Thompson notes that coaches should be mindful of players who play more than one position.  A pitcher may be held to a safe amount of pitches in one game, but may come back and play shortstop or third base in the next game, positions that don’t allow for much arm rest.

 Maximum Pitch Counts

Age                  Pitches/Game

7-8                   50

9-10                 75

11-12               85

13-16               95

17-18               105

Rest Periods Required

Number of  Pitches                  Number of  Pitches

Ages 14 and under                   Ages 15–18                 Required # of Rest Days

66+                                          76+                              4 calendar days

51–65                                      61–75                          3 calendar days

36–50                                      46–60                          2 calendar days

21–35                                      31–45                          1 calendar day

1-20                                         1–30                            None

Source: Little League Baseball

“Players may experience pain in the elbow that doesn’t go away, or comes back very quickly after the player resumes throwing,” Dr. Thompson said.

Since the best treatment for Little Leaguer’s Elbow is rest, year-round baseball can tend to make matters worse.  “Coaches need to be willing to take kids out of the game if they complain of arm pain.   Players may have to stop throwing altogether until the pain and inflammation is gone.” he said.  If a condition is allowed to become severe enough, players may need to shut down their throwing for six weeks or more before slowly working their way back into the game.  Dr. Thompson describes a gradual approach that calls for a rehabilitation program to stop at the first sign of pain.

“Playing through arm pain will only cause further damage,” Dr. Thompson said.