According to Dr. Thomas Souza DC LLE (Little League Elbow) is more like a syndrome than a pathology. It is usually an adolescent pitcher with medial or lateral elbow pain. The adolescent elbow has growth plates in it until around age 24. This information was given to me a general knowledge fact in chiropractic school. The long bone has a diaphysis, a metaphysis, and a epiphysis. The epiphysis is at the end of the bone and in adolescen children it looks like a broken fragment or chip on a radiograph or x-ray. Here is a x-ray of a normal child's wrist.
The end plates of the radius and ulnar bones look broken but these are normal, these bones have not matured yet. I used a wrist because it is easier to see the plates then the ones in the elbow. The radius and ulnar have a proximal end that articulates with the distal humerus. The distal humerus also has growth plates on the distal ends of it to. With LLE there can be two major complaints. The medial or inside part of the elbow may have stretch injuries from the throwing when the external rotator muscles pull the arm back an then stretch the ligaments and then compression injuries can occur on the lateral side. There is a law called Wolff's Law that also can come into play here to. There is a non union of the immature epiphysis along with stress from throwing and stretching of the tissues. Wolff's Law works like this, when a bone has added stress to it then it will increase bone building activity and lay down additional matrix to make that bone stronger. An example of that would be to look at the tibia and femur bones of a long distant runner that is 60 and a couch potato that is 30. The 60 year old runner will have more dense and slightly larger bones from the stress of all that pounding of the body on those knees. The couch potato has really no need for this because they do not bear a lot of weight on their bones so their radio-graphs will show less density in the bones. Now add this stress to a bone that is still not finished growing and you will see that on an x-ray of a child that is right handed, hard throwing, and pitching many innings that their right elbow joint may be slightly larger than their left. It will definitely have an increase in external and internal rotational range of motion in the shoulder as well. The excessive throwing can also cause the growth plate to mature early and the epiphyseal plate will close early. Medial elbow pain is usually due to microtrauma of the medial anterior oblique ligament. The stress may also cause fragmentation of the medial epicondylar ligament. Now imagine your little league all star throws with his right arm and hits from the right side of the plate too.
Now they are experiencing the same medial side arm stretch but holding a weighted lever. The developing arm is experiencing two to three times as much stress as when they were throwing. I hypothesize this from the fact that a baseball weighs nine ounces and a little league bat can weigh 18 to 27 ounces. Some people will argue with me that the swing has two hands involved and the throw only one. I can accept this argument to a point, but from high speed video I can still see the medial arm being stretched.
As much baseball as I played as a kid and all the complete games I threw as a pitcher I didn't injure my arm until I was in college. Here is the difference. I throw right handed and hit from the left side of the plate. My right forearm muscles were getting work on both sides and avoiding an imbalance. The internal rotators involved in throwing where not involved in my hitting, when hitting my external rotators were getting the work. My pectoralis muscle on the throwing side were not getting stretched on the hitting side. I noticed also that I had more than a few students that were not pitchers that were having medial arm pain in their elbow. I thought it was strange that their arms were always hurting and they were not pitchers at all. When I asked them what they did most they said, "I hit three days a week and play tournaments on the weekends." After working with these hitters for a few months their arm problems mysteriously disappeared.
Was it by chance? I really believe it was how I trained them. I used a weighted chain system and made them swing from both sides of the plate to strengthen their core muscles. In the beginning some of them complained that it hurt to much to swing with their top hand or the one stretching the medial arm side. I would have them just do the bottom hand swings with that arm. I had a one handed bat with a chain attached to it and I made them swing that from both sides of the plated using forehand and backhand. Lastly I cleaned up their mechanical flaws and made their swing more efficient. So based on my clinical experience I would train both sides of the whole arm and their arms problems resolved. They trained the accelerating internal rotator muscles and then trained the decelerating muscles. They trained the forearm flexors as well as the extensors and if they were significantly weaker with their bottom hand I had them do more reps with that hand until is became stronger. The pectoralis muscles are part of the internal chain, so the latissimus muscle on the back must be trained too. If your young pitcher is using rubber tubing then I recommend Jaeger Bands. Use these bands for resistance training then use then in the exact reverse motion. Start from the release and jump back the the wind up. The bottom line is if the growth plates are damaged at a young age then the damage may be permanent. Which can mean a lifetime of arm pain and problems. Start out slow when the arms are young and still developing and do not be in a hurry to get them to the major leagues. Baseball is typically a forward moving sport, so do not forget to train the backward moving muscle too. This will create stability and overall greater strength. I have no problems with inning restriction at the lower levels and if curve balls are going to be thrown then proper mechanics are a must. I see so many young players trying to snap the elbow and wrist to make the ball spin. This is a receipt for disaster. My personal recommendation is learn to throw a fastball consistently for strikes to locations first, then a change-up, and curve ball and slider last. I played with professional players that were in there 20's that did not throw a curve ball at all. Best pitch in baseball is a well located fastball with changes in speed. When these guys learned how to throw a slider or curve ball it just put another bullet in their gun.
I hope this information was useful. I value any comments or feedback.
Ref:Differential Diagnosis and Management for the Chiropractor 4th Edition, Thomas Souza DC
