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couldn't happen in Iowa

That's a joke and that's what is wrong with baseball today. We wonder why so many people are getting elbow and shoulder surgery today? there you go. This is only news because it made it to ESPN but just stroll out to your local ballfield and watch 10 year olds throwing 80 - 90 pitches a day.

Ridiculous
 
I had tommy john surgery from Dr. Andrews in 2001 and in his exact words, this injury was due to happen, the amount of scar tissue that we found and the damage that we found to your UCL had been there for a long time and from the over usage during my teenage years. The problem is most youth don't have great mechanics and combine that with over usage and you spell trouble. 194 pitches is unreal, big league managers don't like to leave full grown, 6'3"+ men in their prime out on the mound for 100 pitches.
 
I've seen this happen in Iowa. My sophomore year of high school, a kid threw something like 180 pitches against us in districts. Then he threw like 50-60 in relief in their next game, and threw another 150 in a loss in district finals. Completely ruined what had been a great arm in little more than a week.
 
I have seen numerous HS kids throw easily over 150 pitches.

It is kinda crazy.

There is a school, whose name rhymes with Gladbrook/Reinbeck who has overthrown pitchers year in and year out and they have suffered injuries to their best players from it. Shameful.


Now, if a kid is a senior and he wont be playing after HS, I dont have a problem with a higher pitch count on occasion so long as they get adequate rest. Usually, that would mean a minimum of 4 but preferably 5 or more days rest and the next outing should be lower pitch count than normal. Again, that would not be a regular thing either.

If it is post season and a kid isnt going to be playing after HS, I dont have that hard of a time seeing him with higher pitch counts and less rest. Common sense stuff there is hoped for
 
USSSA team last year caused damage to a few of the players on their team from over pitching.

Played against a team a few years ago that had their 12 year old throw 119 pitches in one game.
 
TM3308, how many innings did this kid throw. The most you can pitch in Iowa one day is 9 innings. If he did he would of had to at least have 2 days rest.
 
I saw a kid throw over 200 in 9 innings on a Monday and came back and threw 7 more on Thursday (not sure how many pitches). It happened about 10 years ago when the kid was pitching against my brother's team. Couldn't believe his coach was doing that to the kid. He was obviously laboring and had lost all effectiveness. Lucky for him he had lost everything he had on the ball and had gone from a hard thrower to one of those guys that has no control, didn't throw hard, but just enough to keep from walking everyone. Guys couldn't make an in-game adjustment on him and ended up on their front foot and were popping up all night.
 
I know the pitching limitation rule is based on innings but I think it should be based on pitch count. My son one game threw only 35 pitches in 5 innings but had to have 2 days rest because of the rule.
 
Originally posted by acoach#5:
I know the pitching limitation rule is based on innings but I think it should be based on pitch count. My son one game threw only 35 pitches in 5 innings but had to have 2 days rest because of the rule.
He shouldn't have had to, based on the situation you've described.
 
Parker, I stated that wrong. He pitched 4 innings the next day in relief then had to have his 2 days rest. It sucked that the first day counted as 5 innings with only 35 pitches and he couldn't go longer the 2nd day.
 
Exactly...he would have had to pitch on 2 consecutive days in order to be required to have 2 days rest. Make sure your coach understands the pitching limitation rule.

PITCHING LIMITATION
RULE


A. Sixteen innings will be the maximum total number of innings a pitcher may pitch in a
given week. (For purpose of reference, Sunday through Saturday is a week.)

B. A pitcher may not pitch more than a total of nine innings in any one day or on two
consecutive calendar days. The ninth inning must be followed by two calendar
days of rest. A game started on one calendar day, but is not completed until
the next day, and is not a suspended game is to be considered played on the
original calendar date the game started.
C. If a pitcher pitches on any two consecutive days with the combined total greater than four innings, he
will follow with two calendar days off for rest.
 
Originally posted by acoach#5:
Parker, I stated that wrong. He pitched 4 innings the next day in relief then had to have his 2 days rest. It sucked that the first day counted as 5 innings with only 35 pitches and he couldn't go longer the 2nd day.
Gotcha! I agree that pitch count is something that should be figured into the equation somehow. I'm sure that 5 inning game was nothing more than a nice bullpen session and probably felt great the next day! Too bad.
 
Originally posted by acoach#5:
TM3308, how many innings did this kid throw. The most you can pitch in Iowa one day is 9 innings. If he did he would of had to at least have 2 days rest.
The first game was 7 innings. Couple days later, I want to say he threw like 3 innings in relief. The district final, IIRC, only lasted 5 innings. He got drilled by Lenox the year they won the 1A title. So the coach was within the rules, but any idiot should have known that it was well beyond excessive.

Basing it on pitch count is flawed, too, but it's better than going by innings. Throwing 45 pitches in an inning is extremely taxing, so even if a kid throws two innings and 60-65 pitches, he could have put a lot of strain on himself. Now if you've got a kid who has 2-3 longer innings like that in a game (say 25-35 pitches is a longer inning), but is very effective in the others, his final pitch count will be a little deceptive.

Ultimately, it comes down to coaches knowing how to handle their pitchers. Which means this problem isn't getting solved anytime soon.
 
I've read where Dr. Andrews has said the radar gun and showcases are huge contributors to the injury. He's also said that year-round baseball is a big factor too.

To his point, I've seen several instances where a pitcher/player get's overamped in certain situations and blows the UCL in one mighty attempt to impress the radar gun or a scout/coach they know is in the crowd. I've seen it happen at showcases, summer league ball (e.g., Cape League, NorthwoodsLeague etc...) and in high school games.

Here's a pod cast from the Baseball America on the arm injuries occuring a the college and pro level. If you're not familiar, these guys are baseball fans who run a website and magazine out of North Carolina. Not vouching for their credibility, but I thought they raised some interesting points.

http://www.stitcher.com/podcast/baseball-america/episode/33940419?autoplay=true
 
the kid from Gilbert threw a mother load of innings during the state tourney a couple of years ago. That coach should have lost his job. The abuse (regardless of the rules) that is endured just to win a game is horrendous.
 
Originally posted by gg2224:

I've read where Dr. Andrews has said the radar gun and showcases are huge contributors to the injury. He's also said that year-round baseball is a big factor too.

To his point, I've seen several instances where a pitcher/player get's overamped in certain situations and blows the UCL in one mighty attempt to impress the radar gun or a scout/coach they know is in the crowd. I've seen it happen at showcases, summer league ball (e.g., Cape League, NorthwoodsLeague etc...) and in high school games.

Here's a pod cast from the Baseball America on the arm injuries occuring a the college and pro level. If you're not familiar, these guys are baseball fans who run a website and magazine out of North Carolina. Not vouching for their credibility, but I thought they raised some interesting points.

http://www.stitcher.com/podcast/baseball-america/episode/33940419?autoplay=true
I think specialization is a big factor, too. Only working the same select group of muscles in the same way is not good physiologically. Participating in a variety of different sports/activities throughout high school, IMO, would help cut back on the number of Tommy John surgeries among high school and college players.
 
an arm only has so many throws in it. so while all of these things that everyone brings up are factors there is no indication of when a specific arm / shoulder will go out. Genetics, training, diet all come into play as to how this happens. Pitch counts are the best precaution but every case with every pitcher is different and has to evolve over time.

What I find funny is everyone complains about how much a kid pitches but.....how many times have you seen this.....kid throws 5 or 6 innings....then coach removes catcher - sometimes in the middle of the inning and throws catcher on the mound. That one drives me crazy. I pulled my oldest kid off of an elite team when he was 12 years old because in a tournament in March in 30 degree weather.

It all comes down to education....and parents have to stand up to these pinhead coaches and tell them these are my rules and if you don't like it we will find somewhere else.
 
I think most quality programs have coaches that monitor pitch count pretty closely now. I graduated in 05 and I never had a pitch count kept on me until college. Needless to say it was too late. I had shoulder surgery my freshman year of college. I've been coaching a pretty decent 1a team during spring ball and it's an easy argument to win when a kid resists being pulled because of a pitch count!
This post was edited on 5/22 7:13 AM by SkipRip
 
Kerry Wood....holy crap....horrible mechanics and needed to throw his slider in place of his fast ball.....Yes he probably through to much but him along with Prior had the worst inverted L ever.

Mechanics I would say led to their problems more than overthrowing...but overthrowing was an issue for both
 
Originally posted by oonfoofoo:
Kerry Wood....holy crap....horrible mechanics and needed to throw his slider in place of his fast ball.....Yes he probably through to much but him along with Prior had the worst inverted L ever.

Mechanics I would say led to their problems more than overthrowing...but overthrowing was an issue for both
Mechanics were definitely a big factor for both of them. But overuse also had a hand; you throw 10 pitches with those mechanics, odds are you're probably going to be fine. But they threw God only knows how many pitches over 15+ years, all with those same poor mechanics. That's absolutely got a cumulative effect.
 
Ah yes... Mark Prior the perfect pitcher. Just ask Tom House. House said he was perfect and he was the only one saying it....everyone else bought into it. Prior even said himself that he wasn't perfect. I heard him speak once and he was asked about his mechanics and he said - all upper body and whip. He admitted that if he would have relied more on lower body drive that he might not have been throwing 98 but he would have had a longer career. When he came back in 2009 you can clearly see the difference in his mechanics and he said that "this feels right". Too bad....he was fun to watch when he was on.
 
None of these are from Tom House, influenced by him? probably


"but I've been led to believe by multiple sources--as diverse as (Montreal Expos minor league pitching coordinator) Brent Strom and our own Will Carroll--that Prior's mechanics are as drop-dead perfect as they come. I'm inclined to think that Prior is the Tom Seaver of our generation,"


"In the terminology of pitching biomechanics, Mark Prior is a freak."

According to Gary Heil of the National Pitching Alliance (sic), Prior was tested using high-tech Matrix-like technology to assess his mechanics.
"No one else was even close," Heil said. "He's the model; he's perfect."

Dr. Mike Marshall is a former Cy Young Award winner who has completed extensive scientific studies of the pitching motion. Using basic, Newtonian principles of inertia and reaction, Marshall's teachings show that Prior's controlled delivery is near ideal.

"His mechanics GPA was off the chart, with elite marks in every category across the board: ideal balance and posture, excellent momentum, plus-plus torque, and amazing repetition of timing. It is certainly possible that mechanics contributed to Prior's injury risk. However, it is also a tribute to his mechanical efficiency that he was able to perform so well under such harsh conditions. The collective understanding of pitching has devolved thanks to the popular misconception that Mark Prior had bad mechanics"
 
Tom Seaver? you can look at the two in slow motion and see that they were not even close in mechanics. Inverted W must have been ideal back then?

This all comes from House and others being followers of Paul Nyman. Nyman marketed the inverted W as the cure all to velocity and people like House - who admitted this, bought into it.

House started all of the commotion about Prior and everyone that saw that information and people that you have quoted are all supporters of Nyman and the inverted W - or were at the time. I grew up in socal when this was going on and I can tell you that house either was looking to the future for marketing or saw that he could be the next Dedaux or what? nobody will ever know.

pretty good google search though!
 
I am playing a half-hearted devil's advocate here and the following comments are meant to be provocative (after all, the season doesn't start for another three days, what else are we going to talk about)....

In addition, I know there are smart pitching people out there and I'm generally interested in opinions on the following:

1) In high school, is it "fair" to restrict a pitcher's participation, one who has worked hard to develop good mechanics and has historically practiced excellent arm care - in order to protect others - specifically, those who may not have been so wise or lucky enough to have a coach/parent protect him, through innings and instruction, when they were young?

2) And as a corollary, in what other sport do we, by rule, reward foolish/harmful behavior by restricting the participation of those individuals who are disciplined enough to practice smart behavior?

3) Or are high school pitching limitation rules really more about preventing practiced, learned and health conscious pitchers from dominating a sport and less about the preservation of player health?
This post was edited on 5/23 8:44 PM by gg2224
 
I've been working with a young kid who really loves baseball and wants to be a pitcher. I played a lot of baseball but didn't pitch beyond the middle school level.

What are the main points to emphasize when developing a young pitcher? What specific fundamentals are most important to avoid arm trouble in the future?

This kid throws very hard and has pretty good basic mechanics (in my humble opinion), but I'd like to be sure that I'm teaching him the right things.

Curious as to everyone's thoughts, and thanks.
 
Originally posted by gg2224:

I am playing a half-hearted devil's advocate here and the following comments are meant to be provocative (after all, the season doesn't start for another three days, what else are we going to talk about)....

In addition, I know there are smart pitching people out there and I'm generally interested in opinions on the following:

1) In high school, is it "fair" to restrict a pitcher's participation, one who has worked hard to develop good mechanics and has historically practiced excellent arm care - in order to protect others - specifically, those who may not have been so wise or lucky enough to have a coach/parent protect him, through innings and instruction, when they were young?

2) And as a corollary, in what other sport do we, by rule, reward foolish/harmful behavior by restricting the participation of those individuals who are disciplined enough to practice smart behavior?

3) Or are high school pitching limitation rules really more about preventing practiced, learned and health conscious pitchers from dominating a sport and less about the preservation of player health?
This post was edited on 5/23 8:44 PM by gg2224
I think the first point is probably the best one. It's not fair to the individual kid who's worked hard, etc. But that kid represents a very small minority; very, very few kids have outstanding mechanics and really take care of their arms -- especially in Iowa. Think about the players at the small schools in your area, and ask yourself how many of them run X-number of poles, ice their arms, etc. religiously after pitching. They're high school kids, not college/major league pitchers; the majority of them aren't going to take care of their arms as well as they should, mostly because they don't know any better.

It sucks for the handful of guys who could easily handle a bigger workload because of how well they take care of themselves, but there's no realistic way to determine which kids need limitations and which ones don't, and there are plenty that do need those limitations. So the limitation applies to everyone.

I definitely don't think the third point enters the discussion at all. Especially in the smaller classes, you don't need great mechanics to be dominant. Look at Ethan Westphal at Lenox/MSTM. He didn't have anywhere near flawless mechanics, but was he not the most dominant pitcher in Class 1A for three years?
 
Why do we have laws? Most people follow the law, are law abiding citizens and are just good people. Without laws your have anarchy. without pitching limitations you have doctors making boat loads of money on surgery.

There are other reasons for these rules. What people don't realize is pitch inning limitations were put in to keep teams from using one or two players every game and not giving a unfair advantage to teams that would throw their stud every game. The rule when it was put in originally was not about protecting kids from number of pitches. I have seen kids throw 60 pitches in an inning and nobody blinked...."he only threw two innings" from the coach.

On number 2 in your questions...because the kids that are throwing don't have the say. The coaches make the determination on the kids pitching....hence the foolish behavior.

And yes on number 3
 
I agree with TH. With the number of score book apps available, which can easily track the number of pitches, there's no good reason not to use pitch count. Ticket clickers work fine too.

Even Andrews' recommendation of 105 pitches a day with 4 days rest seems pretty generous for a skilled pitcher. An ace that can throw consistent strikes might still be able throw 2 complete or near complete 7 inning games per week. That's not far off from our current 16 inning weekly limit. Of course, a bad inning here or there and your weekly innings could drop fast - but that is the point isn't it.

What I like about pitch count limits, especially at younger ages, is it forces teams to develop more pitchers, which has to be good for the sport in the long run.

A recent position statement from the American Sports Medicine Institute on Tommy John surgery. Addresses some good questions about trends, ect...

http://www.asmi.org/research.php?page=research&section=TJpositionstatement
 
Dr. Andrews was on with Dan Patrick yesterday and once I got pasted how thick of a southern drawl he had listening to him speak was amazing.

This is well worth the watch/listen

https://www.youtube.com/watch?v=R_bQowbKxU4

Interesting to note, out of all the factors that have been listed the one that he seems to point to as much as anything is how quickly that kids are maturing, physically, now and how their ligaments can't keep up. Yes, pitch count and what pitches are thrown play into it but that's something that hasn't really been brought up before.

Kids at 14-15 years old now are well past were kids at 14-15 were 30-40 years ago physically.
 
Thanks for posting that interview.

I thought Andrews comments on the trend to treat young players as 'professionals' and the pressure for kids to specialize in a sport and position was particularly on point.
 
A couple years ago at a summer party I overheard a couple parents bragging among themselves about how many pitches their 5th and 6th graders were pitching a week. It was actually kinda sick to listen to them boasting about "beating the system" and having their kids double up on AAU pitching and little league. While the pitch count rules were per week and were to include both there was no mechanism to avoid abuses and doubling up. According to what they said the parents on the other teams who knew about the infractions didn't say a peep because their kids were double dipping too. It also sounded like most coaches knew what was going on but were using a "don't ask don't tell" policy on what was happening on the "other" team.

I also agreed with the interviewer when he talked about "in his opinion this is starting at an early age". Too many parents don't use common sense and think that the more reps they get for their kid in every athletic situation the better off they will be from the experience. While that is true in most athletic situations, when it come to pitching these parents could be doing more harm to their kid than good.

This post was edited on 6/1 1:52 PM by ghost80
 
Throwing a baseball, with the arm raised up behind the head, is not a natural motion. Millard West High senior Mitch Ragan eventually developed elbow problems that led to his recent Tommy John surgery. The operation has become routine in baseball and has a success rate of 90 percent, so Ragan hopes to be back on the mound next season.

Mitch Ragan walked into the doctor's office wearing his favorite sweats, his Red Sox hat and his Millard West letter jacket. Mom and dad were at his side, sharing words of encouragement.

Good news was coming.

Ragan was one month from the start of baseball season, a critical point for a junior who'd targeted college or pro ball since seventh grade. He couldn't wait to take the mound. At 6-foot-3, 250 pounds, he was pushing 90 mph on the radar gun. And his mechanics were better than ever. He just needed Doc to check his elbow.

Two weeks earlier, an early February night at an indoor Omaha baseball facility, Ragan winced during a bullpen session. He'd battled sporadic elbow pain for three years. This time, he felt a clicking sensation. His pitching instructor feared the worst.

Across the country, the most valuable elbows in professional baseball were breaking down,

casualties of an epidemic that experts couldn't solve. But those guys were in their 20s. Ragan was still 16.

Good news was coming.

The doctor, whom the Ragans had known for four years, entered the exam room and echoed the family's optimism. Probably another case of tendinitis. A few weeks of rest and Ragan would be fine.

Then Dr. Doug Tewes laid eyes on Ragan's MRI. He recognized the fluid around the ulnar collateral ligament, or UCL, signaling a detachment from the bone.

When Doc raised his hand to his chin, Mitch knew bad news was coming.

Rather than attracting recruiters and scouts, rather than competing with teammates for a state championship, rather than standing 60 feet, 6 inches from home plate and firing his fastball past hitters who could barely see it (let alone hit it), Ragan would spend 2014 in rehabilitation. Four months later, the farthest he's thrown a baseball is 5 feet.

Tewes turned the MRI toward the Ragans ? "See this ligament here?" ? and uttered a name that always gave Mitch goose bumps.

Tommy John.

***

Baseball has a strange way of recognizing its most gifted pitchers.

Stephen Strasburg was the No. 1 pick of the 2009 draft, the most exciting pitcher in the game ? until he missed 12 months of action during 2010-11 following ulnar collateral ligament reconstruction. Jose Fernandez, the 2013 Rookie of the Year, is out for the '14 season after his own elbow surgery. So are Matt Harvey and Matt Moore and Patrick Corbin and, well, elbows are beginning to resemble ticking time bombs.

Why? That's what Mitch Ragan wanted to know.

Tommy John surgeries, named after the first recipient of successful UCL reconstruction in 1974, have skyrocketed the past decade at all levels of baseball. Twenty-one major-league pitchers have undergone season-ending surgery, a record pace for one year.

But finding consensus among coaches, orthopedic surgeons, physical therapists and data analysts is like turning a quadruple play. Somehow devoting more time and resources to arm care has exacerbated the problem. Fingers point in every direction.

Is it higher velocities? Pitchers are training more intensely, thus, throwing harder. Maybe the elbow can't handle the torque associated with a 95-mph heater. What about mechanical inefficiencies? High-speed cameras allow experts to analyze the pitching motion like never before, revealing faults undetected by the naked eye.

Some say full-grown pitchers are being abused. Some say they're being coddled ? instead of obsessing over pitch counts, they should actually be throwing more in order to strengthen the arm. Some blame the one-size-fits-all method of training; if pitchers come in all shapes, sizes and physiologies, then why are coaches treating them the same?

There's no magic formula for arm care.

"You can name 20 things, and it's probably a part of all 20," said Omaha Westside coach Bob Greco, who won a Class A state championship in May.

There is, however, one factor on which all parties agree. It is the primary cause of pitching injuries, according to doctors. It is the one thing coaches would change immediately, if only they could.

The next generation of baseball players is playing far too much baseball.

***

Mitch Ragan lives in the same house he did when he first picked up a glove. At night he could look across Q Street and see the baseball field lights at Millard West.

"He used to dream about playing baseball there as a little kid," said his mother, Shelly.

Mitch joined his first team at 5 years old. His little Cincinnati Reds jersey is now part of a quilt he gave his mom for Christmas.

His kindergarten teacher called him the gentle giant. He was bigger than his friends. Threw the ball harder, too.

At 8 he joined his first select team and quickly became a pitching ace. Each baseball season started a little earlier, each coach asked for a little more time. Mitch's parents tried to find balance.

Throwing a baseball is not a natural motion ? "there's a reason we don't walk around with our arms over our heads," ESPN analyst and Omaha native Kyle Peterson says ? but Ragan's actions looked totally natural within the youth baseball culture, where parents assume coaches know what they're doing, where coaches feel an obligation to maximize parents' investment, where kids can't get enough.

When a coach asked Mitch how his arm felt after a long inning, he said "Fine," even if he felt pain. When his team reached the Sunday championship game of a select tournament, Mitch threw three or four innings, even though he'd pitched six Friday and played catcher all day Saturday.

"The bad part about being a big kid and growing faster than your peer group is you're going to dominate," said Ragan's pitching instructor, Jim Haller.

"And you're going to be expected to dominate. What does the dominant pitcher do? He throws more. He's cajoled, 'Man, you throw hard.' Right? So what does a kid want to do? Throw harder."

Ragan's older brother, also a pitcher, who's playing now at Wayne State, suffered a shoulder injury in high school. Mitch regularly felt shoulder pain, too, until seventh grade, when he tweaked his motion. He began reaching back farther. His shoulder ? and his velocity ? improved. But his elbow flared up.

Before high school, he visited Dr. Tewes in Lincoln. Tewes noticed a widening of the growth plate, indicating the arm had been stressed. Doctors called it "Little Leaguer's elbow."

He didn't need surgery, but as pitchers become teenagers and their growth plate closes, the stress shifts to the UCL. It stretches, bends, frays and, especially without the proper rest, eventually breaks.

"This is cumulative trauma," Tewes said.

Pain forced Ragan to take about a month off from pitching in eighth grade, at his mother's urging, then again as a freshman, then again as a sophomore. His parents were wary of pitch counts, often telling coaches, "Sorry." When he did pitch, Ragan demonstrated the tools to be one of Omaha's best prep pitchers.

Haller said Ragan has as much potential as any young pitcher he has tutored. He has a big frame; he started on Millard West's offensive and defensive line as a sophomore and junior. He has mental strength. He's willing to be coached.

When Tewes completed 90-minute Tommy John surgery on Mitch's elbow in February, Haller was in the waiting room with mom and dad.

"If his rehab goes well," Haller said, "I wouldn't hesitate calling any college coach in the country and saying 'You've got one here.' "

Haller has seen enough to know.

***

On the morning of Sept. 25, 1974, Jim Haller was scheduled for surgery in Los Angeles, the latest setback in a frustrating pro career.

At 6-foot-6, the Creighton Prep graduate possessed an explosive arm. When he struck out Dave Winfield in an American Legion tournament, scouts fawned over him. The Dodgers drafted Haller ninth overall in the 1970 draft. But poor mechanics contributed to elbow problems.

That morning in California, Dr. Frank Jobe performed an ulnar relocation on Haller's elbow. Routine operation. Then Jobe washed up, entered another operating room and executed "this bizarre Frankenstein surgery," Haller said, better known as the first UCL reconstruction in baseball history. The patient?

Tommy John.

Jobe made an incision on the inside of the elbow and replaced the torn UCL with a wrist tendon harvested from John's wrist. He wrapped the graft through two tunnels in the bones ? like a figure eight ? then sewed it to the old ligament, reinforcing the new tissue.

Creative? Yes. Effective? Nobody would've bet on it.

When Haller saw Tommy John at spring training six months later, John's pitching hand was "curled up like a stroke victim," Haller said. John opened his fingers with his off hand, put the baseball in it and threw it as far as he could ? about 15 feet.

"We were, like, 'Give it up, Tommy. It's not happening.' "

But in '76, John made it back. The lefty pitched till he was 46, winning more games after surgery (164) than he did before (124).

By the time John retired in 1989, UCL reconstruction had become routine in baseball. Now the success rate is so high ? 90 percent ? that doctors occasionally hear from pitchers and their parents who seek Tommy John surgery for minor pain, believing ? falsely, according to doctors ? that the scars eventually will lead to a stronger arm.

Jobe died at age 88 in March. Not before his Frankenstein surgery had become a medical monster.

***
 
BASEBALL
Excess pitching fuels explosion of elbow injuries

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MATT MILLER/THE WORLD-HERALD

Throwing a baseball, with the arm raised up behind the head, is not a natural motion. Millard West High senior Mitch Ragan eventually developed elbow problems that led to his recent Tommy John surgery. The operation has become routine in baseball and has a success rate of 90 percent, so Ragan hopes to be back on the mound next season.
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Posted 8 hours ago

By Dirk Chatelain / World-Herald staff writer


Mitch Ragan walked into the doctor's office wearing his favorite sweats, his Red Sox hat and his Millard West letter jacket. Mom and dad were at his side, sharing words of encouragement.

Good news was coming.

Ragan was one month from the start of baseball season, a critical point for a junior who'd targeted college or pro ball since seventh grade. He couldn't wait to take the mound. At 6-foot-3, 250 pounds, he was pushing 90 mph on the radar gun. And his mechanics were better than ever. He just needed Doc to check his elbow.

Two weeks earlier, an early February night at an indoor Omaha baseball facility, Ragan winced during a bullpen session. He'd battled sporadic elbow pain for three years. This time, he felt a clicking sensation. His pitching instructor feared the worst.

Across the country, the most valuable elbows in professional baseball were breaking down,

casualties of an epidemic that experts couldn't solve. But those guys were in their 20s. Ragan was still 16.

Good news was coming.

The doctor, whom the Ragans had known for four years, entered the exam room and echoed the family's optimism. Probably another case of tendinitis. A few weeks of rest and Ragan would be fine.

Then Dr. Doug Tewes laid eyes on Ragan's MRI. He recognized the fluid around the ulnar collateral ligament, or UCL, signaling a detachment from the bone.

When Doc raised his hand to his chin, Mitch knew bad news was coming.

Rather than attracting recruiters and scouts, rather than competing with teammates for a state championship, rather than standing 60 feet, 6 inches from home plate and firing his fastball past hitters who could barely see it (let alone hit it), Ragan would spend 2014 in rehabilitation. Four months later, the farthest he's thrown a baseball is 5 feet.

Tewes turned the MRI toward the Ragans ? "See this ligament here?" ? and uttered a name that always gave Mitch goose bumps.

Tommy John.

***

Baseball has a strange way of recognizing its most gifted pitchers.

Stephen Strasburg was the No. 1 pick of the 2009 draft, the most exciting pitcher in the game ? until he missed 12 months of action during 2010-11 following ulnar collateral ligament reconstruction. Jose Fernandez, the 2013 Rookie of the Year, is out for the '14 season after his own elbow surgery. So are Matt Harvey and Matt Moore and Patrick Corbin and, well, elbows are beginning to resemble ticking time bombs.

Why? That's what Mitch Ragan wanted to know.

Tommy John surgeries, named after the first recipient of successful UCL reconstruction in 1974, have skyrocketed the past decade at all levels of baseball. Twenty-one major-league pitchers have undergone season-ending surgery, a record pace for one year.

But finding consensus among coaches, orthopedic surgeons, physical therapists and data analysts is like turning a quadruple play. Somehow devoting more time and resources to arm care has exacerbated the problem. Fingers point in every direction.

Is it higher velocities? Pitchers are training more intensely, thus, throwing harder. Maybe the elbow can't handle the torque associated with a 95-mph heater. What about mechanical inefficiencies? High-speed cameras allow experts to analyze the pitching motion like never before, revealing faults undetected by the naked eye.

Some say full-grown pitchers are being abused. Some say they're being coddled ? instead of obsessing over pitch counts, they should actually be throwing more in order to strengthen the arm. Some blame the one-size-fits-all method of training; if pitchers come in all shapes, sizes and physiologies, then why are coaches treating them the same?

There's no magic formula for arm care.

"You can name 20 things, and it's probably a part of all 20," said Omaha Westside coach Bob Greco, who won a Class A state championship in May.

There is, however, one factor on which all parties agree. It is the primary cause of pitching injuries, according to doctors. It is the one thing coaches would change immediately, if only they could.

The next generation of baseball players is playing far too much baseball.

***

Mitch Ragan lives in the same house he did when he first picked up a glove. At night he could look across Q Street and see the baseball field lights at Millard West.

"He used to dream about playing baseball there as a little kid," said his mother, Shelly.

Mitch joined his first team at 5 years old. His little Cincinnati Reds jersey is now part of a quilt he gave his mom for Christmas.

His kindergarten teacher called him the gentle giant. He was bigger than his friends. Threw the ball harder, too.

At 8 he joined his first select team and quickly became a pitching ace. Each baseball season started a little earlier, each coach asked for a little more time. Mitch's parents tried to find balance.

Throwing a baseball is not a natural motion ? "there's a reason we don't walk around with our arms over our heads," ESPN analyst and Omaha native Kyle Peterson says ? but Ragan's actions looked totally natural within the youth baseball culture, where parents assume coaches know what they're doing, where coaches feel an obligation to maximize parents' investment, where kids can't get enough.

When a coach asked Mitch how his arm felt after a long inning, he said "Fine," even if he felt pain. When his team reached the Sunday championship game of a select tournament, Mitch threw three or four innings, even though he'd pitched six Friday and played catcher all day Saturday.

"The bad part about being a big kid and growing faster than your peer group is you're going to dominate," said Ragan's pitching instructor, Jim Haller.

"And you're going to be expected to dominate. What does the dominant pitcher do? He throws more. He's cajoled, 'Man, you throw hard.' Right? So what does a kid want to do? Throw harder."

Ragan's older brother, also a pitcher, who's playing now at Wayne State, suffered a shoulder injury in high school. Mitch regularly felt shoulder pain, too, until seventh grade, when he tweaked his motion. He began reaching back farther. His shoulder ? and his velocity ? improved. But his elbow flared up.

Before high school, he visited Dr. Tewes in Lincoln. Tewes noticed a widening of the growth plate, indicating the arm had been stressed. Doctors called it "Little Leaguer's elbow."

He didn't need surgery, but as pitchers become teenagers and their growth plate closes, the stress shifts to the UCL. It stretches, bends, frays and, especially without the proper rest, eventually breaks.

"This is cumulative trauma," Tewes said.

Pain forced Ragan to take about a month off from pitching in eighth grade, at his mother's urging, then again as a freshman, then again as a sophomore. His parents were wary of pitch counts, often telling coaches, "Sorry." When he did pitch, Ragan demonstrated the tools to be one of Omaha's best prep pitchers.

Haller said Ragan has as much potential as any young pitcher he has tutored. He has a big frame; he started on Millard West's offensive and defensive line as a sophomore and junior. He has mental strength. He's willing to be coached.

When Tewes completed 90-minute Tommy John surgery on Mitch's elbow in February, Haller was in the waiting room with mom and dad.

"If his rehab goes well," Haller said, "I wouldn't hesitate calling any college coach in the country and saying 'You've got one here.' "

Haller has seen enough to know.

***

On the morning of Sept. 25, 1974, Jim Haller was scheduled for surgery in Los Angeles, the latest setback in a frustrating pro career.

At 6-foot-6, the Creighton Prep graduate possessed an explosive arm. When he struck out Dave Winfield in an American Legion tournament, scouts fawned over him. The Dodgers drafted Haller ninth overall in the 1970 draft. But poor mechanics contributed to elbow problems.

That morning in California, Dr. Frank Jobe performed an ulnar relocation on Haller's elbow. Routine operation. Then Jobe washed up, entered another operating room and executed "this bizarre Frankenstein surgery," Haller said, better known as the first UCL reconstruction in baseball history. The patient?

Tommy John.

Jobe made an incision on the inside of the elbow and replaced the torn UCL with a wrist tendon harvested from John's wrist. He wrapped the graft through two tunnels in the bones ? like a figure eight ? then sewed it to the old ligament, reinforcing the new tissue.

Creative? Yes. Effective? Nobody would've bet on it.

When Haller saw Tommy John at spring training six months later, John's pitching hand was "curled up like a stroke victim," Haller said. John opened his fingers with his off hand, put the baseball in it and threw it as far as he could ? about 15 feet.

"We were, like, 'Give it up, Tommy. It's not happening.' "

But in '76, John made it back. The lefty pitched till he was 46, winning more games after surgery (164) than he did before (124).

By the time John retired in 1989, UCL reconstruction had become routine in baseball. Now the success rate is so high ? 90 percent ? that doctors occasionally hear from pitchers and their parents who seek Tommy John surgery for minor pain, believing ? falsely, according to doctors ? that the scars eventually will lead to a stronger arm.

Jobe died at age 88 in March. Not before his Frankenstein surgery had become a medical monster.

***

James Andrews, the modern-day Jobe, has published a list of recommendations for young pitchers that reads like a little league version of the Ten Commandments. Among his points of emphasis:

» No overhead throwing of any kind for at least two to three months per year ? four months is preferred.

» No pitching more than 100 innings in games in any calendar year.

» Avoid using radar guns.

» A pitcher should not also be a catcher for his team.

» Follow limits for pitch counts and days rest.

Stop by a suburban sandlot this week ? hundreds of select teams from around the country have descended on Omaha ? and you'll find those rules routinely disregarded.

An 11-year-old USSSA tournament, for instance, consists of 46 teams.

Many will play seven games in 2½ days. A few are eligible to play eight. Eleven-year-olds will be permitted to throw as many as 10 innings. Even at 15 pitches per inning, which is efficient by youth standards, that's a heavy burden. You won't find a major-leaguer all season who throws 150 pitches in a 2½-day span.

Contrast this with Andrews' recommendation: Any pitcher under the age of 14 who throws 65-plus pitches should rest for four days.

It's not just Omaha. Tournaments across the country follow similar rules. Some don't track innings limits at all. According to Ragan's former coach Rich Bishop, Mitch's workload was relatively conservative. One opposing pitcher in eighth grade threw 11 innings in 24 hours.

Often kids play on two teams in the same season, pitching for both. The coaches face no consequence for abusing an arm because, as Bishop said, "you're not going to blow your ulnar collateral ligament when you're 11. So they just pass him on."

Haller, who grew up playing only 15 to 20 organized games a summer, watches youth baseball tournaments in which kids throw one inning the first game, two the next, four the next. He sees high school relievers warm up multiple times before they face a batter. He sees 12-year-olds throwing at radar guns.

"What the hell are we doing to these kids?" Haller said.

***

Mitch Ragan is in week 16 of rehab. He follows Dr. Tewes' instructions to the letter, determined to pitch again under the Millard West lights.

Harvesting the tendon from his wrist stripped away the blood flow, rendering it a dead piece of tissue. Even though it's part of his elbow now, Mitch has to wait for the body to make it alive again. It's a slow process, week after week, month after month, just as it was 40 years ago.

If all goes well, Ragan will start throwing this winter and return to the mound next spring, just in time to earn his college scholarship, maybe even get drafted.

He'll stare down his catcher and wait for the sign ? fastball. He'll coil his torso, kick his leg and reach back ? way back.

He'll whip his arm toward home plate, hoping the scars don't get in the way
 
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