Elbow Pain While Pitching

If you are a pitcher, you should be very wary of the rampant number of elbow injuries going through MLB.

Just look at a small sample of the injury report from 2016

The term “Tommy John Surgery” is recognizable even to Pony Leaguers.

In this article, I will go through the possible elbow injuries a baseball player could encounter in their career. I will provide information about what they are, what causes them and what it takes to rehab them if you’re injured.

• Ulnar Collateral Ligament Injury
• Little Leaguer’s Elbow
• Medial Epicondylitis (Flexor Tendonitis)
• Fractures (various types)
• Lateral Epicondylitis (Extensor Tendonitis or Tennis Elbow)

Elbow Pain Pitchers


• Pain on the inside of the elbow?
• Sensation of looseness?
• Funny bone pain?
• Increased with throwing?

The ulnar collateral ligament (UCL) is the medial stabilizer of the elbow.

Besides rotator cuff tears, UCL tears are one of the more probable injuries for an overhead athlete.

Let’s go over everything you need to know about an UCL injury.

What is an Ulnar Collateral Ligament Injury?

The ulnar collateral ligament (UCL) is a complex of ligaments on the inner portion of the elbow.

It attaches the humerus (arm) to the ulna (forearm). It is also known as the “medial collateral ligament of the elbow.”

What causes an Ulnar Collateral Ligament Injury?

Repeated stress to the ligament can create damage and laxity.

Pitchers and other throwing athletes are at high risk because the inner elbow can be subjected to a ton of stress before ball release.

An UCL injury can happen with a series of tiny tears or one large one.

UCL Rehab

In general, shoulder and elbow injuries with pitching is strongly correlated to poor pitching mechanics. ULC tears are no different.

Studies have shown the UCL can only physically tolerate a small fraction of the force it is subjected to during a pitch if working alone.

With proper throwing mechanics, there are two factors that spare the UCL from repeated damage.

#1 The head of the radius assists the UCL absorb the force

#2 The spiraling affect of the arm decreases the pure valgus force the UCL would be getting due to poor mechanics

UCL Injury

How can you rehab an Ulnar Collateral Ligament Injury?

When truly torn, an ulnar collateral ligament injury is in need of surgery if you intend on pitching ever again.

Beware, however, as minor tears of the ligament can present in imaging, yet are not the pain generator. The flexor tendon group is very close in location and can be your issue.

Post operative and pre operative rehab should almost be the same.

We typically like to stabilize the joint via the structures crossing it.

Muscle, tendons, and ligaments are all game.

We also need to train the joint to tolerate the acceleration and deceleration forces it will be subjected to in pitching.

Ulnar Collateral Ligament Throwing

There are four phases of rehab: (Wilk 2004)

• Phase I—immediate motion phase
• Phase II—intermediate phase
• Phase III—advanced strengthening phase
• Phase IV—return-to-activity phase

Return to play is governed by a few mandatory criteria:

• Full elbow range of motion
• No pain or tenderness
• Passing clinical testing
• Passing isokinetic testing

Although I am citing the guidelines of the post op standard of care, the non-op rehab almost parallels it.

I have an Online Course coming soon if it is not already available. Keep checking back. I want to make it easy on you.

There was a great progression of rehab we based our rehab protocol on. You can find it HERE.

What kinds of treatments can be done for an Ulnar Collateral Ligament Injury?

Reduction of pain is important. These treatments can greatly assist you in reduction of pain.
• Active Release Technique
• Deep tissue massage
• Tool assisted tissue work
• Acupuncture
• Prolotherapy
• Chiropractic adjustments or mobilizations
• PRICE therapy




Most Cases


We Only Use High Reward/Low Risk Treatments



Even Though our Costa Mesa Chiropractor are Not A "Real Doctor" 🙂


No Bone Cracking Required To Feel Good


Dr. Gonzales & Costantino Only Uses Current Evidence-Informed Methods






• Pain on the inner elbow?
• Pitch count high over the last month?
• Still growing taller?

Little Leaguer’s Elbow is not a well-known injury to most coaches and parents, but it desperately needs to be.

Young pitchers should not have pain. There is no reason for it, so if they do, you need to assume it is Little Leaguer’s Elbow until proven otherwise.

Read on and we will tell you everything you need to better identify it in your kid.

What is Little Leaguer’s Elbow?

Little Leaguer’s Elbow is a growth plate injury.

What is a growth plate?

It is a softer section of bone that allows you to grow. For this reason, Little Leaguer’s Elbow is an injury you only get when you are still growing.

There are different severities of growth plate injuries. Rehab centers around the severity.

What causes Little Leaguer’s Elbow?

The cocking and acceleration phase of the windup expose the elbow to repeated strain, which can result in fragmentation of the growth plate.

The humerus is an attachment point for muscles of the forearm and wrist, which can also pull on the growth plate creating separation.

How can you rehab Little Leaguer’s Elbow?

Rehab depends on the extent of the injury.

If there has not been an avulsion (pulling of the bone off from tendon contraction), then we can rehab in a similar fashion as a non-op UCL injury.

Rehab centers around a few goals:
• Reducing pain
• Increasing strength
• Graduated return to throwing

The safest type of strength training is isometrics, so we start there.

Here is an example of the isometric series of exercise we use for elbow flexion.

When can you lift heavy again?

The lower body is fair game, but the elbow will have to wait around three months.

When can you throw again?

When pain decreases and testing is negative. Retesting is the key.

What if there is an avulsion fracture? You could be immobilized for a period of time, so you’d better go see a doc to have your elbow evaluated.

What kinds of treatments can be done for Little Leaguer’s Elbow?

Decreasing pain associated with Little Leaguer’s Elbow is extremely important, but we need to remember if there was an avulsion fracture, a decrease in pain is not an indication that you are ready to throw again.

The following therapies are great at controlling pain.
• Active Release Technique
• Deep tissue massage
• Tool assisted tissue work
• Acupuncture
• Prolotherapy
• Chiropractic adjustments or mobilizations
• PRICE therapy


• Pain on the inner elbow?
• Pitch count high over the last month?
• Hurt to grip objects?

Flexor Tendonitis is one of those conditions every pitcher with elbow pain thinks they have.


I have no idea. Probably for the same reason runners all seem to think they have IT Band Syndrome if they have lateral knee pain.

Flexor Tendonitis is very treatable.

Let me show you the proper tools, and it can be improved over a week… not to say it is fixed forever though.

What is Flexor Tendonitis?

Flexor Tendonitis happens when some of the muscles and tendons in this complex of tendons become torn.

Yes, a tear sounds like a serious thing, but these are micro-tears from overuse or abnormal demand.

What muscle/tendon?

The two most common ones are the pronator teres or the flexor carpi radialis.

What causes Flexor Tendonitis?

Just as in shoulder injuries with throwers, elbow conditions are mainly a result of throwing mechanics.

Sure, you could have hurt it doing something else, but more times than not, we should be looking at what affects throwing mechanics.

Was the culprit an issue that was taught?

Is the lower half of the body strong and powerful enough to supply velocity?

Flexor Tendonitis is like any other tendon injury… it was forced to do too much and became damaged in the process.

How can you rehab Flexor Tendonitis?

If we are sure there is no other injury, such as a fracture or UCL injury, then we can focus on decreasing pain as the primary treatment goal.

Tendon injuries also need to be loaded.

Load is safest via a non-movement contraction (isometric contraction) and when you’re ready for it, we would move you to shortening and lengthening contractions as well.

Here is a video of an exercise we use to load the pronator tendon in the beginning stage.

What kinds of treatments can be done for Flexor Tendonitis?

• Active Release Technique
• Deep tissue massage
• Tool assisted tissue work
• Acupuncture
• Prolotherapy
• Chiropractic adjustments or mobilizations
• PRICE therapy


I won’t spend a lot of time talking about these since a fracture is a fracture in my book. They need to be managed by an orthopedic doctor.

I have heard many athletes say they are going to deal with it on their own.

“Why would I go? He is just going to tell me to stop playing and cast it.”

Well… ya!

And we have to figure out WHY it fractured.

Is there a tumor? Who knows? Go have it checked out please.


• Pain on the outer elbow?
• Worse with gripping or lifting?
• Painful to sleep on?

These are all signs of “Tennis Elbow.”

Don’t play tennis? It does not discriminate. It is actually pretty common as a weight room injury if you are dominating pulling motions or Olympic lifting.

It is hard to treat if it becomes severe, so let’s deal with it now. You don’t have to play with it.

Read the article below, and I will explain everything you need to know about Lateral Epicondylitis as a baseball player.

Tennis Elbow Pitchers

What is Lateral Epicondylitis?

Lateral Epicondylitis is a tendon injury. The lateral epicondyle is the attachment point for the extensors of the wrist and the “-itis” part of the name means inflammation.

Is the tendon truly inflamed? And the suffix “-itis” is still up for debate, since the “-itis” means a fresh injury, so technically, if this is older than six months or it is your second time through the same injury, then we need to call it Lateral Epicondylosis… meaning chronic.

The term we are starting to go with now is Lateral Epicondalgia… meaning pain.

What causes Lateral Epicondylitis?

Just like a tendon injury on the inner part of the elbow, the tendon is being subjected to micro-tears.

The micro-tears cause pain over time and also make the tendon less able to stretch. The tendon is a very exciting part of the musculoskeletal system.

It is very dynamic, but just like a Ferrari, it is easily damaged.

How can you rehab Lateral Epicondylitis?

Tennis Elbow can be rehabbed with a few goals in mind.

• Pain reduction
• Strategic loading of the tendon/muscles
• Finding the offending activity

Reducing pain can occur with a variety of treatments. I have supplied a list in the next section but here is a stretch we like to use:

Wrist Extensor Stretch:

Loading of the muscles comes with isometric contractions.

What are isometrics? A contraction of a muscle without allowing the joint to move.

After we have gone through a short duration of isometrics, in a few weeks we start to add other types of contractions, and then increase the weight and speed.

Lastly, we NEED to know what was going on to create this in the first place.

Are you a student that had to type a 20-page essay that week?

Did you decide to do 50 pull-ups and a high rep deadlifting session in the same day?

There are many options, but we have to decrease gripping activity for sure.

This is individualized.

What kinds of treatments can be done for Lateral Epicondylitis?

• Active Release Technique
• Deep tissue massage
• Tool assisted tissue work
• Acupuncture
• Prolotherapy
• Chiropractic adjustments or mobilizations
• PRICE therapy