FIRST OF TWO PARTS

Sometimes blessings bring problems. And so it is with pitchers and arm injuries. Hawaii’s weather allows for baseball year-round, which sounds like a great thing. And it often is, unless you throw too many innings without enough down time, especially at a young age.

Also, a couple of high-profile triumphs that brought plenty of sports pride to our state — the Little League World Series championships of 2005 (Ewa Beach) and 2008 (Waipio) — amped up an already competitive youth baseball culture. That could also be putting young players at risk.

Baseball arm injuries are nothing new in Hawaii, or anywhere the game is played. But serious ailments, many times with surgery as the prescribed treatment, have increased at all levels.

There are many factors, many of them inexact and unmeasurable. But experts have lately begun pointing to overuse issues, sometimes going back to when kids aren’t even double-digits in age.

"About 48 to 52 percent of youth sports-related injuries coming into clinics, even in the emergency department, are due to overuse as opposed to acute, such as a sprained ankle or getting hit by the ball," said Dr. Rachel Coel, medical director and staff physician at Queen’s Center for Sports Medicine, specializing in pediatrics.

Overuse is often the result of young athletes specializing in one sport, playing it year-round at an early age, medical professionals and coaches say. Baseball pitchers are especially vulnerable.

"Back in the old days you played different sports during different seasons," said Curt Watanabe, a longtime sports physical therapist and the owner of Star Physical Therapy in Pearl City. "You worked different parts of your body and rested others. Now we’re seeing a lot more 8-, 9-, 10-year-olds with elbow and shoulder problems. It’s not only muscles and ligaments. It’s bones and growth plates."

Watanabe played various sports before narrowing it down to baseball at Waipahu High School and went on to star as a third baseman on some of the University of Hawaii’s best teams in the late 1970s.

Another owner of a physical therapy company who happened to play baseball at UH, Franz Yuen, said he is also seeing younger patients with serious arm ailments.

"It’s definitely an epidemic," Yuen said, also citing early specialization as a culprit. "It’s hard enough to play (the same sport) year-round when you’re in college. When you’re 10, it’s ridiculous."

It’s especially alarming that more younger players are requiring surgeries to repair elbows and shoulders. Dr. Elizabeth Ignacio of IMUA Orthopedics, Sports & Health, also described the increase as "epidemic."

"Without question," Ignacio said. "It’s true at the highest level of the sport but just as concerning is the need for surgeries at younger and younger ages. It’s a travesty.

"A decade ago you only heard talk of ligament damage at the professional and college levels. Now you’re seeing that in prepuberty adolescents. That’s ridiculous."

Ignacio and another surgeon, Jay Marumoto of Orthopedic Associates, said that even pitchers who use proper technique and mechanics are vulnerable — and in some cases, more so.

"One misconception is that if you have good throwing form you won’t get hurt," Marumoto said. "That’s not true. It’s overuse. Kids with better form, better mechanics, they pitch more and they get injured."

Youth leagues have rules regarding the number of innings pitchers can throw in a certain time period. But those rules are easily skirted when youngsters play in multiple leagues and coaches don’t know — or don’t want to know — how much pitching they do on their other teams and when.

"They play on two or three different teams at the same time," Watanabe said. "If a kid is the ace pitcher for one team he is for the other, too."

Current UH pitcher Jarrett Arakawa has even noticed a different environment from when he was a youth player just a few years ago.

"A lot of kids are overdoing it because it’s so competitive," Arakawa said. "You see kids pitching on back-to-back days."

Arakawa, who will be a fifth-year senior for the Rainbow Warriors next season, avoided arm trouble up until college.

"I think I had pretty good coaches growing up — even in travel ball I never felt like I was overworked," the former ‘Iolani three-sport star said. "I pretty much grew up playing everything. My parents didn’t push me to specialize. Baseball was my first love, and when I was about 12 or 13 I had my eyes set that way. But I did take a lot of breaks from pitching."

Arakawa is proof, however, that serious arm injuries can arise without overuse as a contributing factor. He suffered a torn labrum that required surgery and forced him to miss the entire 2013 season. He was also shut down midway through the 2014 season.

Arakawa and UH coach Mike Trapasso both said they’re not sure what caused the injury that the pitcher suffered in the 2012 Cape Cod Summer League.

He was coming off a regular season in which he’d pitched 97 innings — by no means an outrageous amount for a healthy college pitcher over the course of a four-month season.

"My arm felt good. I had just come off the season, but I don’t think I was overworked," Arakawa said. "I can’t lie, I guess I wanted to light up the gun. But it felt good up until the time I hurt it."

By "the gun," Arakawa means the radar guns that measure the velocity of pitches. A high number on the gun can lead to a scholarship or a big pro contract. And throwing for the gun can cause injuries, especially for youngsters.

Arakawa is a savvy, mature-minded pitcher, so it says something that even he could be seduced by the gun.

"The big thing now is they’re throwing for the gun, not to learn how to pitch. That’s the mentality now," Yuen said. " ‘Oh, the showcase is coming up, I gotta hit 90 (mph), I gotta touch 85. But it won’t matter if you get hurt."

Trapasso now has pitchers who have thrown 60 or more innings in the regular season take a break in the summer. He said he’s following the lead of a friend, Fresno State coach Mike Batesole, but there was no tipping point.

"It’s been a gradual thing. More a situation where I want to work with the guys (in the fall). We have to remember we’re often sending them to coaches we don’t know," Trapasso said. "It’s not an indictment of summer baseball. But some (coaches) are focused on winning and summer baseball is not about winning, it’s about development."

The same can be said about youth baseball, where there is often psychological pressure to go with the physical.

"A father told me, ‘My son is not putting in the time. He doesn’t have the fire.’ How old was he? Seven," Watanabe said. "Some of the kids can handle playing all year round. But that’s a few.

"It’s not only muscles and ligaments," Watanabe continued. "A certain part of the bone is soft and not calcified yet and when you put stress and torque on it, it inflames and leads to pain."

Physical pain that kids sometimes try to hide from their parents and coaches. Sometimes it’s emotional pain that can lead to them never wanting to play the game again.

"It’s a delicate balance. It’s not the fault of parents, not the fault of coaches," Ignacio said. "But I have some kids come in and sometimes physically we can’t pinpoint the problem. Sometimes we have to excuse the parent and ask the kids, ‘Johnny, what’s really going on here? Do you really like this sport? Do you like playing?’ It’s not a small thing. They feel pressure."

Arm overuse and sport specialization at too young an age can turn something that is supposed to be fun into misery for young athletes.

"The worst-case scenario is it becomes not a baseball problem but a lifetime problem," Watanabe said.

Monday: Prevention and treatment

Reach Dave Reardon at dreadon@staradvertiser.com or 529-4783. Read his blog at staradvertiser.com/quickreads.