How many pitches is too many? In college baseball playoffs, it’s an annual debate. – The Denver Post

If it’s June, it’s time to scrutinize pitch counts in the college baseball playoffs.

On June 2, junior Paul Skenes threw 124 pitches in LSU’s 7-2 victory over Tulane in an NCAA Division I Regional. Three days later, sophomore Matt Savedoff tossed a career-high 147 pitches in Johns Hopkins’ 8-2 win against Baldwin Wallace in the Division III College World Series semifinals.

And last Thursday, graduate student Gabriel Romano threw a career-high 164 pitches — nearly twice as many as MLB pitchers average (86) in a given start, according to Baseball-Reference — in the Blue Jays’ 11-6 victory over Lynchburg in the finals.

The high pitch counts caused a stir on social media with several commentators criticizing the teams for the usage of their pitchers. Skenes’ performance raised eyebrows in Major League Baseball circles, according to The Washington Post.

These cases are not equal. Romano was likely pitching the last game of his career. Skenes, meanwhile, is expected to be the first or second overall pick in next month’s MLB draft and will likely pitch again for the Tigers before turning pro.

For UMBC coach Liam Bowen, the outcry was expected, and it came again after senior Quinn Mathews threw 156 pitches in Stanford’s 8-3 win against Texas in a Division I Super Regional on Sunday.

“It’s that time of year,” he said. “It’s almost like an annual tradition because the games are so important and there’s always going to be one pitcher that goes really long.”

There is a consensus in medical and baseball communities that excessive workloads for pitchers can expose them to shoulder, elbow and wrist injuries. One of the most debilitating is ulnar collateral ligament (UCL) reconstruction, which is more commonly known as Tommy John surgery and named after the first MLB pitcher to undergo the operation.

But the suggestion that high pitch counts conclusively lead to injuries is debatable. A review of extreme workloads for MLB starting pitchers and subsequent trips to the injured list for those pitchers between 2010 and 2015 demonstrated “no association between preceding years of cumulative pitches, starts, innings pitched, or average pitches per start and being placed on the [injured list] for any musculoskeletal reason,” according to a 2018 report from the Journal of Shoulder and Elbow Surgery Board of Trustees.

But another search that analyzed studies regarding risk factors associated with UCL injuries in baseball players showed that one of the five most consistent modifiable risk factors was a high pitch count or volume, according to a 2023 analysis from the Arthroscopy Association of North America.

“Nobody really knows where to draw the line in the sand,” said Dr. Christopher Looze, a former first baseman at George Mason and within the Toronto Blue Jays organization in 2005 and 2006 who is a MedStar orthopedic surgeon and a team physician for the Orioles. “I think it’s a flag that these guys are throwing more pitches, but it’s also something that we have to look at and try to understand, ‘Are these guys putting themselves at an increased risk?’”

Dr. Mohit N. Gilotra, a University of Maryland Medical System orthopedic surgeon specializing in acute and chronic shoulder and elbow pain, said he went online after watching Mathews’ 156-pitch showing for Stanford and found that the last major league pitcher to throw at least 135 pitches was former San Francisco Giants star Tim Lincecum, who hurled 148 in no-hitter on July 13, 2013. As of Wednesday, only two pitchers — the Blue Jays’ Kevin Gausman and the Philadelphia Phillies’ Zach Wheeler — are averaging more than 100 pitches per start this season. No MLB starter has eclipsed 119 pitches in a game this season, and only 15.7% of starts have surpassed 100.

“From a doctor’s perspective, we’re thinking mostly about the health of the athlete, not about what’s the best chance of winning,” he said. “So we’re all going to err on the side of safety, and it is alarming to me.”

Both doctors agreed that each pitcher’s situation is different and will involve factors such as previous work, past and current health and future eligibility and professional prospects. Mathews, the Pac-12 Pitcher of the Year, was drafted by the Tampa Bay Rays in the 19th round last year but elected to return to the Cardinal for his senior season. He made it clear that he didn’t care about his workload against Texas.

“I told them I was good to go,” he said. “It wasn’t like they were going to try and take the rock out of my hand.”

In Johns Hopkins’ postgame conference, Romano defended his desire to finish his team-high fourth complete game of the season.

“I knew it was going to be the last time I was going to pitch,” he said. “I just wanted to go out there and get us that second game and do what I can do. We made it to that second game, so that’s all I could do. So that was it. I would have stayed out there for 200 pitches. It was just about getting that win.”

Romano maintained his position on social media and even got some backing from former major league pitcher David Cone.

A Blue Jays spokesman declined requests to interview Romano, Savedoff and coach Bob Babb for this story. Maryland-Eastern Shore interim coach Shawn Phillips, who pitched at Delaware State, said he could empathize with pitchers reluctant to leave the mound. He said critics might be focusing too much on pitch counts.

“I think everyone looks at the pitch count, but did they watch the game? Did they see how many stressful innings he had?” he said. “There’s a lot of variables. The number is eyebrow-raising and stuff like that, but there’s a lot of things that go into it as well.”

Dr. Gilotra said long-term effects of excessive pitching can include calcification buildup and arthritis in joints such as the shoulder, elbow and wrists. If asked, he said he would advise college baseball coaches to keep pitch counts in playoff games to 100.

“There’s no hard data that says that 90 is better than 100 or 120,” he said, “but that range seems reasonable.”

Dr. Looze said he is more concerned with what he described as abrupt increases in a pitcher’s workload, especially in the postseason.

“What we’re really worried about is overuse injuries,” he said. “It’s the balance between how much volume are you doing, how much of a workload do you have, how much stress are you putting on the arm and basically overwhelming the body’s ability to heal?”

Towson coach Matt Tyner was in the outfield on May 18, 1979, when Miami teammate Mark Batten set an NCAA postseason record by pitching 15 1/3 innings in a 3-1 win against The Citadel in a regional game. Tyner said he trusts his pitchers to inform him when they’re beginning to feel fatigued.

“I would say that we teach these kids to communicate and share with us how their bodies feel on an honest platform,” he said. “We tell our guys, ‘You at 70% is not as good as John Smith at 100. So keep that in mind. You could be going out there and damaging the team.’”

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