It's sign-up time for Little League again, and young players are gearing up for an exciting new season of baseball. If your child is among the players tapped as a pitcher for their team, be proud and beware.

Just like grownup players, Little Leaguers — especially pitchers — are at risk for injury, especially when pitching arms get fatigued and are not given time off to recuperate between games.

The American Sports Medicine Institute (ASMI) recently designed guidelines to reduce the most common arm injuries, but it’s hard to tell if they’re working, or if they’re even being followed.

So a new study set out to find out what kinds of injuries are being reported in Little League pitchers, and what kinds of risk factors may be at play.

The Kent State University researchers then examined the risk factors associated with the injuries the players experienced.

There are several recommendations included in the ASMI guidelines:

  • Children need to have a four-month break in competitive pitching each year.
  • Coaches and parents should carefully adhere to the guidelines for pitch counts and rest days (which vary by age of the player).
  • Pitchers should not pitch on more than one team at a time, and should not play as both pitcher and catcher.
  • Pitchers should avoid playing other sports besides baseball during the season, and if shoulder or elbow pain develops, they should stop pitching.

Researchers first studied whether these guidelines were being followed. They gave questionnaires to over 750 Little Leaguers, aged 9 to 18, in 28 states, asking them about their playing schedules, resting schedules, instances of pain or fatigue, and any shoulder and elbow injuries over the past year.

About 13% of the of the players responding had pitched in games more than eight months of the year, and almost half of this group pitched all year round. Almost half of the Little Leaguers pitched in leagues where pitches were not counted, and nearly as many were pitching on consecutive days.

About one in five kids had pitched in multiple games on the same day, and 30% pitched on more than one team, and about 10% of the pitchers also played as catchers, another position that requires intensive throwing and puts a huge strain on young arms. As you might notice, all of these trends go against the ASMI guidelines and raise the risk of injury to young arms.

Unsurprisingly, about one-third of the pitchers experienced pitching-related problems like elbow and shoulder injuries. Almost 70% reported that they’d experienced arm fatigue “sometimes” or “often,” and almost 40% said they’d experience pain while they were actually pitching.

A few of the players had already had surgery for arm injuries, and 10% of the players were in physical therapy and/or on medication for arm injuries.

The Kent State University researchers then examined the risk factors associated with the injuries the players experienced. In general, overuse — that is, going against the AMSI recommendations in any of the ways mentioned above — was the main culprit.

Players who played too many months of the year, played on multiple teams, pitched on consecutive days, or played more than one game per day were all at greater risk for arm problems.

Pitching with arm pain or arm tiredness was also linked to a much higher risk of arm injury; throwing curveballs was linked to a significantly greater risk of arm pain, but other types of throws were not.

The takeaway message from the study is that the ASMI guidelines should be taken seriously, and Little League coaches should be aware of the risk of not doing so. The number of pitches young players are pitching should be carefully tracked, as should the number of days and games each player plays.

Parents of pitchers should talk with their child’s coach about observing the recommendations, since ignoring them can lead to at minimum, fatigue and pain; and on the other end of the spectrum, to serious injury and surgery.

The study is published in the American Journal of Sports Medicine.