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Rise in pitching injuries has experts on alert

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From Major League Baseball all the way down the ranks to Little League, doctors, researchers and baseball coaches are worried about pitchers' arms.

Pitching-related arm injuries are on the rise across the country, sparking a debate about how to reduce their frequency. At the high school level, the concern is heightened with the number of arm injuries and the fear that pitchers are being overused.

Pennsylvania's high school pitchers are governed by an innings limit, which sets restrictions on how many innings a pitcher can throw and how many days rest he must get before his next start.

But some observers say enacting a pitch count would be more effective in curtailing the number of injuries.

“There’s an epidemic going on here where coaches across the nation are just throwing their pitcher too much,” Central York baseball coach Mike Valencik said. “There has to be a limit. That limit now is limitless.”

UPDATE, JAN. 26, 2017: The PIAA approved enacting pitch count rule for spring 2017. Click here to read more.

Doctors and researchers would likely agree.

Since the mid-1990s there has been an increase in arm injuries and the need for Tommy John surgery.The procedure, known in medical terms as an ulnar collateral ligament reconstruction, is done to replace a torn ligament in the arm.

Andrews Sports Medicine, headed by world renowned surgeon Dr. James Andrews, in Birmingham, Ala., has seen a significant increase in Tommy John surgeries done there, according to Glen Fleisig, the research director for the American Sports Medicine Institute.

“What’s most disturbing is the percentage of high school and younger pitchers, which was essentially trivial or none before the mid-1990s, became a significant (amount),” he said.

A 2015 study by the American Orthopedic Society for Sports Medicine found that 56.7 percent of Tommy John surgeries were performed on 15-to-19-year-olds between 2007 and 2011. The study also revealed that during the time frame researchers saw an average increase of 9.12 percent per year in athletes in that age demographic.

The National Federation of State High School Associations (NFHS), the governing body of high school sports in North America, has been watching these trends closely. At the organization's baseball rules committee meeting this month, the group plans to recommend that all states move to a pitch count limit.

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Restrictions on pitching have been in place nationally since the 1980s, but individual states differ on the specifics. Researchers have made the push for pitch counts to replace inning limits, because they say it gives coaches a more precise limit since the number of pitches thrown in an inning can vary widely.

“How many times you pitch is really the damage on your arm. Not how many innings you pitch,” Dr. Fleisig said.

A pitch count rule is not on the books in the PIAA, but York County coaches have made the effort to keep an eye on how much their kids throw.

How teams manage their pitchers varies from school to school, said former West York baseball coach and athletic director Roger Czerwinski, but 60 to 70 percent of teams in the YAIAA monitor pitch count in some way.

“The coaches that have been around awhile they know how to do it the right way. Otherwise they wouldn’t be still coaching,” said Czerwinski, who is now the athletic director at Manheim Township in Lancaster County.

Northeastern coach Andy Srebroski and Valencik have both said they monitor pitch counts. However, both coaches noted that a player’s pitch count can vary depending on who’s on the mound and what he's throwing.

Video: Pitching 101
Watch a demonstration of five pitches from Spring Grove's Matt Brooks and Derek Hoiles.
Brandon Stoneburg, Sean Heisey

The different types of pitches and the pitcher's fundamentals can put different stresses on their arm.

“I think you have to be careful when you monitor what pitches are being thrown in accordance to a pitch count,” Srebroski said. “If you throw predominantly fastballs then you can get away with a little bit more of a pitch count than if you throw a lot more breaking stuff, you’d obviously want to limit your count a bit.”

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For Northeastern senior pitcher Kody Reeser, it is a bit of mystery of why arm injuries have become more prominent in the sport.

“I think our great-grandpas and stuff like that were throwing two games in one day and then would come back two days later and throw another game,” Reeser said. “So it’s kind of like, what did they do differently that we didn’t do? … What made them different that they could do it?”

Part of the reason, observers say, has to do with athletes playing a singular sport year round. It has become more common for athletes – not just in baseball – to specialize in one sport, and they begin to do so at a younger age.

“The rise of one-sport specialization and the rise of baseball pitching injuries are related," Fleisig said.

Valencik has taken notice to the rise of the one sport athlete. He recalled 15, 20 years ago when players would build up their arm strength and throw during the season and over the summer. But after that, they would then shut down for six months.

“They’d play other sports, rest, relax, and just be a kid,” Valencik said. “The arm had plenty of time to rest and recuperate, and regenerate, and grow muscle. The arm problems weren’t nearly as much as they are today.”

Coaches have tried to counteract it by encouraging their players to participate in multiple sports. Reeser heeded his coach’s advice and takes pride in the fact that he has played three sports through his high school career.

“I think it’s important to play multiple sports,” said Reeser, who also plays football and basketball. “I love it and I think playing different sports helps you when you go on and play baseball. … I think they all go together.”

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Tommy John surgeries typically have a high rate of success, with four out of five pitchers returning to action, according and Dr. Fleisig. However, the high success rate doesn’t mean the procedure should be taken lightly.

Kaden Hepler knows firsthand about arm injuries and what it’s like to go under the knife for Tommy John surgery. The 2012 West York graduate played three years of varsity baseball for the Bulldogs and led the program to its first state title his senior season.

Hepler never went through any arm injuries in high school and went 14-0 in his final year in high school, posting a .93 ERA and 131 strikeouts. He threw 90 1/3 innings that season and was utilized heavily in the state tournament, including a 135-pitch outing in the championship game.

But in his first college outing at Winthrop University, Hepler felt his elbow pop after 15 pitches in relief.

“Initially your mind thinks oh you’re fine,” Hepler said. “The next pitch … I threw it over into the third base dugout about like 30 feet. As soon as I let go of it I knew something wasn’t right and just started walking off the field.”

After an MRI the following day, Hepler elected to have Tommy John surgery to repair the injury. On March 14, 2013, he had the procedure, and two months later he had to have a second one done to move a nerve in the arm, because he didn’t have any feeling in the right side of his hand.

Hepler did a lot of work on his shoulder and arm strength when he was rehabbing from the surgery, but things haven’t been the same since.

Hepler says his arm strength and velocity have never returned to where they previously were. Hepler made only three relief appearances during the 2016 season and had just two during two seasons prior.

“With kind of how my arm kind of came back, it’s just never really given me the opportunities to try to show that I can still be affective and get guys out,” Hepler said.

Why Hepler’s elbow popped is still unclear. Hepler told GameTimePA in June 2013 the injury wasn’t related to previous wear and tear and recently said, “It’s just one of those things that happen over time.”

Still the situation has stayed with Czerwinski, who was West York's coach at the time.

“One kid in 18 years is what we had, but that one kid is on my mind all the time because of that,” Czerwinski said. “So maybe I am a little bit more leery now.”

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When the NFHS baseball rules committee meets this month, part of  it will discuss a recommendation to implement a pitch count rule instead of the old innings limit restrictions. If the membership passes the proposal, pitch counts would become the national standard for governing when and how much a pitcher can throw in a game.

Srebroski is in favor of moving toward a pitch count based rule over the current regulations.

“You could have a kid go out there and have a kid throw 65 pitches in an inning and come back tomorrow,” he said.

While Hepler also favors a pitch count rule, he contends there's no way to prevent all injuries.

“I think that it’s a good start to try and help,” Hepler said. “There’s only so much you can really do until just nature takes over and you can’t really do anything else. But I think the pitch count is definitely a good step forward ensuring safety in kids’ arms.”

Others have also added that educating coaches, athletes, and parents would also be a good way to fight arm injuries. Major league Baseball has teamed up with USA Baseball to help educate coaches, players, and parents on preventing arm injuries. And Elliot Hopkins, the director of Sports, Sanctioning and Student Services for the NFHS, said he’s worked with the American Baseball Coaches Association.

"I think the wisdom is we have to protect these kids in a lot of instances for themselves," Hopkins said. "A kid will never say his arm is sore because he doesn’t want to be taken out of the ball game. It’s just the competitive nature of kids, but we have to help them see it’s OK. You don’t want to throw so you can’t hold a spoon to eat your cereal in the morning.

Pitch count already going into affect in other states

The abundance of information already out there has encouraged several state high school athletic associations to reconsider their current pitching rules. Oklahoma recently proposed the adoption of a pitch count rule for their 2016 fall regular season. The Illinois High School Athletic Association is mulling over the idea of a pitch limit, as is Minnesota and Maine. Three other states – Kentucky, Colorado and Vermont – already have pitch count limits in place, and Alabama approved a pitch count rule for the 2017 season. 

Little League baseball was one of the first organizations to move to a pitch count in 2000, and Major League Baseball teamed up with USA Baseball to start the Pitch Smart initiative in 2014. Pitch Smart sets recommended guidelines for how many pitches a player should throw depending on their age, and for how many days they should rest depending on how much they throw. 

However, Pitch Smart is only an educational tool for players, coaches, and leagues.