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Elbow pain is the number one reason throwing athletes miss games, skip practices, or even retire from their sport entirely. Whether you’re a parent watching your Little Leaguer wince after every pitch, or a young athlete dealing with nagging discomfort that just won’t go away, understanding pitcher’s elbow is essential for protecting your athletic future.

If you’re a younger player experiencing elbow pain, it’s typically coming from one of three different areas: the outside of the elbow (lateral elbow), the back of the elbow where bones rub against each other and create friction, or the inside of the elbow, which could signal a muscle strain or damage to the ulnar collateral ligament.These three pain sources actually all stem from the same underlying issue, the force on your elbow is greater than your body can currently tolerate.

Where you feel the pain tells us how serious the problem has become and how urgently you need to address it. When caught early, most elbow issues in throwing athletes are completely manageable.

In this guide, we’ll break down everything you need to know about pitcher’s elbow, from identifying which type of pain you’re experiencing to understanding why it happened in the first place and, most importantly, what you can do to fix it and prevent it from ever coming back.

The Three Types of Pitcher’s Elbow Pain

Understanding where your elbow hurts is critical because the location of your pain tells us not just what’s damaged, but how far the problem has progressed. Let’s break down each type so you know exactly what you’re dealing with.

Inside (Medial) Elbow Pain: The First Warning Sign

Pain on the inside of your elbow is typically where problems begin. This discomfort usually indicates either a muscle strain or damage to the ulnar collateral ligament (UCL)—the ligament that baseball fans know gets reconstructed in “Tommy John surgery.” When you feel pain here, your body is sending you an early warning signal. The forces from throwing are starting to exceed what these tissues can handle, but if you address it now, you have the best chance of a full recovery without long-term consequences.

Back (Posterior) Elbow Pain: The Middle Stage

If pain develops in the back of your elbow, you’re dealing with a problem that exists between the bones. During the throwing motion, bony prominences in the back of the elbow rub against each other, causing friction and irritation. This type of pain indicates that stress has already been building in your elbow for some time. The issue is progressing, and your body is running out of ways to compensate for the excessive forces being placed on the joint.

Outside (Lateral) Elbow Pain: The Worst-Case Scenario

If you have pain on the outside of your elbow, you’re in the most serious situation. Pain on the lateral side means you’ve already had stress on the inside of the elbow, you’ve run through problems with the bony prominences in the back, and now you’re actually compressing bones on the outside. This compression wears down the cartilage and we don’t have a good way to fix worn cartilage. If this damage continues long enough with a high level of pain, it can become unrepairable. This is not something the elbow can fully recover from.

That’s why early identification is so important. Pain usually starts on the inside and progressively moves toward the outside. If you try to throw through the pain, it will almost certainly get worse, eventually reaching that outside position where you’re facing a situation that could end your throwing career.

Understanding the Pain Progression

The pattern of pitcher’s elbow pain follows a predictable progression that every throwing athlete should understand. Recognizing where you are in this progression can make the difference between a quick recovery and permanent damage.

Pain typically begins on the inside of the elbow. This is your body’s first distress signal, telling you that the forces from throwing are starting to exceed what your tissues can tolerate. At this stage, intervention is most effective, and full recovery is very achievable.

If you ignore these early warning signs and continue throwing, the problem migrates. The stress moves to the back of the elbow, where bones begin rubbing against each other with increased friction. You’re now in the middle stage of the progression, and your body is running out of compensation strategies.

Continue pushing through, and the pain eventually reaches the outside of your elbow. This is the endpoint you want to avoid at all costs. By the time pain appears on the lateral side, you’ve already caused damage to multiple areas of your elbow, and you’re now wearing down cartilage that cannot be effectively repaired.

Here’s the critical takeaway, at every stage of this progression, the underlying issue remains the same. The force on your elbow is greater than your body can currently handle. The longer you wait to address it, the more structures get damaged and the harder it becomes to fix. If you’re experiencing any elbow pain while throwing, don’t try to be tough and throw through it. Get attention early and address the problem before it progresses to something irreparable.

Risk Factors: Why Young Pitchers Are Vulnerable

If you’re between 12 and 14 years old and experiencing elbow pain, you’re not alone, this age group faces the highest risk for pitcher’s elbow. Understanding why can help you protect yourself during this critical period of development.

The Growth Spurt Problem

At the end of the day, young athletes in this age range simply aren’t strong enough yet. As you’re growing, getting bigger and longer, your ligaments and other tissues struggle to keep pace with the size of your body. Longer limbs create more leverage and more force. You’re getting stronger overall, which means you’re throwing the ball harder with more velocity. This increase in velocity places greater stress on the structures in your elbow. If those structures aren’t robust enough to tolerate the increased demands, pain develops.

Your body is essentially outgrowing its own ability to handle the forces you’re generating. The tissue strength hasn’t caught up to your new dimensions, and that gap creates vulnerability.

Mechanical Issues

The second major risk factor is throwing mechanics. If the mechanics you’re using aren’t good or aren’t ideal for your specific body type, you’re going to see more force placed on the elbow because of these faulty mechanics. Your body will compensate in ways that overload the joint.

That being said, here’s something important to understand: mechanics can be amazing and very close to perfect, and even if that’s the case, you can still develop problems. Why? Because of the growth spurt and growth cycle that Little League players go through. Perfect mechanics don’t make you immune to the challenges of rapid growth.

Why It’s Never the Elbow’s Fault

If there’s one key takeaway message from this entire guide, it’s this. If your elbow is hurting, it’s never the elbow’s fault. Let that sink in for a moment, because understanding this concept changes everything about how you approach treatment and prevention.

Your elbow is simply the place where pain shows up because something else in your body isn’t doing its job properly. So what are the real culprits?

Shoulder Strength and Mobility Deficiencies

You always want to be aware that if your elbow is hurting, it’s because you don’t have enough shoulder strength or you don’t have enough shoulder range of motion. Your shoulder is supposed to generate and control most of the force in your throwing motion. When it can’t, your elbow gets stuck handling loads it was never designed to manage. 

Mechanical Breakdowns

Another common trigger is improper throwing mechanics. Even small flaws in your kinetic chain force your elbow to compensate, placing excessive stress on structures that become overloaded with each throw.

Rapid Growth Without Adaptation

Finally, there’s the growth factor. You grew fast and your body is not ready or used to the load being placed on it. Your frame changed, but your strength, tissue robustness, and motor patterns didn’t have time to catch up.

These are the most common triggers of why your elbow is hurting in the first place. Address these root causes, and the elbow pain resolves. Ignore them and only treat the elbow, and the problem will keep coming back.

Treatment and Prevention Strategies 

Now that you understand what’s causing your elbow pain, let’s talk about solutions. The good news is that most cases of pitcher’s elbow are preventable and treatable when you address the root causes rather than just chasing the symptoms.

Strength Training: The Number One Solution

The solution for all of this is 1000% getting stronger. Developing a comprehensive strength training program for your whole body is non-negotiable if you want to throw pain-free and stay healthy long-term. While whole-body strength matters, a program specifically focused on the shoulder and elbow needs to be a priority.

Remember, your elbow pain exists because the forces placed on it exceed what your body can currently tolerate. To fix it you need to increase your body’s capacity to handle those forces. Strength training builds the muscular support, tissue resilience, and joint stability necessary to absorb and control the stresses of throwing. This isn’t just about preventing future problems, it’s about healing current issues and making sure they never happen again.

Professional Assessment and Guidance

As a physical therapist, we can provide very skilled assessment to determine exactly which factors are contributing to your elbow pain. Is it a shoulder strength deficit? Limited range of motion? Mechanical flaws? Growth-related issues? Or a combination of several factors?

This professional evaluation is crucial because it guides you through the process of healing with a targeted approach rather than guessing at solutions. A PT can create a customized treatment plan that addresses your specific limitations and ensures that the issue is resolved completely, not just temporarily masked.

Taking Action: What You Need to Do Now

If you’re currently experiencing elbow pain, the worst thing you can do is ignore it and hope it goes away. Early intervention is everything. The sooner you identify the problem and address the underlying causes, the better your outcome will be.

Start with a proper assessment from a qualified physical therapist who understands throwing athletes. Begin a structured strength program that emphasizes shoulder and full-body development. If you’re in that 12-14 age range experiencing rapid growth, be especially vigilant about monitoring your symptoms and adjusting your training load accordingly.

Don’t wait until the pain moves from the inside to the outside of your elbow. Act now, get stronger, and protect your ability to play the sport you love.