Pitching a baseball is a subtle, complex skill that requires a great deal of discipline and preparation. Unfortunately, few pitchers — and even fewer young pitchers — learn this until after they have suffered a serious injury, often to the rotator cuff.

"Most high school athletes go from football to basketball and then start throwing a baseball at full speed," said Dr. David Lintner, an orthopedic surgeon with The Methodist Center for Sports Medicine in Houston and team doctor for the major league Houston Astros. "The problem is that their arms are not in baseball shape, and they open themselves up to serious rotator cuff problems."

"Pitchers should play catch, not pitch off the mound, for a few minutes every day beginning in December, and gradually increase throwing as it gets closer to the start of spring training,"...

The rotator cuff is a group of muscles and tendons that connect the shoulder blade to the upper arm. Signs that the rotator cuff may be torn include pain and weakness in the shoulder and difficulty raising the arm over the head. Rotator cuff injury can lead to damage to the rest of the shoulder as well as elbow and other arm injury. While it is most common among baseball pitchers, any athletes who make repetitive throwing motions, including football quarterbacks, swimmers, and tennis players (the serve is physiologically similar to throwing), are vulnerable to rotator cuff injuries.

Studies have shown that overwork — especially throwing too many curve balls — are two of the biggest causes of shoulder pain in young pitchers. Besides limiting pitching workloads, the best way to avoid these problems is proper pre−season preparation.

"Pitchers should play catch, not pitch off the mound, for a few minutes every day beginning in December, and gradually increase throwing as it gets closer to the start of spring training," said Lintner.

Young pitchers should also do a low−weight, high−rep weight training program for a few minutes every day.

"Pitchers need strong, but flexible arms, so they shouldn't use any more than three to five pounds to do these exercises," Lintner said. "Exercises like bench or military press or curls create bulk, which might look impressive, but is really counterproductive for young throwers."

Pitchers should also work on consistent mechanics and on strengthening their core area, i.e., the upper thighs, abdomen, buttocks, hips and lower chest. The core area is the part of the body that generates pitching power. Keeping the core strong reduces wear and tear on the arm and shoulder.

"We are seeing more and more high school pitchers with rotator cuff problems," Lintner said. "Taking the time before the season to train properly will go a long way towards success in the coming year and prolonging the career of a young thrower."

If you are the parent of a young pitcher, do not wait for an injury to have your child evaluated and put on a proper strengthening program. And do not necessarily rely on your team's coach. Youth league and high school coaches ruin countless young arms each year; most baseball professionals will not let them anywhere near their own children. The best answer is to find a coach, trainer or physical therapist with a track record of working with pitchers at a professional or high amateur level, and have your child evaluated and taught proper pitching mechanics and training techniques.

And most important: speak up if you have concerns about how much your child is being asked to pitch; amateur coaches focus on winning, not necessarily on the long−term health of their young pitchers.