Q. My son plays Little League Baseball and is a very good pitcher. He has recently developed discomfort, swelling, and difficulty straightening his elbow on his throwing arm. We have stopped all pitching for now. What could the problem be? 

A. “Little League Elbow” is a very common overuse related problem. It tends to happen in the better pitchers since they are often called upon more often to throw and the repetitive stresses of throwing can create some damage especially around the vulnerable growing elbow. There are a variety of ailments that can happen including tendinitis, stress fractures, ligament strains and even areas of damage to the joint surface. If there is swelling and any loss of motion including extension (fully straightening the arm) then pitching should be stopped and a proper evaluation sought. This will include physical exam and x-rays and probably a period of down time and therapy to allow healing.

Proper conditioning of the entire body can help prevent this and very often there are issues with throwing techniques so a pitching coach can be helpful as well. Monitor the number of pitches that are thrown in a given week since this has a direct effect on the incidence of elbow problems in Little League Baseball. While there are no hard set rules, there are some useful guidelines. For little league pitchers, the total number of pitches thrown in one week (including games, practice, and even horsing around- i.e. at home) should not exceed 200. It has also been suggested that young pitchers stay between a total of 4 and 10 innings pitched per week, pitching no more than twice in a week, 80-100 pitches per game and no more than 30-40 pitches in a single practice session.

Young athletes will vary on what their bodies will tolerate. Pain is an important signal that should never be ignored. Any pain that persists, or is associated with swelling or any motion loss in the elbow (or shoulder—similar things happen there in young pitchers) should disqualify the young athlete from play until properly evaluated. “Playing through the pain” is not an option and risks permanent damage.