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Editorial Commentary: Pitching Should Come With a Warning Label
Editorial Commentary: Pitching Should Come With a Warning Label
Abstract: Pitching is not without risk of overuse injuries. Pitch counts have been instituted to reduce the risk, but Riff et al.’s article clearly demonstrates that as pitchers get older they do not adhere to these counts, which increases the risk of injury.
See related article on page 1559
W
e are seeing more and more articles in the literature discussing the increasing number of young pitchers undergoing surgery for overuse injuries to their arms.1-4 Other authors have written articles discussing the use of a pitch count to prevent injuries (Table 1).5,6 Many of these articles tend to group these young athletes together. I believe that these athletes should not be clustered together as one group and should be stratified into smaller groups of 2-3 years. This is because at no time in individuals’ lives do they go through more changes and/or maturation than during adolescence. The changes and stress on the body are not just physiological but also psychological and social. These individuals seek an identity and many achieve their identity through sports. Performing well enhances this identity, but many times safety is sacrificed for success.7 In their article “Epidemiologic Comparison of Pitching Mechanics, Pitch Type, and Pitch Counts Among Healthy Pitchers at Various Levels of Youth Competition,” Riff et al.8 help fill in some of the blanks about pitching mechanics and pitch counts and how these variables change with age. They showed that as the young pitchers age, they throw more pitches per game, per season, and per year and are more likely than younger pitchers to violate pitch count recommendations. Older pitchers tend to pitch with improved mechanics and velocity. The proportion of pitchers throwing breaking pitches increases with age, with the greatest increase occurring between ages 12 and 13. We should be cognizant of Riff et al.’s conclusions, especially about the increasing number of throwers who violate pitch count restriction as they get older. As physicians, part of our duty is not only to diagnose and treat but also to educate. We need to reinforce to Ó 2016 by the Arthroscopy Association of North America 0749-8063/16499/$36.00 http://dx.doi.org/10.1016/j.arthro.2016.06.001
Table 1. Pitch Count Guidelines From American Sports Medicine Institute6 2006 USA Baseball Guidelines Daily limits, number of pitches 17-18 yr N/A 15-16 yr N/A 13-14 yr 75/game 11-12 yr 75/game 9-10 yr 50/game 7-8 yr N/A Weekly limits, number of pitches 15-18 yr N/A
13-14 yr 11-12 yr 9-10 yr 7-8 yr
125/wk; 1,000/season; 3,000/yr 100/wk; 1,000/season; 3,000/yr 75/wk; 1,000/season; 2,000/yr N/A
2010 Little League Baseball Regulations 105/d 95/d 95/d 85/d 75/d 50/d 31-45 ¼ 1-d rest 46-60 ¼ 2-d rest 61-75 ¼ 3-d rest 76þ ¼ 4-d rest 21-35 ¼ 1-d rest 36-50 ¼ 2-d rest 51-65 ¼ 3-d rest 66þ ¼ 4-d rest
N/A, not applicable.
parents as well as our patients that the pitcher’s arm is not indestructible. It is not only important to consistently stretch and strengthen the arm, but also pitch counts (Table 1) are there for a reason and that should not be ignored. Merrick J. Wetzler, M.D. Associate Editor
References 1. Erickson BJ, Nwachukwu BU, Rosas S, et al. Trends in medial ulnar collateral ligament reconstruction in the United States: A retrospective review of a large privatepayer database from 2007 to 2011. Am J Sports Med 2015;43:1770-1774.
Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 32, No 8 (August), 2016: pp 1569-1570
1569
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EDITORIAL COMMENTARY
2. Hodgins JL, Vitale M, Arons RR, Ahmad CS. Epidemiology of medial ulnar collateral ligament reconstruction: A 10year study in New York State. Am J Sports Med 2016;44: 729-734. 3. Jones K, Dines J, Rebolledo B, Weeks K, Dines D, Altchek D. Ulnar collateral ligament reconstruction in adolescent athletes: Minimum two-year follow-up utilizing the docking technique. Arthroscopy 2013;29: e19-e20. 4. Mahure SA, Mollon B, Shamah SD, Kwon YW, Rokito AS. Disproportionate trends in ulnar collateral ligament reconstruction: projections through 2025 and a literature review. J Shoulder Elbow Surg 2016;25: 1005-1012.
5. Bohne C, George SZ, Zeppieri G Jr. Knowledge of injury prevention and prevalence of risk factors for throwing injuries in a sample of youth baseball players. Int J Sports Phys Ther 2015;10:464-475. 6. American Sports Medicine Institute. Position statement for youth baseball pitchers. ASMI website. http://www.asmi.org/ research.php?page=research§ion=positionStatement. Updated April 2013. Accessed May 10, 2016. 7. Masland RP Jr. The adolescent: Athletics and development. J Adolesc Health Care 1983;3:237-240. 8. Riff AJ, Chalmers PN, Sgroi T, et al. Epidemiologic comparison of pitching mechanics, pitch type, and pitch counts among healthy pitchers at various levels of youth competition. Arthroscopy 2016;32:1559-1568.
Abstract: Pitching is not without risk of overuse injuries. Pitch counts have been instituted to reduce the risk, but Riff et al.’s article clearly demonstrates that as pitchers get older they do not adhere to these counts, which increases the risk of injury.
See related article on page 1559
W
e are seeing more and more articles in the literature discussing the increasing number of young pitchers undergoing surgery for overuse injuries to their arms.1-4 Other authors have written articles discussing the use of a pitch count to prevent injuries (Table 1).5,6 Many of these articles tend to group these young athletes together. I believe that these athletes should not be clustered together as one group and should be stratified into smaller groups of 2-3 years. This is because at no time in individuals’ lives do they go through more changes and/or maturation than during adolescence. The changes and stress on the body are not just physiological but also psychological and social. These individuals seek an identity and many achieve their identity through sports. Performing well enhances this identity, but many times safety is sacrificed for success.7 In their article “Epidemiologic Comparison of Pitching Mechanics, Pitch Type, and Pitch Counts Among Healthy Pitchers at Various Levels of Youth Competition,” Riff et al.8 help fill in some of the blanks about pitching mechanics and pitch counts and how these variables change with age. They showed that as the young pitchers age, they throw more pitches per game, per season, and per year and are more likely than younger pitchers to violate pitch count recommendations. Older pitchers tend to pitch with improved mechanics and velocity. The proportion of pitchers throwing breaking pitches increases with age, with the greatest increase occurring between ages 12 and 13. We should be cognizant of Riff et al.’s conclusions, especially about the increasing number of throwers who violate pitch count restriction as they get older. As physicians, part of our duty is not only to diagnose and treat but also to educate. We need to reinforce to Ó 2016 by the Arthroscopy Association of North America 0749-8063/16499/$36.00 http://dx.doi.org/10.1016/j.arthro.2016.06.001
Table 1. Pitch Count Guidelines From American Sports Medicine Institute6 2006 USA Baseball Guidelines Daily limits, number of pitches 17-18 yr N/A 15-16 yr N/A 13-14 yr 75/game 11-12 yr 75/game 9-10 yr 50/game 7-8 yr N/A Weekly limits, number of pitches 15-18 yr N/A
13-14 yr 11-12 yr 9-10 yr 7-8 yr
125/wk; 1,000/season; 3,000/yr 100/wk; 1,000/season; 3,000/yr 75/wk; 1,000/season; 2,000/yr N/A
2010 Little League Baseball Regulations 105/d 95/d 95/d 85/d 75/d 50/d 31-45 ¼ 1-d rest 46-60 ¼ 2-d rest 61-75 ¼ 3-d rest 76þ ¼ 4-d rest 21-35 ¼ 1-d rest 36-50 ¼ 2-d rest 51-65 ¼ 3-d rest 66þ ¼ 4-d rest
N/A, not applicable.
parents as well as our patients that the pitcher’s arm is not indestructible. It is not only important to consistently stretch and strengthen the arm, but also pitch counts (Table 1) are there for a reason and that should not be ignored. Merrick J. Wetzler, M.D. Associate Editor
References 1. Erickson BJ, Nwachukwu BU, Rosas S, et al. Trends in medial ulnar collateral ligament reconstruction in the United States: A retrospective review of a large privatepayer database from 2007 to 2011. Am J Sports Med 2015;43:1770-1774.
Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 32, No 8 (August), 2016: pp 1569-1570
1569
1570
EDITORIAL COMMENTARY
2. Hodgins JL, Vitale M, Arons RR, Ahmad CS. Epidemiology of medial ulnar collateral ligament reconstruction: A 10year study in New York State. Am J Sports Med 2016;44: 729-734. 3. Jones K, Dines J, Rebolledo B, Weeks K, Dines D, Altchek D. Ulnar collateral ligament reconstruction in adolescent athletes: Minimum two-year follow-up utilizing the docking technique. Arthroscopy 2013;29: e19-e20. 4. Mahure SA, Mollon B, Shamah SD, Kwon YW, Rokito AS. Disproportionate trends in ulnar collateral ligament reconstruction: projections through 2025 and a literature review. J Shoulder Elbow Surg 2016;25: 1005-1012.
5. Bohne C, George SZ, Zeppieri G Jr. Knowledge of injury prevention and prevalence of risk factors for throwing injuries in a sample of youth baseball players. Int J Sports Phys Ther 2015;10:464-475. 6. American Sports Medicine Institute. Position statement for youth baseball pitchers. ASMI website. http://www.asmi.org/ research.php?page=research§ion=positionStatement. Updated April 2013. Accessed May 10, 2016. 7. Masland RP Jr. The adolescent: Athletics and development. J Adolesc Health Care 1983;3:237-240. 8. Riff AJ, Chalmers PN, Sgroi T, et al. Epidemiologic comparison of pitching mechanics, pitch type, and pitch counts among healthy pitchers at various levels of youth competition. Arthroscopy 2016;32:1559-1568.