Copyright 2004 Gale Group, Inc.

Copyright 2004 International Medical News Group

Family Practice News

May 15, 2004

SECTION: No. 10, Vol. 34; Pg. 1; ISSN: 0300-7073

IAC-ACC-NO: 118041798

LENGTH: 1173 words

HEADLINE: Count pitches to avoid use injuries: youth baseball.

BYLINE: Kirn, Timothy F.

BODY:

VANCOUVER, B.C. -- Children who pitch should be followed closely

with a pitch count to avoid overuse injuries, regardless of how many

innings they have pitched, Dr. Tracy Ray said at the annual meeting of the American Medical Society for Sports Medicine.

Many baseball coaches and organizations, including Little League,

limit the number of innings a young pitcher can spend on the mound. But an abundance of research and opinion now suggests that it is the number of pitches a child throws during an outing that matters, said Dr. Ray, a family physician who practices sports medicine in Birmingham, Ala.

As importantly, children need to rest between pitching stints, and

they should take at least a couple of months off from throwing a

year.

In general, an 8- to 10-year-old child should not throw more than 50

pitches per outing; a child 11-12 years old should not throw more than 75, Dr. Ray said. Moreover, children in either age group probably should not exceed 75-100 pitches a week, and if they throw 50 or more pitches in an outing they should rest for at least 4 days between outings (see table below).

Arm and shoulder injuries have become increasingly common in young

Pitchers as children play less street or sandlot baseball, but spend more time in competitive, organized baseball, even playing year-round in some parts of the country, Dr. Ray said. "We really feel like what we are seeing, at least in our area of the country, is an awful lot of throwing over a 4- or 5-year period, as these kids move from Little League to high school, and some of the problems we are seeing in high school and early college can be linked back to what they

were doing as 8- and 9-year-olds," he said.

This problem has been recognized for some time, and the recommendations

come from an effort started in 1996 by USA Baseball, sponsor of the

National Team and Olympic Team. The organization began its research by surveying 28 experienced orthopedic surgeons and baseball coaches. When asked what mattered in injury, the respondents overwhelming said that number of pitches and fatigue were more important than the number of innings.

They were also asked to address when a player should be allowed to

start throwing breaking balls. They recommended that no children

should throw curve balls in competition until they are at least 14 years old; they shouldn't be throwing sliders until they are 16 years old.

To build on that information, Dr. Ray and other investigators

followed 200 pitchers aged 8-12 years over two seasons (1997 and

1998), conducting interviews with the pitchers and their coaches at the start and the end of the season, and making midseason telephone calls to some participants in a study funded by USA Baseball.

They found that 50% of the pitchers reported arm or shoulder pain

after pitching at some point during their 3-month season, and it

seemed to correlate with having thrown more than 75 pitches an outing and/or more than 600 pitches a season.

The group refined their study for the next season, redefining

pitchers studied to those aged 9-14 years who participated in spring

leagues in the Birmingham area. These 476 pitchers, and their 147

coaches, completed questionnaires before the season began, after

every game pitched, and after the season ended. This survey confirmed 75 pitches a game and 600 pitches a season as a threshold.

Parents often want to know if throwing mechanics can affect a

child's propensity for injury. The study attempted to look at that,

Dr. Ray said, despite limitations in their ability to assess the

mechanics of all the pitchers. The researchers videotaped some

pitchers and brought 25 pitchers into a motion lab at Dr. Ray's institution. The completed questionnaires, as well as the tapes, showed that there really was not much meaningful difference in the mechanics of the different pitchers, and the investigators concluded that mechanics do not matter.

"Intuitively, that does not make a whole lot of sense, but that is

what we showed," Dr. Ray said. The study also found that pitchers who threw curve balls developed shoulder pain and pitchers who threw sliders developed shoulder and elbow pain.

The specific recommendations, therefore, do not conflict with what

the coaches told them about throwing breaking balls.

If a pitcher needs another pitch in addition to the fastball, "We'd

encourage the change-up," Dr. Ray said.

There was a concession about the pitch count, however. Since exact

pitch counts can be difficult to keep, the recommendations state

that it is acceptable to count batters--10-15 per outing, or 120 batters a season, since the average number of pitches to a batter is about five.

Dr. Ray said there was also some concern that savvy coaches could

abuse a 50-pitch, rule by having their batters hold their swing and

take pitches in order to get the pitch count high quickly.

Practice is probably a good thing, and it is primarily the hard,

competitive throwing that leads to fatigue, that leads to injury, Dr. Ray said.

"We actually encourage throwing in the backyard or with a coach

because we felt like there is something to be gained regarding

strength and flexibility," he said.

The pitchers who were observed during 1999 are still being followed

to see who eventually gets injured or requires surgery.

Recommended Workload for Young Pitchers