Like a typical grandparent, George Gusman watched with joy as 12-year-old Dominic played baseball last week in a tournament.

As an experienced high school coach, he also took interest in the way the youth team coach moved the players around the field.

"They get these guys to play multiple positions," Gusman said. "He’s played second base, then outfield and third base. Tomorrow he’s going to pitch."

Gusman made the observation with admiration for the coach. He knows that a diverse experience on the baseball diamond is good for youngsters still learning the game, and there is plenty of time later to hone in on one position, or even one sport.

"At Saint Louis we encourage our young guys to play multiple sports," said Gusman, who guided the Crusaders baseball team to a state championship in the spring. "We just think it’s healthier."

Gusman is among a growing number of coaches and medical professionals concerned about the effects of youth sports specialization and how year-round participation in one sport, especially for pre-teens, can lead to overuse injuries.

This can be a problem in many sports, but baseball pitchers are especially vulnerable because of repetitive stresses put on developing arms.

It’s an issue at every level, including the professional ranks with a recent increase in ulnar collateral ligament (elbow) injuries, leading to Tommy John surgery. A growing number of younger pitchers have been incurring the same injury, as well as shoulder problems.

FOR YOUTH PLAYERS, pitching usage standards vary widely for different ages. For example, junior Pono Anderson pitched in three games in four days at the state high school tournament. Gusman and his staff closely monitored their pitcher, and Anderson was well within the Hawaii High School Athletic Association rules for usage and rest in the tournament.

Anderson’s effectiveness (no runs allowed in 11 innings) meant fewer pitches, less fatigue and less chance of injury.

"We count the pitches," Gusman said. "We also take into account the time he sits on the bench before he goes back out to pitch. If he throws 20 pitches and if the other team’s pitcher throws 10 and he’s right back out there, that’s a (warning) flag."

A steady diet of stretching exercises and proper offseason rest are other components of keeping pitchers healthy, Gusman said.

Most top-level Hawaii high school players play American Legion baseball in the summer and some in the fall.

"In the fall, it’s a max two innings pitched," Gusman said. "The frontline guys, we shut them down in the fall."

AFTER EIGHT YEARS without a surgery, University of Hawaii baseball suffered a rash of serious injuries to top pitchers last year, the effects of which continued to 2014. But coach Mike Trapasso hopes the success enjoyed by senior Matt Cooper is indicative of what skipping summer league ball provides.

"It was a great result, but the sample size is just one," Trapasso said. "We shut him down for the summer (of 2013). We put him on a long-toss program late in July, early August, and he added the cut slider in the fall. He had a great year. It was good enough that we think we’ll do it more."

If only it were that simple for everyone. While it is obvious children need to build their arms gradually with plenty of rest, debate continues at the higher levels about the merits of more work vs. less for adult pitchers — and that can warp expectations and perceptions for youth baseball.

"There’s pitch-count limits and number of rest days, but those are always debatable. Some are proponents of throwing more and it works for some. The thing that makes it difficult is it’s athlete-to-athlete. Some have rubber arms, some don’t," physical therapist Franz Yuen said. "The important thing, especially with kids, is to err on the side of caution."

Young pitchers also risk injury by throwing breaking pitches when they are too young. Medical professionals and most coaches generally agree that throwing curveballs before puberty is not a good idea for long-term health of a pitcher. Trapasso recommends pitchers don’t try to throw sliders "before they start shaving."

Trapasso said it is important to do everything possible to protect even college-age arms, and he has set protocols to that ideal. But sometimes fate trumps all.

"We have four things we think about," he said. "One, mechanics. Two, conditioning. Three, don’t overuse. And, four, you can be spot on with the first three and pitchers still get hurt."

For the younger athletes, Dr. Rachel Coel has specific guidelines to prevent overuse injuries and burnout in baseball and other sports.

"Overuse injuries are preventable (in children)," said Coel, who is medical director and staff physician at Queen’s Center for Sports Medicine, pediatrics. "Would you rather change your practice routine or get a stress fracture in your upper arm and be out three to six months? If you look at overuse, it’s been around forever but not at this epidemic level we’re seeing now. When 50 percent of the youth sports injuries are related to improper training, that is an epidemic."

Youth baseball coach Aron Hiramoto stresses communication from parents to ensure proper rest. "If your kid plays on another team, tell the coach, ‘Hey, my kid just pitched however many innings in the other league, don’t pitch him, even if he says he can.’ "

Acclaimed sports orthopedic surgeon James Andrews has started a national campaign to raise awareness, "STOP Sports Injuries" (www.theandrewsinstitute.com/InjuryPrevention/).

Advice there includes: "If the athlete complains of elbow or shoulder pain the day after throwing, or movement of the joint is painful or restricted compared to the opposite side, see a physician familiar with youth sports injuries immediately."

Everyone would much rather see young athletes on the playing field and not at the doctor’s office … and especially not in the operating room.

Reach Dave Reardon at dreardon@staradvertiser.com or 529-4783. More information: stopsportsinjuries.org.