Medical experts bare out benefit of pitch counts

Newsday—Melville, N.Y.—August 10, 2008

Yankees pitcher Justin Louis Chamberlain’s place on the injured list in spite of restrictions placed on his number of pitches may raise some concerns about the efficacy of pitch counts. However, according to David Altchek, M.D., of Hospital for Special Surgery in New York, his injury does not immediately discount pitch counts as a valuable tool for teams looking to minimize injury.

"It would be very hard to have an entire pitching career without having some strain in the elbow or shoulder that would require rest," Altchek said. "It's inevitable. And it doesn't mean anybody did anything wrong."

Effective or not, pitching restrictions in major league baseball have little bearing on the ones that are found in little league. Pitch counts are especially important when they are applied to child athletes, according to David Dines, M.D., also of Hospital for Special Surgery in New York.

"But when you're talking about kids, it's really different," Dines said. "Because they still have growth plates that are open" -- 11 in the elbow, two in the shoulder -- "and I don't think you can extrapolate that to Joba Chamberlain."

So why do major league athletes have pitch counts imposed on them if they are long without growth plates?

More than permanent risk, for a major-leaguer, is the matter of fatigue. Pitch counts can still be a benefit because "by the sixth inning, these guys are spent," said Dines, who formerly worked with the Mets. "They don't have much more giddy-up. The fatigue factor in the cuff is not all about numbers; it's about how long you can generate that much power and keep going for it."

Not surprisingly, there are arguments from old-time ballplayers and statistics-obsessed fans that past generations survived wonderfully without pitch counts; that Nolan Ryan once threw more than 250 pitches in one 12-inning game, compared with current maximums of roughly 100.

But Dines points to changes in the sport that have changed that dynamic. "In those years, you had to learn how to pitch, change speeds," Dines said. "Now you come up, throw 97 miles per hour to overpower people, but the problem is, you're not only overpowering batters, you're overpowering yourself."

The increased use of split-finger pitches, Dines said, further causes a "violent contracting back" in the rotator cuff, and sliders create "more pressure on the rotational aspect of the shoulder."

With past overuse injuries, Altchek said: "You didn't get an MRI. You just got a shot [of painkiller] and toughed it out. And when you couldn't do it anymore, you retired, like Sandy Koufax. I doubt anything was really different then except those cultural factors. The MRI has changed sports medicine radically."

In the meantime, the "whole secret behind" pitch counts, he said, "is common sense. A pitcher gets tired and his mechanics begin to subtly change, and in throwing, that's a really, really big deal. That's when you start to strain things,” Altchek said. "Without doctors, baseball figured that out: the managers and the pitching coaches. It wasn't a doctor who said you have to have five days of rest and be limited to so many pitches."