Pediatric Conditions and Treatment Pitcher’s Elbow: What to Know About this Overuse Injury

Pitcher's elbow is when the medial elbow (the inner side) feels irritated from a repeated throwing motion, especially if the athlete uses poor form. Doctors call pitcher's elbow "medial epicondyle apophysitis." That's a fancy way of saying the medial growth plate of the elbow is hurt from too much stress. This can happen in any overhead throwing position, in both baseball and softball.

Around what age does pitcher's elbow start?

It's most common in kids between 9 and 14 years old, especially those who play baseball all year round. Remember, kids' bones are different in that they have growth plates. The growth plate can undergo painful stresses while throwing, and this is why children can develop pitcher's elbow and adults do not.

The key is early treatment to avoid long-term problems.

What are the first signs of pitcher's elbow?

If your athlete starts complaining about elbow pain, don't ignore it. Some kids may feel the pressure to keep playing and avoid the conversation all together, so play detective without hovering because everyone knows the earlier an injury is caught, the better.
Here's what you can look out for if you suspect pitcher's elbow in your child:

Pain on the inside of the elbow

• Swelling or tenderness
• Trouble straightening the arm
• A popping sound or feeling in the elbow
• Loss of speed or control when pitching-be extra observant during practices and games. Talk to the coach.

If your child has any of these symptoms, it's time to see a doctor. A sports medicine or pediatric orthopedic specialist can check the elbow and recommend treatment.

Rest is the most important part of treatment [for pitcher's elbow]. That may mean stopping all throwing activities for several weeks, sometimes longer, depending on the injury.

Your child's care team may recommend the following tips:

• Switch up the position-if your child is pitching too many innings or games, encourage them to talk to their coach and see what can be done. USA Baseball and Little League have pitch count guidelines based on age. Make sure your child's coach follows them. This helps protect young arms from too much stress.
• Self-care and rest between seasons-rest and recovery between seasons are extremely important.
• Ease back into it-if your athlete is recovering from an elbow injury, encourage them to ease back into their pitching position. Throwing too hard to too fast, too soon, can make everything worse.
• Practice pitching techniques-have your athlete check up on their form occasionally. Their coach or a sports physical therapist can help with this.
• Encourage different sports-it's ok to love a sport, but it's also ok to dabble in others. This can help the body use different muscle groups and avoid overuse injury.
• Don't skip warm-up and cool-down-this goes for every sport. Stretch, stretch, stretch… and ice if needed.

>>Related: Ask a sports physical therapist: the 101 on overuse injuries in young athletes

How is pitcher's elbow treated?

The good news is that most kids get better without surgery-as long as they follow the guidelines above. Rest is the most important part of treatment. That may mean stopping all throwing activities for several weeks, sometimes longer, depending on the injury.

Your child's sports medicine team may also recommend:

• Icing regularly to reduce swelling
• Over-the-counter pain medicine, as needed
• Sports physical therapy to restrengthen the area and get your athlete back into the game. This will mean a gradual return to throwing or pitching, with proper form.

Sometimes, surgery is the best option if the injury is severe enough, but this is very uncommon. So, early detection is key.

Before anything, though, your child's sports medicine team will check their range of motion and will likely do an X-ray to see what exactly is going on inside the elbow.

Final thoughts about pitcher's elbow:
Pitcher's elbow is a common problem in young athletes who love to throw. But with the right steps, it can often be prevented and treated without long-term damage.