(Amy Joyce)

What happened this week in my clinic is not unlike most weeks: A young boy and his mother walked in because his elbow hurt after throwing a baseball. I had a strong feeling what was going on with this 9-year-old patient.

With baseball season in full blast across the country, with millions of players practicing and playing daily year-round in youth and travel leagues and the Little League World Series in high gear, it is important that parents and caregivers of our kids know simple ways to prevent overuse throwing injuries.

There has been a substantial amount of press and evidence based medicine published on overuse throwing injuries in the past few years. As a sports medicine physician, I unfortunately see plenty of throwing-arm injuries in our adolescent population, particularly at the start of the season (which seems to be year-round now). What’s unfortunate is that a typical story includes a young boy or girl continuing to throw in pain even though we know that the risk for developing a throwing injury has been shown to increase by 36 times in adolescent pitchers who continued throwing with a fatigued arm.

Because of an increased awareness of throwing injuries thanks to voluminous research in the past 20 years, the sports medicine community hopes there will be a slowdown in the number of preventable injuries. One help is the increased emphasis on pitch restrictions, particularly at the youth and high school levels. Originally, Little League Baseball, the USA Baseball Medical and Safety Advisory Committee and the American Sports Medicine Institute developed pitch count restriction recommendations based on age. More recently, Major League Baseball developed Pitch Smart, a website that provides information to players, coaches and parents to prevent overuse injuries in youth and adolescent pitchers. With all of this information, the sports medicine team is becoming more aware of ways to prevent overuse injury.

But how about parents?

While coaches may keep a close eye on the volume of pitches thrown, lots of children may throw during sports camps, play catch with their buddies or just throw against the wall. No one is counting those pitches. With that in mind, here are some easy suggestions for parents of children who love baseball but want to reduce the likelihood of an arm injury.

1. No competition in terms of hours greater than age per week. Your child should not be playing in competitive sports more hours per week than his or her age. As more kids play in organized sports for longer periods of time, injuries are increasing. This is particularly true if they specialize in one sport. Free play, physical education and generalized camps do not count toward these hours.

2. Follow the throwing recommendations from MLB’s Pitch Smart websiteThis is a great resource for parents to see what the recommendations are for pitching volume and days of rest if their child is at least 8 years old. Recommendations from Pitch Smart include:

  • “Watch for signs of fatigue during a game, during a season and the whole year. The American Sports Medicine Institute (ASMI) found that adolescent pitchers who undergo elbow or shoulder surgery are 36 times more likely to have routinely pitched with arm fatigue.”
  • Don’t let kids throw too many innings in one year. “ASMI found that players who pitched more than 100 innings in at least one year were 3.5 times more likely to be injured than those who did not exceed 100 innings pitched. Every inning — whether it be during a game or showcase event — should count toward that threshold.”
  • Take time off from baseball every year. “ASMI also found that pitchers who competed more than eight months per year were five times as likely to suffer an injury requiring surgery. Pitchers should refrain from throwing for at least 2-3 months per year and avoid competitive pitching for at least 4 months per year.”
  • Get enough rest. “Numerous studies have shown that pitchers who throw more pitches per game and those who do not adequately rest between appearances are at an elevated risk of injury. Pitch count programs reduce the risk of shoulder injury in Little League Baseball by as much as 50 percent. The most important thing is to set limits for a pitcher and stick with them throughout the season.”
  • Don’t pitch on consecutive days. “Pitchers should avoid pitching on consecutive days, irrespective of pitch count. Pitchers who pitched on consecutive days had more than 2.5 times greater risk of experiencing arm pain, compared with pitchers who did not pitch on consecutive days.”
  • Watch for excessive throwing elsewhere. “A pitcher should not also be a catcher for his team as it is the next most throwing-intensive position. ASMI found that amateurs who played catcher while not pitching were 2.7 times more likely to suffer a major arm injury.”
  • Beware of playing for multiple teams. “Players who participate on multiple teams at the same time are at an increased risk of injury as it makes it more difficult to monitor pitch limits and results in reduced rest.”
  • Watch for non-arm injuries. “Players should be cautious about returning to play after any injury. A sprained ankle or oblique strain can affect the player’s biomechanics, changing the way he throws and putting more stress on his arm.”
  • Follow proper strength training routines. “Any strength and conditioning program should include a shoulder and elbow component. Numerous studies have shown that deficits in upper extremity strength and mobility are strongly correlated to serious arm injuries.”
  • Throwing curveballs and sliders at a young age. “Amateur pitchers who threw curveballs were 1.6 times more likely to experience arm pain while youth pitchers who throw sliders are 86 percent more likely to experience elbow pain than those who do not.”

3. Encourage multi-sport participation/Discourage sports specialization. Specializing in one sport can lead to lack of overall skill development, lead to overuse injuries, and increase the likelihood of burnout. Encourage participation in various sports with different skill sets, such as alternating between a throwing sport and a non-throwing sport. Additionally, participation in the same sport should be less than 8 months per year.

4. The kinetic chain. The kinetic chain connects body segments and transfers energy from one body segment to the next during motion such as throwing. Deficits in the kinetic chain, otherwise known as weak links, such as in the core, spine, hip and shoulder range of motion, may lead to arm injury in throwers. It’s extremely important to train the entire body in the offseason while allowing the throwing arm to rest.

5. Throwing program. If you are going to run the Boston Marathon, would you start training a week before Patriot’s Day? Of course not. Then obviously, it’s not okay for your child to pick up a ball the day before a new season starts. Kids need to train their arm just like the big leaguers do, with a gradual return to throwing. A gradual progressive program for four to six weeks before the first week of practice is a good idea.

6. NEVER throw or pitch in pain. If your child’s arm hurts, never let them throw through the pain. This is also true for “dead-arm” or the feeling like their arm is fatigued. Pain is the body’s way of trying to tell you something is not right and that you should seek out a qualified medical professional.

Jason Zaremski is an assistant professor and Non-Operative Sports Medicine Physician and the Co-Medical Director of the University of Florida’s Adolescent and High School Sports Medicine Outreach Program in the UF Department of Orthopaedics and Rehabilitation. He is also an avid baseball fan and former collegiate baseball player. You can find him on Twitter at @DrzSportsDoc.

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