Surgery throws young pitchers a curveball

More parents push for operations to rebuild their kids' elbows ruined by overuse, poor form.
By Dave Dye / The Detroit News - July 18th, 2005

Dave Herrick remembers that spring 2002 day, the second game of the season, his junior year at Livonia Churchill High. He especially remembers the pain.

"I threw a curveball and I heard a pop," Herrick recalled. "I didn't think much of it ... I threw another pitch and I felt more discomfort. I threw a third pitch and the ball went to the backstop and there was a loud pop ... it was excruciating pain."

That was the end of Herrick's pitching career -- and his induction into a growing fraternity of young players who undergo reconstructive surgery on their pitching elbows.

It's no longer only professional ballplayers who are having their elbows rebuilt. Surgeons report an alarming increase in kids -- high school age and some barely teenagers -- undergoing the procedure because they've damaged their arms from overuse, throwing too many curveballs at too young an age or from poor pitching mechanics.

Why the increase? Some blame parents, who don't hesitate to pursue the operation if they believe their child has potential for a college scholarship or pro contract.

"A lot of people don't understand what they're getting into," said Dr. James Andrews, a renowned orthopedic surgeon at the American Sports Medicine Institute in Birmingham, Ala. "You're not sure they're going to be a baseball player anyway, but the parents say they're being scouted. Sometimes we scratch our heads. There's tremendous pressure (on the doctors) to do the surgery."

There also are concerns about the long-term effects.

"Could they have arthritis and other problems 50 years later?" said Dr. James Carpenter, an orthopedic surgeon for the University of Michigan's athletic program and chairman of the school's Department of Orthopedic Surgery.

"Surgery is kind of a last resort for a kid. This is a surgery that is only necessary for baseball."

Surgeries on youth pitchers have increased "five- to sixfold" since 2000, Andrews said. "I would say it's in an epidemic nature."

Cause for concern

According to the American Sports Medicine Institute Web site (asmi.org), Andrews operated on the elbows of 190 pitchers (94 pro, 74 college, 21 high school and one recreational) between 1995 and 1999, and the elbows of 627 pitchers (198 pro, 303 college, 124 high school and two recreational) between 2000 and 2004.

Andrews said he is on pace to perform more than 50 surgeries on high school or younger patients this year.

Through studies at the institute, Andrews identifies these risk factors:

• Overuse because of year-round baseball. Andrews said this is a bigger problem in warm-weather states, but he is starting to see more incidents in the Midwest as pitchers throw on a regular basis at indoor batting cages during the offseason.

• Overuse during the season. Little League, for instance, limits a pitcher to six innings per week. Better players, however, also often compete on travel teams, which do not have such restrictions and might play six or seven games during a three-day tournament.

• Radar guns. "All they're trying to do is see how hard they can throw it," Andrews said. "There is just no need to have that kind of pressure."

• Showcase tryouts. Andrews said hopefuls often aren't in pitching shape for offseason tryouts, yet overthrow to impress college recruiters and pro scouts.

• Poor pitching mechanics, especially throwing a curveball improperly. Andrews recommends not throwing a curve "until you shave."

"We need to get the message out to parents and coaches," Andrews said. "With just common sense, these injuries are preventable."

Therein lies the rub, according to Joe Loria, a former college pitcher who gives private pitching instruction.

"A lot of dads that are coaches are living vicariously through the kids," Loria said. "That's out there a lot. They're trying to relive what they missed because they weren't good enough."

It starts early

Tommy Graves, 14, of Grosse Pointe Farms pitched seven innings in the first game of a doubleheader for his travel team, and then was asked to pitch the last four innings of the second game.

His father, Tom, put an end to that idea.

"He was in demand," Anne Graves said of her son. "But we don't want him to burn out because he would pitch all the time (if allowed)."

Loria, who works with Graves, said this is a familiar situation because the kids aren't likely to admit that their arm is tired.

"He (Graves) wants the ball all the time," Loria said. "If you're a competitor, it's hard to turn the ball down.

"But Roger Clemens doesn't start a game on Saturday and come back and start a game on Monday, and yet we do this to our youth in America. I don't know any professional teams that play six games in three days, and they have 11 or 12 pitches. These (youth) teams have 12-, 13-, 14-man rosters."

Loria said the focus is too much on success at a young age as opposed to doing what's best for a player over the long haul.

"Some of them get penalized because they were very good when they were young," Loria said. "They get abused. They never get a chance to show how good they could have been. Some don't even get to the high school level. The No. 3 pitcher on a (youth) team might turn out better than the No. 1 and No. 2 pitchers because he's not abused."

Critics worry that some adults don't put the safety of youngsters first.

"Unfortunately, there are very selfish people who are coaching who want to win at any cost," said Jim Pangborn, who has been coaching since 1969. "My position has always been, we're doing it the right way. If we're getting beat by someone who, in my opinion, is teaching kids the wrong way, I tell the kids, if you wait three to four years, you'll be throwing in high school, and they probably won't be throwing at all or making the team."

Doug Jenzen, who has 26 years of youth coaching experience, agrees.

"Everybody wants to win, instead of worrying about the kid on the mound," he said. "The thing we need to worry about most is developing the kid who is playing."

Vaughn Calloway is not only a youth baseball coach in Detroit, but he's also a scout for the Tigers.

He said part of scouting pitchers is identifying who might have been overused as a youth and, therefore, more susceptible to injury later.

"We see a lot of tired arms," Calloway said. "Kids are being rushed. I believe they're being overworked.

"That's something we monitor. Kids jumping a lot (to pitch for different teams in the same season), that's not a good sign."

Calloway said his son Michael's 13-and-younger team has 13 players on the roster, with nine of them used as pitchers.

"That's a luxury everybody doesn't have," Calloway said of the pitching depth. "The better teams have pitch counts (limits). The lesser teams have to pitch the same kid two or three times."

Changing the game

Andrews admits he's embarrassed to say how many operations he's performed on young pitchers, including a 13-year-old.

"It's a problem right now, and it seems to be increasing," said Dr. Scott Wenger, an orthopedic surgeon from College Station, Texas, who started observing youth arm injuries more closely while working with Dr. Frank Jobe during a fellowship.

Jobe, a team physician for the Los Angeles Dodgers, pioneered this surgery 31 years ago. His first patient was Tommy John, a left-hander with the Dodgers.

Previously, torn elbow ligaments meant the end of a pitching career.

But that all started to change after John returned to win 164 games following the surgery. The surgery is now commonly known as Tommy John surgery.

The well-documented success stories -- around 85 percent of pro pitchers who have undergone the surgery are able to return to pitching -- are part of Andrews' problem.

Some players say they throw harder after surgery. That could be because the recovery program focuses on strengthening the arm overall and correcting any flaws in pitching mechanics that might have caused the injury.

Former major league pitcher Billy Koch once said, somewhat jokingly, "I felt so good when I came back, I said I recommend it to everybody ... regardless what your ligament looks like."

It's a statement that makes Andrews cringe. Some of the pressure he feels is from parents who hear such talk and believe their young pitcher's injured arm automatically will be stronger with surgery.

"That's the wrong message," Andrews said.

A second chance

Carpenter, of the University of Michigan, isn't convinced youth pitching injuries really have increased all that much. He thinks they're simply being diagnosed and treated more frequently because of medical advancements.

"That's the debate," said Carpenter, who operated on Herrick. "Either the injury is increasing (in youth) or there are just more people who are knowledgeable and interested in treating these injuries, including doing surgery.

"I'm not really sure which it is. But I don't think it's that much more common. That's my gut feeling."

Carpenter said he performs about five Tommy John operations a year on youths, but typically recommends a more conservative approach for young pitchers.

"They can often come back (from the injury) without surgery if they're patient," Carpenter said.

Among the recommendations is that a player take significant time off from throwing, at least three months, followed by a very slow progression when he does return to throw, usually another three months.

Herrick is now a baseball player at Madonna University in Livonia. He attempted that approach first.

After blowing out his arm, Herrick was relegated to designated hitter the rest of his junior season while resting his arm for six months. He came back to do some catching as a senior at Churchill, but his arm wasn't the same, so he finally opted for surgery in December 2003, his first year in college.

He counts his experience as a success.

"My arm feels strong, back to where it was before the surgery," he said, but only after a grueling nearly yearlong recovery.

Still, Herrick "would not advise anyone go through this unless they have to."

 

 

Former college pitcher Joe Loria, working with Tommy Graves, 13, of Grosse Pointe Farms, says young pitchers are overworked.
 
Coach's Corner
 
Tigers pitching coach Bob Cluck offers some simple rules to help protect young pitchers:
 
• Warm up properly before pitching. Even kids need a full 10 to 12 minutes of throwing to be ready to pitch -- somewhere between 40 and 60 throws to warm up.
 
• A relief pitcher should get 15 to 20 throws, not just eight. You can't come in from the field and make eight throws and be ready.
 
• Multiply a pitcher's age by six and you have a good place to cut a kid off. A 10-year-old's limit is 60 game pitches; a 14-year-old's is 84; the limit for everyone is 100. Pitchers should not throw more game pitches (maximum-effort throws) than this in any one game. Don't count the warm-ups or pitches between innings, just the game throws.
 
• Rest should be calculated as follows: Divide the number of pitches by 25 and give the pitcher a full day's rest for every multiple of 25. This works for any age. For example: A 12-year-old throws 75 pitches Tuesday, he can pitch again after three days' rest, on Saturday. A 9-year-old throws 50 pitches Thursday, he can pitch again after two days' rest, on Sunday.
 
If the pitcher feels any discomfort at all, add two days rest. If it is still there, take him to a sports doctor.
 
• Pitchers should not pitch year-round. Give him at least two months off twice during the year.
 
Source: "Think Better Baseball" by Bob Cluck
 
Another Box
------------------
Did you know?
 
What is Tommy John surgery?
 
It's an elbow operation to reconstruct a torn ulnar collateral ligament. A tendon from the forearm or hamstring is removed and weaved in a figure-eight pattern into the elbow through tunnels drilled in the humerus and ulna bones.
 
How did it get its name?
 
John, a former major league pitcher, underwent the first surgery of this nature in 1974. Dr. Frank Jobe, a surgeon for the Los Angeles Dodgers, pioneered the surgery.
 
How much does it cost?
 
The total package, including rehab, can run around $15,000-$25,000. It is often covered by insurance.
 
How long does it take?
 
About 70 minutes in most cases; typically on an outpatient basis.
 
How long is the recovery?
 
At least a year, if not longer.
 
The elbow is immobilized in a hard brace the first week. Range-of-motion exercises begin the third week. A throwing-type motion is simulated around the 10th week.
 
In week 16, a throwing program typically begins with soft tosses from about 45 feet.
 
At six months, throwing off the mound is usually allowed at about 50 percent the normal speed with no curveballs.
 
Batting practice is thrown beginning around the eighth month.
 
A return to competition is normal in the 11th to 12th month.
 
Why don't softball pitchers have the same problem?
 
The underhand motion is more natural, whereas baseball's overhead throwing motion puts extreme stress on the shoulder and elbow.
 
Who has had the surgery?
 
Some of the top success stories include the New York Yankees' Mariano Rivera (surgery in 1992), Atlanta's John Smoltz (2000), Chicago Cubs' Kerry Wood (1999), Boston's David Wells, St. Louis' Matt Morris (1999) and Pittsburgh's Jose Mesa (2000).