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Baseball Elbow Pain: Explore The Best Treatments

Athlete /

Ulnar Collateral Ligament (UCL) injuries commonly cause elbow pain for athletes who participate in overhead-throwing sports like baseball. These injuries can range from mild inflammation to complete tears, resulting in UCL reconstruction surgery (more commonly known as Tommy John).

Ulnar collateral ligament (UCL) injuries are rising at an alarming rate, especially in 15- to 19-year-olds. 57% of UCL Reconstructions are in pitchers between 15-19 years old1! Unfortunately, this number is still growing at a 9.8% rate each year. 

This blog post explores the available treatment options for UCL injuries, with a focus on non-surgical approaches offered by Sports Physical Therapy professionals.

Understanding the Anatomy of Baseball Elbow Pain: What is a UCL Tear?

The Ulnar Collateral Ligament crosses at the elbow joint and connects the humerus (upper arm) to the ulna (forearm). This ligament provides stability to the elbow joint, especially at 30 to 120 degrees of elbow flexion.

Injuries to the UCL are usually due to chronic overuse and repetition. The repetitive nature of a throwing motion and the chronic load of a baseball season (and beyond) put baseball pitchers at a high risk of injury.  Working through small micro tears over time results in a complete rupture of the ligament. 

Although it seems like “everyone” has had Tommy John surgery, this is a surgery you want to avoid if possible. 75% of high school-aged athletes will return to sport, however, that recovery time is about 12 months2. Missing a whole year of your sport (at your position) is difficult physically and mentally.

The Best Way to Treat Elbow Pain is to PREVENT it From Happening

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Risk Factors and Causes of Baseball Elbow Pain

Risk Factors

Since UCL tears are due to overuse many factors contribute to the injury itself. The good news is that there is A LOT you can do as an athlete to decrease your risk of injuring your elbow. 

  1. Overuse and Fatigue

The baseball season has slowly turned into a year-long sport for young players. What used to be a spring/summer season has become showcases in the Fall and intense winter training to prepare for the spring season. 

World-renowned experts like Dr. James Andrews recommend at least 3-4 months off per year when athletes are not playing an overhead sport3.

Adhering to a proper pitch count based on age is also important. You can check out the PitchSmart guidelines by following the link here. 

  1. High Velocity Throwing

It makes sense that Pitchers who throw the ball faster are going to have more stress placed through their joints during the movement4. 

The growing use of radar guns to measure throwing speed may emphasize the wrong goals with young pitchers. It is important to build a good foundation of throwing mechanics before worrying about increasing velocity. 

Increased stress in the elbow joint, combined with poor mechanics and overuse is a recipe to end up on the operating table before the season ends. 

  1. Early throwing of breaking pitches and curveballs

Good coaching and proper mechanics are vital before throwing more skill-based pitches such as breaking balls and curveballs. It is recommended that pitchers have a good grasp on their mechanics, as well as wait for their bones to mature to withstand the stress of these types of pitches. 

  1. Improper warm-ups

How many times have you walked out onto the baseball field and just started throwing the ball as your warm up? While this is a “warm up”, that is only 1 piece. 

The latest research has shown that a proper comprehensive arm care program can decrease injury risk by almost 50% and increase throwing velocity by 2MPH!5

Baseball Elbow Pain: Recognizing Symptoms

When addressed early on, elbow pain due to a micro tear of the UCL has a chance of conservative treatment (meaning: no surgery!)

Symptoms of UCL Elbow Pain are:

  • Medial Elbow Pain (the inside part of your elbow)
  • Swelling in the elbow
  • Tenderness to the touch at the inside part of the elbow
  • Decreased accuracy and velocity when throwing

When you are experiencing elbow pain as a baseball player, it is important to stop throwing and seek out medical attention from a qualified healthcare professional. 

Navigating Treatment Options for Baseball Elbow Pain

Experiencing elbow pain as a baseball player (especially pitchers) can feel overwhelming. There are many options available for treating UCL tears, including surgical interventions like Tommy John surgery and non-surgical approaches such as rest, bracing, PRP injections, and physical therapy.

Non-Surgical Treatment for Baseball Elbow Pain

Conservative management is the preferred choice in partial-thickness UCL tears. There is an 85% chance of return-to-play (RTP) in pitching athletes with partial-thickness tears. 

Treatment Interventions Include:

  • Relative Rest and Activity Modification

Avoiding throwing movements is important during this healing time. 

Here at In Motion Physical Therapy, we always recommend our athletes continue to exercise in safe ways, so this does not mean complete rest. A knowledgeable strength coach or Physical Therapist will be able to modify your exercise program to avoid stress through your elbow while strengthening other areas of weakness. 

  • Bracing

These are not always recommended, but a brace can provide stabilization and support to the elbow joint. Minimizing movement in certain directions can help the ligament heal properly. 

  • PRP Injections

Platelet-Rich Plasma is a relatively new treatment intervention that uses stem cells and the bodys ability to heal itself to repair damage to the UCL. Portions of the ligament do not have a good blood supply, and this treatment can help promote healing to those areas. 

When appropriate, this can help athletes avoid surgery and return to sport faster. 

  • Physical Therapy

An essential treatment for baseball elbow pain is good physical therapy. Pillars of treatment include:

  1. A thorough evaluation to determine possible underlying causes of elbow pain For example: decreased shoulder, hip or upper back movement can put more stress through the elbow. 
  2. Pain Management: use of modalities such as electrical stimulation, ice and heat can be used as needed to decrease pain
  3. Range of Motion: restoring full mobility of the joints surrounding the injury
  4. Strengthening: A personalized exercise plan will be designed to help you strengthen the muscles that support the injured ligament. 
  5. Proprioception and Balance Training: You need to know where your arm and legs are to throw a baseball effectively. Injuries to ligaments create impairments to the signals sent to our brain about where our body is in space.

Surgical Treatment for Baseball Elbow Pain

Unfortunately, not every baseball player with elbow pain is a candidate for conservative treatment. The surgery for the UCL is commonly known as Tommy John surgery, named after Dr. Frank Jobe’s experimental surgery on baseball pitcher Tommy John in 1974. 

This surgery usually consists of harvesting a tendon from elsewhere in the body (usually the palmaris longus or hamstring), and then reconstructing the Ulnar Collateral Ligament using this tissue.

The patient is then usually braced at a 60-90 degree angle and sent off to being Physical Therapy!

General Return to Sport Time Line:

  • Full Range of Motion: 2-4 months
  • Strength Program (for surgical arm): 2-3 months 
  • Throwing Program: 5-9 Months
  • Full Return to Sport 9-12 Months

How to Treat Baseball Elbow Pain: What Should I Do?

There is no 1 size fits all approach to managing elbow pain in baseball players. Each athlete is going to have a different presentation and different goals that they are working towards. Here are some basic steps to take when you are considering the right treatment approach for you. 

The severity of the tear: After having MRI imaging done (usually with contrast) you will have an idea of the size of the tear. Keep in mind MRIs do not show EVERYTHING, the only way to truly know the extent of the tear is to perform surgery. As a rule of thumb, minor tears often respond well to non-surgical approaches.

Activity level and goals: Athletes aiming to return to competitive throwing likely need surgery, while recreational athletes may succeed with non-surgical options. If you are looking to play at the collegiate or professional level, the upside of fixing the issue and having surgery may outweigh the downside of missing 1 year of play. 

Mental Considerations: Some athletes feel more confident knowing that their elbow is intact when competing at the highest levels. 

Age and overall health: Younger, healthy individuals may be better candidates for surgery than older or individuals with other health conditions.

The Role of Sports Physical Therapy in Baseball Elbow Pain

Physical Therapy is a crucial element to treating elbow pain in baseball players, despite the treatment intervention. Sports Physical Therapists are knowledgable in the rehabilitation process from onset of injury to return to play. 

Phases of Treatment:

  1. Range of Motion

Ensuring the return of all movement is the priority of treatment. All joints surrounding the elbow joint must be considered. There is growing evidence that range of motion limitations in the shoulder, neck and upper back all contribute to elbow pain in baseball players. It is important to take this time to not only regain mobility in the elbow joint, but all of the joints required to effectively throw a baseball. 

BASEBALL MOBILITY ROUTINE

  1. Strength

After allowing the UCL to heal (surgically or not), regaining strength in the affected arm is the second focus of treatment. Exercises performed in Physical Therapy will be progressive in nature, adding resistance and repetitions as your body responds to the load appropriately. 

We always recommend continuing a general strengthening program with a strength coach in conjunction with Physical Therapy. A good strength coach will know how to modify your program to avoid stress on your injured arm while continuing to strengthen your legs, core and unaffected arm. 

3 KEY EXERCISES FOR BASEBALL ELBOW PAIN

  1. Return to Sport

After 4-5 months of rehabilitation after surgery, a return to sport plan can be initiated. There are a few ways to know if you are ready to initiate a return to throwing program:

  1. Range of Motion: Full Range of Motion 
  2. Strength: At least 90% of uninjured side (measured by handheld dynamometer, tindeq or isokinetic testing)
  3. Balance Testing: Upper and Lower Body balance (Y Balance) 
  4. Endurance: Plank Testing (60 seconds plank, 30 seconds side plank)

These testing measures are not perfect, but they give insight to the challenge that the athlete is able to withstand. If there is no pain or discomfort during these tests, it is up to the discretion of the PT, Doctor and Athlete to determine the best way to progress to return to sport safely. This process requires a lot of nuance and is very much patient specific. Do not get discouraged if your return to sport is not a straight line.

Next Steps for Baseball Players with Elbow Pain

Experiencing elbow pain as a baseball player is a scary. It is overwhelming when your future all of sudden seems so unsure. 

Using information in this blog post, I hope that you have more confidence in your plan to treat your elbow pain. Whether you opt for non-surgical or surgical interventions, find a Physical Therapist that you trust. The rehabilitation process after an injury like this can be upwards of 1 year. It is important to have a realistic, step by step plan in place to achieve your goal of returning to the baseball field again.

If you are looking for specific advice and are located on Long Island, contact us today to set up an evaluation. Our expert Physical Therapists will work together with you, your doctor and sports coaches to determine the best course of treatment. 

References:

  1. Agresta CE, Krieg K, Freehill MT. Risk Factors for Baseball-Related Arm Injuries: A Systematic Review. Orthopaedic Journal of Sports Medicine. 2019;7(2). doi:10.1177/23259671198255
  2. Petty DH, Andrews JR, Fleisig GS, Cain EL. Ulnar collateral ligament reconstruction in high school baseball players: clinical results and injury risk factors. Am J Sports Med. 2004 Jul-Aug;32(5):1158-64. doi: 10.1177/0363546503262166. Epub 2004 May 18. PMID: 15262637.]
  3. https://www.littleleague.org/partnerships/pitch-smart/year-round-play/#:~:text=Risk%20%E2%80%93%20Year%2DRound%20Baseball%20and%20Softball&text=In%20the%20case%20of%20year,four%20months%20off%20each%20year.
  4. Hurd WJ, Jazayeri R, Mohr K, Limpisvasti O, Elattrache NS, Kaufman KR. Pitch velocity is a predictor of medial elbow distraction forces in the uninjured high school-aged baseball pitcher. Sports Health. 2012 Sep;4(5):415-8. doi: 10.1177/1941738112439695. PMID: 23016114; PMCID: PMC3435942. 
  5. Matsel KA, Butler RJ, Malone TR, Hoch MC, Westgate PM, Uhl TL. Current Concepts in Arm Care Exercise Programs and Injury Risk Reduction in Adolescent Baseball Players: A Clinical Review. Sports Health. 2021 May-Jun;13(3):245-250. doi: 10.1177/1941738120976384. Epub 2021 Jan 29. PMID: 33514287; PMCID: PMC8083153.