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IM IIIDV C'l IMin Sports Med 2001; 31(1): 61-73IIMJUKT V^LIINIV^
0112-1642/01/000161/S22,00/0
Adis International Limited. All rights resen/ed.
Fast Pitch Softball InjuriesMichael C. Meyers,^ Barrett R.
Brown'^ and Joel A. Bloorn^
1 Human Performance Research Center, Department of Sports and
Exercise Sciences,West Texas A&M University, Canyon, Texas,
USA
2 Department of Health and Human Performance, University of
Houston, Houston, Texas, USA
ContentsAbstract 611, History of Fast Pitch Softball 622,
Incidence of Injuries 62
2.1 Head Injuries 642.2 Upper Extremity injuries 642.3 Lower
Extremity injuries 642.4 Thoracic and Abdominai Injuries 65
3, Aetiology 653.1 Collisions 653.2 Base Running 653.3 Playing
Surfaces 663.4 Age and Experience 663.5 Physical Demands 673.6
Overuse 673.7 Contributory Factors 68
4, Prevention 684.1 Safer Playing Environment 684.2 Coaching and
Piayer Education 694.3 Conditioning 69
5, Conciusion 70
Abstract The popularity of fast pitch softhall in the US and
throughout the world is welldocumented. Along with this popularity,
there has been a concomitant increasein the numher of injuries.
Nearly 52% of cases qualify as major disabling injuriesrequiring 3
weeks or more of treatment and 2% require surgery.
Interestingly,75% of injuries occur during away games and =31% of
traumas occur duringnonpositional and conditioning drills. Injuries
range from contusions and ten-dinitis to ligamentous disorders and
fractures. Although head and neck traumasaccount for 4 to 12% of
cases, upper extremity traumas account for 23 to 47% ofall injuries
and up to 19% of cases involve the knee.
Approximately 34 to 42% of injuries occur when the athlete
collides withanother individual or object. Other factors involved
include the quality of playingsurface, athlete's age and experience
level, and the excessive physical demandsassociated with the sport.
Nearly 24% of injuries involve base running and aredue to poor
judgement, sliding technique, current stationary base design,
un-orthodox joint and extremity position during ground impact and
catching of
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62 Meyers et al.
cleats. The increasing prevalence of overtraining syndrome among
athletes hasbeen attributed to an unclear definition of an optimal
training zone, poor com-munication between player and coach, and
the limited ability of bone and con-nective tissue to quickly
respond to match the demands of the sport. This has ledroutinely to
arm, shoulder and lumbar instability, chronic nonsteroidal
anti-in-flammatory drug (NSAID) use and time loss injuries in 45%
of pitching staffduring a single season.
Specific attention to a safer playing environment, coaching and
player educa-tion, and sport-specific training and conditioning
would reduce the risk, rate andseverity of fast pitch traumas.
Padding of walls, backstops, rails and dugout areas,as well as
minimising use of indoor facilities, is suggested to decrease the
numberof collision injuries. Coaches should be cognisant of
overtraining, vary day-to-day training routines to decrease
repetitive musculoskeletal stress, focus on motorskills with equal
emphasis on speed and efficiency of movement, and use drillsthat
reinforce sport-specific, decision making processes to minimise
mental mis-takes. Conditioning programs that emphasise a
combination of power, accelera-tion, flexibility, technical skill,
functional capacity and injury prevention arerecommended. Due to
the limited body of knowledge presently available on thissport, a
greater focus on injury surveillance would provide a clearer
picture ofinjury causation and effective management procedures,
leading toward safer par-ticipation and successful player
development.
1. History of Fast Pitoh Softball
The popularity of Softball in the US and through-out the world
is well documented. ['" 1 Softball hasbecome a staple of organised
sport programs inschools, recreational and industrial leagues,
militaryinstallations and intemationai competitions.t*'^'
AtSoftball's inception as an indoor sport in 1887 atthe Chicago
Farragut Boat Club the game was orig-inally referred to as
kittenball, pumpkin ball or mushball.I^-' l League play began in
1900, rules werepublished by 1906 and the official name
'softball'was coined by W. A. Hakanson in 1926. In the 1930s,the
sport moved outdoors and city, state and na-tional play was
organised with the creation of theAmateur Softball Association
(ASA), the nationalgoverning body in the US.1 1 During this time,
in-formal physical education programs were popular-ised and
Softball could be found in 90% of women'scollegiate athletics
programs.t' -''*! Today, =1.23 mil-lion athletes in the US compete
in over 82 000 fastpitch junior Olympic teams consisting of
playersaged =18 years.I'^l Of these, 96% or 1.19 million(79 000
teams) of young competitors are female.
Early interest regarding orthopaedic injury andtreatment in
softball was limited, especially in fastpitch.['^'''1 It was
initially thought that the under-hand pitching style and limited
physical contactamong players associated with the more popularslow
pitch game resulted in minimal stress and lim-ited predisposition
to injury compared with base-ball.[^'^l With the advent of Title IX
legislation andincreased exposure of women's sports in the US,there
has been a steady rise in the number of fastpitch athletes
participating in programs from highschool to professional
leagues.''^1 However, this in-creased participation has led to a
dramatic increasein the number of injuries, accelerating renewed
in-terest in and a need for additional research in this
2. Incidence of Injuries
As previously mentioned, the majority of softballliterature has
focused on slow pitch injuries, '"' ^"^^]with limited attention to
the high velocity and splitsecond timing associated with the fast
pitch envi-ronment, t'^l Due to the increased popularity of
fastpitch softball within the last decade, a greater in-
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Fast Pitch Softball Injuries 63
terest in understanding the forces, biomechanicsand similarities
of the sport to baseball has resultedin a resurgence of focus on
this growing sport.
According to early information derived from theNational Athletic
Injury/Illness Reporting System(NAIRS) involving 10 teams during
the 1975 to 1978National Collegiate Athletic Association
(NCAA)women's softball season, there were 1.8 significantinjuries
per 1000 athlete exposures and 8.7 signif-icant injuries per 100
athletes.^','' A significant in-jury was defined as a minimum loss
of 1 week ofplaying time. Based on the mean annual rate ofinjuries,
40% of trauma cases were diagnosed assprains, 25% as various
fractures, 12% as muscularstrains, 4% as neuro-related, 4%
attributed to chronicorthopaedic origin, 2% as dental fractures and
13%involved various other injuries. The authors alsonoted that 52%
of cases qualified as major disablinginjuries requiring treatment
and/or rehabilitationfor 3 weeks or more before optimal return to
playwas established and 2% required surgical interven-tion.1'^'
Nearly 25% of cases revealed further com-plications or recurrent
trauma. Interestingly, 75%of all injuries and 37% of significant
injuries oc-curred during away games each season.
A more recent report from the NCAA InjurySurveillance System
(ISS) sampled 57 member in-stitutions according to reportable
injuries, numberof athletic exposures and injury rate.I'l
Areportableinjury was defined as any trauma resulting in 1 ormore
days of time loss. An athletic exposure wasconsidered to be any
activity leading to potentialinjury during a single practice or
game. The injuryrate was determined by calculating the number
ofinjuries per total athletic exposures x 1000 to de-rive a ratio.
Based on a seasonal total of 2249 games,2780 practices and 72 125
total athletic exposures(26 834 at games and 45 291 at practices),
161 in-juries (injury rate 3.6) occurred during practice and143
(injury rate 5.3) occurred during games. Ofthese, 76% of practice
cases were diagnosed as newinjuries compared with 91% of those
occurring dur-ing games. All remaining game and practice
casesinvolved reaggravation of injuries from the sameseason, injury
recurrence from the previous sea-
son, additional complications from an injury oc-curring within
the same season and recurrence ofother sport and nonsport trauma.
Approximately82% of practice trauma resulted in a time loss of 1to
6 days, whereas a similar time loss occurred with69% of game
injuries. No fatal or catastrophic non-fatal injuries were
reported.
Of special note is where and when the athletictrauma occurred.
Of the limited seasonal informa-tion available, 71% of practice
injuries occurredduring the preseason, whereas 92% of game
inju-ries occurred during the regular NCAA season.!'^More cases
were reported following away games(69%) than after home games (31
%), with 36% and50% of game injuries occurring during the first
tothird and the fourth through sixth innings of play,respectively.
31 % of NCAA practice traumas oc-curred during nonpositional and
conditioning drills,with the remaining injuries attributed to base
run-ning (13%), outfield (13%), infield (12%), pitching(10%),
batting (9%) and catching (8%) situations.During games, 28% of
injuries were attributableto base running, with others occurring in
the infield(17%), batting (15%), outfield (14%), pitching (12%)and
catching (11%) positions.'''
Overall, the type of injuries experienced by ath-letes is
influenced by practice or game situations.Approximately 34% of
practice injuries consist ofmusculotendinous strains and incomplete
tears, fol-lowed by contusions (19%), incomplete ligamen-tous tears
and sprains (14%), and tendinitis andinflammation (13%).I''
Fractures, torn cartilage,hyperextensions and concussions have also
beenreported, as have a minimal number of
lacerations,acromioclavicular joint separations,
neurologicaltraumas and stress fractures. Bleeding occurs inonly 4%
of practice cases and only 5% of injuriesresult in surgery.'^l
In sharp contrast, are the types of injuries expe-rienced during
games. Approximately 45% of inju-ries involve contusions, 23%
complete and incom-plete ligamentous tears and sprains, 15%
completeand incomplete musculotendinous tears and strains,and 10%
fractures.!^] Other less frequently reportedinjuries include
concussion, inflammation, lacera-
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64 Meyers et al.
tion, abrasion, hyperextension and joint subluxa-tion.
Interestingly, 12% of game injuries result inbleeding and 9% of
cases require in-season or post-season surgery, indicative of
higher intensity com-petition when compared to practice
cases.1^1
2.1 Head Injuries
Head and neck trauma accounts for 4 to 12%of cases involving
NCAA women's fast pitch ath-letes.f''^' At the younger levels of
competition, mildtraumatic brain injury (MTBI) comprises 2.1%
ofhigh school fast pitch cases, with a 0.46 injury rateper 100
player-seasons.'"" Of these, the majorityof traumas are direct
cranial blows, ocular traumasor mouth and dental mishaps.l^'^l
Approximately94% of head injuries have been reported as firstdegree
cerebral concussions.''1 However, incidencesof ocular injuries may
be underestimated, since manycases are documented as minor facial
trauma withlimited ophthalmic follow-up by the athlete.t^^l
2.2 Upper Extremity injuries
Upper extremity trauma accounts for 23 to 47%of all female fast
pitch injuries.[^' Although 38% ofall upper extremity injuries are
specific to the shoul-der, nearly 32% of cases involve the upper
arm,elbow or wrist regions and 27% involve varioushand, finger and
thumb areas.'" Types of traumarange from oedema, ecchymosis, point
tendernessand neurological dysfunction' '' '' ''"' ' to
numerousforms of fatigue or stress fractures.''''''*]
Injuries to the shoulder typically include ante-rior and/or
posterior arthralgia, inflammation, insta-bility and increasing
weakness due to overuse.'^^'^^'Various musculoskeletal strains,
primarily involv-ing the trapezius, biceps, pectoralis and rotator
cuffcomplex, are conimon.' -' -^^] Excessive reactionforces during
throwing or sliding have resulted inrotator cuff tendinopathy,
subacromial and glenoidimpingement syndrome, and acromioclavicular
jointdisorders.[".39-4ii
Upper arm trauma, in both male and femaleathletes, is attributed
to significant throwingforces.t-''*' ''-^! Point tenderness,
contusions fromblunt contact, prodromal pain while throwing,
and
triceps fibrosis with radial nerve compression andrupture have
been reported.I '*"^ ] The majority ofemergency cases involve
spiral and oblique frac-tures of the humerus.[30.32-34,36i
Ulnar nerve compressions, with neuritis, arthral-gia and
tendinitis with concomitant oedema, are hall-mark injuries
attributed to overuse and poor pitch-ing mechanics specific to the
elbow region.t^'^1There have also been numerous cases involving
ra-dial nerve damage associated with denervation andpalsy distal to
the elbow following abrupt cubitalextension and
hyperextension.'^^'^'l
The majority of discomfort associated with theforearm involves
tendinitis. A combination of armspeed and the extreme forces
experienced with aninflexible limb often results in ulnar fatigue
frac-tures and associated oedema reported in pitchers.'^^'Hand and
wrist traumas include various finger andthumb sprains, primarily
attributable to batting mis-haps and from falling on outstretched
arms duringsliding.f^J Tendinitis and inflammation,
metacarpalstress fractures and diminished neurological sensa-tion
are especially prevalent among pitchers.'^^-^'I
2.3 Lower Extremity injuries
Lower extremity trauma accounts for 40 to 58%of total injuries
in a single fast pitch season.''-"JUp to 19% of all cases include
the knee, followedby ankle (11%), upper (10%) and lower leg
(6%)traumas.'"] Approximately 36% and 22% of lowerleg injuries are
specific to the knee and ankle re-gions, respectively.'"
Injuries to the upper leg consist of various con-tusions, and
quadriceps and hamstring strains.'^'Patellofemoral arthralgia and
inflammation, and me-dial collateral ligament (MCL) tears are
consistentwith excessive reaction forces and overuse prob-lems in
the knee.' -"* ! Lower leg traumas range fromvarious contusions to
peroneal neurapraxia and acutecompartment syndromes.' -'*'*' The
majority of footand ankle injuries involve sprains and stress
frac-tures associated with the repetitive demands of thesport and
overzealous attention to plyometric con-ditioning.'^'
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Fast Pitch Softball Injuries 65
2,4 Thoracic and Abdominal Injuries
Although thoracic or abdominal traumas werenot specifically
noted in early studies concerningcollegiate athletes,'''^ a more
recent and compre-hensive study indicates that thoracic, back and
ab-dominal injuries account for 5 to 15% of all trau-mas in fast
pitch competition,1^1 Of these, althoughlower back injuries account
for only 7% of all cases,they represent 65% of thoracoabdominal
cases. Col-lectively, the pelvis, hip, groin and buttock regionsare
involved in 33% of injuries associated withthoracoabdominal
cases,P^
Types of trauma include various contusions ofthe hip and pelvis,
and groin and adductor strains,' ^Back trauma is typically limited
to contusions andgradual-onset or overuse strains.l^l An isolated
caseof posterior brachial neuropathy and axillary nervedamage has
also been reported,'^^!
3. Aetiology
Due to the inherent nature of fast pitch softball,encompassing
both high velocity pitching and splitsecond timing in the field,
injuries often occur whenthe athlete collides with another
individual or ob-ject, or attempts to slide into a base. These
situa-tions are magnified when the quality of the playingsurface,
the athlete's age and experience level, theexcessive physical
demands and overuse associ-ated with the sport are also
considered,l^''"'''*^'''^]
3,1 Collisions
Severe trauma can ensue from high impactforces encountered after
collisions with players,balls, ground and fixed objects,l^^'^^l Of
165 casesreported during a single season of NCAA practices,42% of
injuries were attributed to collisions in-volving player contact
with equipment apparatusand balls (27%), playing surfaces (10%),
compet-itors (4%) and various walls and fences (1 %),['] Ingame
situations, collisions accounted for 75% of143 seasonal injuries,
with equipment and ball con-tacts being the leading source of
trauma (34%),followed by contact with competitors (24%), play-ing
surfaces (16%), and wall and fence contact (1 %),
Although missed catches account for a substan-tial number of
contusions to the face and fingers,^''^^of greater concern are
injuries from direct ball con-tact while at bat. The windmill style
of fast pitchSoftball can generate ball velocities ranging from65
to 113 km/h,I'^2^1 The high speed, in combina-tion with a ball of
limited elasticity, high coeffi-cient of restitution, solid impact
weight and highdynamic hardness, results in a substantial
transferof force upon body impact, placing the batter ineminent
danger of significant osseous and soft tis-sue trauma, [ '* '
']
3,2 Base Running
At the collegiate level, injury associated withsliding into a
base ranges from only 4% of traumaobserved during practice to 24%
of all cases occur-ring during games,''' The majority of base
runninginjuries are attributed to poor judgement, slidingtechnique
and current stationary base design,'' "1
Poor judgement is typically observed in situa-tions where a
player slides late into a base, as aresult of inattention to play
or attempts to stretch abase hit, or when a player tries to reach a
base dur-ing a run-down. These decisions often result in
rapiddeceleration and abrupt contact with the anchoredbase,"'^'*^'
Even during a normal sliding attemptor di veback, upper extremity
and facial abrasions andlacerations occur from horizontal forces
and cutane-ous shearing contact with the infield
surface.''''^''^''Contusions to the chest, hips, buttocks and
kneesresult from ground impact, due to greater verticalforces
associated with feet-first sliding, and a poorhead-first sliding
technique observed among lessexperienced players,''^"^'1 A
significant numberof ligamentous disruptions, patellar
subluxations,meniscal tears, acromioclavicular joint
disorders,subacromial impingement syndromes (Stage I)
andosteochondral fractures usually occur from unortho-dox joint
and/or extremity positions during groundimpact,'''^'^''''''^^' and
catching of cleats (e,g, plan-tar hyperflexion of the
ankle),'''^^'J
The current style of sliding is thought to aggra-vate this
situation. This style involves sliding feet-first into a base, with
extreme momentum, in a
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66 Meyers et al.
semierect or sitting position. This enables a playerto rebound
back up into an erect stance, readilypoised to stretch a hit into
extra bases.''*'! It is instark contrast to the earlier supine form
of slidingobserved in Softball's infancy, which optimised theamount
of force absorbing body surface area in con-tact with the playing
surface reducing the likeli-hood of impact injury.'^''^3'
Unfortunately, the cur-rent style of sliding prevents the body from
absorbingor dissipating impact forces, since there is a limitedbody
surface area in contact with the playing sur-face and a minimal
deceleration time.
In research into fast and slow pitch softball, sta-tionary base
design has received a substantial amountof attention with little
resolve. The standard 2 to4 inch high, foam-filled base, that is
stabilised bysliding the central post into a stanchion or
collarburied below the infield level, has been used
fordecades.'''^''^^' Although the present base designhas been
deemed problematic among sport medi-cine specialists, affordability
of replacements in alimited revenue-generating sport remains a
majorobstacle to introducing new designs with the po-tential to
decrease base running injuries. In sum-mary, the combination of
sliding into a base capa-ble of withstanding force impacts of up to
7000kg,in the currently popular semierect position, enhancesboth
the rate and severity of injury.'^'''^l
3.3 Piaying Surfaces
A major objective, so as to for maintain an op-timal environment
for athletes, is close attention toplaying or field surfaces. As
previously mentioned,10 to 16% of injuries are attributed to
surface char-acteristics that affect sliding, foot and cleat
trac-tion, and ball dynamics."''*^' Soil characteristics,such as
composition, moisture content and compac-tion, affect player
stability and field hardness. Turf-grass characteristics, such as
mowing height, grow-ing ability and durability, will affect
traction, as wellas ball ground speed and rebound.' *-^ '
Improperselection and management of soil composites andturfgrass
varieties leads to increased impact forcesand abrasiveness during
ground collisions, and tountrue ball direction and bounce. The
latter results
in physical impact trauma and to lack of player'stability,
predisposing the player to sprains and lig-amentous
disruptions.
3.4 Age and Experience
Well developed psychomotor skills are a prereq-uisite in
maintaining optimal performance at batand in the field. When errors
and concomitant in-jury in the field are reported, in many cases,
theinjury is attributed to age and inexperienced play,where
hand-eye coordination, sport-skill techniqueand split-second
decision making processes havenot been adequately developed.' ^''
^^J
At an early age, fast pitch injuries may occurfor several
reasons. These include a high centre ofmass, immature skeletal
development, an under de-veloped neuromuscular system and, simply,
poorjudgement. A high centre of mass, due to the cyclicperiods of
femoral growth, decreases a child's stabil-ity. Immature skeletal
development, associated withincomplete epiphyseal plate closure,
increases thepotential for Salter-Harris fractures, which can
com-promise further bone growth. Inadequate proprio-ception, slow
reaction and response time, and lackof agility are indices of an
under developed neuro-muscular system typically observed with early
ad-olescent athletes.
As the age and experience level of an athleteincreases, which is
typically associated with a higheracademic level, one would expect
to see a higherdegree of skill and a diminished likelihood of
in-jury. During collegiate practice this would seem tobe the case,
as 63% of injuries occurred to under-classmen, i.e. freshmen or
sophomores, as opposedto 38% among upperclass or junior, senior and
fifthyear athletes.'*! A similar pattern of injuries was ob-served
during game situations, with 56% of injuriesoccurring in freshmen
and sophomores compared with44% in junior and senior competitors."'
However, noinformation was provided concerning the number
ofathletic exposures or injury rate across class and aca-demic
standing. Although traditionally upperclass-men usually experience
more playing time and ath-letic exposure than lower classmen, the
level ofacademic standing may not necessarily be associ-
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Fast Pitch Softball Injuries 67
ated with experience level, since an increasing num-ber of
freshmen are receiving more playing time atthe collegiate
level,
3,5 Physicai Demands
Several studies have linked a substantial pro-portion of upper
extremity injuries to inherent forcesof the underhand pitching
motion and poor pitch-ing mechanics,"*'"^' An efficient, and
therefore ef-fective, mechanical delivery results in ball
velocitiesas high as 113 km/h, but at a cost of significant
ante-rior capsule and biceps labrum stress.''^'"''^' This
isaccompanied by extremes in internal and/or exter-nal rotation,
flexion and extension of the glenohu-meral, ulnotrochlear and
radiocarpal areas.''^'^'-^^]Additionally, opposing forces in the
forearm struc-tures produce intense distal radioulnar
pronationagainst a restricted brachioulnar range of motion(ROM),
This results in formidable rotational torqueon cancellous and
cortical bone structures,whichhave a limited cross-sectional area
and an inabilityto resist shear forces,' '*' ' ^]
Maffet et al.t'^' divided the violent nature of thewindmill
pitch into 6 phases: windup, phases 2 to 5as on a face on a clock
(a counterclockwise arm move-ment from the 6 through 9 o'clock
position), and afollow-through. In contrast, Barrentine et al,''^'
con-sidered the pitching motion as the windup, stride,delivery and
follow-through. These studies and oth-ers reflect the awkward
positioning, rapid acceler-ation, extreme torque and abrupt
deceleration forceswhich are distributed throughout the shoulder
andupper extremities during the full ROM,' ^-*"' Fromthe
hyperextension (at zero velocity) of the arm atthe glenohumeral
joint during the windup,''*! limbacceleration continues to rapidly
increase througha concerted effort involving the rotator cuff, the
pec-toralis major, the anterior and posterior deltoidsand the
serratus anterior musculature."^'^^'^'"*-'^ In-trinsic with the
pitching motion, muscular intensitybuilds and ranges from 45 to
100% of maximalcapacity in a given performance,''^' During
deliv-ery of a pitch, maximal compression forces at theelbow and
shoulder regions have been recorded tobe as high as 70 to 98% of
bodyweight,"*^' The
follow-through is no less severe, as the entire armacting as a
lever, experiences pronounced deceler-ation as it typically
contacts the lateral hip and thighregion prior to ball
release,''*''^'^^'^"' As a conse-quence, and as observed with other
high velocityand repetitive arm tasks,'' ''"^ ' articular
failureand ulnar, humeral and metacarpal stress fracturesare
common,'3'.34,35,45,681
3,6 Overuse
The physical requirements of the sport, coupledwith repetitive
training and competition, usuallylead to what is referred to as
overtraining syndrome(OTS),'^'-'"] The increasing prevalence of
OTSamong fast pitch athletes has also been attributedto
inconclusive evidence to clearly define the op-timal training zone
for an athlete''^^' and to poorcommunication between player and
coach,'*'! AJ..ditional factors reported to contribute to
muscu-loskeletal compromise include the inherent hypo-vascularity
of connective tissue and the limitedability of bone to remodel at
an expedient rate tomatch the demands of the sport,' '' -'"^*'
Althoughcoaches strive to balance optimal sport-specificworkload
with adequate rest, tournament demandsfor all players may typically
extend to 9 gameswithin 3 days, subjecting athletes to 18 to 36
hoursof actual playing time,'^^'
An excessive number of innings pitched in re-lation to the
amount of recovery between starts hasalso been reported in the
literature,'^'*' With anextensive schedule of batting practice,
double head-ers, and both midweek and weekend games, pitch-ers may
endure an average of 86 to 139 innings perseason leading to
gradual-onset or overuse trauma,'^'It is not uncommon for pitchers
to compete afteronly 2 days of rest or rotation compared with 3 to4
day rotations commonly observed in baseball,''*'The tremendous
forces and torque produced by theunderhand windmill motion of
pitching, in combi-nation with poor pitching mechanics and a
signif-icant number of innings pitched, has led routinelyto
articular arthralgia, instability in the arm, shoul-der and lower
back regions, chronic NSAID useand time loss injuries in 45% of
pitching staff dur-
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68 Meyers et al.
Table I, Recommendations for fast pitch Softball injury
prevention
Check and maintain equipment on a continuous basis
Reinforce the need for athletes to wear protective clothing and
gear, i.e. mouthpiece and sliding pads, at all times
Stay alert to the signs and symptoms of overtraining syndrome
(OTS)
Vary day-to-day training routines to decrease repetitive
musculoskeletal stress on the same joints
Stress the importance cf enhancing motor skills, with equal
emphasis on speed and efficiency of movement in the field and on
the basepath
Utilise drills that reinforce sport-specific, decision making
processes to minimise mental mistakes
Minimise the use of indoor or gym floor facilities
Become familiar with infield and outfield playing surfaces,
checking for cracks, sprinklers, stones and other surface
obstructions
Provide and/or maintain padding, screens and barriers for all
walls, backstops, rails, dugouts and immovable objects in the field
of play
Attend coaching and sports medicine seminars to enhance training
and conditioning techniques
ing a single season.f ''*' ' Due to serious concernamong sports
medicine specialists, and the limitednumber of studies in this
area, further research isclearly warranted.
3,7 Contributory Factors
Other contributory factors have been mentionedwith regard to
ulnar and radial neuropathies, compart-ment syndromes, enhanced
overload to the shoul-der's static stabilisers and fatigue
fractures. Theseinclude inadequate attention to bilateral
muscu-loskeletal function, muscular endurance and flexi-bility, and
abrupt changes in pitching technique.Gender differences in lean
body mass, technique,strength, handgrip size and ligamentous laxity
havealso been documented,''''' ' '' '*''' "^^] Additional
con-tributory factors reported include stenosis in thenarrow
fibrotic arch of the triceps, neuralgia, fusi-form neuromas, radial
nerve scarring and idiopathicjuvenile
4. Prevention
The majority of fast pitch softball injuries areavoidable, with
numerous opportunities availableto instill measures of safety
throughout the sport.Specific attention to a safer playing
environment,coaching and player education, and
sport-specifictraining and conditioning would reduce the risk,rate
and severity of fast pitch trauma. These effortswould be especially
salient at the younger levels ofcompetition. Recommendations to
prevent injuriesin fast pitch softball are summarised in table
I,
4,1 Safer Piaying Environment
Although 53% of fast pitch game injuries occurin the infield,
46% of documented trauma caseshave occurred on outfield or natural
and artificialgrass surfaces, necessitating that equal attention
begiven to all playing surfaces.''' Initially, attention tofield
surfaces begins with soil properties and turf-grass selection.
Following construction, maintenanceof the playing surface should
focus on field hard-ness, turfgrass cutting height, frequency of
mow-ing, clipping removal, soil moisture content, irriga-tion and
drainage control, aeration and avoidanceof excessive wear,''**- '
'
Besides natural and field conditions, other play-ing
environments pose some concern. In responseto foul weather, many
coaches choose to use indoorfacilities to maintain practice
schedules. In a recentstudy, players experienced a greater number
of prac-tice injuries (53%) and a higher injury rate (3,5)
onnongrass surfaces, i,e. gym floors, compared withnatural grass
(23% and 2,0, respectively),'" The lim-ited floor space, harder
playing surface and poorerball visibility and contrast contribute
to an increasedoccurrence of blunt traumas resulting from
playercollisions, falls and greater ball speed and bouncethan that
observed with normal field conditions.
Additional attention to padding of walls, back-stops, rails and
dugout areas has been suggested todecrease the number of collision
injudes.'^'^^' Elimi-nating the use of the on-deck circle and
installingprotective screening and barriers for dugouts andcoaching
boxes have also been proposed, because
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2001; 31 (1)
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Fast Pitch Softball Injuries 69
of the continual incidences of direct ball and batcontact
traumas to both players and coaches."'^'"Lastly, recessed,
low-profile or breakaway bases,as well as improvements in base
installation, shouldbe considered to reduce the trauma associated
withbase
4.2 Coaching and Player Education
A greater emphasis on coaching and player ed-ucation has been
recommended as a measure to re-duce the frequency of injury in this
sport.' - ' ^l Aspreviously mentioned, several studies have linkeda
number of both upper and lower extremity trau-mas to poor
techniques or mechanics.'' '*' ' ' ^]Others have attributed a
substantial proportionof injuries, i.e. fractures, to gradual-onset
or over-use, or to a lack of attention to protective equip-ment
[8,30,31,34,45,86,87] jj, 59 to 91% of head and fa-cial injuries a
mouthpiece was not worn."!
In regards to gradual-onset or overuse injuries,coaches should
be cognisant of the signs and symp-toms of OTS, a condition
exacerbated by repetitiveoveruse and minimal recovery and/or
rest.'^"'^''Although predicting OTS is often difficult and
in-conclusive with subclinical traumas, over 94 phys-iological,
psychological, immunological and bio-chemical markers associated
with this increasingproblem in sports have been
reported.'^'-^^"^''] Pro-gression of training from a normal
adaptive micro-trauma (AMT) to subclinical injury may be mini-mised
by varying day-to-day training routines todecrease repetitive
musculoskeletal stress on thesame joints.'^'-'^l Players with a
seasonal historyof chronic arm pain, muscular fatigue,
diminishedperformance or showing sudden changes in the
bio-mechanics of throwing or pitching so as to alleviateprodromal
discomfort are demonstrating hallmarksigns of overt orthopaedic
trouble.' ^^'"' l Thesesymptoms are usually suggestive of a stress
frac-ture.' ^^'''^'' Breaking the repetitive cycle of com-petitive
overuse, shoulder pathology, minimal re-habilitative and recovery
time, and excessive useof steroids and analgesics should be a
primary goalto minimise further career-ending articular
insta-bility."^'
Although many programs are conducted withlimited coaching staff,
special attention to motorskills, with equal emphasis on speed and
efficiencyof movement in the field and on the basepath, ishighly
recommended.''* '''*"^ ' Using drills that re-inforce
sport-specific, decision making processesshould minimise mental
mistakes and reduce theincreasing number of player'
collisions.'^'''^'*'''l Ul-timately, a greater understanding of
anatomy andsport physiology, along with concomitant attentionto
injury prevention through more careful planningof practices, player
rotation, sport-skill techniqueand protective equipment for coaches
and players,should result in a lower incidence of
significanttime-loss cases.' '
4.3 Conditioning
Sport-specific conditioning is considered to bethe cornerstone
of todays successful athletic pro-gram. As games become faster and
players morephysical, it is imperative to design programs
thatemphasise a combination of power, acceleration,flexibility,
technical skill, functional capacity andinjury
prevention.'^^'""']
Since 47 to 49% of all practice injuries are at-tributed to
noncontact pitching and throwing situ-ations,''"'*^'^^' specific
attention to upper torso,shoulder and rotator cuff musculature
should be apriority.''*'^' This is particularly important
amongfemale athletes, who have an inherently lower per-centage of
lean body mass and, subsequently, lessstrength than male
competitors."^-^'*!
Despite its popularity, only limited informationon specific
training routines for fast pitch softballhave been
published.'^''^^' Since softball is consid-ered an
intermittent-activity sport utilising up to80% adenosine
triphosphate-creatine phosphate(ATP-PC),' '*J enhancing
speed-endurance throughhigh intensity interval training has been
recom-mended.'^^' This involves year-round conditioningthat
especially focuses on improving sport-specificarm and back
strength, leg power, explosive move-ment and a full ROM.'5''0'1
Training volume, in-tensity, recovery, duration and activities are
variedas the athlete moves through a series of phases that
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2001; 31 (1)
-
70 Meyers et al.
progress from general preparation through basicstrength,
functional strength, power, maintenanceand active rest.'^^'"^'
Although isotonic, isokinetic and plyometricconcepts have been
successfully applied in varioussports, results among throwing
athletes are equiv-ocal. In one study, greater increases in
shoulder powerwere observed with isokinetic training than
withplyometrics, but with insignificant effects on func-tional
performance,"""' Others have noted substan-tial closed-chain
development of functional powerin the trunk and in the upper and
lower extremitiesusing plyometric and isotonic techniques in the
con-ditioning progranu'^^''^^' Optimally, the goal is tocombine all
3 forms of work with adequate rest toachieve a high degree of
functional capacity on thefield of play,"0'''"2]
Incorporation of an off-season or preseason pro-gram using a
progressive combination of long andshort throws has been
successfully used in base-ball,''"^' This type of early throwing
program would bebeneficial for all softball positions. It could
easilybe adapted to the underhand windmill style of pitch-ing to
enable the shoulder musculature to meet theimpending demands of
fast pitch competition,'"*^-'"?'Since specific training and
rehabilitation modali-ties are beyond the scope of this article,
the readeris referred to excellent reviews on the topic,''
^^'"J'
5. Conclusion
Fast pitch competitors experience a significantlevel of injury.
Although only limited preventativemeasures exist which will totally
eradicate compet-itive injury, even moderate attention to
preventa-tive recommendations may decrease the number andseverity
of problems (see table I), Of greater con-cern, is the
underestimation of trauma because ofthe limited body of knowledge
currently availableon this sport,'^' For example, out of 902
NCAAmember institutions fielding approximately 500 to600 teams,
injury surveillance data are only avail-able on 10 to 15% of fast
pitch programs.'^' Themajority of other reported injuries have been
lim-ited to isolated case studies, studies of small samplesizes and
hospital records, and represent a modest
fraction of participating athletes.'2'^''^"''"'*' There-fore,
broadening efforts and funding to increaseaccessibility of
surveillance systems to a greaternumber of programs would provide a
clearer andmore accurate picture of the prevalence of injuryin this
sport.
There is also an increased need for research thataddresses
optimal management and playing surfacecharacteristics for fast
pitch softball,''**' Compari-son of various turfgrass properties
with softball shoeand cleating systems would enhance our
understand-ing of more effective field grass selection and
du-rability, resulting in a decrease in traction injurieswithout
compromising quality of play. Comparisonof soil mixtures to
determine optimal texture andmoisture retention would lead to
better player sta-bility, truer ball speed, bounce and direction,
andwould minimise surface hardness and abrasiveness.These efforts
would result in a pronounced decreasein the number and severity of
collision and slidinginjuries.
Continued research should be directed towardboth preventive
aspects of sports medicine andpost-injury care. Although studies
have quantifiedthe specific phases and muscle firing activity of
thethrowing'*^''"^''"*' and pitching motion,''*'''''*^-''^'more
accurate recognition and diagnosis of injuryis needed. In addition,
conditioning and rehabili-tation protocols that specifically impact
on thesuccessful functional outcome of an injury in thissport have
not been firmly established and warrantfurther investigation,"'''
Finally, additional effortsshould be directed towards comparing
institutionsand programs that address medical, coaching
andenvironmental concerns previously outlined withthose programs
that lack preventive mechanisms.Results from this comparison would
provide a clearerpicture of injury causation and effective
manage-ment procedures, leading toward safer participa-tion and
successful player development,
Aci
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Fast Pitch Softball Injuries 71
uations of the authors and do not represent the views of
theofficers, staff or membership of the NCAA.
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Correspondence and offprints: Dr Michael C. Meyers, Hu-man
Performance Research Center, Department of Sportsand Exercise
Sciences, POB 60216, West Texas A&M Univer-sity, Canyon, TX
79016, USA,
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