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From out of the park and into the hospital? If you have a child in Little League this year, this is a trip you might be worried about making.

You're not alone. Every spring, more than 2.9 million children participate in Little League baseball and softball (source: Little League Online). The Sports Medicine Institute for Young Athletes at New York's Hospital for Special Surgery sees many injured young ball players every baseball season and emphasizes that child athletes must be treated differently than their adult counterparts.

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"The conditioning and training of young athletes is
not the same as that for adult athletes," according to Jordan Metzl, M.D., medical director of the Sports Medicine Institute for Young Athletes. "Winning isn't everything when it comes to kids. Therefore, parents must involve themselves in the health and safety of their children on the playing fields. They must aggressively protect their children from overuse injuries and physical damage that can result in lifelong disabilities," said Dr. Metzl, who is the author of "The Young Athlete: A Sports Doctor's Complete Guide for Parents" (Little Brown, 2002).

The Little League organization has placed an emphasis on improving safety on its fields — including adding fence tops that protect players from exposed wire; ball returns that keep out-of-play balls off the field until players are ready to use them; and overhead screens to protect spectators. Yet more than 5,500 injuries still occur annually (source: Little League Online).

The Hospital for Special Surgery offers the following tips for parents and coaches to prevent injuries this baseball season:

Training and conditioning guidelines

• Good health and a well-balanced diet are essential.
• Age-appropriate training and recovery time are necessary. "A good rule of thumb to remember is to ensure that your young athlete's OVERALL training increases by no more than 10 percent per week in amount and frequency," Dr. Metzl notes.
• A daily regimen of warm-up and stretching exercises will decrease muscle tendon imbalances, increase range of motion, promote circulation and improve performance.
• Lifting should not begin earlier than age ten. However, there appears to be no increase in musculoskeletal risk if the young athlete is:
  • Mature enough to accept instruction.
  • Training in a controlled, supervised setting.
  • Using proper form and equipment, i.e., performing full range-of-motion exercises.
  • Properly spotted.
  • Not competing with other lifters.

Pitching do's and don'ts

"Parents and coaches should pay special attention to the pitching prowess of adolescents," said Dr. Metzl. "Professional pitchers who most likely enjoy long and successful careers are those who did not overwork their arms while they were still maturing." Therefore, parents and coaches should remember to:

• Limit the amount of throwing that a child does at the start of the season.
• Build up arm strength and endurance gradually.
• Emphasize trunk strengthening as the support of the kinetic chain.
• Don't graduate a child from throwing to pitching until the child is between ages 8–10.
• Encourage a child to throw more overhead pitches.
• Pitchers under age 13-14 should focus on fastballs and changeups.
• A child should throw NO curve balls until age 13-14 at the earliest. Safe mechanics are difficult to master before this age.
• Limit the number of pitches that a child throws per week. Little League guidelines call for pitching for no more than six innings per week. General guidelines dictate that prepubescent and early adolescent pitchers should not throw more than 80 to 100 pitches per week. As the pitcher matures and builds up strength and endurance, the number of pitches thrown can gradually increase.
• Adolescents should not throw competitively between games they pitch.

Early warning signs and symptoms of injury

Since young ball players are very enthusiastic about playing the game, they do not often report problems with their elbows or shoulders. Therefore, to help improve the chances of early diagnosis and treatment, parents and coaches must pay attention to these early warning signs of impending injuries:

• Arm fatigue
• Arm soreness that persists for more than a day
• Shoulder or elbow stiffness and soreness with trouble "getting loose"
• Impaired throwing mechanics and/or poor batting performance

Sports facilities and equipment safety guidelines

• Athletes should have access to and use the protective gear recommended or required for their sport during both practices and games. Examples of common preventive equipment are mouth guards, helmets, shin guards and eye shields.
• Equipment should fit properly.
• Equipment should be in good working order and appropriate for the size of the athletes.
• Playing surfaces need to be in good condition.
• Breakaway bases minimize lower and upper extremity injuries.
• An automated external defibrillator (AED) machine should be at all practices and games. Although the law requires schools to have AEDs at all games, it is loosely applied since schools often have only one machine because of the high cost.

"Parents and coaches must remember that most super-athletes are not born that way," Dr. Metzl added. "Their talents and aptitudes are developed properly over time.” So be sure you cover all the bases and keep your child safe, on the field and off.

For more information, visit the Little League Online.

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