CLAYTON - Grant Austin's pitches were falling short of home plate. Little League coach Jamie Jones of the Clayton Braves called out to the bullpen and looked at Grant's father, Jake.

"His arm's starting to hurt," said Jones, before comforting the young pitcher. "Don't ever be shy about that."

The 9-year-old wasn't happy to be taken out though, slapping his glove on the dugout bench.

Little League Baseball has made a new pitch at saving young arms from overuse -- but the rule, put into place this season, does nothing to protect pitchers in other youth baseball leagues. Little League's rules changes affect only official league teams. Many baseball programs in the Triangle are governed by other organizations and have different pitching rules.

The key change is to limit the amount of pitches thrown, rather than limiting the number of innings, in order to gain more control over how often kids throw in a game.

The organization also has partnered with UNC-Chapel Hill for a five-year study to better understand the effects on young arms and shoulders of throwing often and throwing certain types of pitches.

While Grant hadn't reached his pitch limit, it was the type of self-policing the league has tried to encourage.

They want to prevent young, developing arms and shoulders from ending up on the operating table.

Overuse the issue

The changes were made because, increasingly, orthopedic surgeons were blaming injuries on overuse -- young arms throwing too many pitches at a time when their bones are growing and soft.

"We've seen more and more kids getting injured at younger and younger ages as they sort of specialize in sports," said Dr. Rebecca Demorest, Medical Director of Sports Medicine at Children's National Medical Center in Washington.

Young bones have areas called growth plates at their ends. These areas are more vulnerable, especially when overused, said Demorest. The bones are weaker than the surrounding muscle and tissue.

"It's the weakest part that's going to give out first," she said.

There are two types of growth plates, one where bones grow and another where tendons attach. Both types can be injured.

Demorest explained two common injuries. One, "Little League shoulder," can result in decreased range of motion, while the other, "Little League elbow," can cause an elbow to lock into a position.

'Just stop throwing'

The solution is simple, said Mark Wood, an orthopedic surgeon with Wake Orthopedics in Raleigh.

"You just stop throwing," said Wood. "Problem is, it's easier said than done. Sometimes, it's not the kid you have to worry about."

Surgery is the extreme consequence for throwing too much, said Wood, who said modern medical techniques are very effective in rehabbing these types of injuries.

"[But] at all costs, you should avoid that route [surgery]," said Wood. "Sometimes, you are never as good as you were before."

While Little League takes in players ages 5-18, by age 15 or 16, the growth plates in boys' arms are better developed.

Demorest and Wood agree that part of the increase in these injuries is related to playing one sport year-round.

Injuries still happen

Robert Walters is an avid baseball fan, but he's been cautious with his 14-year-old son, Brett, who's been in youth baseball leagues since he was 5.

Walters has kept his son from playing baseball year-round and has encouraged him to play basketball and football.

Even so, that didn't prevent Brett from getting a growth-plate injury.

Brett's AAU baseball league started up just after he turned 13, a time when he was also going through a rapid growth spurt. At the AAU level to which he had just advanced, pitchers have to adjust to throwing the ball another five feet to about 60 feet, the length that major league pitchers throw the ball from the mound to the plate.

Before the team had played an official game that season, the young Walters told his father that his shoulder was hurting.

"He's always told me to let him know if something doesn't feel right," Brett said.

The father didn't think too much of the pain until his son complained again.

"He's a tough kid, so he doesn't complain unless something is wrong," Walters said.

Doctors took X-rays that revealed that the growth plate in Brett's shoulder was inflamed. So he was kept off the pitcher's mound for six weeks and then went through physical therapy.

When the pain returned again, the young arm was shut down for the rest of the season.

"It couldn't have been an overuse issue," said Robert Walters, noting the season had just started.

He believes the inflammation was caused by one of three factors or a combination of them: the increased pitching distance, the possibility that his son's mechanics were off, or his son's growth spurt, which may have made him more susceptible to a growth plate injury.

And for all the precautions the Walters family has taken, Brett wasn't able to pitch this year after he fractured his wrist playing football, which required surgery to install a pin.

"You don't know how much you miss it until you're actually not playing it," said Brett, who is expected to be able to pitch again.

Safeguards debated

There's still debate about the best way to safeguard young players.

The term "Little League" is often used generically, but the official league doesn't govern leagues such as Babe Ruth and Pony, which don't have to abide by the new rules.

North Wake Baseball, which isn't governed by Little League Baseball, has its own pitching rules, based on the number of innings. The rules are similar to Little League's old policy.

But North Wake president Ken Shuey said there are loopholes in the system. Kids can throw more by playing in different, unaffiliated leagues.

"When you count innings, nobody counts the time when you warm up," Shuey said.

And parents are often the ones who want their kids on the mound as much as possible.

"It really does need to be monitored," Shuey said.

North Wake Baseball does have stricter rules in one area -- pitchers are only allowed to throw fastballs and changeups.

Many experts believe curveballs and other breaking pitches are harmful to young arms because of the increase in torque needed to deliver them.

Little League has considered banning these pitches, but held off, stating there wasn't any solid evidence to back up such a move.

Instead, Little League and UNC-Chapel Hill have partnered on the five-year study to see if those pitches put arms at greater risk of injury.

Research needed

That study will also look at the number of pitches being thrown, said Dr. Stephen Marshall, associate professor of epidemiology at UNC, who is working on the project.

Demorest said Little League's rule change is the best thing out there until more research is done.

Rules-related pitching strategy was playing out in the Clayton White Sox dugout in the late May game against the Braves.

In the bottom of the third inning, pitching coach Lio Drian pulled 10-year-old ace pitcher Dalton Beamer out of the game.

It's not that Dalton was having a bad outing. Drian kept count of Dalton's pitches with his clipboard in one of the Clayton White Sox's last regular-season games.

There were 56 notches for each of Dalton's pitches inked when the change was made.

"We want to keep him under 60 [pitches] because we have an important game on Saturday," Drian said during the game.

According to the rules, Dalton would have been ineligible for three days and that weekend game, if he would have thrown more than 60 pitches.