By Sapna Pathak
Staff Writer

Illustrated here is a case of medial epicondylitis with pain and inflammation located within the ligaments and tendons of the inner elbow. Abnormal stress is placed on the ligaments joining the medial epicondyle of the humerus and the radius of the lower arm. (Courtesy Graphic/fairview.org)

The science behind throwing curveballs is actually straightforward.

Orthopedic surgeons, physical therapists and athletic trainers are all too familiar with what is commonly known as Little League Elbow (LLE), or medial epicondylar apophysitis.

“It’s a very pervasive problem,” said Nick Vailas, CEO of Bedford Surgical Center and an exercise physiologist. “We’re trying to make Major Leaguers out of Little Leaguers, but the consequences are too high. Tommy John surgery is becoming all too common in younger arms.”

Vailas’ experience with arm injuries hits close to home; his son Jimmy, a gifted athlete, has been sidelined from sports thanks to “throwing too hard, too young.” He is scheduled for surgery later this year.

Caring for Jimmy Vailas will be his uncle, James, who trained in California learning such ground-breaking techniques as Tommy John surgery, a procedure named after the former Major League pitcher in which the ulnar collateral ligament is reconstructed using another ligament from the wrist or hamstrings.

Nick Vailas recalled his son throwing in Little League and in Bedford’s Babe Ruth league before joining with a specialized pitching coach. Vailas said the pitching coach emphasized “throwing junk (curveballs and sliders) over placement of the (fast)ball,” something Vailas said most coaches do.

Rebecca Underwood, a physical therapist at Salem Sports and Rehab, sees far too many young pitchers with arm problems.

Underwood said when young players come in complaining of medial, or inner, elbow pain, her first inclination is to ask them what kinds of pitches they throw. Underwood said the answer, more often than not, is curveballs.

Generally, damage is done to either the medial epicondylar apophysis or the inner growth plates within the bones of the upper and lower arms. An apophysis is any growth or protrusion from a bone, in this case located in the inner elbow.

Through a male athlete’s teenage years, growth plates are still active, causing bones to develop and grow. During the motion of throwing curveballs, abnormal tension is placed on the ligaments attaching these bones.

“The ends of long bones tend to be the weakest part of the bone,” said Dr. Paul Urbanek, Pediatric Orthopaedic Surgeon at Concord Hospital. “Because they’re the weakest link in the chain, they tend to be injured easier where the ligaments are. When these kids throw curveballs, there is so much stress