My son wants to play again in the summer Little League program. He was a pitcher last year and often complained of pain on the inside part of his throwing elbow. What can we do to avoid a recurrence of these problems?

Your son was probably suffering from a condition called ''Little League elbow.'' This is predominantly seen in the Little League pitcher and catcher positions. The condition is a result of high repetitive tension forces on the medial or inner side of the elbow during the acceleration phase of the throwing. These tension forces stress the growth plate of a player's developing elbow, if overuse is allowed to occur without guidance. Concern for protecting the Little League player against injury resulted in rules being adopted by the Little League Baseball Inc., limiting a player to pitching six innings per week. However, at that age, children often play sandlot baseball with friends on a daily basis. This can result in 100 throws per week, thus limiting the innings pitched competitively must be tempered with guiding the throwing during unsupervised free time. The development of an effective pitching style requires a balance between repetition and the risk of overuse syndrome, such as Little Leaguer's elbow. Signs to look for are persistent pain and swelling on the inside of the elbow. Often the player will report a popping sensation. Typically, the symptoms develop over a period a few weeks. Loss of full extension can occur as well. In most cases, a 36-week period of rest will end symptoms of full-blown Little League elbow.
Ice and aspirin are useful in controlling the initial symptoms. Before a player can return to competition, one should have a painless full
range of motion of the affected elbow. Above all, a return to throwing should be gradual. It would be advisable to initially limit the throwing activities by having a player play first base or designated hitter for a few weeks. If symptoms persist, an evaluation by a physician and X-rays should be obtained.