Valgus extension overload (VEO)
Valgus extension overload (VEO) can cause pain at the back and inside of the elbow, particularly during throwing or overhead sports. Over time, it can make it increasingly difficult to train, compete or even carry out everyday activities comfortably.
What is valgus extension overload (VEO)?
Valgus extension overload (VEO), sometimes called pitcher's elbow, is an overuse injury caused by repeated throwing or overhead movements that place excessive stress on the elbow joint. Over time, this repeated strain can damage the cartilage at the back of the elbow, particularly around the tip of the elbow bone (the olecranon). It may also irritate the surrounding soft tissues and lead to the formation of small bony growths, known as bone spurs (osteophytes), which can further limit movement and cause pain. VEO most commonly affects athletes involved in sports such as baseball, cricket, javelin, tennis and handball, but it can develop in anyone who regularly performs repetitive overhead activities. Because valgus extension overload is often linked with injuries to the ulnar collateral ligament (UCL), it's important to have persistent elbow pain assessed by a specialist so that any associated problems can be identified and treated appropriately.
What are the symptoms?
Symptoms usually develop gradually and may include:
- Pain at the back or inside of the elbow, particularly when straightening the arm
- Pain during or after throwing or overhead activities
- Swelling around the elbow
- Reduced range of movement
- A catching, locking or clicking sensation in the joint
- Tenderness around the back of the elbow
- Bony lumps caused by bone spurs (osteophytes)
How is it diagnosed?
Your consultant will begin by talking with you about your symptoms, sporting activities and how your elbow is affecting your performance and daily life. They'll then examine your elbow, checking its movement, stability and any areas of tenderness.
To confirm the diagnosis and rule out other causes of elbow pain, we may recommend:
- A detailed medical history
- Physical examination
- Assessment of elbow movement, stability and throwing-related symptoms
- X-rays to identify bone spurs or changes within the joint
- MRI or CT scans where further assessment of the cartilage, ligaments or surrounding structures is needed
How is it treated?
Treatment depends on the severity of your symptoms, how the condition is affecting your elbow and your personal goals.
Your consultant will explain your options clearly and recommend the approach that's most appropriate for you.
Treatment may include:
- Temporarily reducing or modifying activities that aggravate your symptoms
- Anti-inflammatory medication if appropriate
- Physiotherapy to improve strength, flexibility and elbow function
- Assessment and correction of throwing technique where appropriate
- A gradual return-to-sport programme
- Surgery if symptoms continue despite non-surgical treatment or if there is significant joint damage or elbow instability
Treatment routes for VEO
Most people with valgus extension overload improve without surgery.
Treatment usually involves reducing repetitive stress on the elbow while improving strength, flexibility and throwing mechanics through a personalised rehabilitation programme. Your physiotherapist will also help you address any movement patterns that may be placing excessive strain on the joint, helping you return to activity with greater confidence.
Recovery goals after VEO
Recovery initially focuses on:
Reducing pain and inflammation Protecting the elbow while symptoms settle Beginning gentle movement when appropriate Preventing stiffness
As rehabilitation progresses, recovery aims to:
Restore elbow movement Improve strength and stability Optimise throwing mechanics where appropriate Return to normal daily activities
The final stage of rehabilitation focuses on:
Building strength and endurance for sport Improving control and coordination Returning safely to throwing and overhead activities where appropriate Reducing the risk of further injury
Working with elbow professionals and teams
Our elbow specialists support professional athletes, sports teams, active individuals and people whose work places high demands on their elbows. Working closely with radiologists, physiotherapists and the wider multidisciplinary team, they provide coordinated care from diagnosis through to rehabilitation, helping each person return safely to sport, work or everyday activities.
The same specialist expertise and collaborative approach are available to every patient, whatever your activity level or recovery goals.
Our Experts - Leaders in Elbow treatment
How to pay
We offer flexible options depending on how you choose to access care at Fortius. Whichever option you choose, we’ll help make the process clear and straightforward from the start.
Private medical insurance
If your care is covered by private medical insurance, we’ll usually invoice your insurer directly. Please check your policy in advance and request an authorisation code if your insurer requires one. You’ll be responsible for paying any policy excess or costs that aren’t covered by your insurance.
Paying for yourself
You don’t need private medical insurance to access care at Fortius. If you’re paying for your own treatment, our team will explain the costs clearly and provide a personalised quote before you decide whether to go ahead.
VEO FAQs
Valgus extension overload is usually caused by repeated throwing or overhead movements that place excessive stress on the elbow. It is most common in sports such as baseball, cricket, javelin and tennis, where the elbow is repeatedly forced into extension under load.
Yes. Most people improve with non-surgical treatment, including physiotherapy, activity modification and improving throwing technique. Surgery is usually only considered if symptoms continue despite appropriate rehabilitation or if there is significant joint damage or instability.
No, but the two conditions are closely linked. Valgus extension overload affects the back of the elbow joint, while a UCL injury involves one of the main stabilising ligaments on the inside of the elbow. Some people have both conditions, so a specialist assessment is important.
Recovery varies depending on the severity of the condition and whether surgery is needed. Many people improve over several weeks to a few months with physiotherapy, while recovery after surgery typically takes longer and includes a structured rehabilitation programme.
Most people are able to return to sport once pain has settled, strength has been restored and elbow function has improved. Your rehabilitation programme will include a gradual return to throwing or overhead activity to help reduce the risk of further injury.
Find a clinic near you
Fortius Clinic City
Our City Clinic is conveniently located between Bank and Monument stations, within the historic and financial heart of London. At our modern, two-floor facility we have nine consulting rooms, spacious waiting areas, well equipped treatment rooms and an imaging centre.
Explore our City Clinic with our virtual tour.
If you are travelling by Tube, our closest underground stations are Bank and Monument, exit 6 for King William Street.
Should you be travelling by car, the closest parking is a three minute drive away at NCP Car Park London Vintry Thames Exchange. If you are attending clinic on a weekday, please be aware that we are based in the congestion charge zone.
- 75 King William StreetEC4N 7BE
- 0203 195 2442
- Monday to Friday from 8.00am to 8.00pm.
- Snow Injuries Clinic
- Tendon
- Sports & Exercise Medicine
- Ultrasound
- X-Ray
- Physician services
- Rheumatology
- MRI Scan
Fortius Clinic Marylebone
Our Marylebone Clinic is conveniently located in the historic area between Baker Street and Marylebone High Street, just off Manchester Square, home to the iconic Wallace Collection. We have seven consulting rooms, private waiting areas on each floor, well equipped treatment rooms and diagnostic imaging.
- 17 Fitzhardinge StreetW1U 2EU
- 020 3195 2442
- MRI Scan
- Ultrasound
- X-Ray
- Physician services
- Rheumatology
Fortius Clinic Marylebone Wing
Our 79,000 sq ft, seven-story, private hospital on Wigmore Street has 39 en-suite inpatient rooms, consultation and treatment rooms, and a physiotherapy suite.
The hospital has a high-spec imaging suite fully equipped with an MRI, CT scanner and X-ray machine. There are three state-of-the-art operating theatres, two anaesthetic rooms and a recovery bay.
Fortius Clinic London has two Mako robots for hip and knee joint replacements.
- 66 Wigmore StreetW1U 2SB
- +442031952442
- Open 24 hours
- Sports & Exercise Medicine
- Snow Injuries Clinic
- Tendon
- Ultrasound
- X-Ray
- Physician services
- Rheumatology
- CT guided injection
- MRI Scan
- CT Scan
Fortius Clinic Wimbledon
Our Wimbledon clinic houses a state-of-the-art imaging centre with a 3T MRI and X-ray scanners, Ultrasound, seven consulting rooms, two spacious waiting areas and well equipped treatment rooms all located on one level, ensuring easy accessibility for all patients.
Our partnership with Spire St Anthony’s Hospital allows us to provide orthopaedic surgery closer to our clinic. We treat a full range of conditions and perform joint replacement surgery using the latest Mako robotic assisted technology.
Take a tour of our clinic virtually through Google 360 views here.
We are open Monday to Friday from 8.00am to 8.00pm, and Saturday mornings from 8.30am to 12.30pm.
If you are travelling by Tube, our closest underground station is Wimbledon (District Line), which also has rail and tramlink services from central London and beyond.
There is no parking available at the clinic, but we have a number of parking facilities all within a 10-12 minute walk of the clinic: Centre Court Car Park, Broadway Car Park, and Hartfield Road Car Park. Please note that all of these facilities are paid car parks.
The building at 22 Worple Road has steps leading up to the front entrance. If you require assistance please inform us before your arrival by calling ahead on 020 3195 2442
- 22 Worple RoadSW19 4DD
- 0203 195 2442
- Snow Injuries Clinic
- Ultrasound
- X-Ray
- MRI Scan
1 of 4