HOUSTON – According to medical and pitching experts, two different arm injuries on the rise in teenagers and young athletes in the Houston area. These injuries are ulnar collateral ligament (UCL) tears—which require “Tommy John” surgery—and “Little League Elbow.”
Houston’s Little League baseball and “travel ball” culture is among the strongest in the country. There are more kids committing significant time to playing competitive baseball at an early age, and as a result, there has been a noticeable uptick in severe injuries caused by pitching.
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“I think [Tommy John and Little League Elbow] kind of increase it concurrently with each other,” Corbin Hedt, a physical therapist with Houston Methodist who specializes in throwing injuries, told KPRC 2. “The more kids that you have playing, more kids that you’re playing year-round, you’re going to see the Little League Elbow.”
Over the years, these significant arm injuries—and the surgeries that treat them—have become increasingly more mainstream across all levels of baseball.
Earlier this year, Cristian Javier and Jose Urquidy, two prominent starting pitchers for the Houston Astros were ruled out for the remainder of the 2024 season, because they each needed Tommy John surgery.
At the adolescent level, the trend also has grown.
KPRC 2 spoke with Will Young, an 18-year-old pitcher from the Houston area who is on the road to recovery. When he sat down with KPRC 2′s Mario Diaz, Young was able to count 23 pitchers who he knew personally who had suffered a significant arm injury.
Both UCL tears and Little League Elbow involve the pitcher’s throwing elbow. However, they are caused by different circumstances and treated differently.
Tommy John (UCL tears)
“Tommy John” is the informal name for the surgery performed to repair a torn UCL. The surgery requires the damaged UCL to be replaced by a healthy tendon from somewhere else on the body.
The surgery can require anywhere from 12 to 18 months to recover from, and it requires a strict regimen to ensure the highest likelihood of a successful rehabilitation. Due to advancements in the surgery and its rehabilitation over the last 50 years, the odds of a full, or nearly full, recovery are higher than ever before.
This said, experts say more surgeries are being conducted at all levels of the game.
Young had Tommy John surgery in July of 2022. In his procedure, a tendon from his left wrist was used to replace the damaged UCL, which is a standard tendon used in the procedure.
“[Needing this surgery] messes with your head,” Young said. “In a weird way, when I heard that I needed an operation, that was really good news to me, because operation in me meant that there was going to be a fix, and it was going to make my arm feel better. Before that surgery, for the eight months prior to that, it hurt really bad.”
Little League Elbow
“Little League Elbow”—another informal term—is used to describe a medical condition called medial epicondyle apophysitis, or inflammation of the growth plate on the inner elbow.
Like Tommy John, this injury comes from overworking a throwing arm during repeated intense motions, such as pitching. A Tommy John injury can happen to any pitcher, but Little League Elbow—as the name might imply—is typically only seen in children and teens.
The injury is unique to young athletes, because the growth plate in a still-developing arm is more exposed to potential damage than the arm of a fully-grown player.
“If you’re throwing harder than your body is ready for more frequently than your body is ready for, if you’re done growing, your ligament will fail,” explained Dr. David Lintner, a Houston-based orthopedic surgeon said. “If you’re still growing, probably your growth plate will start to fail, maybe even fracture.”
All of this is the result of parents and coaches pushing kids to extreme levels.
How you can prevent these injuries
As mentioned previously, the root cause of these elbow injuries is overuse of the arm through strenuous pitching motions. Although there are arm exercises and routines that can substantially limit the amount of strain on the elbow, the most vital practice to prevent major arm injuries is to control and monitor how many pitches young athletes are throwing.
Little League Baseball has official guidelines that protect young pitchers from being overworked.
Pitches per day by age
- Children ages 6-8: 50 pitches per day
- Children ages 9-10: 75 pitches per day
- Children ages 11-12: 85 pitches per day
- Children ages 13-16: 95 pitches per day
Thresholds of rest after pitching for ages 14 and under
- 1-20 pitches: 0 days rest
- 21-35 pitches: 1 day rest
- 36-50 pitches: 2 days rest
- 51-65 pitches: 3 days rest
- 66+ pitches: 4 days rest
Thresholds of rest after pitching for ages 14 and older
- 1-30 pitches: 0 days rest
- 31-45 pitches: 1 day rest
- 46-60 pitches: 2 days rest
- 61-75 pitches: 3 days rest
- 76+ pitches: 4 days rest
These guidelines were provided by the official Little League, inc. website. More information can be found here.