Under The Knife: Lack of oversight could ruin generation of hurlers

Emerson Gibbs is a right-handed pitcher, a senior for New Orleans Jesuit. He's 18, 6-foot-1, 180 pounds and signed to play at Tulane. Last weekend, he faced Mitch Sewald from rival Archbishop Rummel, another top prospect from the area, signed to play at LSU. Sewald, also a senior and right-handed, is 6-5, 206 pounds and also 18. I mention their sizes and ages because of what happened in that game. Jesuit and Rummel went 18 innings in a division matchup, an instant classic that the schools web site said "had fans on the edge of their seats." Big deal? Yes, the game was even carried on local TV. Somehow, no one was watching Gibbs and Sewald. I say that because Gibbs was allowed to throw 193 pitches, while Sewald threw a mere 154. Gibbs had 13 strikeouts in 15 -- 15! -- innings of work, while Sewald had 10 strikeouts in his 10 innings. Neither factored in the 2-1 decision, won by Jesuit. One-hundred ninety-three pitches is a lot at any level. In Wednesday night's Giants-Phillies game in which Cliff Lee went 10 innings and Matt Cain went 9, they combined for 193 pitches.

Calls to both schools and to LSU and Tulane were met with plenty of "no comments," but Rummel Athletic Director Phil Greco was candid. He seemed concerned, but said "I have to trust the judgment of my coach." He explained that Sewald "hadn't pitched much" this season, "about thirty innings." He said this was very unusual and that when these two teams and pitchers faced each other earlier this season, Sewald was removed in the eighth inning of that game despite having a no-hitter. Louisiana has no rules or guidelines for pitcher usage, so there's nothing officially untoward here. Like Kerry Wood throwing both ends of a doubleheader in Texas after having been selected by the Cubs, there may be damage done, but then again, Wood went on to have one of the best starts in baseball history before his elbow popped. It's not Wood, Dylan Bundy (181 last year) or Lance Lynn (177 as a HS senior) or any major league pitcher who has a high pitch count game in high school that's the issue. It's the hundreds of kids who didn't go on to the majors, the ones that may -- may -- have had a chance, that will always feel a twinge in their arm because of one game.

Coaches get these kinds of star-level players once in a career in most schools. If they don't win, if they don't beat their rivals, they'll be out of a job. While we hope that these coaches would put the good of the kid before their own self-interest -- and I've found that universally that is the case -- it's hard in the moment to see it. It's hard to take your ace pitcher out of a tie game when he says he feels fine and the fans are "on the edge of their seat." A coach will look across and see the other coach looking back. Did Rummel's coach think twice when he went out in the 10th, wondering if Jesuit would send their ace back out? It's impossible to know the consequences. At some level, it's wrong to single this game out. It's not normal. But it shouldn't have happened. It's not just the school, the coach, or even a parent that let these kids down. It's the game of baseball. Louisiana's lack of guidelines put the onus on a coach who's conflicted by definition. Louisiana is not alone. Only Vermont has a rule using pitch counts, though several states have workload restrictions on tournament play.

Dr. Glenn Fleisig of ASMI is perhaps the top expert on pitch counts and biomechanics around. He helped develop Little League's pitching rules. When asked about this situation, Dr. Fleisig wrote: "The growth and development of a young pitcher is a balancing act between too much and too little pitching. Unfortunately, even a high school coach with the best intentions doesn't see the harm caused down the road. Too much pitching causes microscopic tears in muscles and ligaments that can get bigger and bigger pitching game after game. Ultimately -- often years later -- a tear grows into a serious injury. It's kind of like giving a kid a pack of cigarettes a day to smoke (which I don't recommend). You wouldn't see any harm at the beginning, but this surely could lead to cancer down the road." Intentionally or unintentionally, too many high school coaches right now are holding the lighter.

Powered by an afternoon with Tommy John, on to the injuries:

It's a basic tenet of this column: The wall usually wins. Young bounced off the wall in left center and despite the padding there and in most parks, Young's shoulder was the loser. Tests originally showed just a bruise, but "just" in this case is at the point of the shoulder, a place that's tender and fragile. Further tests showed a tear in the AC joint, which is where the collarbone and shoulder come together. The sprain is not considered severe, but he will miss a couple weeks to make sure that it heals properly. The D'backs will let him heal up, then get him back in once his throwing and swing is back to normal.

The news was better with Upton, who has a bone bruise at the base of his thumb. It's not serious, but he will need rest in order to let it heal. The D'backs used him as a pinch runner on Wednesday, which is the best indication that they think it will heal quickly. Having two guys day-to-day is a tough situation for Kirk Gibson, but the D'backs handle medical situations with the best of them.

Wilson had Tommy John surgery on Thursday. As I said above, I spent the afternoon with Tommy John -- you'll hear more with next week's Inside Fantasy podcats -- but one of the toughest things about the surgery is figuring out when to do it. Wilson has a significant, but incomplete, sprain. Even the best surgeons don't agree on when a ligament is too far gone, too compromised and requires replacement. Yes, it was Wilson's decision, and while the Giants team doctor was present at the surgery, it's a medical decision, which is always made between a patient and their doctor. It's no surprise that Wilson chose to have the surgery with Jim Andrews, who did Wilson's first Tommy John in 2003. Wilson will begin the rehab process immediately and should be throwing at spring training next year.

Miss four, play two. That's the pattern that will cost the Cardinals over the next 15 days. By giving Berkman the chance to play after a couple days of rest, they lost nearly a week of DL time. When Berkman had a setback, he was forced to the DL. The calf is going to need at least 10 days of rest, which means he might not be ready once the 15 days are up. Berkman won't need a rehab assignment, but there's concern about the calf leading to further issues. Berkman's knees and legs have had problems in the past, though he was healthy and productive last year for the Cardinals. The absence gives Matt Carpenter a bit more time to establish himself, something Mike Matheny seems willing to entertain.

The Yankees are giving mixed signals about Gardner. His elbow issue went quickly from a quick lineup scratch to a DL stint, but then they replaced him with a reliever, a move that usually means there's going to be some roster juggling. It's Gardner's non-throwing arm, which confuses things even further. Word is that Gardner has a bruise on his elbow and a strain. That can be the same thing. The mechanism of the injury actually suggests a hyperextension would be the more accurate term. It's easier to see in this video of the diving catch he made and how his arm moved. Given the information we have, this shouldn't be a long term problem, but the 15 days should be enough to heal things. In the meantime, the Yanks will be forced to use Andruw Jones more. (Imagine someone saying that 10 years ago. Who would have thought it could be a drop-off?)

The Tigers let Fister get back on a mound this week, and while things didn't go well, it wasn't exactly a setback either. He only made it through 12 pitches, but there was no problem. Fister was uncomfortable and stopped, much more than a re-injury or setback in the strictest sense. The Tigers medical staff felt he might be ready to take the next step and he wasn't. By being honest and being properly monitored, the Tigers got a new piece of information. There was some risk, yes, but it's a smart play by an underrated medical staff. Fister will probably try again next week. It is a good time to try to steal him, if he's a pitcher that would upgrade your staff.

As closer injuries have gone this year, a mild hamstring strain is well down the list. The Pirates would rather have Hanrahan healthy, but his absence has shown that they have options, including Juan Cruz. In most years, that would get people thinking "trade bait" and maybe the Pirates will, if they get the right offer, but a GM I spoke with last year talked about one of the real values of a closer being confidence for a young team. He said that losing close games can wear on a team that's trying to establish itself. It makes some level of sense, though I think it's reaching since it implies a team with a proven closer doesn't also lose games and think -- if Mariano Rivera blows a save, is that any different from David Robertson doing it? Hanrahan will be back in the pen on Friday and could be used if he and Clint Hurdle feel comfortable.

BJ Upton will come off the DL on Friday. He should go into the Rays lineup immediately. Omar Infante is expected back on Friday after missing a couple games with a mild hamstring strain. Don't be surprised if it goes an extra day or two, though signs are positive for a normal return ... Kerry Wood got an anti-inflammatory injection in his shoulder and should return this weekend ... Allen Craig was pushed back to quickly and had a setback with his knee. He's at least a few weeks away from trying again ... Casey Kelly got some good news, in that there's "no structural damage" in his elbow. He'll still be shut down a bit and watched closely when he does return ... Chien-Ming Wang will begin a rehab assignment this weekend. The Nats aren't tipping what role he'll fill, so how long he goes in his first outing will be the best clue ... Dustin Mosely will have surgery to repair his cuff and labrum. He's out for the year and this could be a career-ender ... If you want a unique view on the pitch count debate, listen in to this week's The Nickel, where we talk with Chris Franzese. He once threw 193 pitches in a high school game and his take on this might surprise you.