Interesting Article

Found this on another board thought I’d share it here it’s definitely an interesting read

Debate grows over how to protect young pitching arms

Good stuff, doesn’t thwart the debate. There are some really solid guidelines for parents and players to follow here. Thanks

curve balls does not hurt young arms on every throw, But it increases the likely hood when thrown hard. period.

Kids still growing and throwing too much seems to be the culprit.

Conclusion and Implications for Clinical Practice

[quote]The older and more experienced high school pitchers have more pitching arm injuries than do Little League pitchers. Baseball pitchers playing at the high school level in our sample pitched, on average, more innings, in a larger proportion of games, and had a higher prevalence of pitching with pain and tiredness. The increased bone mass and increased upper arm mass in the older individuals may also increase the load on the shoulder and elbow. We identified important associations among many of the pitching practices.

Our findings, in conjunction with biomechanical studies, lend support to the importance of the regulation of pitch count in young athletes, both within and outside specific teams and leagues. This appears to be particularly true when pitchers are of high school age. Although our study supports the concept of pitch-count regulations to limit pitching volume in these athletes, the implementation of these regulations is problematic because significant numbers of pitchers play concurrently in more than one league.[/quote]

Bold added.

From the research, a five year study which began in 2006. They set out to prove that the breaking ball was breaking kids arms and found out not so much. Why are prominent doctors in the medical field still calling for a ban on breaking balls? Because they started calling for it way before the research was done and they can’t backtrack now.

And now the implementation of the pitch count rules has been found ineffective due to [quote]problematic implementation[/quote].

Should we keep a rule that doesn’t achieve its purpose? Aren’t the kids most at risk also the kids most likely to participate on multiple teams on a year round basis? These are the same kids that the pitch limit has no effect on.

Yes, it’s a wonderful concept, but we are taking the wrong approach.

Educate…one coach, one parent, one player at a time.

Actually there is research correlating curveballs to injuries in youth pitchers.

In 2008, in Prevention of Arm Injury in Youth Baseball Pitchers, J. La. State Med. Soc., Vol. 160, March/April 2008, Drs. Andrews, Fleisig, et al. state that “past data have demonstrated a risk of arm pain in younger pitchers (ages 9 – 14) who throw breaking balls (curveball),” and in the footnote they cite their own 2002 article Effect of Pitch Type, Pitch Count, and Pitching Mechanics on Risk of Elbow and Shoulder Pain in Youth Baseball Pitchers, Am. J. Sports Med. 2002, 30:463-468.

Southpaw,

This is not what the article you cited said. It said:

[quote]Although past data have demonstrated a risk of arm
pain in younger pitchers (ages 9 – 14) who throw breaking
balls (curveball),2 this case controlled study did not show
a correlation between age at which a curveball was first
thrown and risk of subsequent surgery.[/quote]

Bold added - “pain not injury”.

And then it went on to say:

[quote]However, numbers of pitchers for both groups were relatively low for those who threw curveballs before reaching puberty. Subsequently,
a recent analysis of biomechanics of various pitch types
suggests that the curveball may not be more harmful than
the fastball for youth pitchers.
[/quote]

Bold added.

The issue is not what pitch, it is how many and the frequency and the intensity and a variety of other variables. Andrews will tell you to avoid curveballs at the younger ages not based on the myriad of research studies that conclude this, but out of personal anecdotal reason. They have been looking for a correlation between the curveball and injury for a decade at least and cannot demonstrate one.

Let’s go right to the source…

This is the ASMI March 2011 position statement update:

[quote]Thus, the recommendations for preventing injuries in youth baseball pitchers are:

Watch and respond to signs of fatigue. If a youth pitcher complains of fatigue or looks fatigued, let him rest from pitching and other throwing.
No overhead throwing of any kind for at least 2-3 months per year (4 months is preferred). No competitive baseball pitching for at least 4 months per year.
Do not pitch more than 100 innings in games in any calendar year.
Follow limits for pitch counts and days rest. (Example limits are shown in the table below.)
Avoid pitching on multiple teams with overlapping seasons.
Learn good throwing mechanics as soon as possible. The first steps should be to learn, in order: 1) basic throwing, 2) fastball pitching, 3) change-up pitching.
Avoid using radar guns.
A pitcher should not also be a catcher for his team. The pitcher-catcher combination results in many throws and may increase the risk of injury.
If a pitcher complains of pain in his elbow or shoulder, get an evaluation from a sports medicine physician.
Inspire youth pitchers to have fun playing baseball and other sports. Participation and enjoyment of various physical activities will increase the youth’s athleticism and interest in sports.[/quote]

I don’t see anything in there about the curveball…if they had any research that even hinted in that direction wouldn’t you think it would be in there?

You know why? Because the curve ball has now turned into the hot potato just like pitch limits were before. My thought is the reason they see anecdotal connections between curveballs and injuries in their practices is because the effective pitchers are throwing curveballs, they are being used more because they are effective and they are being injured due to overuse. So there is a good reason to limit a pitcher’s effectiveness…so every coach in your area won’t want to throw him on the bump every chance he gets.

Dino,

Arm pain in youth pitchers is bad, bad, bad. It often is a precursor to injury that manifests later in life.

I’m not going to blithely dismiss that scientific study finding “pain” in youth pitchers resulting from curveballs on the simplistic ground that it found “pain” and no (yet) developed injuries.

Rather, I happen to agree with Dr. Timothy Kremchek, who, in the article linked in the original post, states:

[quote]Dr. Timothy Kremchek, an Ohio orthopedic surgeon who is the Cincinnati Reds’ physician and whose practice frequently treats youth pitchers, called Little League’s stance [allowing curveballs] irresponsible.

“They have an obligation to protect these 12-year-old kids and instead, they’re saying, ‘There’s no scientific evidence curveballs cause damage, so go ahead, kids, just keep throwing them,’” Kremchek said. “It makes me sick to my stomach to watch the Little League World Series and see 12-year-olds throwing curve after curve. Those of us who have to treat those kids a few years later, we’re pretty sure there is a cause and effect.”

Kremchek said he performed 150 elbow ligament reconstructions a year, a complex operation named after the former major league pitcher Tommy John, who had the surgery when it was developed in the 1970s.

“Seventy percent of those surgeries are pitchers who haven’t hit college yet,” Kremchek said. “I ask each one the same question: when did you start throwing curveballs? And they say: ‘I was 10. I was 11.’ Sometimes, it’s 9.”[/quote]
Dr. Kremchek’s advice against youths throwing curveballs coincides exactly with what my orthopaedic surgeon friend says. And that’s all I need to hear: my 10 year old is not throwing curveballs.

I was going to originally post this in Coach Baker’s topic, but I thought it fit better here. It does not really relate to number of pitches, but rather my introduction to the breaking ball. Enjoy!(I apologize for grammatical/spelling errors in advance)

My dad introduced the curve-ball to me, in my opinion, a very effective way.

When I was 13, during the summer, I was curious about how to throw it. My dad said I couldn’t throw it in a game or hard, but I could play around with it when I played catch. So that’s what I did. I didn’t throw a lot of the and I didn’t really snap them off that hard. I wanted to see a lot of break.

I played fall ball that year, my birthday is Aug. 27, so I was 14 when I was playing fall ball. It was a rec league so we didn’t play that many games. 15 tops. So my dad let me start throwing during that season.

Summer ball starts next year and I’m allowed to pitch it, but I baby it really bad. My dad didn’t said that I babied it, but I never really got the concept of snapping it hard until I was older. I think that was a blessing in disguise because I was able to have an effective breaking pitch and I was able to learn the arm motion of a curve-ball.

I know can throw a curveball and a slider with a simple change of the grip. I never have to think about what my arm of hand does when I throw a breaking ball.

I think that too many youth pitchers don’t learn the motion of the breaking pitch first. They learn to snap their arm as hard as they can and the results can be bad. Mechanically and health wise.

You can’t completely tell a kid to not throw a curve when he’s playing catch. He’s probably going to try to throw it anyways. I see a lot of kids that play high school ball and throw hard, but have a terrible breaking ball.

I think if you teach kids how to throw it at a younger age with sound mechanics, it will help them throw it when they are older.

That being said, the youngest I would let a kid throw is 14. But I guess it depends on the maturity of the kid. It makes me sick seeing the little league world series will 4’10 90 kids throwing breaking ball after breaking ball. They don’t really snap them, but they sure do throw a large number of them.

Southpaw,

My son did not throw a curve ball until he was 14. I salute your resolve to protect your son’s arm and I defend your right to do it the way you feel is best because guess what? Who knows your son more than you?

Just because I point out that science has not produced a direct link between curveballs and injury, doesn’t mean I think its a good idea to let your young pitcher throw breaking pitches. The 2002 study did not separate overuse and specific use (curveballs). I provided a theory on why they saw a connection between curveballs and pain (a precursor to injury). It is because kids with curveballs tend to pitch ALOT.

What I do is allow for a parent, who knows his kid well, to chose to allow his kid to throw the breaking ball, taught correctly and if the parent is smart, he will protect him from overuse.

Dr. Kremcheck sees a cause and effect. I wouldn’t discount this “blithley” either. My son actually never threw the overhand curveball much. He went right to the slider. And at about that time he became a very effective pitcher and pitched half the games for his high school. And that’s when overuse began to rear its ugly head. Showcases, college visits, side workouts for invitationals, scout teams. But all this happens to the successful youth pitcher at growing younger ages. They appear in the offices of orthopeadic surgeons in ever increasing numbers because they play year round and for multiple teams and they happen to throw the curveball because that’s what made them good pitchers.

Hey, that’s my opinion. I respect yours.

Dino,

Glad to hear your son didn’t throw a curve until 14. Looks like Jimster also threw his first curve at 14.

I like 14. It’s the age my father let me start throwing curves, and I pitched through high school without ever having any arm pain or injuries (unfortunately I grew very late, from 5’9" my senior year in high school to 6’1" in college, and so was too small for college ball). Hell, to this day I’m one of the few 50-ish coaches who can still throw 150-pitch batting practices to my son’s LL Majors team! :lol:

You’re right about my care for my son, who’s 10. It’s interesting, with each passing season I seem to have a greater sense of how young he really is and how much still lies ahead of him. I started teaching him to pitch as he neared his 8th birthday, and he pitched in a game for the first time at 8 in LL Minors. I have always been “by the book” on his pitch counts, rest days, etc., and if anything have erred on the side of pitching him too little. So when I see him bat in LL Majors now against 11 and 12 year old pitchers who throw curves right and left, I just don’t get it. Sure, the curves are effective, if not devastatingly effective, against 12U batters. But what is the pitcher achieving? “Glory” in a Tuesday night LL game? :roll: At what cost?

To me, the bottom line is that, as Dr. Fleisig says in the article linked above, these latest studies “did not prove curveballs are safe.” Until they can prove they are, I’ll follow Dr. Timothy Kremchek . . . and my old man. :slight_smile:

Dino,

Your last post sounds like a perfect argument for pitch count implementation to me. :wink:

If what you say is true, any problems that came about, lie directly on your shoulders. What you should have done was to set some kind of limits, and force the boy to stick to them, the same way you’d set limits for watching TV, having a curfew, or not allowing tobacco use, thus forcing him to be more judicious about using his allotment of pitches.

But you didn’t do that very well, and prolly for the same reasons I didn’t. You liked seeing the boy succeed, and put that above his safety. The difference between our stories is, I did my job well enough while my boy lived under my roof and was my responsibility, because although he had quite a workload, he never had any arm issues. It wasn’t until he was off to college that there were any issues, and undoubtedly his prior workload had something to do with what issues he had.

But that’s what the parents of every pitcher have to deal with. Some do it better than others, and for sure all children have different tolerances. Its more than difficult to pick the “correct” amount, and almost impossible to refuse a child the opportunity to have success, but that’s what parents are for. Each of us must make his/her own decisions about how to raise their children, then we have to live with those decisions. Trouble is, so do our kids. Its great when we’re right, but when we’re wrong, it’s a terrible burden.

I’d like to follow up this conversation with some personal observations on the arm injury front.

Well, our 2012 Little League Majors season is winding down in the next few weeks. We have several of our best 12 year old pitchers - 4 at last count - who are now “out” due to arm pain. They have all been seen by orthopedic doctors and cannot pitch any more this season and may have to miss Little League All Stars this summer.

What do all four of these 12 year old pitchers have in common? They threw curveballs. Lots of them.

What do all the other 12 year old pitchers in our league who are not injured have in common? They threw no curveballs or very few curveballs.

And before anyone blames these injuries on “over pitching” instead of the curveballs, let it be known that our local Little League has actually stricter pitching limits than what is required by Little League International. The Little League International limit of 85 pitches per game for a 12 year old is, in our local league, also a weekly limit. Thus, a 12 year old cannot throw more than 85 pitches in a week even if he meets the “days rest” requirement. For example, he can’t throw 65 on Monday and get three days rest and throw 85 on Friday, which would be 150 pitches for the week. He can throw only 20 on Friday, making a total of 85 pitches for the week.

In short, I know what I have seen. My eyes don’t lie. And, what my eyes tell me only confirms what Dr. James R. Andrews et al. found in their 2002 study of 476 youth pitchers (9 to 14 year olds):

“Effect of Pitch Type, Pitch Count, and Pitching Mechanics on Risk of Elbow and Shoulder Pain in Youth Baseball Pitchers,” Am. J. Sports Med., Vol. 30 No. 4 (2002).

Anecdotal at best, or a case of “You See What You Want To See.” Anyway, we know what your opinion is and it is certainly consistent.

Interesting that your strictly adhered to conservation pitch count rule, did nothing to protect these pitchers arms. Which, if what you perceived happened…happened…demonstrates that the ASMI inspired pitch count rule although well intended is an unmitigated and complete failure because no league has banned curveballs.

So is it time to ban the curveball? Or ban overhand pitching? Or perhaps ban pitching altogether? Why not a pitching machine? Then we can have a website called "LETSTALKPITCHINGMACHINES.COM.

It is what it is. It’s what happened here in our league. You calling it “anecdotal” isn’t going to change what happened or remedy any of these kids’ arms.

You’re also mixing apples and oranges. The pitch count rules were not a “failure” but rather a success, as all pitchers in our league were held to the pitch count rules and not one pitcher has had an arm injury – except those pitchers who regularly threw curveballs. Interesting that from these facts, which clearly point to curveballs as the culprit, you try to blame the pitch counts. LOL. Hey, at least you are consistent in your disdain for pitch counts.

As for banning curveballs in Little League, greater minds than mine (and yours) advocate this. As reported in the New York Times, Dr. Timothy Kremchek, who is an orthopedic surgeon and the Cincinnati Reds’ physician, performs “150 elbow ligament reconstructions a year, a complex operation named after the former major league pitcher Tommy John, who had the surgery when it was developed in the 1970s. ‘Seventy percent of those surgeries are pitchers who haven’t hit college yet,’ Kremchek said. ‘I ask each one the same question: when did you start throwing curveballs? And they say: I was 10. I was 11. Sometimes, it’s 9.’ Kremchek has coaxed about eight Ohio youth leagues to prohibit breaking pitches.” http://nyti.ms/Kv6gLd

I’m not a medical doctor. But forced to choose between an orthopedic surgeon who is the Cincinnati Reds’ physician and a person who is neither, the choice is easy.

And by the way, my friend who is an orthopedic surgeon and my friend who is the Manager of a Minor League team, both hold the same view as Dr. Kremchek.

south paw,

Believe me, I know how frustrating it is to try to discuss the subject of curveballs and how they relate to youth injuries, let alone when you throw pitch counts into the discussion too. As much as I hate to say it, you’re just gonna have to get used to ignorance and lack of common sense, and just keep doin’ what you know is the right thing to do. Once you accept that there will always be a percentage of people who value winning a game above everything else and will risk anything to get it, the frustration doesn’t go away, but it reduces to the point where it doesn’t drive ya quite as nuts as it could. :wink:

Free will…you go your way, I’ll go mine. That’s the way it should be. If you want to avoid pain altogether…Only one pitch count works. That’s zero. Everything after that is a crap shoot.

Please, return and report how many of those pitchers actually pitch for the All Star Team this summer. I would be interested in knowing.

I believe pitch counts are good but not fool proof. Screwy scheduling and playing both league/travel puts responsibility on the parent to use common sense. My son is 13 years old and plays both league & travel, no Jr High ball where we live and long wait for travel to start at this age. Agreement with travel coach before agreeing to play is league is primary until concluded and no pitching in travel period. Position play and hitting, make every game we can. When league is over he will play full time travel ball. Even in league with pitch counts easy to overuse. 95 pitch per game limit and eight innings per week. Ended up with three games in five days over course of two different weeks. My responsibility as a parent is to say no to pitching all three games even though he could. Even though his arm doesn’t hurt and he wants to pitch in tournament one day after pitching 96 pitches in a league game it is my responsibility to say no even though he can. By the way his pitching coach chided me for letting him throw 96 in a game, says to limit to 75 at his age even if the arm feels fine. Also recommends running for twenty minutes the day after and throwing (not pitching). Easy to abuse young arms and stay within the rules, our responsibility to watch out for them.

[quote=“Dino”]Free will…you go your way, I’ll go mine. That’s the way it should be. If you want to avoid pain altogether…Only one pitch count works. That’s zero. Everything after that is a crap shoot.

Please, return and report how many of those pitchers actually pitch for the All Star Team this summer. I would be interested in knowing.[/quote]

That’s where the ignorance starts. No one’s trying in any way, shape, or form trying to avoid pain altogether, but its something folks like yourself dream up in order to validate your beliefs that pitch counts are worthless. Its about easily avoidable injuries.

Why is it so important that kids fight through pain and injury to prove their manhood? What is it that they gain?

South Paw,

Any idea what percentage of those kids’ pitches were curves? Also, did those kids play on other teams in parallel with Little League? Do they play year-round? How are there mechanics?

I know it’s difficult to know all of this - thus the problem of youth pitching injuries - but there’s just too many variables for me to pass judgement. I’m not saying throwing curves didn’t cause or contribute to the kids’ injuries - I’m open to the idea that curves are hard on the arm. But I just don’t have enough info from what you’ve reported to say for sure one way or the other.