Elbow pain in 10 yo RH pitcher

My 10-yo son is experiencing pain in his elbow after pitching 30-35 pitches in game situations - to the point where he has to stop throwing. He does not feel any pain or even discomfort when long tossing (2-3 x week), warming up or in longer practice bullpen sessions. He gets plenty of rest between pitching outings. He throws significantly harder (>60 mph) in games than in his typical warmup or practice. He has a long stride (51-52"; he is 5’1" tall) and what looks to be a good follow through (reaches out and pronates with a good torso bend). Generally, his mechanics look OK to me, both live and on slow-mo video, but I may not be looking for the right things. The pain is centered deep in his elbow just above the joint, under the midline of his arm with his palm facing up. Based on what I’m reading (here and elsewhere), could taking his arm beyond the home-2nd plane be stressing the brachialis muscle? Would this type of overreaching be consistent with this type of elbow pain and when it occurs?
Worried Dad

This is a pretty low number, which suggests some sort of mechanical problem.

This is a problem. He has to throw at the same speed in both warm-ups and games so that his muscles are fully developed. It sounds like his body has not been conditioned to handle the load that he puts on it during a game.

Can you post a video of him throwing?

Have you taken your son to a doctor? If not, you should. At a minimum they will be able to give you a better sense of the exact location of the problem.

When you say “above,” do you mean above toward the hand or above toward the shoulder?

Excessive reverse-rotation could cause problems by increasing the load on the elbow. So could a couple of other things.

Does your son break his hands with his thumb down and his fingers on top of the ball? Does he show the ball to Center Field? If so, then that could also be related to the problem.

Finally, where do you live? How many months of the year does your son play baseball?


I’m aware that he should be using the same effort warming up and in the game, but he gets his competitive juices going and cranks it up a notch when in the game - will try to get more consistent. In addition to long toss, he does light weight work (2-3 lbs) and uses Alan Jaeger’s J-bands (but not as regular as he should) for conditioning.

I could probably figure out how to post a video if there is a post with instructions. Is there an explanation of how to post and a size limit?

No doctor yet, but we’re thinking about an MRI if after a weeks rest the pain recurs. By above the elbow I mean proximal, or closer to the shoulder.

Pretty sure he breaks with thumbs down and I’ll look at video tonight to see if he shows the ball to CF or SS. What is preferred, not necessarily traditionally, but in light of best current understanding?

We are in Colorado, so he starts pitching indoors in Dec/Jan and finishes by early July - he also catches, so there is an additional workload element in season, but I keep it monitored (and he never has pain throwing to 2nd). Lots of football throwing from August through Oct, but never any pain.

Thank you for your time!

Remind him that Sandy Koufax had to take it down a notch before he was successful.

You could just e-mail it to me.

(but of course you should talk to an M.D about this, but what you are describing does sounds like the Brachialis. Given the location, that would put the problem more in the middle of the muscle rather than the end, which suggests a tear of the muscle (rather than a tendon problem).

As you know, the role of the Brachialis is to resist the rapid extension of the elbow (what Dr. Mike Marshall calls Pitching Forearm Flyout). It sounds like your son may have a particularly bad case of Pitching Forearm Flyout.

One way to prevent this is to not reverse-rotate the shoulders (at least not so much). Instead, break the hands in line with a line running from Home Plate to 2B.

Pitching Forearm Flyout can also be exacerbated by taking the ball close to the ear (e.g. elbow bent 135 degrees) rather than having the elbow bent 90 degrees (e.g. forearm vertical) at the traditional high cocked position. This sounds plausible given that you said that your son also catches.

I am of the opinion that…

  1. Breaking the hands with the thumbs down.
  2. Keeping the fingers on top of the ball.
  3. Showing the ball to CF (or 2B).

…all increase the likelihood that a player will experience elbow problems.

I prefer that my guys show the ball to SS (or better yet 3B) when they are passing through the high cocked position.


You might want to consider have him doing some dry throwing (e.g. without a ball) at slow speed with light wrist weights (e.g. 1-2 lbs). This could help to build up the muscles in his arm.