In a Growing Arm the Growth Plate Fails Before the Ligament Does
Your child has been complaining about their elbow after games.
Yet, they’re still playing though. And they dont complain about it the next day. So maybe…it’s okay?
Look, here’s the thing that changes how seriously to take it.
In an adult thrower, the weak link is a ligament, and a ligament injury is bad but repairable. In a child or adolescent, the bones still have growth plates in them, and a growth plate is weaker than the ligament attached to it.
So the same throwing force that frays an adult’s ligament pulls at a child’s growth plate instead. And growth plates, damaged badly enough, affect how the bone grows.
That’s why elbow pain in a young thrower doesn’t get the benefit of the doubt that the same complaint would get from an adult.
Inner elbow: the common version
Little league elbow usually means irritation of the growth plate on the inner side, at the bony bump you can feel there. Typical age is around nine to fourteen, and it builds over weeks of throwing rather than arriving in one moment.
Signs to look for:
- Pain on the inner elbow during or after throwing.
- Throwing less far, less accurately, or with obviously changed mechanics. Children very often adjust their action before they complain…because they dont know it’s not normal to have pain or weakness, they just try again and again.
- Not wanting to pitch, or asking to play a different position. Take this at face value rather than as reluctance.
- Any loss of full straightening compared with the other arm.
Caught here, treatment is genuinely simple: stop throwing for around 4 to 6 weeks, keep the rest of the body conditioned, then a graded return-to-throwing program with the mechanics reviewed.
Most children do very well just doing this alone (but yeah, it’s hard to convince them haha!).
The version I don’t want: a sudden pop during a throw with immediate pain and inability to continue. That’s the growth plate being pulled off the bone as a fracture, and it needs assessing the same day.
Outer elbow: the one that actually worries me
Pain on the outside of a young thrower’s elbow is a different and more serious animal, and it gets far less attention because it’s less common.
The same throwing force that pulls the inside apart compresses the outside, where two bone surfaces are jammed together repeatedly. In a growing skeleton, that repeated compression can damage the blood supply to a patch of cartilage and the bone beneath it.
That’s osteochondritis dissecans, usually in the 11 to 15 range. If the damaged fragment loosens and separates, it becomes a loose body floating in the joint, and it causes permanent damage to a joint surface that doesn’t repair itself.
Inner elbow pain in a young thrower usually means rest. Outer elbow pain, catching, locking, or an elbow that won’t fully straighten means imaging.
Catching, locking, swelling, or loss of straightening on the outer side should be imaged rather than rested and reviewed. This is the one where waiting and seeing costs the most.
The uncomfortable prevention conversation
Almost everything that causes these is a decision an adult made.
- Volume. Pitch counts and mandatory rest days between appearances exist because they work. They are limits, not guidelines, and they’re routinely exceeded by children playing for a school team and a club team who don’t compare notes.
- Throwing tired. Fatigue is the single strongest predictor of injury in young throwers. A tired arm changes its mechanics to keep producing speed, and the elbow absorbs the difference.
- Year-round single-sport play. A growing athlete needs months off the throwing motion every year. Playing baseball all twelve months is one of the clearest risk factors there is.
- Chasing speed. Radar guns and showcases push children to throw at maximum effort repeatedly, at exactly the age their growth plates are least able to tolerate it.
(I’d add one that isn’t a rule: children under-report. A child who wants to play will tell you their elbow is fine. Watch what their arm does, not what they say about it.)
Recovery and getting back
- Weeks 0 to 6: no throwing at all. Full range of motion maintained. Conditioning for legs, hips, core and shoulder continues, because the return will be faster if the rest of the body hasn’t detrained.
- Weeks 6 to 10: pain-free full movement first, then a formal interval throwing programme: short distance, low effort, building distance before intensity, with rest days between sessions.
- Weeks 10 onwards: return to pitching last, and to full-effort pitching last of all.
Any return of pain drops back a stage. That rule is what stops the cycle of repeated flare-ups across a season.
For osteochondritis dissecans the picture is different and depends entirely on whether the fragment is stable. Stable lesions may heal with a long period of rest. Unstable ones and loose bodies are surgical, and return can take many months.
The short version
A growing thrower’s elbow pain is a growth plate problem until proven otherwise, and it deserves a lower threshold for stopping than an adult’s would.
Inner elbow pain, building gradually: stop throwing, get it assessed, come back properly.
Outer elbow pain, catching, or an elbow that won’t fully straighten: get it imaged.
And none of this is your child being soft. The forces are real, and the arm they’re using isn’t finished yet.
Written by Nigel Chua, hand occupational therapist in practice since 2005. Tens of thousands of hands, wrists and elbows assessed and treated. My credentials are here. This article explains; it doesn’t examine. A sudden pop with inability to throw, or a locking elbow, needs assessing the same day.