Note: This is the second of a two-part series on youth pitchers injury. The first post discusses a recent study that links youth shoulder and elbow injuries to throwing more than 100 pitches per year. This post offers suggestions for parents and coaches to keep young pitchers healthy and on the field.

Pitchers injury tip #1: Limit young pitchers to less than 100 innings a year.

A recent study by Glenn S. Fleisig, PhD et al. published in the February 2011 issue of The American Journal of Sports Medicine followed 481 pitchers aged 9-14 over a 10-year period. The authors found that pitchers who throw over 100 innings per year are 3.5 times more likely to undergo shoulder or elbow surgery or retire due to a throwing injury. (See Part 1 of this series for more about the risks of pitching too many innings.)

Pitchers injury tip #2: Do not allow young kids to throw breaking pitches until the appropriate age.

While there is a lot of conflicting evidence about the effects of off-speed pitches such as the slider and curveball, it is probably safer to limit these pitches to athletes above a certain age. USA Baseball has a list of the appropriate ages at which kids should learn certain pitches. The rule of thumb is that a young pitcher should not throw curveballs until he is old enough to shave. The fear is that these off-speed pitches put a tremendous amount of stress on the shoulder and elbow of kids who are not finished growing, so their bones cannot withstand the stresses over long periods of time. Like I said, there has been a lot of debate about these risks, but I think it is safer to avoid them in young kids.

Pitchers injury tip #3: Take three months off from baseball each year.

I think that the transition to year-round baseball has certainly played a role in the increased incidence of shoulder and elbow injuries in young pitchers. Instead of playing different sports in different seasons, now kids can play for different baseball teams throughout the year, year after year. This concentration on one sport leads to continued stress on growing shoulders and elbows with no rest. They should take three consecutive months off each year. They can play other sports, but I would encourage them to play sports that don’t stress the shoulder and elbow, such as soccer or other non-throwing sports.

Pitchers injury tip #4: Avoid “showcase” events.

Showcases, where coaches, scouts, and other talent evaluators attend, have become popular in recent years. They attract the top baseball players, especially pitchers. Unfortunately, with a strong desire to impress these coaches and scouts who are unfamiliar with their skills, the pitchers often throw too hard. These events often occur on weekends when the kids have been playing all week, so the kids have often had little rest. It seems likely that injuries would be more likely to occur at these events.

Pitchers injury tip #5: Do not pitch through shoulder or elbow pain.

If a child is complaining of pain in his shoulder or elbow, he should be encouraged to stop throwing and to take a few days off to rest. Often kids are reluctant to mention that they hurt, so parents and coaches need to monitor these kids closely and look for signs of subtle injuries. If the pain does not seem to be improving with several days of rest or worsens with a return to throwing, kids and their parents should seek evaluation with an orthopaedic surgeon who treats youth pitching injuries.

Pitchers injury tip #6: Focus on proper mechanics.

Rather than focusing on throwing multiple pitches, especially off-speed pitches, at a young age, kids, parents, and coaches should focus on learning the proper mechanics of the fastball and changeup only. Kids can become very successful pitchers by learning proper technique and learning to locate the pitches alone. In time, as they progress through high school and college baseball, they can add in curveballs, breaking balls, and sliders.

Pitchers injury tip #7: Make baseball fun again.

One of the problems in all sports, not just baseball, is the increased emphasis on winning. All youth sports, including youth baseball, need to focus on having fun. Parents and coaches need to be emphasizing the rules of the game and learning proper techniques and mechanics of skills such as batting and pitching. There shouldn’t be too much pressure from parents for kids to play for multiple teams or play year round out of fear that their child will fall behind. If he enjoys baseball, he can dedicate himself solely to that sport as he gets older. He will also be less likely to drop out due to fatigue, burnout, or injury by varying the sports early on, taking the appropriate amount of rest each year, and ultimately choosing the sport that he loves.