Why Pitch Counts Might Be High School Baseball's Ace 'Reliever'

If you have a child involved in or you coach a youth, high school or travel baseball program, you'll want to become familiar with and understand the purpose of some new and very important pitch restriction rules instituted by the National Federation of State High School Associations that take effect for the spring 2017 baseball season.

As Major League Baseball spring training gets underway, so too will America's young athletes begin (or continue) hitting the field to play ball. Called "America's favorite pastime" for a reason, baseball is just one of those sports that beckons a love and reverence shared at home and abroad. Unfortunately, over the years many youth baseball programs -- and specifically those focused on high school ball -- have come to treat this sport not as a pastime, but as a full-time career -- with year-round playing in widespread pre- and post-season games, on club and travel teams, with rigorous practice schedules and in extreme cases, virtually no rest for players' young arms.

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I emphasize the word "young" for a reason. Some high school baseball players may look and can throw like an adult, but that doesn't mean they should. My sports medicine colleagues and I have treated far too many young ball players -- at rising rates and at younger and younger ages. So it's important to understand that when it comes to players' physical development in terms of bones, joints and musculature, they are still children, and allowing them to play beyond what their body was designed to do at their age can have a catastrophic toll.

That toll is evidenced in the alarming and rising rates of Tommy John surgery performed on teens ages 15 to 19. Tommy John surgery entails the surgical reconstruction of the ulnar collateral ligament, or UCL, and is indicated for individuals who have sustained a partial or complete tear of the UCL -- an elbow injury most frequently caused by overuse of the arm. One study of national insurance records showed that the number of Tommy John surgeries increased by approximately 4 percent each year between 2007 and 2011, but that increase was more than double (approximately 9 percent) among high school pitchers. In fact, the study showed that more than half of the Tommy John surgeries were on teens between the ages of 15 to 19 years old.

Although the statistics are alarming, there is good news: Overuse injuries among high school baseball players are a problem recognized and being addressed at national and state levels like never before. Thus, some changes instituted for the spring 2017 are a hopeful sign that arm injuries in young athletes are being taken seriously by coaches, parents and players.

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Previously, the rules related to pitching restrictions in high school baseball included a limitation on the number of innings a pitcher could pitch in a week's time. Those rules have become far more defined. In its announcement of the new rules last summer, the NFHS stated: "High school baseball rules now will require a pitching restriction policy based on the number of pitches thrown in a game." In addition, the announcement also indicated that it will be up to the member state association to develop its own policy on pitching restrictions based on the number of pitches a player can throw during a game and the amount of mandatory rest required after a game. This rule is designed to give players' arms the rest they need in order to avoid serious orthopedic injuries.

The Pitch Smart program, developed by USA Baseball and Major League Baseball, with consultation from a number of renowned orthopedic experts, provides concise and easy-to-understand guidelines for pitchers at a variety of age levels -- from 8 and under all the way up to 22. Their stated purpose is simple, but it bears repeating: "Baseball is a safe game to play at all ages, but research has shown that pitching too much -- particularly at a young age -- can increase a pitcher's risk of injury."

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One of our goals as sports medicine specialists is to correct injuries before they become life-limiting. Another -- especially in the case of youth athletes -- is to educate in an effort to help prevent those injuries from happening in the first place. When it comes to limiting the number of pitches a high school or youth pitcher throws in a game, season or over the course of years, I can promise that adherence to policy is completely worth the potential frustration that comes with following any type of new "rule." On the player, coach and parent levels, I hope these new guidelines will be embraced in the spirit in which they were developed -- to protect the current and future health of our young athletes.

Luga Podesta, MD, is the director of sports medicine at St. Charles Orthopedics in East Setauket, New York. He's a nationally recognized sports medicine physician specializing in the non-surgical treatment of orthopedic, musculoskeletal and sports-related injuries to the shoulder, elbow, knee and spine, and he's considered a pioneer in the new field of regenerative medicine, an area of medicine with the potential to fully heal damaged tissues, offering hope for individuals who are unable to or do not choose to undergo surgery.

Dr. Podesta serves as a consultant to the U.S. Open Tennis Tournament, Major League Baseball Umpires and World Baseball Classic and as a sports performance consultant to Cirque Du Soleil-Iris. He is the head team physician for Suffolk Community College athletics and team physician and consultant to a number of Suffolk County, New York, high school athletic programs and elite sport clubs. You can visit his website or follow him on Facebook.