Recent Softball Injury Article from the Athletic Trainer Perspective

Shoulder Range of Motion, Pitch Count, and Injuries among Interscholastic Softball Pitchers: A Descriptive Study

Shanley, E., Michener, L.A., Ellenbecker, T.S., & Rauh, M.J. (2012). Shoulder Range of Motion, Pitch Count, and Injuries among Interscholastic Softball Pitchers: A Descriptive Study. International Journal of Sports Physical Therapy, 7(5), 548-557.

Injury incidence has been discussed in previous studies (Centers for Disease Control and Prevention, 2006; Hill, et al., 2004; Knowles, 2010; Loosli, et al., 1992; Shanley, Rauh ,Michener & Ellenbecker, 2011) that have found between 0.95 and 5.6 per 1000 athletic exposures for softball players. On the whole, the research has shown that the highest rate of injury is in the upper extremities. Also, new research has reported higher risks, 2- to 3- fold, of shoulder and rotator cuff re-injury (Rauh, Macera, Ji & Wiksten, 2007). This could possibly be due to a tendency for overuse to occur in pitchers particularly, but in many of the other position players as well. Further research has shown that the majority of shoulder injuries occur early in the season and in conjunction with the increase in game participation (Shanley, Rauh ,Michener & Ellenbecker, 2011).

In baseball studies, extrinsic performance factors such as innings pitched, pitch types, pitching with fatigue or pain, and pitch counts have been hypothesized as possible reasons for non-contact baseball related injuries (Freehill, et al., 2011; Laudner, Sipes, & Wilson, 2008; Lyman, Fleisig, Andrews, & Oskinski, 2002). Range of motion (ROM), internal rotation greater than 20° without concurrent increases in external rotation ROM combined with reduction in side-to-side horizontal abduction are intrinsic factors associated with posterior shoulder tightness and contributors to shoulder pathology (Burkhart, Morgan, & Kibler, 2000; Burkhart, Morgan, & Kibler, 2003; Myers, et al., 2006; Ruotolo, Price, & Panchal, 2006; Wells & Draper, 2006). Also, because baseball and softball are non-continuous sports, meaning that there are significant rest periods. For non-continuous sports, factors such as games played, are not accurate measures for assessing risk of overall play (Crocket, et al., 2002). Therefore, factors such as pitch count, or total plays, are more descriptive for assessment for baseball (Crocket, et al., 2002). Crocket, et al. (2002) also concluded that pitch count was the most accurate determination of the stresses of baseball pitching.

Pitch counts have been used in softball as well, but haven’t produced the same results. So far pitch counts have not been associated with injury at the collegiate level. And, even though many organizations control pitch counts for baseball players, pitch counts in softball are still not utilized.

In the current study, 12 high school pitchers age 13-18 (mean = 15.2 years) were recruited to participate in a year-long study. They analyzed internal and external shoulder rotation passive range of motion (PROM), shoulder abduction PROM, pitch counts, and previous injury history. They didn’t, however, compare the data points due to the small numbers of subjects and injuries (only 17% time loss from previous injuries).

Six of the pitchers threw in more than 60% of their games. Three of the pitchers threw in less than 25% of their games. The pitchers threw in 4.3 innings per outing and threw 14.9 pitches per inning on average. They averaged 61.8 innings and 745.8 pitches per year. They also averaged 119.1° of external shoulder rotation PROM and 60.6° of internal shoulder rotation PROM for a total average PROM of 179.7°. The mean horizontal abduction PROM was 30.5°.

Although not possible for comparison analyses, two of the pitchers did get hurt. The table below illustrates the means of the injured vs. non-injured pitchers:

	Injured	Non-Injured
Total Pitches per Season	1170.5	660.8
Total Pitches per Game	78.3	58.2
Total Games Pitched	14.5	9.4

They also found that the injured pitchers appeared to average less dominant horizontal abduction than non-injured pitchers at 20.3° for the injured pitchers vs. 32.6° for the non-injured pitchers in their dominant arms.

Although the two injured pitchers did have higher pitch counts, standard deviations showed that some of the non-injured did have some overlap with their pitch counts. It’s a delicate balance between training and game pitching, as well as maintaining a proper preventative strengthening protocol to keep the pitchers healthy. One thing that wasn’t discussed in this study, or any previous study, was the number of pitches thrown in training, particularly in pre-season workouts. As stated before, most injuries happen early in the competitive season. Doing too much and over-stressing the pitcher in the preseason, or the opposite, throwing too little and leaving the pitchers unprepared, could both be factors to early season injury.

In-season protocols are also an issue. Pitch counts between games may also be an integral factor in a pitcher’s health. Many coaches still feel that a pitcher can throw every day, even though there isn’t a physical activity in the world where every day activity is healthy. Appropriate rest and control of inflammation is essential for strength development and recovery.

This was a good study, but it needs repeating. If PROM is important in the preseason, then more than likely it will continue to be important throughout the season. Maybe there are risk factors that develop throughout the season that need to be monitored on a regular basis. Future studies should include regular monitoring of shoulder PROMs. Also, a larger sample is necessary for comparison data. Future studies should also look into pitch counts throughout the year, monitoring, not only the competitions, but also pitches in training, and rest. Year long pitch logs would be appropriate, possibly.