August 8, 2014

It's hard to believe, but the fall sports season is just around the corner. Football, volleyball, cross country and swimming practices will get underway on Monday. However, despite its end at the high school level in Iowa this past weekend, baseball is center stage in the national sports landscape. And this year in Major League Baseball a spike in high-profile injuries has come to the forefront and been as much a part of the discourse as Derek Jeter's farewell season. OK, almost as much.

Matt Harvey (New York Mets) and Jose Fernandez (Miami Marlins) headline the list of bright young pitchers who have undergone Tommy John Surgery in the past calendar year. The procedure, which replaces the damaged ulnar collateral ligament (UCL) in the throwing elbow with a tendon from elsewhere in the body, has become prevalent in today's game. Dr. James Andrews has become as synonymous with the injury as Tommy John himself, as he is the go-to orthopedic surgeon for most elite athletes who have suffered ligament damage. Within the past year, Dr. Andrews has brought to the light the fact that the injury isn't just a problem in the professional game.

"I started seeing a sharp increase in youth sports injuries, particularly baseball, beginning around 2000," Dr. Andrews told The Plain Dealer last year. "I started tracking and researching, and what we've seen is a five-to sevenfold increase in injury rates in youth sports across the board. I'm trying to help these kids, given the epidemic of injuries that we're seeing. That's sort of my mission: to keep them on the playing field and out of the operating room.

"I hate to see the kids that we used to not see get hurt. ... Now they're coming in with adult, mature-type sports injuries."

The problem stems in youth baseball, which is why Little League, under the advisement of Dr. Andrews and Glenn Fleisig of the Sports Medicine Institute, eventually adopted pitch-limit rules. For example, at this year's Little League World Series these are the rules for 11 and 12 year olds:

- A firm limit of 85 pitches in one game;

- Mandated rest of four days (after a pitcher made 66 or more pitchers), three days (51-65 pitches), two days (36-50 pitches) one day (21-25 pitches);

- A pitcher can finish the batter he or she is facing if the limit is reached during an at-bat;

- A pitcher can't remain in the game as the catcher if he or she has tossed 41 or more pitches in a game.

The high school game is where things become even more dicey. The perceived value of winning is heightened and it happens to coincide with the increased importance of pitchers who have college or professional dreams being able to light up the radar gun. At times, the result can be a reckless disregard for a teenager's future.

The Iowa High School Athletic Association does have provisions in place to try and prevent pitcher overuse:

- Sixteen innings will be the maximum total number of innings a pitcher may pitch in a given week. (Sunday through Saturday is considered a week)

- A pitcher may not pitch more than a total of nine innings in any one day or on two consecutive calendar days. The ninth inning must be followed by two calendar days of rest. A game started on one calendar day, but is not completed until the next day, and is not a suspended game is to be considered played on the original calendar date the game started.

- If a pitcher pitches on any two consecutive days with the combined total greater than four innings, he will follow with two calendar days off for rest.

It's up for debate whether or not innings limitation is the appropriate construct for injury prevention among pitchers. Research is constantly evolving and more signs appear to be pointed toward the pitch limits, which have been implemented at the youth level. However, there are complications in using that method, says IAHSAA baseball coordinator Roger Barr.

"There's been a little talk about pitch count," said Barr in a phone interview Thursday. "I think the biggest concern that there probably is at this stage in the game would be one coach's word against the others."

Barr also noted discrepancies could arise in end-of-game scenarios - coach's disputing pitch counts - or in cases in which pitchers who are in the middle of an at bat when they reach the decided upon pitch limit.

"It's that coach's word against the other's, what do you do then?" he asked rhetorically.

A six-coach advisory board structured the current set of rules and, as of now, there has been very little issue with those rules.

"I think it's a pretty fair rule for most of our teams," Barr said. "We have no had a concern from our coaches from that standpoint with changing anything with it, so I think it works for them."

Locally, through my rather rudimentary stat keeping, there were no abnormalities in the amount of pitches thrown by starters in a small sample size. And most coaches who I've talked to both on and off the record acknowledge they closely monitor pitch counts and try to take the necessary precautions.

As tournament time approached, though, pitch counts from two non-Daily Times Herald teams' pitchers reached alarming levels in district games. The win-or-go-home mantra is usually on full display at this time of year and it's far too often at a detriment to young arms.

For anonymity sake, we'll refer these two as Pitcher A and Pitcher B.

Pitcher A threw 120 pitches in his first outing. He then came back - adhering to the required two days rest - and threw 133 pitches three days later. It was only 14 innings, but he threw 253 pitches in four days - a work load that would border on abuse for a major-league pitcher, let alone a high school kid.

Pitcher B was used for the same amount of innings as Pitcher A, but was much more efficient in his pitch counts. With the same amount of rest, he threw 175 pitches in four days. Not excessive, but still above average considering the relatively little rest.

Both pitchers led their teams to wins and went on to throw seven more innings after receiving three days rest.

Obviously, no two pitchers are the same. Pitching mechanics, size, shoulder strength, lower-body strength; all of it factors in to how much duress an arm or elbow ligament can withstand.

Ultimately, the onus falls on the coaches. And, unfortunately, winning takes precedence too often and overrides the judgment of far too many.