On Twitter, a number of people alerted me to the rule change issues by the National Federation of State High School Associations. The consensus seemed to be that people think these changes are a good start to decreasing the rates of Tommy John surgeries and other overuse injuries in youth pitching. I wanted to share my thoughts in my latest newspaper column.

For several decades after Los Angeles Dodgers pitcher Tommy John underwent the surgery that now bears his name, only professional baseball players needed reconstruction of the ulnar collateral ligament (UCL) in their elbows. As I’ve discussed before, kids today throw too much, too soon, for too long without enough rest. We shouldn’t be surprised that kids now suffer adult injuries.

High school baseball players undergo the most Tommy John surgeries

A study presented at the 2015 American Orthopaedic Society for Sports Medicine Annual Meeting found that 56.7% of the UCL reconstructions performed in the United States between 2007 and 2011 were on patients between the ages of 15 and 19. Basically, a majority of the Tommy John surgeries are performed on high school pitchers, not major leaguers.

Also read:
The misperceptions of Tommy John surgery
Do baseball pitchers from warm weather areas have a greater risk for Tommy John surgery?

Will pitch count rules prevent youth pitching injuries?

The National Federation of State High School Associations proposes pitch count rules

Last week, the National Federation of State High School Associations took steps to keep young pitchers injury free. Starting next season, each state must regulate how many pitches a player can throw in a game. Each pitcher will have a mandatory rest period between outings based on the number of pitches he throws.

This new rule replaces limits on the number of innings pitches. For example, South Carolina high school pitchers could not throw more than 10 innings within a 72-hour span.

How states will determine their pitch count rules for high school baseball

We don’t yet know what the specific pitch count limits will be in different states. In my state, the South Carolina High School League will work with the South Carolina Baseball Coaches Association to select the actual number of pitches allowed. SCHSL associate commissioner Charlie Wentzky told The State that the limit will be the same number of pitches for games in the regular season and postseason.

Pitch Smart guidelines to prevent youth pitching injuries

In 2014, Major League Baseball partnered with USA Baseball and medical experts from around the country to create Pitch Smart. The organization teaches young pitchers and their parents and coaches about the risks of overuse shoulder and elbow injuries. It also offers guidelines for pitch counts and rest periods based on a player’s age.

Pitch Smart recommends that players aged 15 and 16 throw no more than 95 pitches in a single outing. 17- and 18-year-olds may throw no more than 105 pitches. If a pitcher throws more than 75 pitches, then he must rest at least four days.

Baseball teams pushing their pitchers to throw too much in order to win

Hopefully states adopt rules along those lines. We have seen countless examples of high school teams with only one or two good pitchers use those kids too much in order to win. This spring, a junior high school pitcher in Kansas threw 157 pitches in 10 innings in a regional championship game.

Other aspects of the rule will need to be worked out. How will the rule be enforced during the game? Who will keep track of the number of pitches thrown? What happens if a pitcher hits the limit during an inning, or in the middle of facing a batter?

Also read:
4 risk factors for youth pitching injuries
7 tips to strike out youth pitching injuries

Young baseball pitcher

A good start to prevent injuries and surgeries in young pitchers

Even with those issues waiting to be resolved, this rule change is a reasonable first step to protecting these kids’ arms. Tommy John surgeries are completely preventable. Limiting the number of pitches that high school players throw can keep them on the mound and out of the operating room.

Note: A modified version of this article appear as my sports medicine column in the July 20, 2016 issue of The Post and Courier.


Midlands baseball coaches weigh in on pitch-count limit. By Lou Bezjak. The State. July 14, 2016.

Pitching Restriction Policies in Baseball to be Based on Pitches. By Maddie Koss. NFHS News. July 12, 2016.

Tommy John Surgeries Increasing for Youth Athletes. American Orthopaedic Society for Sports Medicine News Release. July 12, 2015.