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The next arm epidemic? CNY doctors call for softball pitching rules, but coaches still unsure

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The next arm epidemic? CNY doctors call for softball pitching rules, but coaches still unsure
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Maddie Walters was in her second year of junior varsity softball for Union Springs when, during a game late in the season, she began experiencing elbow pain while getting ready to pitch.

At first, she thought it was normal soreness.

Then, two games later, Walters was going through her pitching windup when her arm went completely numb.

She finished the inning but experienced a tingling sensation in her hand and expressed to her coach that she couldn't feel the ball. She requested to switch to catcher — Walters generally alternated between pitching and catching — but her arm remained numb for hours after the game.

After visiting a chiropractor, a pinched nerve in her back was ruled out. At the recommendation of a physical therapist, Walters underwent MRIs and X-rays, and that's when the root of the issue was discovered.

Walters had a tear in one of her elbow flexors; when she'd pitch the muscle would swell and press on her ulnar nerve causing the numbness.

Having just completed her junior year for Union Springs' varsity team, Walters still pitches and continues to deal with the effects of her injury.

"I was told the tear isn't going to heal itself, but they don't want to operate on it because it's not large and it's not debilitating," Walters said. "It's just kind of something I've got to deal with."

Two years ago, baseball in New York state was changed forever. Due to the growing totals of elbow injuries in pitchers, the NYSPHSAA installed new rules that not only limited high school pitchers to 105 pitches per outing, but required a requisite number of nights rest depending on how many pitches were thrown.

While overuse in high school was only a fraction of the issue — coaches and medical experts pointed out year-round pitching with travel teams and bad pitching mechanics were part of the problem — the rule did what it set out to achieve: protect the players.

Despite growing concern among sports medicine professionals, pitch count rules in softball have yet to be discussed, let alone approved, by the NYSPHSAA.

Common belief holds that pitching underhand with a windmill-style motion does not cause harm. Dr. Dale Buchberger, a specialist in sports-related shoulder and elbow injuries at Active Physical Therapy Solutions in Auburn, disagrees.

Buchberger wrote a column for The Citizen in March that referenced a book by Dr. James Andrews, a well-known sports orthopedic, addressing the misconception that underhand throwing can't lead to injury.

In the book, "Any Given Monday," Andrews expressed that, "The repeated movement and velocity of pitches thrown, even in the windmill style, are now even tearing the 'Tommy John ligament,' resulting in (ulnar collateral ligament) injury. Pitching limits matter in softball as much as they do in baseball."

"We view the softball thing as benign, and it's not benign," Buchberger said in an interview with The Citizen. "What is a common belief doesn't necessarily make it a truth. The question is, why is it that we will protect our little boys but we won't protect our little girls? That's it in a nutshell."

When a pitch is thrown windmill-style in softball, force is produced at both the elbow and the shoulder. As fatigue sets in, the body begins to compensate, and that's when there's a greater risk for tears in the arm. Buchberger recommends that all pitchers be on a proper throwing program to help delay fatigue. He also suggests some off-beat activities, like rope climbing, wall climbing and water-skiing, to help strengthen the shoulders, though he adds such exercises must be performed regularly to be effective.

For some, like former Moravia High School pitcher Maddie Funk, a proper throwing program is almost a year-round process.

Funk, now a pitcher for Nazareth College in Rochester, joined Moravia's varsity team as an eighth-grader in 2014 and was the team's only pitcher for five straight years. Once each high school season was over, she'd pitch every night during the summer, "whether it was at (travel) practice or in the backyard with my dad.”

Her only months off were August and September. When October arrived, Funk would throw for around two hours every Sunday with a pitching coach in Candor, about 40 miles south of Moravia, and that continued through the winter until high school season started up again. Funk was also a varsity basketball player at Moravia, but even during hoops season she’d regularly use the gymnasium to pitch.

Aside from typical postgame soreness, Funk has never suffered a pitching-related injury.

"It never really bothered me at all," Funk said. "I never really had any issues. I pitched year-round and kept my shoulder in shape. I would say from my experience, underhand is not as taxing as overhand."

While some doctors are convinced that softball needs more pitching regulations, many coaches are still unsure. Some, like Auburn High School softball coach Kelley Horbal, believe each player needs to be handled on an individual basis.

"It's tough ... because every athlete is different," she said. "I don't necessarily think a pitch count is needed or necessary, but knowing your athletes and knowing what their bodies are telling them is what's important to be aware of."

Sandy Donahue has coached Weedsport's varsity softball program since the mid-2000s. She's had years when one pitcher dominated all the innings, like former all-state selection Abby Marsden, and other years like this past season when she utilized a staff approach.

Among the benefits of the latter, Donahue said that the mental state of her pitchers is much better when one individual isn't carrying the load "because they knew if they had an off game they could rely on their teammates to step in."

While innings don't pile up at the same rate with a three- or four-pitcher staff, Donahue said she still watches for signs of fatigue. How is the ball being released? Is the pitcher shaking her arm between pitches? Is she throwing a lot of balls or working long counts? Coaches must constantly observe and answer those questions.

Sometimes it comes down to something as abstract as a coach’s instincts.

"I always base (who pitches) off who I'm feeling is going to be the best for the team on any given day," said Horbal. "It depends on what we have numbers-wise and who is better than who at any given moment. You just kind of go with it."

But the reach extends only so far for high school softball coaches and the NYSPHSAA. Donahue noted that many of her players, even the younger, less physically-developed ones, play more softball than she’s comfortable with.

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During high school season, many softball players simultaneously participate in travel leagues. A pitcher could throw 300 pitches across two or three games for their high school team — whether it be varsity, junior varsity or modified — during the week, then throw 300 more that weekend for their travel team.

"This is where I kind of struggle," Donahue said. "I look at some of my younger players and they're playing travel ball during my season, going all summer long and a bunch are playing other sports, and it doesn't seem like they're getting a break. I do see more and more that we're not doing that as a society.

"It's that mentality that we've got to have the best kid, that my daughter's got to be the best pitcher in the world."

Part of the divide between coaches and the medical community is the lack of information, says Dr. Marc Pietropaoli, the founder of Victory Sports Medicine and Orthopedics in Skaneateles. 

"The bottom line is (softball injuries) just hasn't been as well-researched," Pietropaoli said. "It's starting to catch up and people do realize that pitching too much, even in softball, is not a good thing. Women's research tends to lag behind the men. Unfortunately that's the case, but that's also catching up which is a good thing."

That’s where the parents come in, and Buchberger challenges mothers and fathers to be vigilant of the wear-and-tear that comes with pitching a softball.

"Moms and dads need to step up and say, 'I don't want my daughter pitching two or three days in a row,'" Buchberger said. "On the outside they may look really strong and they can do all this stuff, but the underlying architecture is still flawed and it's flawed because they're 13, 14, 15 years old. Coaches and parents lose sight of that."

Tommy John was 31 years old, a major league veteran of 355 games and over 2,000 innings when he underwent surgery to replace the ulnar collateral ligament in his elbow in 1974.

Back then, torn ligaments in the elbow were typically career-ending for pitchers, but this breakthrough gave longtime hurlers a second life in the majors.

At first, "Tommy John surgery" was most common among professionals with years of major league experience under their belt. Then, it trickled down to college pitchers and by the mid-1990s high school players, and that stems from the increased amount of pitches thrown at the youth baseball level.

According to Andrews Sports Medicine, in 1995 only 10% of UCL surgeries were performed on youth and high school pitchers.

By 2015, it was 60%.

The National Federation of High Schools, the governing body for high school sports in the United States, didn't require its members to adopt pitch count rules for baseball until 2017.

Even with a small sample size, Pietropaoli, a understudy of Andrews, says he's treating fewer patients with baseball-related elbow injuries than before. 

"It's only been a couple years, but looking back I'd probably say we did have less this year than last year. I can say that honestly," Pietropaoli said. "Ask me again in a couple years and I think we'll know more for sure."

How long will it take for the NFHS to recommend similar rules for softball? Buchberger, who has followed arm-related softball injuries for “probably 12 years or so,” hopes it’s sooner rather than later.

"The science is catching up to them, and they can either wait for the science to overtake them or they can start to buy in," he said. "The writing is on the wall, and it's coming, so they can either be ahead of the curve and start getting themselves ready for this, or they're going to be overtaken by the science.

"Then they're going to be the bad guy."

As Moravia’s only pitcher during her five-year high school softball career, Maddie Funk admits that she would’ve been crushed if the NYSPHSAA created a pitch count rule during her career. She questions how small schools, with enrollments that generally fall under 300 students, would adapt.

"There might be a few tears shed," Funk said. "That would've been difficult for our team because I was the only pitcher. There was nobody else that had any instruction or anything."

Like in baseball, those small schools would have the biggest adjustment, especially in places like New York state where wet spring weather leads to postponements and, later in the season, weeks that include five or six games. 

Coaches would be forced to explore expanding their pool of pitchers. At Weedsport, Sandy Donahue wouldn’t hesitate to tell her junior varsity coaches to try out more players in the circle, and she’s confident they’d comply.

She’d also support pitch count rules in softball, as long as it’s only implemented for the junior varsity and modified levels.

"If we start at that level, then we're allowing these girls to learn the game and develop the game as they're growing," Donahue said. "By the time they're at the varsity level, that should be a non-issue because they're stronger, their bodies are developed and they're used to throwing."

Maddie Walters still has one year left for her varsity softball career at Union Springs and she doesn't intend to play in college.

She thinks it's time for rules to be put in place.

"Just how often I've seen girls get hurt — not even just their arms, but one of the girls I know, her back is completely thrown out," Walters said. "I've seen torn rotator cuffs, elbow issues, all that stuff.

"Even though it might put a little more pressure on coaches to work more girls into being pitchers, I think it's important."

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Sports writer Justin Ritzel can be reached at 282-2257 or at justin.ritzel@lee.net. Follow him on Twitter @CitizenRitz.

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