Understanding Little League Elbow: What Parents and Athletes Need to Know
- Arthur J Lee, PT, DPT, CSOMT
- Oct 2
- 3 min read
If your child plays baseball, especially as a pitcher, you may have heard of “Little League Elbow.” It’s one of the most common injuries in youth baseball players, and it can sideline a season if not managed correctly. Let’s break down what it is, why it happens, and how we can prevent it—without getting lost in medical jargon.
What is Little League Elbow?
Little League Elbow is an overuse injury that affects the inside of the elbow (the medial side). It happens when the repetitive throwing motion places too much stress on the growth plate and tendons around the elbow. Kids are particularly vulnerable because their bones and joints are still developing.
Think of it like this: every time your child throws, their elbow experiences a small tug. Over time, too many of those tugs without enough rest or proper mechanics can lead to pain, irritation, or even damage.
Why Does It Happen?
The throwing motion requires a ton of power and coordination. The shoulder and elbow work together to create velocity, but if one area is weak, stiff, or unbalanced, the elbow takes the hit.
One key piece that often flies under the radar is something called the MER/ER ratio:
MER = Maximum External Rotation (how far the shoulder rotates back during a throw)
ER = Passive External Rotation (how much natural flexibility the shoulder has when rotated outward without active effort)
If a young pitcher’s MER (the “layback” position during throwing) is far greater than their passive ER, that means they’re cranking their shoulder into a range their body isn’t naturally built to handle. When this happens, the elbow and soft tissues around it end up taking on more stress than they should.
An easy way to picture this: it’s like trying to bend a door hinge past where it was designed to open. Eventually, something starts to wear down.
Signs of Little League Elbow
Here are a few things to watch for:
Pain or tenderness on the inside of the elbow
Swelling or stiffness after throwing
Decreased throwing speed or accuracy
Complaints of “something pulling” in the elbow
If these signs show up, it’s important to take them seriously. Continuing to throw through pain can lead to more serious injuries down the road.
Prevention and Treatment
The good news? With the right plan, Little League Elbow is treatable and preventable.
Strength Balance – Training the rotator cuff, scapular stabilizers, and forearm muscles helps balance out throwing forces.
MER/ER Ratio Screening – A sports physical therapist can measure this ratio to identify risky imbalances. If the shoulder can’t naturally rotate as much as the throwing motion demands, targeted mobility and strength training can reduce stress on the elbow.
Pitch Counts and Rest – Following age-appropriate pitch count guidelines and giving the arm proper rest is critical.
Throwing Mechanics – Small tweaks in throwing form can make a huge difference in reducing stress on the elbow.
Early Intervention – If pain starts, rest and a professional evaluation are the best next steps—not “pushing through it.”
Takeaway
Little League Elbow isn’t just about the elbow—it’s about how the whole arm and shoulder work together. By understanding concepts like the MER/ER ratio, we can see that injury risk comes down to more than just pitch counts. It’s about balance, mechanics, and making sure the shoulder has both the mobility and control to handle the demands of pitching.
At our clinic, we specialize in helping athletes not only recover from injuries like Little League Elbow but also build resilience to prevent them in the first place. If your child is showing signs of elbow pain, or if you want a proactive screen to catch imbalances before they become injuries, schedule a consultation today.
