High School and College Coaches have a Responsibility to Protect Amateur Pitchers

 

This column was originally written for the July issue of Big Leagues Monthly | Magazine.

By Lincoln Hamilton | @LHamiltonPP

Rental cars and out of state license plates packed the cement parking lot as grown men have come from across the nation to see a 17-year-old high school senior. The 1995 Major League Baseball Draft is fast approaching, and with his team down 1-0 in the best-of-three State Semifinals, this could be the last chance any of them get to see the year’s best pitching prospect.

He dazzles. His mid-90’s fastball sinks and crashes on hitters’ fists. His curveball moves so much it confuses umpires as often as opposing batters. He works hard, throwing over 100 pitches in the course of a complete game. His team wins. The Gophers are kept alive, at least until the next game which was scheduled to start shortly after completion of the first (if necessary).
Impressed by what they’ve seen, the scouts begin trading stories as they walk back to the parking lot eager to get relief from the Texas summer’s sun. Then a new buzz overcomes the group. “He’s warming up?”

“Again?”

The seats are filled once more with khakis and radar guns as young Kerry Wood takes the mound. The Grand Prairie High School Gophers win again. Wood is relieved in the fifth inning, once the score is well out-of-hand.

When asked after the game how they could let any pitcher, much less one this valuable, throw 175 pitches over two games on the same day his father, Gary, and Head Coach Mike McGilvary defend the workload pointing to the fact that the strapping six-foot-five teenager had handled similar workloads in the past.

This line of reasoning is so wrong it almost deserves respect -- in a twisted, morbid sort of way. The truth is severe pitching injuries are nearly always caused gradually.

“Some pitchers may describe throwing a single pitch, they hear a pop and have pain in the medial aspect of the elbow and discover that they have torn the ligament. But these usually happen in people who have been throwing for a while. Their ligament has undergone some attenuation and stretching over their careers.”, said Dr. Luke Oh, a sports medicine orthopedic surgeon at Massachusetts General Hospital and a Boston Red Sox team physician, in an interview with the Andover, Maryland Eagle-Tribune.

Muscles and ligaments grow by filling in microtraumas with new protein structures. This period of hypotrophy only occurs during periods of rest. Rest and recovery time is absolutely fundamental to the health of athletes. Without it, overuse injuries become a problem.

A 2006 study* by the American Sports Medicine Institute (ASMI) found that youth pitchers (aged 14-20) who threw “regularly with arm fatigue” were 36 times more likely to have arm surgery.

Yet, increased medical knowledge has not lead to a decrease in injuries. The problem is growing fast.

In a three-year span from 1996-99, Dr. James Andrews, a preeminent orthopedic surgeon, performed Tommy John surgery on 19 pitchers high school aged or younger. From 2004-07, that number had jumped to 146 high school or youth league players — a seven-fold increase.

The rise was not merely due to the upshot in overall surgeries performed. In 2010, 31 percent of Tommy John surgeries at Andrews’ facility were on youth and high school pitchers. Ten years earlier, the figure was just 18 percent.

Despite specific pitch counts being implemented at youth levels, the numbers of severe arm injuries in amateur pitchers show little signs of slowing. Even as awareness of injuries has risen, the prevalence of year-round play and increased competitive stresses on young pitchers has contributed to the problem.

In previous generations pitchers who excelled athletically also played shortstop, point guard and wide receiver. Today it’s far more common for young hurlers to play shortstop, pitcher, pitcher and pitcher.

In Prevention of Arm Injuries in Youth Baseball Players doctors Edmunt Kerut, Denise Kerut, Glen Fleisig, and James Andrews state that “the advent of youth year-round baseball has come with an increased incidence of pitching related injury and surgery, most notably involving the shoulder and elbow (ulnar collateral ligament). These injuries become evident in high school and college, but begin at the youth level.”

The article, published in the March-April 2008 edition of the Journal of Louisiana State Medical Society, is actually a review of previous studies aimed specifically at helping “guide primary care physicians and pediatricians when discussing youth pitching and injury prevention with parents and coaches.”

An interesting dichotomy exists in the world of athletic injury prevention; the person best able to feel the stress on the body (the athlete themselves) is the least likely to want to report it. As long as athletes, specifically young males, are culturally expected to “play through pain” in order be perceived as “tough” or “macho” the ultimate responsibility falls to those targeted by the article: parents and coaches.

The injury equation is an extremely complex one, and one that almost no one ever has all the specific variables for. Humans, baseball coaches included, have a tendency to treat extremely complex questions with simple, oftentimes egotistical answers.

A basic concept of economics is that people tend to act in ways they perceive to be their own best self-interest. If a person can’t fully know or grasp how their actions affect the future, they tend to act in a way that benefits them in the short term. Even if we may cognitively understand that cholesterol leads to health problems, it doesn’t stop most of us from cramming a burger and chips down our gullets. SUV’s still pack the nation’s freeways, despite most people acknowledge some environmental concerns.

Pushing an amateur pitcher a little harder could be bad, but winning today’s game is definitely good.

Certainly no parent or coach ever wants to see a young person hurt. The problem is not one of malevolence, merely an inability to properly balance long-term risk versus immediate gratification.

All too often, the desire to stretch an elite amateur one more inning or the need to max out in order to impress scouts at a showcase event takes precedent over long-term health. Once or twice is unlikely to do much harm. But when the absence of immediate injury is taken as proof of health and used to justify even further increase in workload, severe injuries become likely.

Imperfect knowledge of long-term effects is no excuse for inaction. Even without noting the exact force loads at every point in pitcher’s delivery or the tensile strength of a specific individual’s ulnar collateral ligament, parents and coaches can control the big factors: workload, mechanics and recovery time.

No one specific variable guarantees a severe arm injury, but the numbers suggest that parents and coaches are currently doing a poor job of managing risk. Each ball a tired pitcher throws with imperfect mechanics is like smoking a cigarette. One isn’t much too worry about, but if it keeps on going, the health risks increase exponentially. The current system of year-round youth baseball has created a generation of young pitchers with the equivalent of a two-pack-a-day habit.

*[Risk Factors in Adolescent Baseball Pitchers. Olsen SJ, Fleisig GS, Dun S, Loftice J, Andrews JR. Risk factors for shoulder and elbow injuries in adolescent baseball pitchers. The American Journal of Sports Medicine 34:905-912, 2006.]