Little League Elbow (LLE) is a common overuse injury to the medial elbow, meaning tissue breakdown exceeds tissue repair. This occurs when a repetitive valgus stress is placed on the elbow from high repetitions of multidirectional mechanical forces which result in bony/soft tissue overload. This results in microtrauma to the medial elbow affecting the elbow at the origin of the wrist and hand flexors, and the pronator teres muscles by creating tension on the medial supporting structures. Medial supporting structures include the medial epicondyle, medical epicondylar apophysis, and medial collateral ligament. In conjunction with the tension on the medial support structures, there is also compression of the lateral structures, which include the radial head and capitellum.
In younger athletes, there may be a lack of flexibility and/or muscle imbalance. Injury to a thrower’s elbow is specific and age dependent. It is primarily seen in young baseball players, ages 8-16 years old. Most often, these baseball players are pitchers. It has also been diagnosed in young tennis players and football quarterbacks. Understanding how different stresses occur during each phase of throwing is helpful to identify elbow injuries. Throwing phases include: winding-up, cocking, late cocking, early acceleration, late acceleration, deceleration, and follow-through. Little League Elbow is most commonly seen during the throwing phase of cocking and acceleration. Cocking Phase occurs when the front foot hits the ground and the pitching arm is abducted and extended as far as possible behind the body. The shoulder is in complete external rotation, the elbow is flexed and the forearm is supinated. This is when the most tension occurs on the lateral and medial aspects of the elbow. Acceleration occurs as the throwing arm is internally rotating and adducting the shoulder, while the elbow is extending. This is where the ball is released quickly, applying a great deal of stress on the medial aspect of the elbow. Lateral injuries are most commonly seen during late cocking and early acceleration.
Signs and symptoms of little league elbow include stiffness, soreness, swelling, painful throwing, pulling, popping, giving out, tenderness at the medial joint, instability, and interference with activities of daily living. Little League elbow can be a sudden onset of elbow pain or a gradual pain that is felt over time, secondary to overuse.
A physical therapist can diagnose and treat Little League Elbow. He/She will evaluate the biomechanics of the arm/elbow, range of motion, and strength of surrounding muscles. Treatments may include manual therapy to promote an increase in painfree range of motion, stretching to lengthen any tight musculature of the arm/elbow, and modalities to promote healing. Another treatment for Little League Elbow may include helping the athlete to understand what the problem is, why it is occurring, and how to change his/her pitch or method of play to decrease the stress on the medical aspect of the elbow. A physical therapist will put him/her through a stretching and strengthening exercise program to eliminate the pain felt by the Little League Elbow and return the athlete to his/her normal everyday lifestyle without pain, as quickly as possible. Joint Ventures’ physical therapists can perform all of these treatments to assist in the recovery of Little League Elbow.
