New Study: Common Injuries in Softball Players

Background photo courtesy of Jacob Rice.

"Given [the high pitching volume] it is not surprising that approximately 38 to 60% of pitching injuries can be attributed to overuse injuries” (1,2,3).

August is the gift that keeps on giving— at least, in terms of new sports medicine studies on female athletes. You know we get excited about this, given the documented data disparity in sports research on women.

Last week, we posted a summary and our thoughts on a recent study on softball coaches and injury prevention knowledge. We learned that more than half of coaches don’t implement injury prevention strategies because they either lack the knowledge or don’t have enough staff. We also learned that 36% of coaches disagree (or strongly disagree) that pitchers should adhere to a pitch count.

This study published in the Journal of the American Academy of Orthopaedic Surgeons investigates the mechanism behind softball player injuries (and not just pitchers) and looks at safety measures that can be implemented to reduce their chances of injuries.

Let’s get into it.

Common Injuries in Female Competitive Softball Players

Authors: Tysklind, Robert G. MD; Kraus, Kent R. MD; Dillon, Mark T. MD

Access the Article: Journal of the AAOS

Summary

The authors organized their review by areas of the body— upper extremity, lower extremity, and the head/neck. There is a large section dedicated to pitchers only due to the nature of the windmill pitch and associated injury rates.

Each section examined the types of injuries, their rates, and their causes. Then, the authors discussed the available strategies to increase athlete safety and decrease overuse injuries.

This review was comprehensive, and the softball coaching community would benefit greatly from reading the whole thing. There’s a lot of granularity, so our key insights list below is pretty long.

Key Insights

Pitchers, specifically:

  • Between 38-60% of pitching injuries are due to overuse

  • Approx. 60% of pitching injuries occur in the first 6 weeks of a competitive season

  • Softball pitchers have to use more of their hip musculature to maintain pelvic stabilization than baseball pitchers

  • Softball pitching “produces similar magnitudes of torque at the elbow and shoulder compared with baseball overhand pitching” (1)

  • Pitch volume might impact the occurrences of forearm stress fractures

  • Pitch counts may be a way to limit overuse injuries

  • Off season training programs and pre-season ramp up strategies may lower overuse injuries

Upper Extremity Injuries:

  • Most upper extremity injuries are ball-contact based or a throwing strain or sprain

  • Shoulder injuries happen most often in practice, but hand and wrist injuries most often occur during competitive events

  • Elbow and arm injuries happen at the lowest rates

Lower Extremity Injuries:

  • Foot and ankle injuries account for more than half of all lower extremity injuries

  • Softball athletes incur knee injuries at a higher rate than their baseball peers

  • ACL injuries are statistically low (1.5-2.4% of injuries), but 80% of them result in surgery, and most occur in non-contact situations (cutting, pivoting, decelerating, etc.)

  • Catchers have different knee pathology because of their sustained deep knee flexion

  • Osteochondritis dissecans (OCD) lesions are more likely to occur in younger catchers and more posterior possibly due to the constant and repetitive hyperflexion of their knees (4)

  • Some lower extremity contact injuries may be remedied with breakaway bases and a safety base at first.

Head and Neck:

  • Concussions were the most commonly reported “specific” injury among NCAA softball athletes between 2014-2019.

  • Concussions in softball are most likely to occur during equipment contact (ball, bat, etc.)

  • Most head and neck injuries happen due to contact (ball, person, base, bat, or otherwise), and usually happens to the defense versus the offense

  • Mandating protective headgear in the infield can help mitigate defensive impacts to the head and neck.

Study Limitations

As this study was a comprehensive review, there was no a novel experiment or data collection. Softball does not have as much sports science data available as baseball, so this review is inherently limited.

Our Thoughts

This study pulls so much existing research together— 49 references in all! Because of that, it can provide a unique context on injuries that a single study or dataset might lack. It’s a truly comprehensive overview of injuries and their sources. Softball coaches would benefit from reading this, based on the results of the study we posted about last week.

This study highlights just what’s at stake, and it drives home the importance of good mechanics. It highlights just what happens when volume isn’t managed in any position… not just pitchers.

This review doesn’t mention the prevalent lower back injuries that seem to be common among pitchers. A paragraph focused on the hip musculature, but it DOES NOT talk about what happens when the lumbopelvic hip complex isn’t stable through the windmill pitch. This might be because there’s still a large gap of sports science data on softball overuse injuries when compared to baseball counterparts, and we haven’t run across a piece of research that talks at length about this.

I personally suspect that concussions are more prevalent than what’s reported, considering the amount of whiplash that athletes might endure in some of their incredible defensive and offensive feats.

It’s exciting to see medical doctors agree that pitch counts need to be investigated as a method to lower overuse injuries. This is the kind of momentum that’s needed in the community— similar to what happened from within baseball. If you’ve been following us for a while, you know that we believe that it’s time for a pitch count in softball.

Coming this Fall: Post-game Recovery Program

We’ve released a new post-game Softball Pitcher & Catcher Recovery program. Our in-house athletes have piloted this 30 minute program over the summer travel ball season, and the feedback has been overwhelmingly positive.

This program is designed to help athletes recover faster, restore range of movement, decrease the effects of soreness, and help them be ready for the next competition faster. The program accomplishes this by restoring symmetry through ‘unwinding’ the body’s repetitive motions. Athletes work through low resistance and body weight movements as well as mobility work.

We know that restoring strength symmetry and range of motion is important to reduce the chances of injury (5). It’s vital to their recovery.

Softball Pitcher and Catcher Postgame Recovery Program
$9.99
Every month
$105.00
Every year

Recover through movement with this 30 minute program, utilizing light mobility and exercise post-game to increase blood flow to the affected areas of the body. Cancel your subscription at any time, but no refunds will be given.

✓ Minimize delayed onset muscle soreness (DOMS)
✓ Restore range of motion and symmetry
✓ Regain strength more quickly
✓ Be ready to compete again faster

By purchasing this program you agree to the Program Subscription Purchase Terms of Use Agreement and Liability Disclaimer.

Equipment referenced (but not included in subscription purchase):

  • Large loop band/J-band

  • Mini loop band

  • Massage gun (which you can substitute for a softball or tennis ball).

References

  1. Tysklind, Robert G. MD; Kraus, Kent R. MD; Dillon, Mark T. MD. Common Injuries in Female Competitive Softball Players. Journal of the American Academy of Orthopaedic Surgeons ():10.5435/JAAOS-D-23-00394, August 8, 2023. | DOI: 10.5435/JAAOS-D-23-00394

  2. Smith MV, Davis R, Brophy RH, Prather H, Garbutt J, Wright RW. Prospective Player-Reported Injuries in Female Youth Fast-Pitch Softball Players. Sports Health. 2015 Nov-Dec;7(6):497-503. doi: 10.1177/1941738115606058. Epub 2015 Sep 11. PMID: 26502442; PMCID: PMC4622379.

  3. Saper MG, Pierpoint LA, Liu W, Comstock RD, Polousky JD, Andrews JR. Epidemiology of Shoulder and Elbow Injuries Among United States High School Baseball Players: School Years 2005-2006 Through 2014-2015. The American Journal of Sports Medicine. 2018;46(1):37-43. doi:10.1177/0363546517734172

  4. McElroy MJ, Riley PM, Tepolt FA, Nasreddine AY, Kocher MS. Catcher's Knee: Posterior Femoral Condyle Juvenile Osteochondritis Dissecans in Children and Adolescents. J Pediatr Orthop. 2018 Sep;38(8):410-417. doi: 10.1097/BPO.0000000000000839. PMID: 27442212.

  5. Paul J, Brown SM, Mulcahey MK. Injury Prevention Programs for Throwing Injuries in Softball Players: A Systematic Review. Sports Health. 2021 Jul-Aug;13(4):390-395. doi: 10.1177/1941738120978161. Epub 2021 Feb 4. PMID: 33535878; PMCID: PMC8645320.

Coach J