Roundtable: Is 155 Pitches Too Many?

Tuesday afternoon, Barnstable High senior righthander Willie Nastasi went the distance in a 3-1 win over Taunton, striking out a career-high 16 batters in nine innings while allowing just three hits. But the 6-foot-5 UConn commit also needed 155 pitches to complete the effort, which has since sparked some spirited debate locally about pitch count and what is appropriate. Nastasi has since said it was his own decision to stay in the game. Head coach Joe DeMartino said following the game that Nastasi would not have gone back out if the game went to an extra 10th inning.

Nastasi's performance is one of countless examples of pitchers racking up high pitch counts this season, but one that drew much debate on the Twitter-sphere. Scouts Inc. Baseball Analyst Keith Law went as far as to call it "Absolutely criminal" in a post on Twitter. Still others lauded Nastasi for his performance, which improved the No. 11 Red Raiders to 2-0 in the four-team Old Colony League.

Was it the right call? How much is too much? We asked our regular panel of contributors as well as a few special guests: Eric Cressey, President of Cressey Performance; Dr. Luke Oh of Massachusetts General Hospital, an orthopaedic consultant with the Boston Red Sox; and Kirk Fredericks, head coach of three-time state champion Lincoln-Sudbury High.

Dr. Luke Oh

Orthopaedic Surgeon, Massachusetts General Hospital

Orthopaedic Consultant, Boston Red Sox; medical staff member, New England Revolution, New England Patriots, Harvard University Athletics

There has yet to be a high school or college baseball pitcher in his late teens who needed Tommy John surgery that I have seen who demonstrated good rotator cuff strength, periscapular control, and throwing mechanics. If these variables are not optimized, then it becomes difficult for young athletes to negotiate the fatigue and overuse that develops as the baseball season progresses.

At the professional level, there are comprehensive strength and conditioning programs in place that are baseball-specific. This is certainly not the case at the high school level. In fact, you may be surprised by the number of Division I college teams that do not have a baseball-specific program either.

At the high school level, it would be uncommon to find a pitcher who has the required stamina, mechanics, and strength and conditioning to throw 155 pitches per game on a regular basis without having symptoms of overuse. We have to remember that some of these adolescent athletes are still growing, and other may have finished growing with regard to height but have not filled into their frame. Even for those young athletes who appear to be muscular and well-developed, the rotator cuff and other dynamic stabilizers of the shoulder and elbow that are important for throwing tend to lag behind in development. They are attempting to emulate what the professional athletes are doing, but their bodies are not developed to the same degree.

Some people believe that a pitcher needs to throw more, in order to be able to throw more. In my opinion, there has to be a balance between developing endurance and risking injury from overuse. I think like many things in life, after an optimal range, there will be a decrease in the return on investment and an increase in the risk of injury. Well, what is the optimal range? Is there a specific threshold? This depends on each athlete because there is so much variability in physique, skill, technique, conditioning, etc. It may be counterproductive to simply ascribe a set number for the maximum recommended pitch count in high school because it may become misused and not applied appropriately.

Nevertheless, some experts believe that younger pitchers at the high school level should limit the pitch count to under 100 in an effort to reduce the risk of overuse injury. In some major league ballclubs, the pitch count may be monitored over a span of a few games such that if a pitcher throws 140 pitches in one game, for example, then he will likely throw fewer pitches during his next outing. If such precautions are taken at the highest level of competition for our professional pitchers, then it would be prudent to take additional precautions for our high school athletes.

The tremendous stress placed on the shoulder and elbow during the baseball pitch can take its toll over time. My mentor, Dr. James Andrews, and I have both seen a steady increase in injuries to the ulnar collateral ligament among young pitchers. In my practice, approximately 20-25 percent of Tommy John surgeries that I perform are on pitchers younger than 20 years old. Dr. Andrews has said that Tommy John surgery for athletes in their late teens decreased for the first time last year; but every year before that, it increased each year. Perhaps the message is getting out, and people are paying more attention to the young athlete's development, baseball-specific strength and conditioning, muscle coordination, proper mechanics and other variables that are important for injury prevention as well as optimizing performance.

Eric Cressey

President and Co-Founder, Cressey Performance

Kids might feel fine in the short-term and think they can gut it out, but the truth is that they don't know what damage is going on inside their elbows and shoulders, especially as fatigue sets in and more stress is shifted to the non-ideal places. As an example, at the elbow, when the flexor carpi ulnaris and pronator teres start to fatigue, the ulnar collateral ligament (UCL) takes on more stress. At the shoulder, when the rotator cuff starts to fatigue, the biceps tendon picks up the slack - and the loss of control of the humeral head (ball in socket) causes more and more fraying on the labrum.

Pitching injuries are not rolled ankles; a thrower isn't just fine one day, and then injured the next. Rather, these injuries are the culmination of years and years of microtrauma to the tissues that finally hits threshold. The kids having Tommy John surgeries are the ones that have previous areas of calcification on the UCL from injuries they may have never perceived, or partial UCL tears that will never heal perfectly. Shoulder-wise, almost every thrower you come across will have labral fraying and degenerative changes in the rotator cuff.

Pitch counts are a big can of worms to open because every kid is uniquely (un)prepared. Some work hard to make sure that they have stability and mobility in the right places, warm up correctly prior to outings, and hone their mechanics to make sure that they are eliminating potentially injurious flaws in the delivery. Some choose to throw curveballs over sliders (throwing sliders is associated with an 86% increased risk of elbow injury, according to research) to protect their arms. Some kids simply don't throw hard, so it's harder for them to reach threshold (sprinters don't pull their hamstrings if they don't run fast, do they?).

The take-home point is that pitch counts will always be an inexact science, but a valuable one nonetheless because they help protect the majority -- especially those who are unprepared. Unfortunately, about 95% of pitchers aren't just unprepared; they are WOEFULLY unprepared. Time and time again, the primary factor that predicts injury risk in throwers is overuse - both acute and chronic. And, we have to remember that high school kids are particularly susceptible because they are skeletally immature; otherwise, you'd see growth plate injuries in big leaguers all the tike.

Personally, I think 105 pitches for a high school player is a good cap. Anecdotally, kids seem to struggle when they go back-to-back with 100+ pitch outings, too -- especially when they happen with fewer days between starts. This isn't surprising at all, though, as most of the college pitchers I've seen who go on to pro ball comment on how the hardest adjustment is going from a seven-day to a five-day rotation.

I would like to head off one counterpoint, and it's that many coaches will rebut, "We threw way more pitches than that when I was in school, and we never got hurt!" The response is very simple: we are dealing with a different generation on a number of fronts.

First, kids are more unprepared athletically than ever because of early sports specialization (less variety = less development), and because they sit more than ever before, thanks to the popularity of things like Facebook, Twitter, and video games. After-school "play" is a thing of the past.

Second, kids can throw year-round nowadays, if they want to do so. There can be fall ball, winter lessons/clinics, showcases, and summer ball on top of what someone gets for throwing volume during the high school season. This is likely the biggest change from what players experienced more than a decade ago. Their throwing volumes were dictated by the competitive year.

Third, we are better diagnostically and surgically now. In other words, there likely were more of these injuries in the past, but we weren't as good at evaluating them and treating them, so they weren't as publicized.

Scott Barboza

ESPN Boston High Schools Editor

At the risk of sounding like the old school baseball wonk here, we've so lost sight of the way things used to be. In the 1905 World Series, Christy Mathewson pitched three complete-game shutouts in what is considered to this day as perhaps the finest postseason pitching performances in baseball history. What's makes Mathewson's 27 scoreless innings against Connie Mack's Athletics is the fact that he threw all three games within a span of six days. Yeah, maybe it was the dead ball era, but it still happened. The more fitting example would be Daisuke Matsuzaka's line during Japan's esteemed Summer Koshein series, a spectable of national attention. He threw a 17-inning, 250-pitch quarterfinal game; that is ONE DAY after he threw a 148-pitch complete game shutout. Now, we can argue how Matsuzaka's innings load, pitch count and rigorous warm-up routine might have impacted his time here with the Red Sox, but it's not as though he didn't have nearly a decade of rubber-armed action between then and now.

Look, I'm not saying Willie Nastasi is or will be of the ilk of those aforementioned, although he's certainly a fine player in his own right at the high school level and, likely, in college, but the point remains that this week's performance isn't without peer. Now more than ever, those kinds of lines are becoming fewer and farther between, which makes them all that much more remarkable when they occur. But we might be overlooking the real cause of arm fatigue in Little Leaguers and high schoolers, and that is the use of breaking balls at a young age. If a pitcher has proper mechanics and has trained to carry such a load (particuarly with the development of leg muscles), there's no reason why such a pitch count isn't possible. I think the more pervasive danger to young pitchers is the impetus to throw curve balls and other breaking pitches at a young age, which results in added strain on elbow ligaments. The world of baseball might have the right idea, but the wrong argument. Less isn't more; proper instruction is.

So we should celebrate Nastasi's accomplishment exactly as it is, something few us could ever dream to endeavor. That also doesn't mean it's impossible.

Brendan Hall

ESPN Boston High Schools Editor

For some historical context, I reached out to former Whitinsville Christian pitcher Andrew Green, who grabbed headlines back in 2009 for throwing 225 pitches in 15 innings, in what ultimately was a 1-0 loss to Douglas.

The weight training regimen Green says he was put through as a high schooler involved hardly any upper body work, outside of medicine ball work and pushups. Instead, he went heavy on leg presses and curls, and dynamic squats. The philosophy here was that by generating power from the lower body, head coach Kris Bradley could get more innings out of his thin staff, while minimizing the risk of injury.

Green -- who had earlier in the season threw a handful of 120-pitch, complete game outings -- didn't recall any soreness afterwards.

"It was funny, right after the game, my friend was like 'Come over and sit in my hot tub for as long as you want'," said Green, who is currently an assistant with WC's varsity. "I probably sat in there for two hours. My shoulder was stiff the next day -- not sore, just stiff. My body felt pretty tired. But I never really had any pain, that was the great thing about it.

"I did that on five days rest, and I started my next game five days later. There were a lot of people talking on MassLive [messageboards] about, 'You're going to ruin the kid's arm', but I never had any pain afterwards."

To this day, Bradley said pitch count wasn't as big of a concern with Green.

"I had taught him from his freshman year that his build was perfect for a pitcher, he had a large lower body," said Bradley, who had a short career at the University of Pittsburgh. "We started working with him on his lower body to generate power. A lot of coaches are in love with the tired and true, getting to a balance point [in your delivery]. The real way to pitch is to power yourself with your legs.

"You do that, and as Andrew learned, you can throw from quite a long time. It's not uncommon for guys that pitch for me to throw 80 to 100 pitches in a bullpen session, and that's kind of the way Andrew was as well."

Moreso, since Bradley took over as head coach in 2007, he says none of his pitchers has ever been sidelined with injury for an extended period of time. Defense has actually been the issue with Crusaders squads under Bradley, but that is also a function of lack of facilities -- this is the first year WC has ever had a home field, which in the past meant practicing anywhere from a gymnasium to a parking lot. The Crusaders are off to a 1-5 start, but have already seen pitchers go over the 120 threshold.

"I'm 50 years old, and on a weekly basis I throw anywhere from 500 to 1,000 pitches in a week for batting practice," Bradley said. "And I think the number of times I've had arm soreness in my entire life, I can count on three fingers."

Clearly, there are two distinct schools of thought here. There is the school of thought that errs on the side of caution with pitch count, some stricter than others. Then there's the one shared by the Bobby Cox's and Nolan Ryan's of the world, letting players routinely ring up triple-digits with the mantra of building up arm endurance.

Would Bobby Cox or Nolan Ryan let one of their players ring up 155 pitches in an April game in cold temperatures? Let's face it, probably not.

The first baseball game I covered this season, Pat Ruotolo of Peabody threw 133 pitches in an eventual loss to St. John's Prep. I'm sure there are countless other instances around the state this season where a player exceeded a common threshold this early in the season.

I was also in attendance for the Barnstable game in question here, so let's take into account his mechanics. In Nastasi, I see a little bit of Jordan Cote, the lean 6-foot-5 righty from Winnisquam (N.H.) High who turned down a Coastal Carolina scholarship last summer to sign with the Yankees for $750,000. Like Cote, Nastasi stretches out on the mound, keeps his elbow in, transfers his weight well, and as a result generates high-80's fastball power from his lower body. His mechanics are sharp, but most importantly they are also clean.

And like Green, Nastasi can eat innings on the mound. He didn't show any signs of laboring until the ninth inning, and at that they were minimal.

But let's also consider the human element here. The Old Colony League made the switch this year to nine-inning games and wooden bats only; and with only four teams in the league, every one of these matchups is very important. Nastasi had a good thing going, striking out a career-high 16 batters, and had the winning run at the plate in the top of the ninth. Was Nastasi going to tap himself out? No, and I don't think it mattered whether it was April 24 or June 24. Nastasi earned his scholarship to UConn by being a competitor, not a conservative.

In Green's case, it was one of that last games of the regular season, with the Crusaders still trying to quality for postseason. He was also playing at legendary Soldiers Field in Douglas, where Babe Ruth himself once made an appearance. It was also one of the last starts of his senior season, and he wanted to make it count. Like the majority of high school players, his career didn't continue in college (he briefly tried to walk on at NAIA power Malone University, before returning home and enrolling at Quinsigamond Community College).

I'm sure the high pitch count startled the UConn coaching staff -- or maybe it didn't. Maybe it's the part of his competitive makeup that excites coaches the most.

There are many good reasons Nastasi should have left the game earlier, many of them smartly laid out here, many of them concerning the long-term.

They're probably right.

But in the heat of the moment, you're in the fog of war, and how you'll feel a year from now isn't a priority.

You're trying to win a ball game, and that's all you care about at that moment. And at the end of the day, isn't this what high school sports are all about?

Kirk Fredericks

Head Coach, Lincoln-Sudbury Regional High School

Every situation is different as each kid is different. We have a kid that when he throws over 75 pitches, he can't pitch on five days, he has to go to seven days. As a coach, you need to be educated and you have to know your players. When does your kid change his mechanics? When is he tired and going to hurt himself? It isn't like a cut, where you see blood. You don't see the results of the damage until later.

I don't have an answer for what the magic number is. We look at it as what number is he at and where that puts us for the next time out. If we go one more then where does that put us? I guess the general number is 100. Have I gone over that? Yes, because a kid had an easy 100, or we want one more batter, so they get to 110. But a win isn't important enough to be the person responsible for long-term damage. You never know what damage a kid has from previous history that he is coming in with, so it is always good to side with caution.

What is the highest that one of my pitches has gone? 125 in a state championship, and 133 in a state championship. Is that right? I don't know.

John Botelho

Staff Writer, Brockton Enterprise

No pitcher -- not just a high school kid - should be throwing that many pitches. Simply put, that kind of workload on an arm seriously raises chances of an injury.

It is a good thing that Nastasi not only wanted the ball but also was quick to defend the decision that let him throw more pitches than most pitchers do in a game at any level. It means he's a good teammate and truly cares more about his team winning games than he does his own well-being.

We're not discussing what kind of a teammate he is though, and him hinting that it was decision to stay is where my problem with this type of pitch count starts. A decision like that shouldn't be left in the hands of a player. Teams have coaches for that very reason. If we're going to brush off an extreme pitch count because, well a 17-year-old kid trying to win games with his best friends said he was fine, where do we draw the line? If players dictated playing time, wouldn't every kid believe he should be playing all the time, hitting near the top of the order? So how is letting a kid dictate how many pitches is too many okay?

Think about what would happen to a coach if he let a potentially concussed player return to action without ensuring he was 100 percent. It wouldn't take long for people to call for that hypothetical coaches job. I'm not going to pretend that an arm and a head are anywhere near the same thing, but why is a baseball coach allowed to do something that could cause potential to his player? If any professional - a physical therapist, strength coach, orthopedist, etc. -- could prove there was no harm in throwing that many pitches, wouldn't big leaguers throw more than 100 or so a game, especially since teams are shelling out all sorts of money? MLB teams would love to get more bang for their buck, but instead $15 million investments are babied, and protected as much as possible. Why then, are high school kids who are still developing physically thrown to the wolves then?

For those who would argue that, 'Well, of course MLB teams will baby their pitchers. They pay too much money not to,' I contend that those pitchers well-beings should be no more important than a kid pitching for his high school. If that is your argument though, consider that Nastasi is committed to UConn to pitch next season. Last summer, Huskies pitcher Matt Barnes signed for $1.5M as a first round pick -- something that certainly could've been jeopardized if he needed his arm reconstructed. Furthermore, what is the ultimate pay out for adding this type of risk to a high school kids arm? A few extra wins? Is winning games -- even if they result in a league title banner or better record -- more important than a kids health? Even if these were big tournament games, I wouldn't see this as okay, but right now we're talking about games played in cool and pitcher-unfriendly April weather. Knowing how an arm injury can effect a kids future, this juice just doesn't seem worth the squeeze.

I think you'd have an easier time finding a high school kid act like Nastasi did on Tuesday, willing to lay it all on the line to win the game at hand than you would one who would go to his coach and ask out of the game because his pitch count was mounting. High school athletes are stubborn and hard-headed, naive to the world of baseball injuries that is truly out there. And for anyone who thinks no toll is paid for the mileage piled up on high school arms, a quick look at the arms of college pitching staffs tells a much different story. It's easy to spot the tell-tale labrum fixes with the scars around the shoulder. It's even easier to to spot the train tracks running around the inside of an elbow that has had Tommy John surgery. Those injuries are typically hangover from abuse in high school, when kids regularly throw on short rest with little regard for pitch count. That is not the case at the collegiate level, as starters throw once a week, and aren't asked to go complete games every time out because bigger rosters allows for real bullpens. The injuries still pile up though.

For the sake of argument, I'm going to call Roy Halladay the most durable pitcher in the MLB. Since 2006, he has been an absolute horse, tossing at least 220 innings in each season and throwing as many as 250.2 in a given year. Consider that in that time, he never got anywhere near 155 pitches. He never even reached 140. In fact, only three times in his entire career has he even reached 130 (and never more than 133). Just 16 times in 356 career starts has Halladay thrown at least 120 pitches in a game. The information gets more interesting if you consider that Halladay was 26 the first time he reached 120 pitches in a game. He didn't toss 130 until he was 33-years-old, long after his growth plates had closed, long after his development and physical maturation had ended.

I've been told Coach DeMartino planned to take Nastasi out at the end of the nine innings if it went to extras, but why there? Was it because the pitch total was already far beyond a reasonable amount? Or was 150 or so the magic number? I have to think he puts less importance on pitch counts than I do -- and some coaches do -- because I watched Barnstable pitcher Keegan Dellacona throw about 140 pitches in over eight innings in a loss to Bridgewater-Raynham Thursday afternoon. DeMartino is hardly alone in this practice, and maybe the MIAA needs to step in and establish clean cut rules in regards to pitch count and rest - just as they did with returning from concussions -- to ensure that athletes' safety is made priority number one.

Perhaps that means knocking the Div. 1 state tourney games from nine innings to seven or having teams carry bigger rosters, but one thing is for sure: No pitcher should be throwing 155 pitches, or even approaching that mark, in a high school baseball game.

Ryan Lanigan

Founder, HockomockSports.com

Willie Nastasi had an incredible performance in the win over Taunton with a complete game and 16 strikeouts, but did he stay in too long? For me, I see nothing wrong with the decision to let him finish the game. Nastasi said it was his own decision to stay in but in the end, the coach has the final say no matter. I believe both made the right decision to let him finish the game. The UConn commit is an experienced pitcher and knows his own limits. Yes, some will say that his youth and getting wrapped up in the moment could influence his decision, but in the end, he knows his body. Someone with a bright future wouldn’t jeopardize it by risking their health and Natasi was confident in his decision to throw the amount of pitches he did.

Ryan Kilian

Founder, New England Prep Stars

It is a tough call because I can see both arguments on the issue but I have to think that with proper training and advanced understanding of the individual pitcher it can be done. I think it really begins and ends with the individual pitcher. I come from the Nolan Ryan and Mike Maddux camp where I believe that pitchers to need to re-trained and not be coddled as much. However, I think mechanics and future in the game are two important factors to look as well. There are definitely some deliveries and styles that are more taxing on the body and arm in particular and without proper diagnosis and training you should lean on the side of caution. I would also look at all the advantages that hitters have, such as aluminum bats and the high strike not being called as much as factors in favor of the hitter and advanced pitch counts.

Some pitchers will never be 130 pitch a game pitchers just like some pitchers will never throw 95 mph or average 1.9 walks per game. It depends on the pitcher.

Ben Larsen

Online Producer, MassLive.com

There are a number of variables at play here. Was he equally effective in the later innings? Was the high pitch count due to strikeouts via deep counts? The question I’m wondering though is why it was his decision to stay in the game? It should be up to the coach. With all that said, I think 155 is too much. You rarely see pitchers at the highest level, with the benefit of a complete spring training regimen, reach that mark. In my opinion, if he needed 155 to get through, he wasn’t efficient enough. That is a lot of pitches and this early in the season, surely, it wasn’t a ‘must-win’. This is a game that could have been left in the hands of the bullpen.