Elbow, Wrist & Hand

What It Is

With the start of baseball season in the spring, doctors often see an increase in elbow problems in young players (AAOS, n.d.). The same injuries happen in other sports with repetitive overhead throwing or hitting, such as softball, tennis and volleyball (AAOS, n.d.). In the UK, children also play cricket and rounders. By the river or the sea, children love to throw stones. And racket sports such as tennis and badminton can replicate a movement similar to a throw.

Throwing injuries can affect the wrist, elbow, shoulder, neck or upper back. Most often throwing injuries are repetitive strain injuries, with children doing a large number of throws in a short period of time. This is why some sports limit the number of throws or pitches that a child can do (AAOS, n.d.; Sgroi et al., 2024).

The classic overuse injury is "Little Leaguer's elbow", where repeated throwing pulls hard on the growth plate (the area of growing bone) on the bony bump on the inside of the elbow. The growth plate is weaker than the ligaments and muscles attached to it (AAOS, n.d.; Nationwide Children's Hospital, 2021). If ignored, the pull can tear ligaments and tendons away from the bone and disrupt normal bone growth (AAOS, n.d.).

Other conditions include osteochondritis dissecans, where repeated compression loosens or breaks up bone and cartilage on the outside of the elbow, and tears of the ulnar collateral ligament, the main stabilising ligament of the elbow during throwing (AAOS, n.d.). Muscles and tendons around the elbow can also become inflamed (AAOS, n.d.).

Throwing Injuries in the Elbow in Children Anatomy

Three bones join together to form the elbow joint: the upper arm bone (humerus) and the two forearm bones (radius and ulna) (AAOS, n.d.). Collateral ligaments connected to the bones keep everything in proper alignment. On the inside is the ulnar collateral ligament, sometimes called the medial collateral ligament. On the outside of the elbow is the radial collateral ligament, sometimes called the lateral collateral ligament. These ligaments help stop the elbow from dislocating and provide stability (AAOS, n.d.).

The elbow is a combination hinge and pivot joint. The hinge lets the arm bend and straighten (flexion and extension); the pivot lets the forearm twist and rotate (AAOS, n.d.). During a throw, the elbow rotates as well as extends. Rotation turns the palm up (supination) and down (pronation).

If you throw a ball under-arm, the arm remains in a supinated position. If you throw the ball over-arm, the arm is pronated and has thus rotated.

When Should a Child Stop Throwing?

A child should stop throwing and be checked if they have elbow pain or swelling (especially with loss of throwing speed), feel a "pop", have numbness or tingling in the arm, cannot fully move the elbow, or the elbow locks (AAOS, n.d.).

Not a diagnosis — for more information, contact me or another trusted healthcare provider.

Treatment

Self-Care & Treatment

How to Treat Throwing Injuries in the Elbow in Children

Once your child's doctor has checked the elbow, I can support their recovery with hands-on work, exercises and a gradual return to throwing, working within the doctor's plan. See the My Approach tab for how I work.

1. Get to See a Doctor

Your child's arm needs to be examined so that a clear diagnosis can be made. The doctor may arrange an X-ray, especially after a fall or collision when a fracture is possible, or another scan such as an MRI.

2. Rest

Reducing stress on the elbow is the first line of treatment (AAOS, n.d.). Once pain sets in, your child should stop the activities causing the pain. Continuing to throw may make the injury worse.

3. Ice

To help control pain and swelling, apply an ice pack wrapped in a towel; do not put ice directly on the skin (AAOS, n.d.).

4. Technique

Refining throwing technique, with help from a coach, can help (AAOS, n.d.; Nationwide Children's Hospital, 2021).

Treatments you may want to discuss with your family doctor or nurse practitioner

Options outside my scope

Surgery: surgery is occasionally needed, especially in girls older than 10 and boys older than 12; it may involve fixing a loose or broken piece of bone, bone grafting or repairing a torn ligament (AAOS, n.d.).

How I can help (see the My Approach tab)

Support during recovery, within the doctor's plan
Strength and flexibility work for the shoulder, elbow, forearm and trunk
A gradual return to throwing, alongside the coach's technique work

Tips

If pain continues after a few days of complete rest, or comes back when throwing starts again, stop the activity again until the child gets treatment (AAOS, n.d.).
Most sports have guidelines about how much a child should throw and how much rest they need. Check with your sport's governing body so your child is not over-doing it. For example, USA Baseball and Major League Baseball's Pitch Smart guidelines recommend these maximum pitches per day in a game (AAOS, n.d.; Sgroi et al., 2024):
50 pitches for ages 7 to 8
75 pitches for ages 9 to 10
85 pitches for ages 11 to 12
95 pitches for ages 13 to 16
105 pitches for ages 17 to 18
Even more important, young pitchers must get enough days of rest between pitching (AAOS, n.d.).
Warming up properly helps prevent these injuries (Nationwide Children's Hospital, 2021).

Treatment

My Approach

With a young thrower's elbow, the growing bone and cartilage need protecting first. Your child's doctor decides how long they rest from throwing and when they can start again, and I work inside those limits. If your child has had surgery, I need the surgeon's okay before any hands-on treatment.

Please bring any X-ray or scan reports and notes from your child's medical team to the first visit. They're an important part of planning safe treatment.

I assess how your child's shoulder, elbow, trunk and hips move and how strong they are, since a weak link elsewhere can strain the elbow.

While Throwing Is on Hold

Gentle hands-on work for the forearm, upper arm and shoulder muscles, staying off the sore growth plate
Easing the shoulder, neck and upper back, which often work overtime
Gentle lymphatic drainage if there's swelling, and I'll show you how to use ice at home with your child
Keeping the elbow, wrist and shoulder moving within comfort

Getting Back to Throwing

Scar work once any surgical wound has healed
Stretches for the shoulder and forearm, which I'll teach you and your child
Light, play-based strength work for the shoulder blade, rotator cuff, forearm, trunk and legs, with good form before any added weight
Once the doctor agrees, a gradual return to throwing, alongside the coach's work on technique, pitch counts and rest days

Parents are welcome to sit in, with your child's agreement. A pop, numbness, tingling or locking means stopping and getting it checked (see When Should a Child Stop Throwing?).

What to Expect

Typical Course

Typical course: Visits are usually once or twice a week at first, then weekly, then spaced out as your child manages the home programme, with a reassessment at about 4 to 6 weeks, all fitted around the doctor's plan. Many children rest from throwing for around 4 to 6 weeks before a gradual return, while osteochondritis dissecans or injuries needing surgery can take several months.

What I Focus On

Working Within the Doctor's Plan

Compensation Relief

Elbow & Shoulder Mobility

Whole-Body Strength

Gradual Return to Throwing

Sources

References

American Academy of Orthopaedic Surgeons (n.d.) Throwing injuries in the elbow in children. OrthoInfo. Available at: https://orthoinfo.aaos.org/en/diseases--conditions/throwing-injuries-in-the-elbow-in-children/ (Accessed: 7 October 2026).
American Academy of Orthopaedic Surgeons (n.d.) Elbow injuries in the throwing athlete. OrthoInfo. Available at: https://orthoinfo.aaos.org/en/diseases--conditions/elbow-injuries-in-the-throwing-athlete (Accessed: 7 October 2026).
Nationwide Children's Hospital (2021) Little leaguer's elbow (medial epicondylar apophysitis). Available at: https://www.nationwidechildrens.org/conditions/sports-medicine-little-leaguers-elbow (Accessed: 7 October 2026).
Sgroi, T., Jones, D., Andrews, R. and Giral, J. (2024) 'Throwing injuries and prevention strategies in youth baseball', HSS Journal, 20(3), pp. 341–345. doi: 10.1177/15563316241249139

Massage therapy · Kitchener–WaterlooThrowing Injuries in the Elbow in Children

What It Is

Throwing Injuries in the Elbow in Children Anatomy

When Should a Child Stop Throwing?

Self-Care & Treatment

How to Treat Throwing Injuries in the Elbow in Children

1. Get to See a Doctor

2. Rest

3. Ice

4. Technique

Treatments you may want to discuss with your family doctor or nurse practitioner

Tips

My Approach

While Throwing Is on Hold

Getting Back to Throwing

Typical Course

References

Related Conditions

Book a session

Massage therapy · Kitchener–WaterlooThrowing Injuries in the Elbow in Children

What It Is

Throwing Injuries in the Elbow in Children Anatomy

When Should a Child Stop Throwing?

Self-Care & Treatment

How to Treat Throwing Injuries in the Elbow in Children

1. Get to See a Doctor

2. Rest

3. Ice

4. Technique

Treatments you may want to discuss with your family doctor or nurse practitioner

Tips

My Approach

While Throwing Is on Hold

Getting Back to Throwing

Typical Course

References

Related Conditions

Bennett's Fracture

Boutonniere Deformity of the Finger

Carpal Bone Fracture

Colles' Fracture

Book a session