Little League elbow is an overuse injury to the growth plate on the inner side of the elbow in children and young teenagers who throw repeatedly. The growth plate is weaker than the surrounding ligaments and tendons, so repeated throwing irritates it and causes pain on the inner elbow. It usually settles with a period of rest from throwing followed by a gradual return, but it should not be played through.
Also known as Little League elbow, medial epicondyle apophysitis, thrower's elbow in children
Anatomy: where the problem is
Front view of the elbow. Highlighted in the diagram: inner bony bump (medial epicondyle).
Symptoms
- Pain on the inner side of the elbow during or after throwing
- Tenderness over the bony bump on the inner elbow
- Loss of throwing speed, distance or accuracy
- Mild swelling on the inner elbow
- Difficulty fully straightening the elbow
- A sudden sharp pain or pop on one throw, which needs prompt assessment
Causes and risk factors
- Repeated throwing or bowling while the growth plates are still open
- Throwing too often, for too many months of the year, without enough rest
- Continuing to throw when the arm is tired
- Playing for several teams at once or specialising in one sport early
- A growth spurt, when bones and muscles are changing quickly
- Similar stresses occur in tennis, javelin, cricket and gymnastics
What the evidence says helps
- The main treatment is rest from throwing, usually for around four to six weeks, followed by strengthening and a gradual, staged return.1
- How much a child throws is the main risk factor. Young pitchers who threw the most in a year were about three times more likely to be seriously injured.3
- Throwing when the arm is tired was strongly linked to elbow and shoulder injury in adolescent pitchers.2
- A sports medicine position statement recommends limiting weekly and yearly participation, building in rest, and taking pain in a growing athlete seriously.4
- A sudden pop or sharp pain can mean the growth plate has pulled away, which needs an X-ray and a specialist opinion.1
Things you can try at home
- Stop throwing and bowling until the elbow is pain-free and has been assessed
- Tell coaches so that training can be adapted, not skipped altogether
- Keep up other activity that does not hurt, such as running and lower body work
- Follow a staged return to throwing, building distance and numbers gradually
- Limit how many overs, pitches or throws your child does each week, and plan rest months each year
- Never encourage a child to throw through elbow pain
When to get urgent help
Contact your GP urgently, call NHS 111, or call 999 in an emergency if you have:
- A sudden pop or sharp pain in the elbow while throwing: go to a minor injuries unit or A&E
- An elbow that cannot be straightened or bent, or that looks swollen or deformed: go to A&E
- A hot, red, swollen elbow with a fever, or a child who is unwell: get same-day medical help
- Pain at night or at rest, or pain that is not linked to activity: see your GP
- Numbness or tingling in the hand: see your GP promptly
How Apollo can help
We examine the elbow, shoulder and trunk, and ask about how much your child throws, bowls or trains in a week and over the year. If the findings suggest a growth plate problem, we explain why rest from throwing matters and may recommend an X-ray through your GP. We then guide a staged return with strengthening for the shoulder, trunk and hips, and we are happy to liaise with coaches about workload.
No GP referral needed. Clinics in Sheringham, Coltishall and Norwich.
Related reading
Frequently asked questions
How long should my child rest from throwing?
Most children need around four to six weeks without throwing, followed by a gradual return over a similar period. The exact time depends on how sore the elbow is and what an examination shows. They can usually keep doing other activities that do not hurt.
Can my child play through elbow pain?
No. Pain on the inner elbow in a growing child who throws is a warning sign that the growth plate is being overloaded. Continuing to throw risks a more serious injury and a longer time out.
Does this only affect baseball players?
No. The name comes from baseball, where it has been studied most, but the same injury occurs in cricket, tennis, javelin and other sports that involve repeated throwing or overhead hitting.
References
- Benjamin HJ, Briner WW (2005). Little League Elbow. Clinical Journal of Sport Medicine 15:37-40. View source
- Olsen SJ, Fleisig GS, Dun S, Loftice J, Andrews JR (2006). Risk Factors for Shoulder and Elbow Injuries in Adolescent Baseball Pitchers. The American Journal of Sports Medicine 34:905-912. View source
- Fleisig GS, et al. (2010). Risk of Serious Injury for Young Baseball Pitchers. The American Journal of Sports Medicine 39:253-257. View source
- DiFiori JP, et al. (2014). Overuse injuries and burnout in youth sports: a position statement from the American Medical Society for Sports Medicine. British Journal of Sports Medicine 48:287-288. View source
This page is general information, not a diagnosis or a substitute for medical advice. If you are worried about your symptoms, speak to your GP or a registered healthcare professional. Content prepared from the sources above, November 2026.
