It was 1997. Pennsylvania. John Buonamano had a tall task in front of him.
The high school senior was pitching with a trip to the state semifinals on the line. And he delivered pitch after pitch, after pitch.
He cocked his arm back, forced it forward and released the baseball 176 times that day. He then tossed two innings the next day.
“I never complained. My arm never hurt,” said Buonamano, now the Highland High School baseball coach. “No one talked about that stuff then. And I was a kid. I didn’t know any better.”
His arm was never quite the same, and his college pitching career was eventually cut short by a shoulder injury. But now, officials know better.
On Oct. 19, the New York State Public High School Athletic Association plans to discuss how it will implement a mandatory limit on the number of pitches a scholastic baseball player may throw, a rule change dictated by the National Federation of State High School Associations in July.
The proposed plan calls for limiting pitches to a maximum of 105, with tiered guidelines for the rest a pitcher must have in-between games based on the amount of pitches are thrown, according to state baseball coordinator Ed Dopp.
The rule, which is intended to curb a growing trend of overuse injuries and help preserve players’ dreams of pitching collegiately or beyond, will be revised and go into action this spring, after being finalized in January, Dopp said.
Overuse accounted for 7.7 percent of high school athletic injuries from 2006-2012, according to a study published in the Journal of Pediatrics in March 2015, which examined incidents reported by athletic trainers through the National High School Sports-Related Injury Surveillance System.
The National Federation has been considering a pitch limit for a number of years, according to Elliot Hopkins, the organization’s director of sports, sanctioning and student service, and has examined data showing a high prevalence of ulnar collateral ligament elbow injuries — the most common overuse ailment among pitchers — among high school-aged athletes. More than half of all patients examined in one national study fell into that age group.
The rule change is being praised by medical professionals, as well as area coaches — many of whom had already instituted such rules voluntarily. At least 15 local varsity head coaches kept their pitchers on pitch counts last season, though those limits varied by as many as 30 pitches.
“Elbow problems and shoulder problems are almost an epidemic,” said Dr. Stephen Maurer, of Orthopedic Associates of Dutchess County, “and it’s really an overuse phenomenon.”
Some pitchers have also approved of the change, even as it may conflict with the competitive nature of the game.
“To me, it’s good and bad,” said Ryan Murphy, a right-handed senior who helped pitch Roy C. Ketcham High School to the state semifinals a year ago. “The good, obviously, is trying to save the arms of young pitchers in high school. I know a lot of kids who went on to play college ball and have arm problems in their freshman year.
“But, the competitor side of me wants the ball every single game and to pitch as much as possible.”
Murphy’s coach at Ketcham, Pat Mealy, estimates the average high school pitcher can hurl a ball 80 mph. The average fastball among Major League Baseball pitchers in 2015 was 92.1 mph.
Maurer, an orthopedic surgeon who specializes in sports medicine and injury, called the rule “a move in the right direction” and said the pitching motion is not something meant to be done repetitively, for a long period of time or excessively.
“You’re never going to be able to prevent every injury,” Maurer added. “If we can develop rules in younger people and prevent them from needing surgery, I think it’s a good thing.”
Creating a rule
In the state’s proposal, pitchers would be required to observe at least four nights of rest after throwing the maximum limit of 105 pitches in a game, three nights of rest when throwing between 81-104 pitches, two nights when throwing 56-80 pitches, and one night when throwing 31-55 pitches. Pitchers will not be required to rest when throwing less than 30 pitches.
The proposal offers the stipulation that, if a pitcher is approaching the limit in the middle of an at-bat, he will be permitted to finish pitching to the hitter.
Schools must report the status of their pitchers to the opponent on the day of the game. Warm-up pitches, pick-off throws over to the bases and balks will not count against a pitcher’s pitch count, and the two teams must confirm the number of pitches at the end of each inning.
However, the proposal could be altered before a decision is ultimately made.
“I anticipate the final proposal, which will be voted on in January, will most likely have some adjustments,” Dopp said.
The National Federation of State High School Association creates many, but not all, of the rules for 51 high school sports associations in the country, including the New York State Public High School Athletic Association.
Up until the change, New York mandated an innings limit. Pitchers were allowed to throw a maximum of 12 innings in one day, but no more than 18 innings in six straight days, and two nights of rest were to be observed if a pitcher threw eight innings in one day. Delivery of one pitch constituted having pitched an inning.
“I think (the new rule) is a great thing,” said Pat Tierney, head coach of Arlington High School’s “Maroon” varsity team. “It ensures them a long future, if they’re on the mound in college.”
Hopkins noted Vermont has been using pitch counts in high school baseball for the past decade. Youth organizations such as Little League also utilize pitch counts.
“(The decision to institute pitch counts) was really based off research and data,” Hopkins said. “Once we saw figures and numbers, we saw we had an opportunity to protect the children. We were able to agree that more should be done because we have science supporting overuse injuries.”
A trend of injuries
In June of 2015, the National Federation held a symposium in which several items were discussed, including overuse and injuries in high school pitchers. One report presented at the symposium was a 2015 study conducted by Dr. Brandon Erickson of Rush University in Chicago, which looked at nearly 800 patients who had undergone ulnar collateral ligament reconstruction surgery between 2007-2011, and found 56.8 percent of the patients were between 15- and 19-years-old.
The ulnar collateral ligament is a string of tissue in the elbow which connects the inside of the upper arm to the inside of the lower arm. This particular inner link is crucial for baseball players, as it stabilizes and supports the arm when it performs a motion, such as throwing a ball.
Former Major League pitcher Tommy John was the first player to undergo the reconstruction procedure, recover from it and pitch again. Thus, the operation has been given the widely-known name “Tommy John surgery.” The process involves replacing the torn ligament with a tendon from elsewhere in the body. Typically, it takes a pitcher a full year to recover after the procedure.
“You don’t actually repair the ligament, you reconstruct it,” said Maurer, who said he has performed between 50 and 60 Tommy John surgeries. “You recreate the ligament with another piece of tissue.”
Dr. James Andrews, a surgeon known for performing Tommy John surgeries on athletes, told the USA Today Network in 2014 that the number of times he and colleague Glenn Fleisig performed the procedure on youth and high school players increased from 17 in 2000 to 41 in 2010, which accounted for 31 percent of the times they performed the surgery that year.
While torn ulnar collateral ligaments are the most common injuries to a pitcher’s arm, shoulder injuries and, like in Buonamano’s case, rotator cuff injuries, can also occur from overuse.
After those laborious innings at the end of his high school career, Buonamano went to Marist College to play baseball. He felt twinging in his shoulder, but kept pitching for the Red Foxes for two years before transferring to SUNY New Paltz.
The soreness in his shoulder lingered, though. Buonamano took a shot of cortisone, an anti-inflammatory medication, in order to play through his first season with the Hawks. After the year ended, he underwent surgery on his rotator cuff and was mostly used as a designated hitter after that.
“I think that experience is why I’m overly protective of my guys,” Buonamano said. “I know a lot of coaches feel the same way.”
Poughkeepsie baseball coach Mark Bianco is another proponent of pitch counts. In 2016, he restricted his pitchers based on school grade, size and time of the season.
“(The pitch count) goes up as the year goes on,” Bianco said. “Most kids towards the end of the year throw 80-85 pitches, max. We try to keep them on pitch counts all year long and go from there.”
But, the limits varied by team and coach.
“I analyze the pitcher at 75 pitches and again at 90 pitches, but never allow them to throw more than 110.” Rhinebeck coach Nick Nikolatos said.
Millbrook coach Russell Haentges said he evaluates pitchers as the game progresses.
“I’m constantly asking them what’s going on, what’s working, what’s not, how’s your arm feel?” Haentges said.
Recovering from injury
Arlington High School graduate Connor Chiulli also supports the new rule. Although he did not blame overuse, Chiulli tore the ulnar collateral ligament in his pitching arm, which prevented him from pitching in spring 2016, his senior season. Though Arlington coach Darrell Flynn said he uses a pitch count, and Chiulli’s travel baseball teams did the same, he still sustained the injury. Regardless, Chiulli hopes the pitch count rule will help those others avoid a similar fate.
“I think putting the pitch count rule into play will help prevent a lot of injuries,” Chiulli said. “The stricter the rules, the more of a chance they’ll have coming out of high school and beyond.”
Chiulli knew he was injured the summer after his junior year. When he would throw, he would feel sharp pain that he recognized was unlike regular soreness. At first he thought he wasn’t preparing properly, but it came to a point where he couldn’t pitch without trying to ease the pain.
“I couldn’t make it through five, six innings without needing Advil,” Chiulli said. “It was a real sharp pain and it just progressively got worse.”
Chiulli expects to be able to pitch again in March, a year after his procedure. Recovery from the surgery is a gradual process.
During the first week, the arm must be kept in a brace tilted at a 90-degree angle. After that, a limited mobility brace must be worn and kept on for a month. Chiulli began a three-month physical therapy regimen five weeks after the procedure, and he began light throwing in July.
“You start to get mobility back and you make sure you can extend your arm straight,” Chiulli said.
While most injuries cannot be prevented, Maurer said limiting issues with overuse can be done by switching up exercise routines, properly warming up and utilizing proper pitching mechanics.
That, and addressing the problems when they become noticeable.
“The first thing you do is rest, and don’t ignore the symptoms,” Maurer said. “Mix up exercise routines, so you’re not doing the same over and over.”
A.J. Martelli: email@example.com, 845-437-4836, Twitter: @AJM_PoJoSports
What should the New York State pitch limit be?
“Our pitchers will throw no more than 85 pitches. I have only let two kids go above that, but never more than 90,” Pawling coach Travis Light said.
“Rarely do we let a guy go past 95 pitches,” Haldane coach Tom Virgadamo said.
“I analyze the pitcher at 75 pitches and again at 90 pitches, but never allow them to throw more than 110,” Rhinebeck coach Nick Nikolatos said.
Should it vary?
“I don’t have a specific number for all my pitchers. Some are able to safely throw 80, 90 or even 100 pitches, while others may be done after 40, 50 or less,” Red Hook coach Mike McCrudden said.