May 2016

Lower body conditioning may cut upper body injury risk in softball

5PEDS-Softball-shutterstock_17654488Safety of underhand pitching overrated

By Hank Black

Better pre- and offseason lower-body conditioning may help prevent some serious overuse injuries to the upper extremities of young female fast-pitch softball players, according to the lead author of a recent prospective study of player-reported injuries.

“Because the lower body is the driving force of the windmill pitch, a good conditioning program for the gluteal mus­cu­lature would be important in sequentially stabilizing the pelvis and trunk to provide support for the rest of the kinetic chain,” said Matthew V. Smith, MD, lead author and assistant professor in the Department of Orthopedics at Washington University in St. Louis, MO.

The study included 98 select-level players: 48 pitchers and 50 position players aged 9 to 18 years. Investigators used a web-based survey to gather information on self-reported injuries during a single April to August season. They defined injury as pain that sidelined a player for the remainder of the current practice or game or from her usual participation the day after injury.

Forty-three of the players reported 49 injuries, with a cumulative incidence of injury of 40% (this includes 58 athletes who didn’t respond to the survey); 70% of injuries were to the lower extremities.

The injuries that resulted in loss of significant playing time, however, were primarily to upper extremities and incurred by pitchers. Pitchers sustained 30 of the injuries; 18 of these were directly attributed to pitching.

“Positional players had the standard lower extremity sprains and contusions you’d expect to see in most sports and that kept them from participation for less than two weeks; these were, for the most part, unpreventable,” said Smith. “In pitchers, however, severe shoulder injuries, as well as some stress fractures in the forearm, prevented participation for more than two weeks and appeared to result from overuse in an environment where they pitch in two or three games a day in tournaments lasting up to four days.”

The majority (78%) of pitching injuries happened in the first six weeks of the season, so an increased emphasis on offseason and preseason conditioning may be advisable, said Smith. He also noted the number and severity of pitching injuries counter the notion that fast-pitch softball’s underhand windmill pitch is safe relative to baseball’s overhand pitch. “Underhand pitching is not as safe as some think it is,” he said.

In an ongoing follow-up study, the researchers are using motion-capture technology to gather data on pitchers’ movements during simulated games, as well as collecting ground-reaction force data.

“We are evaluating what happens to lower extremity mechanics as pitchers tire. Our hypothesis is that, as throwing athletes fatigue in their arm and shoulder, their lower body mechanics will change in an attempt to maintain velocity. For example, trunk rotation or pelvic tilt may change to try to use more components of the kinetic chain to generate arm speed,” Smith said.

“Many athletes of this age may get hitting or pitching instruction, but not a good conditioning program to get them ready for the intensity of their sport when the season starts. I think that’s a really critical thing parents should push for–not so much performance training but performance condition­ing,” he said.

Sports Health published the study in its November-December 2015 issue.

“The paper is correct in citing studies that show softball pitching is no easier on the body than baseball pitching,” said Gretchen D. Oliver, PhD, FACSM, ATC, director of the Sports Medicine and Movement Laboratory at Auburn University in Alabama. “Both baseball and softball pitchers will incur injury if their mechanics are flawed or inefficient.”

Oliver, who is an associate professor in the School of Kinesiology, agreed that lower body mechanics of softball pitchers are important to prevent injury.

“Proper utilization of the kinetic chain allows for efficient kinetic energy transfer from the proximal segments to the distal segments. Dysfunction at a proximal segment may lead to altered energy transfer and dysfunction at more distal segments,” she said. “We emphasize total body conditioning and focus a lot on postural control activities. The more body awareness a pitcher has, the better chance they have to develop consistency in their mechanics.”

She noted, “The study did not examine preseason conditioning, so that could be a factor in the early-season injuries, but there are many other factors that should be examined before we can determine the ‘why.’ We are now tracking pitch volume yearlong, as well as examining performance measures.”

Hank Black is a freelance writer in Birmingham, AL.


Smith MV, Davis R, Brophy RH, et al. Prospective player reported injuries in female youth fast-pitch softball players. Sports Health 2015;7(6):497-503.

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