Youth throwing arm

What it is

Throwing generates enormous valgus stress at the inner elbow and rotational stress at the shoulder. In a skeletally immature athlete, the growth plates at those sites are weaker than the ligaments and tendons attached to them, so the plate is what fails.

The single most important thing established by the research is that pitch volume dominates every other risk factor. Pitch counts, rest days between outings, and avoiding year-round throwing reduce injuries far more than any technical adjustment. Youth throwing injury rates rose alongside year-round competitive play, and they respond to limiting it.

What it feels like

• Pain on the inside of the elbow during or after throwing
• Or pain at the top of the arm, in the shoulder version
• Loss of throwing velocity and accuracy before pain becomes obvious
• Reluctance to throw hard, or an altered arm action
• Aching for a day or two after pitching, then settling until the next outing

What causes it

Most people have more than one of these at once, and they feed each other. Read the list looking for the two or three that sound like your week rather than for the one true answer — the ones that describe you are the ones worth acting on.

Repetitive valgus stress on an immature growth plate

Throwing places very high tension on the inner elbow. In a growing athlete the growth plate there is the weakest link, and repeated stress irritates and can separate it.

Pitch volume

The dominant risk factor. Total throws per outing, per week and per year predict injury better than anything else, which is why pitch count limits exist and why they work.

Insufficient rest between outings

Growth plate tissue needs recovery time. Pitching on consecutive days, or in multiple games on the same weekend, removes it.

Year-round throwing

Playing on multiple teams and through the winter removes the off-season entirely. It is one of the strongest predictors of serious throwing injury in young athletes.

Pitching while fatigued

Throwing with a tired arm produces altered mechanics and higher stress on the elbow. Pitching with arm fatigue is among the strongest single predictors of injury.

Breaking pitches at a young age

Long implicated, though the evidence is weaker than for volume. Volume and fatigue matter more than pitch type, which is worth knowing so the right thing is limited.

Poor shoulder and scapular strength

The whole kinetic chain contributes to a throw. Weak shoulder, scapular, trunk and hip musculature shifts more of the demand to the elbow.

Loss of shoulder internal rotation

Throwers develop reduced internal rotation over time. Beyond a threshold this is associated with both shoulder and elbow injury and it responds to specific stretching.

Playing catcher as well as pitching

Catchers throw a very large number of times per game. Combining pitching and catching substantially increases total throwing volume, often without anyone counting it.

Playing through pain

Young athletes routinely under-report. Continuing to throw through elbow pain is how a manageable apophysitis becomes a serious injury.

Who tends to get it

• Young throwers aged roughly nine to sixteen, when growth plates are open
• Anyone pitching high volumes or on multiple teams
• Athletes playing year-round with no off-season
• Those pitching while already fatigued
• Players who both pitch and catch

What makes it worse, and what settles it

The qFIT routine for this

Ready-made routineRotation Sports (Golf, Racquet & Throwing)

qFIT already has this one built. It runs massage first, then stretching, then strength — the order that works on a body that is already sore — and every activity in it carries the reason it is there.

The button below opens your Checklist with this routine already selected, so instead of your whole list you land on just its Categories, Targets and Exercises, each with its checkbox, ready to tick as you work through them.

Have more than one problem? Tick yours under My Problems on My Profile and your Checklist's Routine list gains Recommended for my problems — every routine for the problems you picked, merged into one. Your picks stay private; that filter is the only thing they feed.

Get it checked if…

Persistent elbow pain in a skeletally immature thrower needs imaging - growth plate injuries can end throwing careers if pushed through

And whatever the body part: chest pain or unusual breathlessness on exertion; a fever alongside the pain; unexplained weight loss; pain that is constant and unrelated to how you move; new numbness, weakness or loss of bladder or bowel control; or one calf that is swollen, warm and painful. Any of those, stop and get assessed.

How it usually goes

Caught early, growth plate irritation settles with rest over several weeks to a few months and the young athlete returns fully. Ignored, it can progress to separation of the growth plate or damage to the ligament, which can end a season or require surgery. The whole condition is largely preventable through volume management, which makes counting throws the most valuable intervention available to any coach or parent.

Prevalence basis: Youth sports medicine surveillance

Others the same routine covers

These share the Rotation Sports (Golf, Racquet & Throwing) routine, so the work is the same. If one of them also sounds like you, that is a reason to expect more from it, not less.

This is general information, not a diagnosis, and it cannot examine you. If it matches you, use it to ask better questions of a clinician rather than to replace one.