Dr. Jeffrey Dugas has performed more Tommy John surgeries than he can count. And he’s drawn a rather obvious conclusion: These well-known procedures to repair the ulnar collateral ligament in the elbow of pitchers would be less frequent if more states implemented pitch count rules.
But first, let’s be upfront about something: I want it to be very clear that this column is not meant to point blame at coaches — or anyone, for that matter. This is merely a common sense discussion.
“We in the medical world know that inning counts aren’t sufficient to protect kids,” said Dr. Dugas, an orthopedic surgeon with the Andrews Sports Medicine and Orthopedic Center in Birmingham, Alabama. “There’s a real push for pitch counts instead of inning counts. And there are more and more states that are looking it at.”
Dr. Dugas serves on the Medical Advisory Board for the Alabama High School Athletic Association, which adopted new pitch count rules in October.
The rules, which will come into effect for the 2017 season, cap the amount of pitches that a varsity player can throw in one game at 120. And if they throw over 76 in one day, that pitcher must rest for three full days before pitching in another game. It also limits JV pitchers to 100 in one game and 85 for middle-schoolers.
“We needed to get something on the books, and I’m happy with the rules that we wrote knowing that we’ll have to massage them as time goes on. I’m very proud of Alabama for doing this, and it’s something that needs to happen across the country,” Dr. Dugas said. “In the end, it’s going to save kids from being on the operating table. There is no question in my mind that this is a positive thing.”
Alabama is one of just a few states which has added restrictions on pitch counts, along with Colorado and Vermont. Delaware, Florida, Maine, Maryland, Ohio and others either have proposals in the works or are having serious discussions.
Other high school organizations also have guidelines, such as the Public Schools Athletic League in New York City, which limits varsity pitchers to 105 pitches in one game and JV pitchers to 90 while also requiring certain rest depending on how many pitches were thrown.
Dr. James Andrews of Andrews Sports Medicine and Orthopedic Center is considered to be one of the leading experts on preventing arm injuries. He outlines maximum pitch counts and rest periods based on age groups on his website, AndrewsInstitute.com. He believes that high school-aged pitchers shouldn’t exceed 105 in one day. USA Baseball has published similar recommendations, known as Pitch Smart, which also cap 17- and 18-year olds at 105.
“Dr. Andrews and his team, that’s something that they’ve worked really hard on,” said Dr. Steve Jordan, an orthopedic surgeon who has studied and practiced with Dr. Andrews. “It’s kind of like going out in the sun when you’re a kid. It may not hurt you that week, but it accumulates. A kid may think he got away with it, but once it comes home, then you’re done.”
If so many doctors who specialize in injury prevention are pushing for pitch count restrictions, why aren’t more states heeding their advice?
“It’s always mentioned (at NYSPHSAA meetings), but there’s never much that takes it further,” Section 1 baseball co-coordinator Phil DiRuocco said. “There are layers of bureaucracy. I’d like to see a nice, heated discussion about it, but it never gets to that point. … We haven’t had that grassroots push, where I’m getting calls or emails everyday about it.”
NYSPHSAA baseball chairman Ed Dopp echoed those sentiments, stating that, “Nothing to this point has gone to a formal motion to change.”
“I believe that most high school coaches and ADs welcome anything that protects student-athletes,” Dopp added. “Pitch counts do come down to the logistics of who is doing the counting, how are they recording it and what will be the steps in enforcement, as well as consequences for non-compliance. Some coaches already believe in pitch counts; some coaches do not.”
Currently, New York State — and most states around the country — rely on innings limits. In New York, the maximum of 12 innings per day and no more than 18 in a six-day period provides plenty of leeway and rarely comes into play.
As Dr. Dugas notes, “Inning counts don’t cover it because, shoot, you can throw 30 pitches in an inning.” And that certainly represents how most medical experts feel.
Most coaches already rely on pitch counts to determine when they should pull a pitcher out of a game, as well as other factors such as age, mechanics, weather and how tired a pitcher looks. And the general consensus is that they wouldn’t have a problem with official rules to reinforce that.
“I have no problem with a pitch count,” Clarkstown South coach Mike Amendola said. “To me, it’s what we do anyway. For the health of the kids, it makes sense.”
Of course, there are many hurdles to jump.
What would the exact number be for each age group? Would the pitch limit change for the playoffs? Who would be responsible for tracking the pitches? And will enough people get behind it to spur action at the state level?
These are all legitimate questions, but what isn’t up for debate — at least among those who have studied this topic scientifically — is that the fewer pitches a young arm throws, the less likely that pitcher is to suffer an injury.
It’s true that pitch counts won’t solve everything and some pitchers are capable of handling much more than others — and it’s also true that most coaches are already very careful about this. But even if a new rule would only prevent a few sporadic instances of overuse per year, isn’t that worth it?
“I think it’s actually a good idea,” White Plains coach Marcel Galligani said. “Most coaches have a good feel for preserving the integrity of pitchers’ arms. A reasonable pitch count with sufficient rest in between (outings) is the right thing to do.”