I hope many were watching 2013 Urban Invitational this evening on the MLB network while listening to what the broadcasters had to say about Curveballs and Sliders in the youth leagues.
Young pitchers are increasingly at risk of injury
By JEFF BERSCH
Fort Collins Coloradoan
The scar stretches some 6 inches on Kevin Kroneberger's right elbow, a permanent reminder of the pain he felt one April afternoon.
The Poudre High School baseball player was warming up to pitch a nonconference game at All-City Field in Denver.
"I warmed up pretty good," Kroneberger remembers. "It felt great, actually. Nothing hurt."
A few pitches into the first inning, Kroneberger felt a pain in his elbow. Two pitches later ...
"I felt a pop; it was definitely a huge pop," Kroneberger said. "I felt it snap. I threw one more pitch ... (but) I just couldn't take it. It was that painful."
Kroneberger, 17 at the time, knew something was wrong. After years of playing baseball, he suddenly couldn't throw anymore.
The ulnar collateral ligament, or UCL – the primary elbow stabilizer – had snapped and pulled away from the bone. He needed surgery.
Kroneberger is among a growing number of kids needing what is commonly referred to as Tommy John surgery, named for the first pitcher to have the procedure done 30 years ago.
Once reserved for professionals or college players, the need for Tommy John surgery has trickled down the age ladder.
Doctors couldn't tell Kroneberger why his UCL snapped. The injury usually happens over time, the ligament tearing a bit more with every pitch.
Tommy John surgery – known to doctors as UCL reconstruction – usually requires the UCL to be replaced with another ligament, typically the palmaris longus, an otherwise useless or extra ligament in the wrist. Other times, ligaments are taken from the hamstring or other muscles.
In Kroneberger's case, the UCL simply was reattached. Still, it didn't make it any easier to take.
"I had never had problems with anything," said Kroneberger, adding that he hadn't pitched a whole lot during his baseball career. "I was always a center fielder. I wasn't a starting pitcher. I just pitched when I was needed."
Dr. James Andrews, the nation's most recognized name in Tommy John surgery, has operated on some of Major League Baseball's best pitchers, including Chicago Cubs right-hander Kerry Wood and Atlanta Braves ace John Smoltz.
Dr. Glenn Fleisig, research director at the American Sports Medicine Institute, or ASMI, in Birmingham, Ala., said that between 1995 and 1999, Andrews performed 184 elbow-replacement surgeries on baseball pitchers; 21 were high-school age or younger.
From 2000-04, Andrews performed 624 surgeries, 124 of which were on high-school-age or younger patients.
"I know of no (national) database, but I know what Dr. Andrews has done," Fleisig said. "Year by year, it's been a growing trend."
The reason: Pitchers are throwing too much too soon, Fleisig said.
"Injuries that show up in high school, college or later often can be traced to what happened when players were 9, 10 or 11," according to Fleisig and the ASMI.
"When people get hurt, they think they threw too many pitches one day," Fleisig said. "They didn't get hurt that one day. That day was the last straw. ... People are tricking themselves (because) baseball UCL injuries are always overuse injuries."
Fleisig said the tension on the elbow is the main cause of the injury. With each pitch, the UCL tears a bit more. Without proper rest, those tears add up at a faster rate than can be repaired. Eventually, the UCL tears.
The injury is more apparent now than in the past because youth baseball teams including those in Fort Collins, are playing more games. More games means more pitching is needed.
"Of course we are concerned," said Pat Wunsch, director of the Fort Collins Baseball Club, or FCBC. "We're concerned with the competitive teams, teams that travel and play a lot of games. ... But we have limits on the innings pitchers can throw, and it's in place for the safety of the kids."
Limits on the number of innings pitched are popular, whether in league play or over the duration of tournaments. In Rookie and Select League teams in the FCBC, the number of innings allowed is divided by age group.
The club also encourages coaches to "follow league restrictions for all games (league and nonleague) to ensure the health of all pitchers."
The encouragement is needed because many teams in the FCBC play league games, then compete in tournaments on the weekends. The number of games easily can climb into the 60 to 80 range over the summer.
"I've never had anyone ask why (we limit innings)," said Phil Ebersole, the competitive chairman for FCBC. "In fact, the feedback we get is that we should track it for tournaments, too.
"Logistically, that's just not possible. We can't track how much a kid throws in his backyard, either. But the feedback is that we should be even more careful."
The FCBC requires the winning team in each league to report the number of innings pitched by each player. The innings are posted and tracked on the club's Web site.
Wayne Flax, a coach for the FCBC's 14-and-under Sandlots, said his teams have played 50 to 60 games a summer the past five seasons. He is aware of the risk of overusing pitchers. Flax, whose team plays only in tournaments, hasn't found it to be a problem.
"Most of the tournaments have their own limits," he said. "Nobody abuses it.
"Our pitchers are throwing only one game a week, maybe seven or eight innings at the most. ... We're definitely not going to risk it to win a ballgame."
Scott Bullock, the coach at Rocky Mountain High School and the school's summer legion team, keeps close tabs on the number of pitches thrown each outing, as well as innings pitched per week and season.
The second-year coach said he's removed pitchers who were throwing well because they had reached their pitch limit.
Scott Bachman, who just finished his junior season with the Lobos, said he has had some elbow tendinitis during his baseball career. He said rest helps and he hasn't given too much thought to serious elbow injuries.
"You try not to let that cross your mind," said Bachman, a left-hander. "It's just not something you think about, and you just have to take care of your arm and do everything you can to keep it from happening.
"At Rocky, you're never put in a situation where you're throwing a ridiculous amount of pitches. It's about keeping you safe before winning. They won't leave you out there because they want to win so bad."
Bachman estimates that between high school and legion games, he throws about 150 to 160 innings. It's considered a good season by a major-league pitcher if he can pitch 200-plus innings. Still, Bachman said he's not worried about the number of innings he pitches.
"At this time," he said, "it's not a huge concern."
In addition to the amount of pitches and number of innings, another concern is the type of pitches thrown. Fleisig and Andrews say boys shouldn't throw breaking balls – curves and sliders – until they can shave.
More and more, however, younger pitchers are turning to those pitches because they work. Bachman said he didn't start throwing a curveball until he was 13. Even then, he said, he used it about four or five times a game, usually with two strikes on a batter. He began throwing more curves once he was in high school.
"I'd see kids in Denver who were 10 throwing curves and striking all these people out," Bachman remembers. "I'd see it and think maybe that's the pitch I need to get. I'm glad I had good coaches. They told me there'd be a time for that."
Jake Brunner, 14, a pitcher and shortstop on Flax's Sandlots team, already has had elbow problems, going back two seasons. To be fair, the problems stem from a camping trip when Jake slipped and fell; he broke the growth plate in his elbow.
This season, however, two years later, Jake complained again of pain in his elbow. Brunner's father, Dennis, said he and his wife, Jill, took Jake to the Orthopaedic Center of the Rockies, where they learned Jake had fractured the growth plate in his elbow.
Dr. Sean Grey of the Orthopaedic Center of the Rockies said that's a major problem with younger pitchers.
"The cartilage in there is weaker and what happens with the 11-, 12-, 13-year olds is that it basically irritates the growth plate," Grey said. "It can actually fragment and then it affects the angle the arm grows."
Grey said with any elbow injury he recommends rest. Dennis Brunner said Jake did not pitch for six weeks and played only second base, where the throw to first base was much closer than shortstop.
"I don't take it too seriously until it hurts too bad," Jake Brunner said. "When it hurts bad enough, I tell someone about it."
Said Dennis Brunner: "It's not something you want to mess with. It can be a long-lasting injury."
Unlike Bachman, Jake Brunner said he started throwing a curveball when he was 12. He said it was a "football curve," thrown like a football without snapping the wrist. It's supposed to relieve the stress on the elbow.
"I heard about (not throwing curves too young) before I started throwing it, but our pitching coach showed us the right ways to do it," Jake said. "I wasn't worried."
Fleisig, though, said no curveball is safe. He recommends a pitcher learn a fastball at age 8, a changeup at 10 and a curveball at 14. All other pitches – such as a slider or split-finger fastball – should not be introduced until high school.
A study of young pitchers in Alabama showed statistically that kids who threw curveballs had a higher chance to have elbow pain," Fleisig said.
He and Grey also emphasized proper mechanics and recommended young pitchers with elbow problems see a pitching coach to make sure there is no mechanical defect.
That's also the first recommendation of Brian Niswender, a former strength and conditioning coach with the Arizona Diamondbacks. Niswender is the owner/director of athletic development at Performance Dynamics in the Edge Sports Center in Fort Collins.
"I've seen kids as young as 7 or 8," said Niswender, a graduate of Rocky Mountain High. "They are having constant shoulder pain or constant elbow pain. ... They're just throwing too much and not in the right way."
Niswender also recommends strengthening the arm and elbow through exercise. With so many things to worry about, Fleisig has some simple advice for players, coaches and parents. Communication is key.
Coaches should listen to their players, and parents should listen to their sons. And players should never be afraid to come forward when something doesn't feel right.
"The truth is, each kid has different limits," Fleisig said. "We can't have scientists watch every kid, so limits are based on stats about what we believe is right. Limitations are guidelines, but the best way to prevent overuse is communication.
"If your kid says his arm is tired of giving the mannerisms – shaking his arm, walking around the mound or is throwing slower and with less control – don't blow it off."
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