Physical Therapy and the Softball Athlete

Physical Therapy and Softball: Common Myths PTs Should Know

Fastpitch softball is one of the most popular female sports in the United States. As of 2008 there were more than 2.5 million young women playing high school and collegiate level softball alone, not including those players starting at ages as young as six years old. These numbers are even higher now than they were several years ago.

Despite the increasing popularity of the sport, there are many myths out there about the game of softball, and limited sports medicine research on the sport. The most common myth among players, coaches, and parents is that softball pitching is safer than baseball pitching. There is a belief that the underhand “windmill” pitching motion places less stress on the arm and shoulder and somehow is a “natural” way of throwing. This is definitely not true.

The second-most common myth is that softball pitching-related injuries are rare.

Myth #1: Softball pitching places less stress on the body

Let’s start off comparing softball to baseball. The majority of softball teams carry a smaller proportion of pitchers on their rosters compared to baseball teams. Most softball teams have one, maybe two, ace pitchers. This translates into more innings pitched for the softball athlete due to the best pitchers throwing the majority of games.

The average high school baseball pitcher is not permitted to throw more than 100 pitches per day. If 100 pitches are thrown, there is a required 4 calendar days of rest before that pitcher can step on the mound again to give the arm and shoulder adequate rest.

However, it is not uncommon for a softball pitcher to throw six to ten 7-inning games in one weekend tournament. That’s more than approximately 1,200 pitches within 72 hours! It is also likely that this same pitcher who threw all weekend will end up pitching the following week in their regularly scheduled games.

There are currently no published rules on pitch count or required rest days for softball, unlike our baseball counterparts. Pitching limits matter in softball as much as they do in baseball, however there is not nearly the amount of attention on the softball arm like there is on the baseball arm.

There are many things that make a direct comparison of the two sports difficult, such as age, gender, weight and size of the ball, as well as height of the pitching mound. However, it’s been found that stresses at the shoulder and the elbow during the delivery phase of pitching are comparable to the deceleration phase of a baseball pitch. In other words, the shoulder and elbow resist the increasing amounts of distraction forces that are comparable to baseball pitching.

Myth #2: Softball pitching injuries are rare

Following all of that, it probably makes sense that softball pitchers are prone to overuse injuries, specifically to the shoulder and elbow.

The most common complaint by pitchers is anterior shoulder pain along the origin of the long head of the biceps tendon. Biceps brachii EMG activity in fastpitch windmill pitching has been found to be significantly higher than overhead baseball pitching.

The second most common injury is to the posterior rotator cuff including the supraspinatus, infraspinatus and teres minor. These muscles are often put on stretch with overuse, leading to dynamic instability of the anterior humeral head. While these are not all the injuries possible, these are certainly two of the most common reports of discomfort and pain in the softball athlete.

What physical therapists should know about softball injuries

So, if you are a PT who is treating a softball pitcher, it is extremely important to get a solid understanding of the following:

  • How many times a week she is pitching
  • How many games in a tournament she typically throws
  • What pitches she normally throws
  • What her warm-up consists of for both practices and games
  • If/how long she pitches during practice
  • What type of strength and conditioning program she is on, if any

Another factor, as this goes generally with most high school sports, there is no systematic approach for a proper strengthening program for these athletes. Not that the coach is at fault for this, but it is likely there is no appropriate and structured strengthening program for softball pitchers.

A common mistake is the lack of lower body strengthening in the weight room. The legs develop the power, the core transfers it, and the throwing arm delivers it in the pitch. Therefore, it is important to perform a global assessment on these athletes to determine where other attributable deficits might be coming from.

Have you had experience working with softball athletes before? If so, I would love to hear about it in the comments below!

References

References

  1. Flynn M. Softball slides into the 21st century: growth in popularity of softball in schools. Parks Recreation. 1995;30(4):36.
  2. Werner SL, Guido JA, McNeice RP, Richardson JL, Delude NA, Stewart GW. Biomechanics of youth windmill softball pitching. Am J Sports Med. 2005;33(4):552-560.
  3. Loosli AR, Requa RK, Garrick JG, Hanley E. Injuries to pitchers in women’s collegiate fast-pitch softball. Am J Sports Med. 1992;20(1):35-37.
  4. Barrentine S, Fleisig GS, Whiteside GA, Escamilla RF, Andrews JR. Biomechanics of Windmill Softball Pitching With Implications About Injury Mechanisms at the Shoulder and Elbow. 1998; 28(6).
  5. Rojas IL, Provencher MT, Bhatia S, et al. Biceps activity during windmill softball pitching: injury implications and comparison with overhand throwing. Am J Sports Med. 2009;37(3):558-65.

About Kristen Smith

Kristen Smith
I am finishing up my Doctorate of Physical Therapy degree in August 2018. I am also a fastpitch softball coach and pitching instructor looking to specialize in working with softball athletes upon graduation.

One comment

  1. Annie George

    I’m currently treating a high school softball pitcher who plays on a summer league in addition to spring season in school and travel. She is a top pitcher and, like your article states, she pitches many 7-inning games in one weekend, and has no protocol for rest throughout the week. She throws high-velocity windmill pitches right-handed, however has primary complaints of left shoulder blade pain. Her pain is primarily located along the medial-superior border of her left scapula. My question is if this is commonly seen in female softball pitchers, and if contralateral shoulder pain points to other biomechanical abnormalities?
    Thanks! Any and all advice is appreciated.

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