High-SchoolBaseball: Dr. James Andrews

Big pitch counts could lead to big problems

May, 31, 2012
Emerson GibbsCourtesy of Jesuit High School of New OrleansJesuit (New Orleans) pitcher Emerson Gibbs threw 193 pitches in a game against Archbishop Rummel (Metairie, La.) in April. His opponent, Mitch Sewald, threw 154 pitches.
Dr. James Andrews couldn’t believe it when he heard the combined pitch count racked up by two Louisiana high school pitchers in a game last month.

The number? Try 347.

“Wow,” said Andrews, who is arguably the world’s most famous and best orthopedic surgeon. “I have a hard time believing two pitchers were allowed to do that. Are you sure that number is for only two pitchers?”

Yes, doc. Just check the box score.

Jesuit School (New Orleans) senior ace Emerson Gibbs threw a whopping 193 pitches in an 18-inning, 2-1 victory over Archbishop Rummel (Metairie, La.) senior star Mitch Sewald, who threw 154 pitches. Gibbs threw 15 innings, while Sewald tallied his high pitch count in 10 frames.

“It’s ludicrous and it’s not safe judgment,” Andrews said. “That is just way too many pitches. That shouldn’t happen anywhere in any league.”

Well, it did happen again.

Two weeks later, another young pitcher was piling up the pitch count in Massachusetts. Barnstable (Mass.) senior ace Willie Nastasi threw 155 pitches in a nine-inning, complete-game victory over Taunton (Mass.).

Nastasi, who struck out 16 in the game, said he doesn’t regret the high pitch count but does agree that 155 is a little too steep for his comfort.

“Looking back, yes it probably was too many pitches and I won’t do it again,” said Nastasi, who is signed to play for UConn next season. “But I also look back at that game and remember that I stayed strong throughout the whole game. I really felt great and had no fatigue.”

[+] EnlargeWille Nastasi
Eric Adler for ESPNBoston.comBarnstable (Mass.) pitcher Willie Nastasi racked up 155 pitches in one start this spring.
All three pitchers drew national attention because of their high pitch counts, and it once again raised the question of when enough is enough when it comes to pitch counts at the youth and high school levels.

Andrews has an answer.

“High school pitchers should not throw more than 90 pitches in a game and they should have to take at least five days rest before they pitch again anywhere,” he said. “No way should they throw more than 100. The elbow isn’t ready for that workload.

“I understand coaches are under a lot of pressure to win. But coaches need to know your No. 1 priority is the health and safety of your young pitchers and baseball players. Your job is to deliver them to the next level without injury.”

All three coaches of the above-mentioned pitchers have caught heat from national media and scouts for the way they handled the pitch count.

Jesuit coach Joey Latino said looking back he would have changed the way he used Gibbs.

“I can’t defend the number,” he said. “It’s something I am going to have to deal with for a while. It’s hard to explain to someone who wasn’t there.”

Gibbs, however, saw no reason why he should have been pulled from the game because of a pitch count.

“I was feeling good the whole game and my velocity stayed the same,” said Gibbs, a Tulane recruit. “I didn’t think it was a big deal.”

Andrews disagrees.

Based on numerous studies he has been involved in, Andrews said most shoulder and arm surgeries in youth, college and professional baseball are related to fatigue in the arm. And high pitch counts are a big factor in the fatigue.

“Pitching too much in one game, one week or one season is a very high risk factor,” he said. “The problem is the injuries don’t always show up when they pitch too many pitches at age 15. When you see a pitcher at age 22 start developing a problem, you go look at their history and most times you find out they threw too much as a teen.”

None of the parents involved with the three pitchers complained to the coach or school district, but Sewald’s father did raise an eyebrow when he watched his son continue to pitch.

“We were shocked he kept pitching,” Chris Sewald said. “[Mitch] knows he probably shouldn’t do it again. He was caught up in the moment. His coach did ask him and he kept saying he was fine. He wanted to stay in.”

All three pitchers felt no pain beyond the usual soreness. And they all continued to pitch this season.

“I felt fine the whole time before and after,” Nastasi said. “But I will say, if I was tired and if I felt like my arm was getting tired I think I am smart enough to know to take myself out. That just wasn’t the case that game.”

His coach, Joe DeMartino, agreed.

“He didn’t look like he was pressing, and in my mind he was looking really strong as the game went on,” he said. “I was confident in my decision. And I still am.”

DeMartino said he always kept Nastasi’s health a concern during the game and repeatedly asked his young pitcher if he was OK to continue.

“It’s a tough call,” he said. “Any coach who has been in my position knows the feeling. But I know what Willie is capable of and I know he works hard and has great mechanics. The key in all this is a coach should know what their pitcher can and cannot do. I can tell when a pitcher is getting tired. I would have had no problem pulling him if I felt he wasn’t good to go.”

Good mechanics or not, Andrews still thinks every high school league in the country should have pitch-count rules.

“Why do we have red lights and stop signs?” Andrews said. “Because we have to have them. Nobody likes them. I hate red lights. But they make you safe. Someone has to police these young kids to get them out of the operating room.”

Dr. James Andrews talks Tommy John

February, 8, 2012
John Smoltz ESPNHSGregory Smith/APFormer MLB star John Smoltz is one of the numerous pitchers who've had Tommy John surgery performed by Dr. James Andrews.

When Dr. James Andrews talks about arm injuries in baseball, it would be crazy not to listen to him.

After all, he is arguably the world’s most famous and best orthopedic surgeon, and he has saved the pitching arms of some of the greatest professional baseball players on the planet.

So when he has a request for the sport he loves, maybe it should be wise and listen to his request -- especially at the youth and high school level.

“I think they should outlaw the radar gun,” he said. “Young pitchers, coaches, scouts and parents put so much emphasis now on throwing hard that these kids are hurting their elbows and their shoulders because they're trying to throw 90 mph.”

The radar gun, Andrews said, is one of many injury risks at the youth and high school level in an age of baseball that is seeing more and more teenage athletes on the operating table instead of the pitching mound.

And frankly, Andrews doesn’t like it.

“Every time I see a high school pitcher walk in my office it makes me sad,” Andrews said. “A lot of these injuries could be prevented, and it’s gotten to a point where I am seeing more and more young kids in my office.”

For decades the majority of his Tommy John patients could be found in the dugouts of major league, minor league and college dugouts. But during the past 10 years, Andrews said, a rapid rise of his patients could be found in your local high school yearbook.

Tommy John surgery is a procedure where the damaged ulnar collateral ligament in the elbow is replaced with another tendon on the body, such as from the forearm or hamstring. It’s also the most common surgery Andrews performs on young pitchers.

Dr. James Andrews
Mari Darr-Welch/APDr. James Andrews has treated high-profile athletes like Drew Brees and Peyton Manning.
One of those pitchers is Bolles (Jacksonville, Fla.) right-hander Hayden Hurst, whom Andrews performed Tommy John surgery on in the eighth grade.

“I definitely can feel the difference,” said Hurst, now a senior. “Before the surgery it felt like I had a bum arm. Now it feels alive.”

Andrews used to do three or four Tommy John surgeries a year on high school athletes. Now he said it’s up to three to four times a week.

“It is surprising,” Andrews said. “Kids are growing up too fast. They are outgrowing the development of their ligaments. They are getting too big and too strong too quick. Their ligaments in the elbow aren’t ready.

“The first thing you need to do is basically have common sense,” he added. “If you step back and really understand the risk factors you can prevent these arm injuries.”

Here are the five main risk factors that Andrews believes contribute to the rash of elbow injuries among high school pitchers. By paying attention to these, it could lessen the chance of a major injury on the mound.

Year-round baseball

Like the radar gun, Andrews thinks they should get rid of year-round baseball.

“Young pitchers now are throwing hard all year and that is not a good thing,” he said. “There is no rest period. Baseball is a development sport and the ligaments in the elbow need rest to develop.”


Slow it down, Andrews said. Thanks to numerous years of experience and a multiple of studies, Andrews said there should be a line on how fast a pitcher should be throwing.

“We found that young pitchers who throw over 85 miles per hour have far greater potential of getting hurt,” he said. “When throwing more than 85, it creates a lot of stress on elbows that are still developing.”


This risk factor should be the easiest to understand, Andrews said. It’s also one of the biggest reasons for injury.

“There should be a pitch-limit rule at every high school in the country,” he said. “I have heard of kids who throw 160 pitches in a game and that’s just not safe.”

Andrews said pitchers should never pitch on back-to-back days and should never try and get through an inning when they feel any soreness or tiredness in their pitching arm.

Travel baseball (also called club baseball) also is a big cause for fatigue because coaches from separate teams do not communicate with each other.

“One coach will pitch a kid for five innings one night and then the next day the same kid will go throw five more innings for a different coach in a different game,” Andrews said. “These pitchers should not be playing in more than one league at once. You have to rest to prevent these injuries.”


Social pressure and scouts at showcase events also play a role in arm injuries.

Andrews said many arm injuries are associated with one-day showcase events where pitching prospects go throw for pro and college scouts. Most of the time, it’s not safe.

“A lot of the times they go to these events not in shape or tired because they maybe pitched the night before,” he said. “They throw them off the mound as hard as they can and damage their arm by doing so.”

The radar gun

“Just outlaw it,” Andrews said. “It’s time.”

Maybe it’s time baseball listens to him.

Hayden Hurst back on top after Tommy John

January, 20, 2012
Hayden Hurst TopCourtesy of Terry IversonBolles (Jacksonville, Fla.) senior right-hander Hayden Hurst pitched in the 2011 Under Armour All-America Baseball Game just three years after undergoing Tommy John surgery.

All it took was a glance at a Major League Baseball player to ease the nerves of right-handed pitcher Hayden Hurst.

Of course, he had every reason to be nervous.

Just an eighth-grader at the time, Hurst sat in an Alabama doctor’s office and was minutes away from having major elbow surgery on his pitching arm.

“Then (current New York Yankees pitcher) Rafael Soriano walked right by me,” said Hurst, now a senior at the Bolles School (Jacksonville, Fla.). “I wasn’t nervous after that.”

It helped him realize pro players get hurt, too, and that they can bounce back from Tommy John surgery, a procedure where the damaged ulnar collateral ligament in the elbow is replaced with another tendon on the body, such as from the forearm or hamstring.

It also didn’t hurt that the doctor who performed that same surgery on Hurst happened to be Dr. James Andrews, arguably the world’s most famous and best orthopedic surgeon.

“Imagine my shock when I call on a Tuesday morning at 10 a.m. and I hear "Jim Andrews, can I help you?” Hayden’s father, Jerry, said. “I froze. It was like, here I am on the phone with the most famous orthopedic surgeon in the world.”

One might think it’s uncommon for an eighth-grader to have Tommy John surgery performed by Andrews, who is known more for operating on professional athletes than high school athletes.

But it’s a growing trend, Andrews said. He sees more teenagers like Hurst than pro players like Soriano. He used to see about three to four teenage athletes a year on his operating table. Now he sees three to four a week who need the Tommy John surgery.

“Oh Lord, it is surprising,” Andrews said. “Kids are growing up too fast. They are outgrowing the development of their ligaments. They are getting too big and too strong too quick. Their ligaments in the elbow aren’t ready.”

That was the case for Hurst, who at the time of his surgery was already 6-foot-3 and 205 pounds. He injured his elbow while pitching on varsity for Bolles in the eighth grade.

Hayden Hurst
Courtesy of Hurst FamilyBolles (Jacksonville, Fla.) senior Hayden Hurst shows off the scar on his right elbow where he had Tommy John surgery four years ago.
Andrews used a tendon in Hurst’s hamstring to perform the surgery. And for 12 months, Hurst rehabbed his pitching arm three times a day.

“I knew the surgery wasn’t just going to fix everything,” he said. “So I looked forward to working out and rehabbing.”

Hurst ended up missing most of his freshman campaign while rehabbing. Before the surgery, he was throwing 88 miles per hour. When he returned to the mound 12 months later, he was topping out at 94 miles per hour.

During his second appearance on the mound after the surgery, Hurst was one out away from throwing a no-hitter in the District 4-3A championship game. He fanned 11 and walked just two in the 4-0 win over Fernandina Beach (Fla.).

Hurst went on to help Bolles win the state title that season and was the starting pitcher on the bump when the Bulldogs repeated as state champs the following year. Bolles fell to Episcopal (Jacksonville, Fla.) in last year’s district semifinals.

Hurst helped Bolles win the state title that season and the following year, while the Bulldogs missed the playoffs last season.

Four years after the surgery, Hurst believes his elbow is stronger than ever.

“I definitely can feel the difference,” he said. “Before the surgery it felt like I had a bum arm. Now it feels alive.”

But Tommy John surgery isn’t magic and it’s definitely not for everyone, Andrews said.

“A myth is the surgery will just fix your elbow,” Andrews said. “You still have to develop correctly. You still have to rehab correctly. A lot of people think the surgery is just going to turn you into a great baseball player.

“I knew (Hurst) had potential and that is one reason why I did the surgery. He did all the things correctly that you have to do after the surgery. Yes, the surgery helped, but the rehab and development plays a bigger factor.”

Hurst certainly put in the time rehabbing his elbow, and now he’s reaping the benefits. The 6-foot-5, 235-pounder is one of the elite pitchers in Florida and has signed to play for Florida State next season, though he’s also considered a top prospect for June’s MLB Draft.

And just like his sophomore and junior years, he will be the ace on staff.

“I just let (my arm) loose when I returned to the mound,” he said. “I have no concerns about my elbow. My confidence is right where it needs to be. I knew I could bounce back.”