Effingham Daily News
Medical professionals seek measures to decrease arm injuries
To read the full article, written by Keith Stewart, click here.
As an orthopedic surgeon and a high school pitching coach, Preston Wolin is an expert on the incredible strain that repeatedly throwing a baseball can put on young athletes.
The Chicago doctor has seen an alarming increase in the number of teens like Kevin Miller, the Altamont pitcher who underwent Tommy John surgery at 14 to replace a ligament in his elbow.
Wolin is urging the Illinois High School Association to adopt pitch-count limits for its players – a proposal that has been met with skepticism in some quarters, and enthusiastic support in others.
“We really do feel that the IHSA has a role to play in terms of helping our younger players,” said Wolin, a member of the association’s sports medicine advisory committee. “We believe that this is something that should be done, and done now.”
An increasingly common injury Wolin sees among young players is the tearing of the ulnar collateral ligament in the elbow. The number of young people undergoing Tommy John surgery to repair that damage has risen steadily since 1994 at Andrews Sports Medicine in Alabama, headed by renowned orthopedic surgeon James Andrews.
In 2011, 23 percent of the Tommy John surgeries Andrews performed were on athletes of high school age or younger, according to the American Sports Medicine Institute.
That kind of data has Wolin pushing for regulations in Illinois that he and other experts say could drive down the number of arm injuries in youth and high school baseball players. Next month he'll meet with the Illinois High School Baseball Coaches Association to make his case and seek its members' support.
Wolin wants coaches to understand the need for a pitch count at the high school level, which would also dictate minimum days of rest. He also wants their suggestions about what limits should be set.
He'll begin with the “Pitch Smart” guidelines set by the Major League Baseball Association and USA baseball, the national body that governs amateur baseball and its 12 million players.
The guidelines for various ages ranges, from under 8-years-old to ages 19 to 22. Wolin is mainly concerned with two age brackets: 15-16 and 17-18.
The guidelines allow pitchers ages 15 and 16 to throw no more than 95 pitches in a game. For 17 and 18-year-olds, that limit increases by 10 pitches. Both brackets enjoy the same days of required rest depending on the number of pitches thrown in a game.
“I think that is a good starting point for discussion,” said Wolin. “You can argue if that number is right. Some people might say it’s too low."
The idea of pitch counts and mandated rest isn’t new. Vermont, Alabama, Colorado, and Kentucky already have regulations. The last two just finished their first high school seasons with the counts in effect. Vermont began in 2008, while Alabama’s rules take effect with the 2017 season. Other states are also in talks about such regulations.
In Illinois, the topic has been discussed at the IHSA level as far back as 2009, according to the association's website.
During a meeting of the sports medicine advisory committee in November 2009, there was a presentation about the increasing number of shoulder and elbow injuries for high school baseball pitchers. That spurred the committee to provide member schools with information regarding the importance of pitch counts.
It also met with coaches to garner support. But Wolin said the initiative stalled.
“We talked to a number of coaches and the response we got was, ‘Well, we can do all of this – but the primary problem is travel ball coaches. We can’t control what’s done in travel ball,’ he said.
That remains a valid concern today, Wolin noted.
It’s one of many.
Litany of Lessons
Many factors contribute to arm injuries in baseball. Experts say some are more important than others.
“Studies do show certain factors for increasing the chance of tearing (the UCL),” said Tyler Belt, a physical therapist with HSHS St. Anthony's Memorial Hospital's Physical Rehabilitation and Wellness department. “So high pitch counts, pitching on back-to-back days, pitching over 100 innings in a year, throwing at a high velocity, pitching while fatigued or not enough rest, and another one is pitching for multiple teams.”
Belt has rehabbed three college baseball players post-UCL reconstruction. He said research attributes the spike in UCL tears to athletes who focus on one sport as opposed to playing a variety of sports in high school and earlier.
“We know through research that increased work load means increased fatigue, which means increased risk of injury,” added Wolin. “We know it. We know for example, playing for more than eight months or more out of the year increases the risk of injury. We also know that the number of pitches increases the risk to injury.”
While that may be, many baseball coaches still aren’t sure about having hard pitch-count limits.
Every kid is different
You won’t find many high school coaches outright ignoring the health of their pitchers’ arms. That isn’t the debate.
Instead, it’s about having the choice to throw a kid who they think is capable of more than 105 pitches.
“My thought on the subject has always been [that] I am against a hard pitch count,” said Altamont head coach Alan Whitt. “I have always tried to carefully watch the pitchers and remove them at the first sign of being tired. I do believe some kids are strong enough to pitch 120-130 pitches, and some kids are not strong enough to pitch 80.”
Windsor/Stew-Stras head coach Silas Pogue played in high school with teammates who threw more than 120 pitches in an outing and came out of it seemingly fine.
But as a father of two boys, Pogue feels that the decision should be left up to parents.
"I think the intentions are good to reduce the quantity of injuries that happen, but I don’t know necessarily about the 105 pitch limit," he said.
North Clay head coach John Frech agrees. He said inning stress plays a role. But Frech isn’t completely opposed to a pitch count limit, nor mandated days of rest. He already counts every pitch his kids throw.
“I think we might have had three or four instances this year where someone threw over 100 pitches,” he said. “I would almost be in favor of [pitch counts] because coaches need to look at more than just two or three guys, but instead developing more guys with the capabilities to play that position.”
Frech injured his own arm in high school due to overuse. That fuels his concerns as a coach.
And, like Wolin and other sports medicine professionals, Frech is also concerned about travel ball and year-round participation.
“Now some of these guys are playing summer baseball, and those summer coaches, a lot of times, don’t reach out to high school coaches and find out what stress guys have been under.," Frech said. "I think, in general, some guys out there are bent on winning and do what it takes to win."
Bert Bradley — minor-league pitching coordinator for the San Francisco Giants — echoed Frech's concerns.
“A lot of coaches don’t care,” he said. “They just want to win, and it’s hurt a lot of kids. I think pitch counts are very important, but a lot of it also has to do with the rest between the number of pitches.”
Bradley says the Giants organization's guidelines say that if someone throws 30 pitches, he has the next day off. If he throws 45 or 50, he earns two days off.
“The biggest thing is ample rest after outings,” Bradley said. “A lot of guys will throw 75 or 80, and then pitch in two days. You have to let the arm sleep. You need to ice it and let the blood flow and let the lactic acid out.”
Most professional teams play by the same rule of thumb for pitch counts.
“Almost every team I know, they don’t allow their guys to go more than 110 a game,” Bradley said. “At the Giants, 100 pitches is the max in the minors. I think 100 pitches for a starter in high school is good, but they need four days off in between.”
Wolin agrees to an extent with the idea that every young athlete is different; that some are capable of pitching deeper into games than others. But he still counsels limits.
“You can throw your younger kids less if you want, but if you think about it, 115 pitches is an awful lot to throw in a game,” he said. “If you only have one pitcher on your staff that can start a game, then you probably shouldn’t have a baseball team.”
The Chicago doctor agrees that pitch counts aren’t a perfect system, nor will they outright prevent arm injuries.
But it’s a start.
“I think if you have rules for high school kids, it makes it easier for parents to turn around and talk to travel ball coaches and say, ‘Hey, this is what happens when kids play in high school, and there’s a good reason for it. Why don’t you do it here?’ It encourages the quality of the discussion of everybody in the baseball community,” he said.
Kevin Miller, now 15 and a soon to be sophomore at Altamont is just now getting back into the game more than a year after his surgery. His mother Jennifer and her fiancé JD Veteto both feel that pitch counts should be instituted earlier.
“You have a lot of kids traveling around with these traveling leagues,” said Veteto. “You have 10 and under and you have younger than that. I really think that if they do it, they’re going to have to stem back even younger, because their body isn’t fully (developed)."
When he meets with the baseball coaches next month, Wolin will be less concerned about the exact number of pitches that a pitcher should throw. He mainly wants to reach a consensus.
The National Federation of State High School Associations, however, has until the end of Friday to vote on a measure that would urge all state associations to adopt pitch counts. A vote in the affirmative would certainly boost Wolin's efforts.
“The point is, let’s not argue about the magic number,” said Wolin. “Let’s just get a number, because you have to remember, it’s not the guys in the room that we’ll be talking to that are the problem. It’s the outliers. We don’t want to penalize the coach. We want to allow him to coach, but somebody has to protect the kids."