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Youth players may throw certain pitches too early, which could lead to future surgery.
Published Aug. 1, 2007

Second in a four-day series

Something was amiss.

Northeast pitcher Michael Cherico finished up the third inning in his sixth start of the season against Clearwater and headed to the dugout. Sitting quietly at the end of the bench, Cherico wasn't thinking about the upcoming Tornadoes' lineup.

The pain in his right arm wouldn't let him.

Cherico, who also pitched in two other youth leagues before his senior season, toed the rubber in the fourth, but each pitch brought a new grimace. Cherico never had a significant injury in his career.

Maybe a pull.

Perhaps a tweak.

But nothing like this.

Two batters later, the 18-year-old removed himself and returned to the bench. There was only one thing on Cherico's mind: his future.

"I was nervous because it hurt," he said. "Bad."

Doctors advised rest and Cherico hoped to return for the postseason but the pain persisted. Two weeks after the season, Cherico was on the operating table, joining a growing list of youth baseball pitchers who have developed serious arm injuries.

Noted orthopedic surgeon Dr. James Andrews, director for the American Sports Medicine Institute, operated on the elbows of 21 high school-aged or younger players from 1995-99.

From 2000-04, that figure jumped to 124.

These startling statistics prompted Little League International to adopt a bold stance. After two years of research and a voluntary pitch count program, Little League rolled out its new, mandatory plan for the 2007 season. Gone is the old rule where pitchers were limited to a certain number of innings per week. In its place, a more precise system dictates the number of pitches thrown per game.

"It was overwhelmingly approved," said District 5 administrator Bob Gibson, who also sits on the Little League International Board of Directors. "Little League has always been out in front in terms of players safety and we had to do something to protect these boys' arms."

ASMI and Andrews, who called the increase in adolescent injuries "alarming" in his letter of support for Little League's pitch count program, stated there was no "magic" number of pitches. But research concluded the higher the pitch count, the higher the risk of injury; the strongest predictor of injury is pitching past fatigue, with those crossing that tipping point 36 times more likely to be injured; and mechanics, strength and pitch counts were a few of the injury risk factors.

"These injuries are a lot like getting cancer from smoking cigarettes," Tampa Bay Devil Rays physician Dr. Koco Eaton said. "You don't get cancer the first time you light up; it's the 10,000th cigarette that gets you."

While Little League's proactive stance is a first of its kind in youth baseball, other organizations have not followed suit. And with top players participating in multiple leagues, Little League's initiative can only do so much.

"With all the throwing and lack of rest these kids are getting, the seeds of destruction are being planted," Eaton said. "And the fruits will come to bear in high school."

Breaking pitches

Little League is looking into another possible culprit for adolescent arm injury: breaking pitches. There are varied opinions regarding how much - if any - damage these types of pitches cause, but not much hard medical data.

Little League and the University of North Carolina are in the second year of a five-year study that examines the effect of breaking pitches. Eaton said developing ulnar collateral ligaments typically can withstand about 35 pounds of pressure and throwing a fastball "with a goodly amount of speed" exerts around 65 pounds of pressure. Eaton said twisting the elbow to throw a curveball weakens the muscles' stability that surround the UCL.

"When I'm asked about an appropriate age to start throwing (curves), I tell people puberty," Eaton said. "Is he shaving on a regular basis? Is his voice changing and is he developing an Adam's apple?"

Little League recommends pitchers under the age of 14 not throw breaking balls, but that advice has fallen mostly on deaf ears. At the Section 7, 9-10 All-Star tournament last month, breaking balls weren't an uncommon sight.

"I watched a 9-year-old kid throw two curveballs for every five pitches," Southwest coach Ron Rhoads said. "Then I look in the dugout and see the (opposing) coach is calling them. Absolutely crazy."

And as the stakes rise, especially in Little League's showcase major division (11-12), breaking pitches are more prevalent. Excluding three intentional walks, Dunedin starting pitcher Noah Klassen threw 57 breaking balls out of 91 total pitches against Georgia in last year's Southeast Regional final at Gulfport.

"When people see me at games they ask me if (the curveballs) bother me," said Eaton, whose children played youth baseball and softball. "I tell them tongue-in-cheek, no, because it's just money in the bank for me. Sooner or later, they'll be coming to see me."

Is it preventable?

Throwing a baseball is an unnatural act, and there are only so many safeguards.

Consider Kyle Westwood.

Westwood, who led his Little League junior team to a second-place finish at the 2005 World Series and is a rising junior at Palm Harbor University, had Tommy John surgery - or UCL reconstruction - in June. Westwood had been closely monitored as a youth pitcher, met regularly for training sessions with Baltimore Orioles scout John Martin and threw "at most 15 curveballs per game" but not until he turned 13, according to his father, Bill.

"My wife and I look at it like it's just crazy," said Bill, who sits on East Lake's Little League board of directors. "We did everything to properly prepare him for success, physically."

Rhoads isn't waiting around for Little League and UNC to complete their study on breaking balls. Rhoads, who has coached Southwest for seven years and co-owns All-Star Baseball School in St. Petersburg, doesn't let his pitchers throw curves.

"That's something I'm adamant about and I don't need a study to tell me throwing curveballs that young is a bad idea," Rhoades said. "I'll never have a parent come to me and tell me down the road their kids' arm is shot because of throwing curveballs at 10, 11 years old."


Arm trouble isn't the only thing Michael Cherico and Kyle Westwood have in common: they are spending this summer in rehabilitation, attending therapy sessions three times a week.

Bill Westwood said it is unlikely his son will play next season for PHU. Cherico also will sit out. His surgery came at a time when many colleges hold tryouts, and all he can do is hope his arm will be strong enough to impress a school for the 2008-09 season.

"All I want to do," Cherico said, "is play baseball again."

Contact Brandon Wright at or (727) 892-2216.

Protect your child's throwing arm

Here are some tips from the American Sports Medicine Institute on how to take care of a child's throwing arm.

Suggested pitch counts Age to learn pitches

Age Max. pitches/game Age Pitch

8-10 52 8 Fastball

11-12 68 10 Changeup

13-14 76 14 Curveball

15-16 91 15 Knuckleball

17-18 106 16 Slider, forkball

Suggested recovery time (rest days), after given number of pitches

Age 1 day 2 day 3 day 4 day

8-10 21 34 43 51

11-12 27 35 55 58

13-14 30 36 56 70

15-16 25 38 62 77

17-18 27 45 62 89

About the series

Second in a four-part series on the competitiveness of youth baseball and sometimes negative consequences.

TUESDAY: Big growth. Little League used to be the league for kids. Now it has competition ... lots of it.

TODAY: Pitch count debate. Many pitchers are overextending themselves, playing in too many leagues and throwing breaking balls too early. The result, Devil Rays orthopedist Koco Eaton says, is major surgery.

THURSDAY: Big business. Parents spend thousands on team memberships, tournaments and private training in hopes of turning their kids into high-calber players.

FRIDAY: A tale of two organizations. AAU is the most competitive league. Could its ability to lure elite players doom Little League?