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Descriptive Epidemiology of Collegiate Women’s Softball Injuries: National Collegiate Athletic Association Injury Surveillance System, 1988-1989 Through 2003-2004

Marshall, S.W., Kamstra-Wright, K.L., Dick, R., Grove, K.A., & Agel, J. (2007). Descriptive Epidemiology of Collegiate Women’s Softball Injuries: National Collegiate Athletic Association Injury Surveillance System, 1988-1989 Through 2003-2004. Journal of Athletic Training, 42(2), 286-294.

This study was less of a study and more of a report of injury incidence during the early years of college softball. An average of 88 schools participated each year within the three NCAA divisions, including 171 in 2000 as the most in one year. On average, 48 games were played by Division I schools, 45 by Division II schools, and 32 by Division III schools, with an average of 12 participants per game for all divisions. Division I and II schools averaged 51 practices with 16 and 15 participants, respectively, per season. Division III schools averaged 47 practices per year with 16 participants per practice.

I feel the only way to report this study is by giving short highlights:

• The average injury incidence per 1000 athletic exposures (AE) for games was 4.3 and for practices was 2.7.
• The highest year for game injury rate was 5.2 and lowest was 3.1 per 1000 AE.
• The highest year for practice injury rate was 3.6 and lowest was 1.9 per 1000 AE.
• In-season game and practice injury rates were higher (4.53 per 1000 AE) than post-season game and practice injury rates (2.39 per 1000 AE).
• Preseason game injury rates averaged 2.65 per 1000 AE but preseason practice injury rates were 3.65 per 1000 AE.
• Of the total injuries, 42% were lower extremity injuries and 33% were upper extremity. 12.3% were trunk or back.
• The most common injury was an ankle sprain for games (10.3 %) and practices (9.5%).
• The most common shoulder injuries during games were muscle/tendon strain (2.8%), tendonitis (1.5%) and subluxation (1.5%).
• Most game injuries resulted from contact with something (not a competitor) at a rate of 51.2%. Sliding accounted for 23% of the total game injuries.
• 27% of game injuries resulted without any contact versus 55% of the injuries in practice were not contact related.
• Of the injuries in games, 24.8% required more than 10 days of recovery. 22% of practice injuries involved more than 10 days of recovery.
• The most common severe injuries costing more than 10 days for recovery were internal knee damage (22.6%), ankle ligament sprain (7.8%), broken fingers (6.5%), and broken hands (6.2%).
• The most common severe practice injuries were internal knee damage (15%), ankle ligament sprain (6.6%), and shoulder tendonitis (5.5%).
• Only 10.8% of the total injured players were pitchers. The most injured players were base runners (28.8%).
• The most common game injury mechanisms were contact with an opposing player (18.3%), contact with the ground (13.6%), and no contact/non-throwing (13.4%). Pitchers’ throwing injuries accounted for 6.3% of the total.
• Softball players averaged 3.3 feet first slides per game vs. 1.34 head first slides. Injury rate per 1000 slides was 12.76, which is significantly higher than in baseball at 6.20 injuries per 1000 slides.
• Out of 2150 game injuries reported, 241 came from contact with a batted ball (11.2% of total), the majority of those were incurred by the batter (60) and the pitcher (54).

This ended up being an interesting study, as others have always pointed out that, in self-reported studies, most pitching injuries were in the shoulder (Hill, et al., 2004). Self-reports are based upon memory, and therefore some stuff may be inadvertently omitted due to their importance, pain factor, or that they were the most recent. The injury incidence was similar to previous studies as well (Hill, et al., 2004; Loosli, et al., 1992). Interestingly, pitchers are not the most injured players on the team, contrary to those early studies.

As a college coach, I know that we don’t practice sliding and diving often. In five years of coaching, I have never been a part of a division I program that worked on sliding and diving technique work. We only worked on it 2 or 3 times at my junior college school, usually when it rained. Obviously, this study reveals that significant technique and skill work should be devoted to sliding and diving.

Keep drawing conclusions and read the study. Like a good book, each time I read this one I see something new and interesting. The more we learn from it and keep our kids on the field, the more successful we can be.

 

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.

The windmill softball pitch: Injury prevention implications

Oliver G.D. (2011). The windmill softball pitch: Injury prevention implications. International Journal of Athletic Therapy & Training, 16(1), 27-31.

As in the last post, the link between the different body segments, also known as the kinetic chain, is vital to both performance and injury prevention. There is also a neuromuscular connection involving a relationship between core muscle activation and the activation of those muscles that control the movement of the extremities (Putnam, 1993; Zattara, Bouisset, & Posturo, 1988).

This article was written as a exercise program concept to help prevent injuries in softball pitchers. The main focus of the program, as with all effective injury prevention programs, is the focus on the core functioning as it relates to the chain. Many upper extremity movements actually involve preceding lower extremity movements that fire the gluteal muscles, hamstrings and core to provide stability for the movement (Cordo & Nasher, 1982). Kinesthetic awareness and postural control are paramount to optimal performance.

Studies have found that athletes who have weaknesses or imbalances in the lumbo-pelvic-hip complex are predisposed to injury (Bliss & Teeple, 2005; Hewett, Ford & Myer, 2006; Ireland, 2002; Leetun, et al., 2004; Myer, Ford, Palumbo & Hewett, 2005; Wilson, Dougherty, Ireland & Davis, 2005; Zazulak, Cholewicki & Reeves, 2008). Many upper and lower body movements involve this area, but not all specifically target it. But, a simple routine involving only 2 minutes per day of isometric exercise with postural control, twice a week for four weeks, can be beneficial to create more lumbo-pelvic-hip stability (Oliver, Adams-Blair & Dougherty, 2010).

In developing a program for your athletes, remember that simple programming can be taken to the field. Also, making a routine, probably near the end of practice, as a team cool down function, or requisite activity before leaving, can keep your players on the field. Here are some exercises that you can do at the field that will help. Remember that doing them properly is more important than doing them for a specific time:

• Planks
• Front
• Side
• Front with contralateral leg and arm extension
• Bird dogs
• Side-lying hip abduction
• Clams
• Side shuffle with bands on the feet (or ankles)
• 45° forward and backward walks with bands on the feet (or ankles)
• Front knee drives with bands on the feet (or ankles)
• Hip bridge
• Back on a bench, bridge while hugging the knee
• Back on the ground, bridge while hugging a knee
• Feet on a medicine ball (one or two feet)
• Single-leg RDL with arm and shoulder extension holding a bat
• Floor mobility exercises
• Leg lifts
• Leg crossovers on the back and stomach
• Rollouts with legs straight, at a 45° and in a butterfly

Stretches include:

• Knee hugs
• Butterfly
• Pigeon pose
• Single-leg RDL (walking or standing still)
• Figure four leg lift
• Quad stretch and reach
• Spiderman walks
• The 3 warrior poses

The windmill softball pitch: Optimal mechanics and pathomechanics of injury

Oliver G.D. (2010) The windmill softball pitch: Optimal mechanics and pathomechanics of injury.  Athletic Therapy Today, 15(6), 28-31.

Most articles written about softball mechanics actually start out with an emphasis on injury. Much of that is the necessity to try and avoid injury, which, in sports like baseball, were addressed through mechanics. And, grant agencies have justified the importance of the research as softball sees 27% more injury incidence than baseball (Powell and Barber-Foss, 2000). Although severe injuries are less common (Axe, Windley, & Snyder-Mackler, 2002), debilitating overuse injuries are common (Loosli, et al., 1992).

Effectiveness in muscle motor patterns have always been based upon the efficiency of energy transfer. Kibler (1995) generalized the efficiency of any upper extremity movement to have a 50-55% contribution of that energy from the lower extremity. As that seems closer to a guess than a conclusion, most wouldn’t argue the importance of the lower half to any athletic movement.

In order for the lower half to transfer energy, a stable middle is paramount. The pelvis has been deemed “the platform” for the scapula, which in turn has been labeled the platform for the arm (Houglum, 2005; Kibler, 1998; Oliver & Keeley, 2010). Just like any platform, political, theatrical, or biomechanical, stability is the key. Therefore, the muscles surrounding the pelvis and scapula have to be healthy, strong, and contract with the proper motor pattern. Understanding the entirety of the process of energy transfer in the softball pitch is still in progress, and, even though some studies have analyzed the kinetics and kinematics of the underhand throw, there is far less knowledge than there is for baseball pitching (Barrentine, et al., 1998; Guido, Werner, & Meister, 2009; Oliver, Plummer, & Keeley, 2010; Werner, et al., 2005; Werner, et al., 2006).

The author illustrated the phases of the pitch. I will be honest, I am not a fan of the breakdown. I am not sure if there is conflict between researchers, but this study was an attempt to veer from the established nomenclature of previous research. I am not sure that the attempt was viable to clear up any confusion. The first phase didn’t actually involve the full push off, and the 5^th phase didn’t involve a full follow through. I feel like it’s rather limited in it’s approach.

That being said, the author did note some important things. First, she noted that the length of the pitcher’s stride correlates with ball velocity (Guido, Werner, & Meister, 2009; Oliver, Plummer, & Keeley, 2010; Werner, et al., 2006), even though in her own study, she found contrary results (Oliver & Plummer, 2011). Second, she noted that, at the top of the backswing, which is approximately 12 o’clock, the humerus is externally rotated, noting the connection with “arm cocking” in baseball.

Third, closing on ball release, the author noted the “posting” position, where the gluteal group fires to extend the hip and stabilize the pelvis, noting that the hips then rotate with ball release. Also, the scapular muscles fire to stabilize, and as the arm internally rotates the bicep begins to fire. They also note that the posting shortens the follow-through and causes the pitcher to move away from the target.

This is the first article that I have reviewed that mentions the kinetic chain. In lay terms, the kinetic chain is a sequence of events that occur in the body, starting in the middle, to force the appendages to accelerate. Generally, in most athletic movements (except kicking), the legs go first, forcing the body to act like a rubber band of sorts, gathering energy and as the energy moves up the body, the legs then initiate the rapid deceleration as well.

Food for thought: How many of you are guilty of telling kids that he hands should lead the swing? Funny right? And then, if you don’t think that the bottom half rotation shouldn’t start the swing, find me video of an elite hitter than doesn’t do that. Better yet, find me video of any elite swinger (tennis, golf, baseball, cricket, hockey) that doesn’t start with the legs.

Happy thinking!

Muscle activation patterns of the upper and lower extremity during the windmill softball pitch

Oliver G.D., Plummer H.P., & Keeley D.W. (2011) Muscle activation patterns of the upper and lower extremity during the windmill softball pitch. Journal of Strength and Conditioning Research, 25(6),1653-1658.

A total of 7 pitchers were recruited with average age, height and weight 17.7 years, 1.69 m, and 69.1 kg, respectively. EMG readings were taken from the Biceps and Triceps Brachii, Rhomboids, Gluteus Maximus and Medius. Each threw 5 strikes, the fastest of which was used for analysis.

Gluteus Maximus activity was most intense during the wind-up, with the pivot foot leg extension (196.3%), and at stride foot contact, in the stride leg (180.1%). Gluteus Medius activity peaked during hip rotation/stabilization in phases 3 and 4 starting at 101.2% and moving to 93.2% through release. Biceps activity peaked through release at 73.2%. The triceps were actively firing the entire motion under 150% and the rhomboids peaked during the middle of the windmill for scapular retraction.

Biceps activity in this study was similar to Rojas, et al. (2009), which is interesting, but previously discussed. The triceps activity was curious in that it constantly fired. However, I would be interested in further studies that involved a discussion of the importance of this finding and why it’s happening. I find the research on the rhomboids to be interesting. Scapular stabilization has been studied over and over in baseball pitching. Due to the intense forces that the overhand motion creates, the scapula must elevate to avoid impingement, while also providing a solid base for the rotator cuff muscles to properly hold the arm in place. The scapular movement has been discussed, but never truly studied in the sense of proper movement, risk factors, etc. Until then, drawing conclusions on what rhomboid activity is meant for is dangerous. However, it does appear to have some activity in retracting the shoulder during arm elevation.

The glute activity in this study is the most intriguing to me. The Gluteus Maximus, the main hip extensor, fires during phase one for the push off. This is consistent with jumping research that has overwhelmingly concluded that hip extension is the main mover in all jumps, particularly horizontal jumping. Then the same muscle in the other leg works eccentrically to decelerate the body during the landing, and maybe extending a little bit as well during pelvic stabilization. The author states that the Gluteus Maximus is most used for weight shifting, but being a pitcher and after reviewing the literature on jumping, I think I can conclude with confidence that the 196.3% activation is a little more than just a weight shift.

Another interesting anecdote is that the author in concluded that the pivot foot gluteus maximus and medius was more active than the stride leg. This is tough to comprehend knowing that during stride foot plant, almost no forces are working on the pivot foot leg, meaning that everything should be loaded on the stride leg. I am curious to see more research looking at leg muscle firing to determine what is really happening. More subjects and better pitchers would be ideal to study. 

Speed up to slow down

Lower-Extremity Ground Reaction Forces in Youth Windmill Softball Pitchers.

Guido, J.A., Werner, S.L., & Meister, K. (2009). Lower-Extremity Ground Reaction Forces in Youth Windmill Softball Pitchers. Journal of Strength and Conditioning Research, 23(6), 1873-1876.

In Werner, Et al. (2005), ground reaction forces were presented but not really discussed in their relationship to the rest of the pitch. The researchers here took that data from the 53 pitchers ages 12-18 (mean 14 years old), average height of 1.65 m and weight of 59 kg, and compared it to the baseball pitch (MacWilliams, et al., 1998). Each threw 10 fastballs and the three fastest were chosen for analysis. The average velocity was 55 mph, average knee angle at stride foot contact (SFC) was 30˚ and average stride length was 1.03 m (62% height).

Braking force peaked at 115 %BW just after SFC and was 0 %BW at release (REL). Medial forces peaked at 42 %BW at .061 s after SFC and vertical forces peaked at 139 %BW also .061 s after SFC. Stride length correlated (r=.765,  p<.05) with ball velocity. Also, time from SFC to peak braking force (r=.764, p<.05) and time to peak vertical force (r=.710, p<.05) correlated with ball velocity. Furthermore, the time from the top of the backswing to release also correlated with time from SFC to peak braking force (r=.788, p<.05) and SFC to peak vertical force (r=.808, p<.05).

In their comparison with MacWilliams’, et al. (1998) data with baseball pitchers, very few similarities were noted. The authors attributed much of the difference to the angle of the baseball mound, which is downhill versus the flat softball mound. They also noted, as did MacWilliams, et al. (1998) that the stride leg serves as an anchor in transferring momentum from the vertical and horizontal components of the leg drive to the arm. Therefore, the more force to stabilize the body against it’s forward energy derived from the leg drive, the better. And they noted that the more leg drive that the pitcher can produce, the more velocity the pitcher will be capable of producing. Research to this point has not touched upon the leg drive component at all.

Studies have shown that the longer force is applied, the higher the performance in other areas of research as well, such as jumping research (Dowling & Vamos, 1993). Pitchers who can reach SFC with their body more “loaded” or with more time to apply force can generate a lot more force. There are a lot of ways to apply these data, one of which I see is in the arm circle. If the pitcher hits SFC with the ball still extended in front of their face vs. over their head, they will have more time around the arm circle to generate force. Although it is difficult to teach, this might be a secret to increasing velocity.

However, there are still gaps to be filled. Without knowing anything about the leg drive component, we cannot apply proper mechanical analyses to any of the end components. Pitchers may be weak because they are recovering from poor leg drive, or they may be braking twice as much from the speed they developed. As always, we need more research. 

If you didn't know, your butt is important...

"It says here that one of your interests is Dabutt???"

"Oh that's da butt. I also enjoy reading."

~Dialog from the movie Lady's Man

Ground Reaction Forces, Kinematics, and Muscle Activations during the Softball Pitch.

Oliver, G.D. & Plummer, H. (2011). Ground Reaction Forces, Kinematics, and Muscle Activations during the Softball Pitch. Journal of Sport Sciences, 29 (10), 1071-1077.

Oliver and Plummer (2011) took 10 female pitchers with an average age of 17.6 years, height of 1.66 m and weight of 67.4 kg and had them throw into a net, selecting the fastest pitch for the study. The average velocity of their pitches was 54.1 mph.

The study listed a few findings that have been contrary to other studies done with similar models. First, according to the current study, pitchers with longer stride lengths threw the ball slower, than those with short stride lengths. This flies in the face of earlier research by Guido, et al. (2009) and Werner, et al. (2006) who both stated that stride length was positively related to ball velocity. Second, there were huge discrepancies in ground forces when compared with Werner, et al. (2005). This table illustrates the differences in the data:

Forces are all in % BW	Oliver & Plummer, 2011	Werner, et al., 2005
Braking/horizontal force	36% BW	115% BW
Vertical force	179% BW	139% BW
Medial force	12%	42% BW

There are a lot of possible reasons for these discrepancies, including sample size, level of expertise, size and athleticism of the pitcher, etc. As research in softball pitching is in its infancy, there will be studies that contradict one another, and only multiple studies will reveal the truth. However, Oliver and Plummer (2011) had only 10 participants, only one trial per participant, and slow average velocities (54.1 mph) from the pitchers where Werner, et al. (2005) had more participants (53), took 3 trials per participant, and had a higher average velocity (55 mph) making it a little more valid. We can also postulate that the pitchers in 2011 had a more vertical motion, as is evident from the foot strike data, which would lead to shorter strides. This would also explain the findings on stride length vs. velocity.

Oliver and Plummer (2011) did however do muscle EMG ratings for the lower half muscles and found that gluteus maximus activation in the stride leg positively correlated with ball velocity. Also, the glutes seemed to be used to not only extend the hips but also stabilize them close to release. Furthermore, a lack of gluteal activity was evident by the great amount of stride knee abduction at foot contact. They also concluded that training the gluteal muscle group bilaterally is salient in the windmill softball pitch.

To put this in perspective, the gluteal muscles act as the main hip extensors of the body. This is more simply put as the muscles that stand you up when you bend over to pick something up. The straighter the hips are, the harder we can throw. The gluteus medius also helps in hip rotation and stabilization. Excercises such as lunges and step-ups can really target train this area, and also all of their variations. I have found that rotational step-ups and lunges are particularly excellent. As we are putting all of this together, we have noticed that the front side needs to be as straight and as stable as possible at release for optimum ball velocity.