Now That I'm Playing Travel Baseball, Why Does My Elbow Hurt When Pitching?

First, there is a lot of evidence showing that pain on the inside of the elbow is only becoming more common in baseball players, particularly pitchers. So, you’re not alone here. The elbow has several structures that become irritated with overhead throwing:  the wrist flexor tendons, the ulnar collateral ligament (UCL), and the ulnar nerve. The set of symptoms you have will vary depending on which of these structure is irritated, but all will create pain on the inside of the elbow that gets worse with throwing.

We never want to see a trend of increasing injury rates, so let’s unpack what might be going on here. There are a few main reasons why you are experiencing elbow pain...

1. Poor mechanics

Despite your best efforts to follow your pitching coach’s instruction, we can all develop bad habits. When we’re trying to throw strikes, trying to throw hard, or just competing to win, our bodies will do anything to accomplish these goals. Although we would like the hours of practice and bullpens honing our mechanics to come through in these moments, we may fall back on dysfunctional habits our bodies know and love. Your elbow may drop, your stride may stretch too long, your hips don’t open up enough, your snap and follow through get a little off. All of these things begin to change the forces going through your body and may put extra strain on your elbow.

2. Other parts of your body aren't doing enough

Oftentimes when we experience pain in a part of our body, it is telling us that our balance of mobility and stability is off. Some parts of the body have become too flexible, while others have become too weak or uncoordinated, which places different structures at risk of injury. In an overhead pitch, the force distribution begins with your feet and their connection to the ground and continues all the way through to your fingertips as you snap the ball on your release. It all starts with the push off of your back leg, the rotation through your pelvis and upper back, the stability of your shoulder blade on your rib cage, the positioning of the torso and shoulder girdle to find the right slot for the arm, the flexibility of the glenohumeral joint into external rotation, the acceleration of the arm forward and the control of the arm in follow-through. You can imagine that all of these pieces have to work together in order to keep the body injury-free.  If any piece of this chain isn’t doing its job, often our shoulder and elbow fall victim to this imbalance.

3. Too much, too fast

Sometimes we simply try to throw too much, too fast. Studies have shown we shouldn’t increase our workload by more than 10% per week if we want to avoid injury. This means we shouldn’t increase our intensity, frequency or duration of an activity more than 10% in any given week. For runners, this would mean not increasing their pace, frequency of running days, or distance too quickly. For a pitcher, this means not increasing your velocity, number of pitching days per week, or number of pitches per day faster than your body can keep up with. If you join a new team, have a new coach, or are in a transition point of the season, these numbers may become more difficult to keep track of.  It is important to remember that you are your own advocate! Others may help monitor these numbers, but you are the only one who knows what’s going on in your body.

In all 3 of these scenarios, you can benefit from seeing a qualified physical therapist who works specifically with overhead athletes. A trained professional can determine WHAT exactly is causing your pain, whether it is the ulnar collateral ligament, ulnar nerve, wrist flexor tendon insertion, or something else. More importantly, they can also determine WHY your elbow is hurting when pitching baseballs.

At Activcore, we take a total body approach to treating the overhead athlete. We look at each body segment and how it may be contributing to your symptoms. We apply this to a systematic process of looking at the body as a whole to find the primary source of any movement dysfunction, weakness and pain. After all, we move in patterns, not in individual segments. The whole is only as good as the sum of all its parts. In other words, even though the pain is coming from your elbow, the underlying source could actually be from your shoulder, pelvis, or opposite leg.

After analyzing your movement to find the root cause, we can then develop a treatment plan tailored for your individual needs, lifestyle and goals. We will educate you about your condition and apply the latest evidence-based techniques to get you back on the mound pain-free, and to prevent re-injury for the long term.

You can learn more about this topic by visiting our Overhead Athlete page.

Disclaimer:  The views expressed in this article are based on the opinion of the author, unless otherwise noted, and should not be taken as personal medical advice. The information provided is intended to help readers make their own informed health and wellness decisions.

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Dr. Elizabeth Dalrymple

Lead Physical Therapist | Doctor of Physical Therapy
Elizabeth Dalrymple is a Doctor of Physical Therapy (DPT) and board certified Orthopedic Clinical Specialist (OCS) who specializes in overhead and rotational sports like softball, baseball, golf, volleyball, swimming, tennis and gymnastics. She works both at Activcore in Atlanta, GA (near Emory University) and at Activcore in Cumming, GA (inside Studio Lotus Pilates). As a former varsity softball player and Ivy League Pitcher of the Year award winner at Cornell University, Elizabeth has a special interest in treating both overhead and rotational athletes.
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