Playing Hurt: New limits designed to protect young pitching arms

A 10-year-old Little League pitcher winds up, reaches back and throws to the catcher, hoping for a strike and perhaps imagining himself as a big leaguer winning the seventh game of the World Series.

Added to this familiar scene this past year has been a coach in the dugout, counting the pitches and enforcing a new Little League rule that limits how much any one player can throw in a game.

Little League, which finished its season with a World Championship game this past weekend in Williamsport, Pa., implemented the rule to protect young arms and elbows from the strain of overuse.

“We’ve seen an alarming increase in arm injuries,” said Little League spokesman Chris Downs.

Beginning this year, Little Leaguers ages 9 and 10 are limited to 75 pitches per game. Players ages 11 and 12 are limited to 85 pitches. Those 13 to 16 may throw up to 95 pitches.

Little League also limits how soon pitchers can return to the mound. Those who throw 61 or more pitches in a day must not pitch for the next three days. Pitchers who reach 41 to 65 pitches must have two days’ rest. And 21 to 40 pitches require a day’s rest.

Pitchers who throw up to 20 pitches can return to the mound the next day.

Little League’s rules previously limited pitchers to a certain number of innings each week. However, Little League innings can linger due to the sometimes limited talent of players in the field, and that can wear down a pitcher.

Evidence of an increase in pitching injuries is largely anecdotal, from doctors and practices such as the Alabama Sports Medicine and Orthopedic Center. A decade ago, less than one in 10 athletes who received sports-related elbow surgery at the center were teenagers. Over the past three years, one in four patients are in high school.

Glenn Fleisig, research director for American Sports Medicine Institute, which was created through the center, said doctors across the country report similar increases.

Fleisig and Dr. James R. Andrews, the institute’s medical director, worked with U.S. amateur baseball officials to study how overuse leads to pitchers’ injuries. Their findings sparked Little League to implement a pitch count.

The most common injury, almost exclusively found in baseball pitchers, is a torn ulner collateral ligament, which holds together the upper and lower arm bones. The injury is caused by overusing the elbow, Fleisig said, and develops over time.

The procedure to replace the ligament is known as Tommy John surgery, named for the first major league baseball player to undergo the operation in 1974. Surgeons use tissue from other parts of the body to fix the damaged ligament.

Andrews’ Birmingham office, one of the country’s leading orthopedic practices, performed more than 600 Tommy John surgeries between 2003 and 2006. Of those, 148 were done on high school students.

From 1996 through 1999, Andrews did just over 100 total procedures, nine of which were performed on high school students.