Here's the Pitch

July 10, 2018

Although there are pitch counts for baseball players at many levels, the standard thought has been that the underhand toss utilized by softball players is safer than the overhand form used in baseball. However, new research says the potential for overuse injuries in softball pitchers is a factor that may be overlooked.

A news release from Washington University School of Medicine in St. Louis reports that research findings suggest softball pitchers show progressive pain, fatigue, and weakness relating to two- and three-day tournaments. This research was published in The American Journal of Sports Medicine.

“The dogma involving throwing athletes is that the underhand pitch is thought to be safer, but there have been biomechanical studies in recent years indicating that the stresses on the shoulder are very similar, regardless of whether one is pitching overhand or underhand,” said Matthew Smith, MD, Assistant Professor of Orthopaedic Surgery at Washington University and one of the study’s authors. “The idea that we should protect these softball pitchers hasn’t really caught on.

“Because there aren’t as many pitchers on most softball teams as there are on baseball teams, coaches tend to ‘ride’ the ones who are successful,” he continued. “Most don’t realize they’re putting the pitcher at risk, but it turns out that the windmill style of pitching that girls use isn’t as safe as some might think.”

In the study, Dr. Smith and his colleagues recruited 100 athletes who were between 14 and 18 years old. They were each about to participate in a two- and three-day tournaments and scheduled to pitch each day of the tournaments.

In order to gauge fatigue, which relates to overuse injuries, the researchers measured the pitchers’ strength. These assessments were correlated with the pitchers’ reports of how they felt.

“We used a device called a dynamometer that allows us to test strength,” said Dr. Smith. “They push against it, and it gives us an objective measurement of strength. We also asked them how they felt, how tired they were and how much pain they were in.

‘We can correlate objective measures of strength and associate those with how the athletes say they feel,” he continued. “Usually during a tournament, we compare these things at the beginning of a day playing to these same measurements at the end of the day. Then we ascertain their strength levels at the start of the next day and determine whether they recover their strength,”

The research team found that as pitchers continue playing, they don’t get enough rest to recover. On top of that, most injuries were sustained during the first six weeks of the season. This could indicate that throwing a lot in a short amount of time (with little or no training beforehand) may contribute to the issue.

“On a fast-pitch softball team, the pitcher is the player doing most of the throwing,” said Dr. Smith. “She’s throwing 70 or 100 or 125 pitches in a game. Meanwhile, the center fielder may only throw at peak effort four or five times in a game. Our study focused on pitchers because they are the ones who most commonly come to the doctor’s office with injuries. There is some data suggesting that fatigue is a precursor to injury. If we limit pitches, get them more rest and give them more time to recover, it’s logical to think the injury risk will decline.”

However, there hasn’t been enough research on softball pitchers to have an estimate for how much rest pitchers may need to recover between games.

“Two and three-day tournaments are commonplace in youth fast-pitch softball with teams often using the same pitcher throughout the tournament,” the authors write. “Our data clearly show that shoulder and elbow strength decline after a single day of competitive windmill pitching and continue to decline over consecutive days of pitching. We also show that there are significant increases in subjective measures of shoulder fatigue and pain coinciding with this decline in strength. Importantly, pitchers did not recover to their baseline many of the tested muscle groups by the day following pitching indicating that there was an inadequate period of rest.”

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