Baseball season has arrived, and millions of adolescents will be taking part in America’s national’s pastime. Approximately 17.5 million athletes play baseball in the U.S., a majority competing at the high school and club level. As with many athletic endeavors, the enjoyment that derives from baseball participation is tempered with the associated risk of injury, especially for those on the pitcher’s mound.

High school baseball pitchers are known to be at risk for shoulder and elbow injuries and have become an amplified concern as they tend to occur more often — and are more severe — compared to those sustained by position players. It has been documented that of high school baseball injuries that resulted in surgery, 73 percent were by pitchers.

Dr. David Altchek, a renowned sports medicine surgeon at the Hospital for Special Surgery in New York and medical director of the New York Mets Baseball club, has decades of experience caring for pitchers at various levels of competition. Dr. Altchek expressed his concern to me like this: “Pitching places great levels of stress at the shoulder and elbow joints. These high stress levels applied to adolescents with open growth plates at the shoulder and elbow may negatively affect these areas, resulting in ligament and/or bony changes. Since tendonitis is not commonly observed in the adolescent competitor, when pain and discomfort arises in the shoulder and/or elbow, the athlete should be evaluated by a qualified sports medicine professional.”

Risk factors for the adolescent pitcher include, but are not limited to, the following:

— Overuse (pitching frequency and volume/pitch count)

— Fatigue

— Pitching mechanics

— Pitching with pain

— Physical conditioning

— Height and weight

[See: Exercising After You’ve Gone Under (the Knife, That Is).]

Overuse is the main contributing factor for shoulder and elbow pitching injuries. Injured pitchers usually demonstrate a significantly high volume of pitching — throwing more months during the year, games during the year, innings per game, pitches per game and overall pitches annually — which often results in excessive fatigue upon the body. Pitchers who continue to pitch, despite the presence of arm fatigue, have been found to be at 36 times increased risk of injury.

The high stresses applied to the shoulder and elbow joints are channeled via the power created by the lower extremities. As the pitching motion approaches, ball release joint distraction forces at the shoulder and elbow approach 1 to 1.5 times body mass. Less than optimal pitching mechanics may result in additional levels of joint stress resulting in increased risk of possible injury. It’s advised that proper pitching mechanics not only be emphasized, but initiated at an early age.

Physical conditioning also plays an important role in both performance and injury prevention. Physical conditioning includes the following benefits:

— The establishment of a pitcher’s work capacity.

— Enhancement of the strength levels of the lower extremities, core and upper extremities, including the scapular and rotator cuff musculature.

— Enhancement of the flexibility and necessary shoulder range of motion for optimal pitching mechanics.

— Enhancement of the proprioception and neuromuscular timing of the shoulder for optimal pitching mechanics to transpire.

Dr. Altchek also emphasizes that “the pitcher should maintain their physical conditioning; shoulder flexibility; scapular and rotator cuff strength throughout the baseball season, as well as ensure a full recovery after each pitching start throughout the competitive season.”

Taller and heavier players demonstrate the ability to pitch at higher velocities, thus resulting in a greater chance of stress and injury. Pitchers who demonstrate velocities of greater than 85 MPH have a 2.6 times increased risk of injury requiring surgery. This statistic likely relates to overuse, as pitchers who have the ability to throw at higher velocities are likely utilized more often in game competition.

[See: 10 Signs You Should Break Up With Your Gym.]

To enhance the baseball pitcher’s performance, as well as attempt to reduce the incidence of possible shoulder and elbow injury, the following recommendations should be observed:

— Limit the number of innings pitched (pitch count) during the game, week, month, season and year.

— Do not participate in more than one league per season.

— Limit baseball showcase participation.

— Ensure the pitcher is well recovered between starts.

— Don’t allow the athlete to play both pitcher and catcher.

— Maintain the pitcher’s physical conditioning, flexibility and strength levels.

— Do not allow the pitcher to compete with fatigue and/or pain, and upon the onset of pain, see a qualified medical professional.

— Initiate and maintain proper pitching mechanics.

— Pay special attention to taller and heavier pitchers throughout the season.

— Take three to four months off annually to participate in different athletic endeavors.

[See: 7 Reasons No One Likes You at the Gym.]

Baseball is a game where the athlete participates for enjoyment. If the athlete is injured, there is little enjoyment watching his or her peers play while sitting on the bench.

Robert Panariello is founding partner and Chief Clinical Officer at Professional Physical Therapy.

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Pitcher’s Arm Plague: Staying on the Mound and Off the Bench originally appeared on usnews.com