DEAR DR. DONOHUE: My 12-year-old son is something of a phenomenon when it comes to baseball, and he loves playing the game. I haven’t pushed him into it. He’s a particularly awesome pitcher, and his coaches are amazed at what he can do.

I practice with him every day. He now has a sore elbow in his pitching arm. I think it might be Little League elbow. My wife blames me, because, she says, I overwork him. I need some guidelines on how much throwing is too much. Thanks. — R.C.

ANSWER: The elbow is a site that’s a potential calamity for the immature skeleton. Children have vulnerable spots in their bones called growth plates. These bone parts haven’t yet become bone. They permit elongation of bones. One of those sites is the elbow.

To make sure we’re talking about the same thing, let the boy’s throwing arm hang down with his palm facing forward. Feel the area of the elbow next to the body. That’s where Little League elbow makes itself known.

It’s an overuse injury, meaning the boy is throwing too many pitches with too little rest. The incidence of elbow pain in young baseball players is quite high — 20 percent to 40 percent. It can be avoided with a sensible program that limits the number of throws per day.

First, your son should not throw until the pain leaves. Then he can resume throwing, but gradually do so. Eventually he can work up to the Little League’s standards for pitching for 12-year-olds. If a boy or girl of this age throws 66 pitches in one game, the child needs four days of rest — no throwing; if it’s 51 to 65 pitches, three days of rest are required; 30 to 50 pitches, two rest days; 21 to 35 pitches, one rest day. In practice, he should be limited to 20 pitches if he throws daily. It he throws more, he should follow the schedule for the number of pitches thrown in a game. If your boy’s pain lasts a week, have the family doctor examine him. If he really has Little League elbow, healing can take six to 12 weeks.

DEAR DR. DONOHUE: I am a 58-year-old man and have been running for 48 years, about 20 miles a week. I estimate my health as excellent. My resting heart rate is in the range of 50 beats per minute. I still run four times a week. My heart rate averages 150 during slow runs and 160 during tempo runs. For fast runs it reaches 180.

What are the long-term effects of racing as I proceed into my 60s and beyond? — R.P.

ANSWER: You are in excellent condition, and your devotion to running is probably one of the main factors for your good health.

Can you keep up the pace that you have become accustomed to? Maybe. The only certain way to find out is an exam by your doctor. A stress test would be ideal to detect any heart trouble that is not now producing symptoms.

DEAR DR. DONOHUE: I have a question that I have never found an answer to.

How does one determine if he or she is “large-boned” or “small-boned”? If I’m large-boned, according to my chart, I can weigh more than I can if I am small or medium-boned. — K.J.

ANSWER: I’ll give you a simple way to determine your bone status.

If you’re right-handed, encircle your left wrist with your right middle finger and right thumb. If the tips of the thumb and middle finger meet, you are medium-boned. If there’s a space between them, you’re large-boned. If they overlap, you’re small-boned. Left-handers use their right wrist and left thumb and left middle finger.

This is not something that can claim a great deal of precision and believability.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.

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