Is your recovery window still open? Free one-page chart ↓
In a Growing Arm, the Growth Plate Fails Before the Ligament Does
Little league elbow is irritation of the growth plate on the inner side of a young thrower’s elbow, usually between ages 9 and 14. Caught early, most children are back throwing in about 6 to 12 weeks: at least 4 to 6 weeks of no throwing at all, then a graded return. A sudden pop with pain, or pain on the OUTER side of the elbow, needs a doctor rather than rest.
Your child has been complaining about their elbow after games.
Yet they’re still playing. And they don’t 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 teenager, 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. Play through it for a season and the cheap version (a few weeks off) can turn into the expensive one (a loose fragment of cartilage in the joint, surgery, and a year out).
Is my child’s elbow pain serious?
Sort it by WHERE it hurts and HOW it started. That’s most of the answer.
- Inner elbow, building over weeks of throwing. The common one. Usually little league elbow. Rest fixes it if you catch it early.
- Outer elbow, aching, maybe catching or locking. Less common, more serious. Needs imaging. More on this below.
- A sudden pop during one throw, then pain and they can’t carry on. Same-day assessment. That can be the growth plate pulled off the bone.
- Back of the elbow, sore when the arm snaps straight. Can be a stress injury of the growth plate at the elbow tip in older teens. Get it checked if it doesn’t settle with a week or two of rest.
If you’re not sure which spot it is, elbow pain by location lays out the map.
What little league elbow actually is
The bony bump on the inside of the elbow (the medial epicondyle) is where the forearm muscles that grip and the ligament that holds the elbow together both attach. In a child it isn’t fully fused to the rest of the bone yet. It sits on a growth plate.
Every throw, the inside of the elbow gets pulled apart as the arm whips forward. Hundreds of throws a week tug on that growth plate until it gets irritated and starts to widen. That’s little league elbow. It builds over weeks of throwing rather than arriving in one moment.
Typical age is around 9 to 14. Pitchers mostly, but catchers and anyone who throws hard and often can get it.
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 don’t 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. Have them hold both arms out straight, palms up, and look from the side.
- Tenderness when you press gently on the bony bump on the inside of the elbow, compared with the other side.
(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.)
Does my child need an X-ray?
Often, yes, and here’s why it’s not overkill.
- X-ray of BOTH elbows. The doctor compares the sore side with the good side, cos a growth plate that’s widened or slightly shifted only shows up against the normal one.
- MRI if the pain is on the outer side, if the elbow catches or locks, or if it won’t straighten fully. MRI shows the cartilage problem that X-rays can miss early.
- Examination checks tenderness on the bump, pain when the elbow is gently stressed, full straightening and bending, and the nerve that runs behind the inner elbow (the “funny bone” nerve).
A normal X-ray with tenderness on the bump still means rest. It doesn’t mean “carry on”.
How long is my child out?
Caught early, treatment is genuinely simple: stop throwing, 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!).
This is the open window. Inner elbow pain caught in the first few weeks usually settles completely. Ignored for a whole season, recovery gets longer and the chance of the growth plate shifting goes up.
- Weeks 0 to 6: no throwing at all. Not “light catch in the backyard”. None. Full elbow movement kept up daily. Conditioning for legs, hips and core continues, because the return will be faster if the rest of the body hasn’t detrained.
- Late in that 6 weeks, once the bump is no longer tender: gentle forearm and grip strengthening starts (below).
- Weeks 6 to 10: an interval throwing program. Short distance, low effort, building distance before intensity, with a rest day between sessions.
- Weeks 10 to 12 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.
If your doctor sets different dates, use theirs. A growth plate that has actually shifted on X-ray may need a cast, a longer break, or occasionally surgery.
Exercises while they’re off throwing
Pain-free only. If any of these hurt the inner elbow, stop and drop back.
- Elbow bend and straighten. Slowly bend fully, then straighten fully. 10 reps, 3 times a day. The aim is to keep full straightening, the first thing a sore elbow loses.
- Forearm turns. Elbow tucked at the side, bent to 90 degrees. Turn the palm up, then down. 10 reps, 3 times a day.
- Grip squeezes (from week 4, if pain-free). Soft ball or putty. Squeeze 5 seconds, relax. 10 reps, twice a day.
- Wrist curls (from week 4 to 6, if pain-free). Forearm resting on a table, a light weight (a full water bottle is plenty). Curl the wrist up slowly, lower slowly. 2 sets of 15, once a day.
- Everything else. Legs, hips, trunk and running. Throwing velocity comes from the legs and the trunk, not the elbow. A child who comes back with stronger legs throws with less strain on the arm.
Can my child still play while it heals?
Usually, yes. Just not throwing.
- Batting: often fine if it’s pain-free. If swinging hurts the inner elbow, it waits too.
- Running, fielding drills without throwing, conditioning: yes.
- Switching to catcher or infield: no. Catchers throw back to the pitcher on every single pitch. That’s not rest.
- Other sports: soccer, swimming kick sets, running sports are fine. Anything with hard overhead throwing or a racquet waits.
Keeping them involved with the team helps. A child sitting at home bored is a child sneaking in a game of catch.
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.
This one runs on a closing window. A stable lesion found early can heal with a long period off throwing, often several months. Once the fragment has separated, that window is shut for that piece of cartilage: it’s surgery, and return can take many months.
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.
(In children under about 10, a similar outer elbow problem called Panner’s disease affects the whole growth center and usually settles well with rest. Your doctor will tell them apart on X-ray. You don’t need to.)
How do I stop it happening again?
The uncomfortable part. Almost everything that causes these is a decision an adult made.
- Volume. Pitch counts and mandatory rest days between appearances exist because they work. MLB and USA Baseball’s Pitch Smart guidelines set daily limits by age. Treat them as limits, not suggestions. They’re routinely exceeded by children playing for a school team and a club team who don’t compare notes. Someone has to add up the total. That someone is usually you.
- Throwing tired. Fatigue is one of the strongest predictors 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. Pitch Smart recommends at least 4 months a year off competitive pitching, with at least 2 to 3 of those months in a row off overhead throwing.
- Pitcher and catcher in the same game. Two of the highest-throw positions back to back. Avoid it.
- 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.
- Breaking balls too early. Get the fastball and change-up mechanics right first. Most coaching guidance holds curveballs back until the child’s mechanics are consistent.
And if your child has already had little league elbow once, the next one is more likely if nothing about their week changes. The rest fixed the elbow. Only the schedule fixes the cause.
Will it affect their growth?
Usually not, if it’s managed properly. Irritation of the growth plate that’s rested settles without any effect on how the arm grows.
The growth plate that’s been pulled off the bone, or a cartilage fragment that separates, is where lasting change becomes possible: an elbow that doesn’t fully straighten, or a joint surface that wears earlier. That’s the whole case for stopping early rather than finishing the season.
For the other elbow injuries in children, see supracondylar elbow fractures in children, pulled elbow in toddlers and growth plate fractures in the hand and wrist. Once they’re 15 or 16 and the growth plate has closed, the adult version is the ligament: thrower’s elbow and the UCL.
Get it checked today if
- A sudden pop during a throw, with immediate pain and they can’t continue.
- The elbow swells quickly, looks out of shape, or they can’t bend or straighten it.
- The elbow locks, gets stuck, or catches mid-movement.
- Numbness or tingling in the ring and little fingers that doesn’t settle within minutes.
Get it checked if
- Inner elbow pain that comes back every time they throw.
- Any pain on the OUTER side of a young thrower’s elbow.
- They’ve lost some straightening compared with the other arm.
- Pain hasn’t settled after 1 to 2 weeks of no throwing.
- Velocity or accuracy has dropped and they’re avoiding pitching.
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. 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.
Part of: Hand, wrist and elbow pain by job, sport and hobby
Every article on this site is written using the Closing Window Method: name the window your condition runs on, find where you are in it, and act while it’s still open.