Researchers propose limits on youth league pitching

Pitching can put a significant strain on the arm especially for 9- to 12-year olds.  Credit: Ezra Shaw/Allsport

WASHINGTON (AP)About half of 9- to 12-year-old pitchers feel pain after the game, and youth baseball leagues should limit the number of pitches so the pain doesn't turn into something more serious, researchers say.

"Nine to 12 years old is a very vulnerable time, and a good time to protect these children," said Stephen Lyman, lead author of a report in the American College of Sports Medicine journal, Medicine and Science in Sports and Exercise.

Lyman, an epidemiologist with a Washington-area insurance trade group on highway safety, had worked on the study while he was with the American Sports Medicine Institute, a research and education organization in Birmingham, Ala.

Over two seasons, the researchers tracked arm pain on a game-by-game basis. The study examined data on a total of 298 pitchers in youth leagues in the Birmingham area. The scientists were looking for pitcher complaints of pain in the elbow or shoulder. Over the study period, players who threw more than 75 pitches a game were more likely to say they hurt.

Elbow pain is especially worrisome because it could signal a more severe problem such as damage to growth plates of the bone, Lyman said. Shoulder pain may simply indicate muscle injury, because more of the shoulder is muscle, he said.

Pitchers were contacted by phone after every game, and were asked to rate the severity of the pain. Mild complaints were defined as those in which the player was not taken out of the game or practice. In minor complaints, the player was taken out. In moderate complaints, the player stayed out for a subsequent game or practice and was evaluated by a doctor. In serious complaints, the player was out for the rest of the season and sought medical treatment.

Forty-seven per cent of pitchers reported elbow or shoulder pain; 70 per cent or more of the complaints were mild. Above 75 pitches per game, odds of elbow pain increased over 50 percent. The risk of shoulder pain was 3.2 times higher above 75 pitches than it was at the lowest level, 25 pitches or less.

Three pitchers who visited a doctor with elbow pain were diagnosed with medial epicondylitis, a form of the syndrome labeled "little league elbow." In this form, small tears in the muscle begin to heal but are re-injured by continued use, becoming scarred and painful. One pitcher who complained of shoulder pain was diagnosed with an inflamed rotator cuff; another had a muscle strain.

The researchers also had coaches count pitches according to specific instructions, and researchers made spot checks to be sure the coaches were doing it right. The study found that split-finger pitches such as sinkers tended to be associated with a 70 per cent higher risk of elbow pain. Among 11- and 12-year olds, however, change-ups had a 73 per cent lower risk of elbow pain.

Pitchers should throw more change-ups, the study concluded. This can be done without making performance suffer, Lyman said.

"For the average batter in that age, it's just as difficult to hit a good change-up as a good curve ball," Lyman said. "If you are working off a strong fastball, and cut 15 to 20 miles off your velocity, the kid is not going to be able to hit it."

Although this study did not directly look at pitching mechanics, a follow-up did, said a colleague in the study, David Osinski, executive director of the American Baseball Foundation, a Birmingham organization that does training in prevention of injuries due to throwing.

In the later study, researchers videotaped the pitching. The unpublished data found no indication that injury risk rose with poor pitching mechanics, such as keeping the elbow far forward when the ball is released, Osinski said. However, the unpublished study does not rule out poor pitching style as a cause of injury, because more careful study of biomechanics might turn up a relationship, he said.

The published study recommended a 75-pitch limit in each game, and said pitchers should be removed when they show signs that their arms are fatigued. It also recommended restricting out-of-league pitching, because this also was a risk factor for elbow pain.

In response, a veteran executive at Little League Baseball Inc. raised doubts about how the study was carried out and the wisdom of its conclusions.

Even in the best of conditions, it's easy for a young player to confuse soreness with pain, said Creighton Hale, former president of Little League Baseball, now a senior adviser.

"If you ask a child whether he has any pain, and he has a stiff elbow or shoulder, he may say yesbut it's soreness," Hale said. The difference is important, because pain is more likely to indicate injury, he said.

Imposing a 75-pitch limit may force pitchers off the mound when they are only sore, not in pain, Hale said. And the limit could keep a pitcher from going the distance even if the kid is working on a shutout or a no-hitter, he said.

Some limitation on the number of pitches thrown may be necessaryeven preferable to the various limits on innings pitched that the league has nowbut more data are needed on what the maximum number of pitches should be, Hale said.

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