Jan 29, 2015Checking the Windmill
On a farm, a windmill can keep going forever. But on the softball diamond, windmill pitchers need to be watched closely for overuse injuries, which are becoming more prevalent in the game.
By Dennis Read
Dennis Read is an Associate Editor at Training & Conditioning. He can be reached at: [email protected].
For a long time, people assumed that softball pitchers didn’t have to worry about overuse injuries. Pitchers would throw and throw and throw, stopping only when the games ended. One college game in 1991 went 31 innings and saw only two pitchers—one for each team.
Recent research, though, has shown that windmill pitching does take a toll on a pitcher’s arm, and the forces it produces are comparable to those experienced by baseball pitchers. Yet softball pitchers are still treated differently than their mound-throwing brothers, who would never think of starting games on consecutive days, never mind two in one day.
In this article, we’ll look at the science behind overuse injuries in softball pitchers and ways to avoid them. We’ll also discuss strength and conditioning programs that can help make pitchers not only healthier, but more effective.
While there is limited research into the windmill pitching motion currently used by almost all softball pitchers, most researchers agree that the movement puts pitchers at risk for injury. One of the first studies conducted in this area looked at pitchers from the 1989 NCAA Division I championships and found that 20 of the 24 pitchers studied had suffered a total of 26 injuries during that season, 17 of which were to the pitching arm. Of the 11 injuries that resulted in missed playing time, nine were to the arm.
A more recent study of 181 pitchers across all three NCAA divisions found that 73 percent suffered at least one injury during the 2001-02 season. A large majority of those injuries (70 percent or 92 injuries) were classified as chronic or overuse injuries, and 52 of them sidelined the pitcher or, in the pitcher’s view, affected her performance.
Sherry Werner, PhD, Director of the Center for Motion Analysis at the Texas Metroplex Institute for Sports Performance in Grand Prairie, has been studying arm injuries in pitchers for nearly 20 years. She’s seen hundreds of pitchers, many of them under 18, who required surgery to repair their arms. “For too long we’ve heard the myth that softball pitchers have a natural throwing motion and they can pitch as much as they want without hurting themselves,” says Werner, who was previously Coordinator of the Human Performance Laboratory at the Tulane Institute for Sports Medicine, and a Research Assistant Professor at the Tulane University School of Medicine. “As a result, every year at Tulane an increasing number of kids, 18 and under, came in to see us. Usually it was some sort of labral injury or damage to the rotator cuff. Many needed shoulder surgery and their shoulders looked like those of a 90-year old.”
Werner led a biomechanical study of pitchers at the 1996 Olympic Games in Atlanta that found the shoulder stresses they faced were similar to those in baseball pitchers, who are rarely asked to pitch as often as softball pitchers. Shoulder distraction stress levels averaged about 80 percent of the pitcher’s body weight and sometimes exceeded the pitcher’s body weight. The elbow, meanwhile faced an average maximum compression force of 61 percent of body weight near the release point. At its fastest point in the delivery, just after the stride foot made contact with the ground, the arm was moving at 2,190 degrees per second, or fast enough to complete six rotations in one second.
A second study led by Werner and published this year found pitchers age 12 to 19 face similar arm and shoulder stresses. This research also examined the forces absorbed by the lower body. Braking forces typically exceeded body weight shortly after the stride foot made contact with the ground, and vertical ground reaction forces sometimes exceeded 150 percent of body weight.
Werner says that not everyone in softball has been receptive to her work, estimating that about half the coaches she hears from say they have little use for it. “Physics and engineering principles are behind everything we do,” Werner says. “I think people need to have an open mind about what the science is telling us.”
There are two main causes of chronic injuries in softball pitchers: poor mechanics and overuse. Poor pitching mechanics can lead to injury even at a young age.
“I coached high school girls for 22 years and never had a pitcher miss a turn because of injury,” says Denny Throneburg, Head Softball Coach and Athletic Director at Lake Land College, who won 647 games and six state titles as Head Coach at Casey-Westfield (Ill.) High School. “I also coached 25 years of travel ball and never had a pitcher miss a turn because of injury. People ask me how, and I tell them it’s because we teach proper mechanics at a young age. The younger they learn the proper way to throw the ball, the better.”
“My main recommendation for anyone who works with softball pitchers is to have their mechanics assessed,” Werner says. “If we can get the mechanics straight, then I think we’re giving athletes a much better chance of avoiding injury down the road.”
According to Throneburg, the starting point for mechanics is shoulder rotation. “The first thing we work on with our pitchers is ensuring that they make a perfect circle with proper shoulder rotation,” he says. “Most injuries are caused by an improper circle.”
Through her studies at Tulane, Werner found that improper hip rotation is another common cause of injury. “Probably the biggest flaw we see in many pitchers is how their hips move when they release the ball,” she says. “When their hips are more closed, or pointed toward home plate at release, it makes for safer mechanics because the trunk and legs are helping to dissipate that large amount of force.”
Stride length is another area where pitchers go astray, usually by not striding far enough. “We have found that the longer the stride, the more they protect their shoulder,” Werner says.
The dangers aren’t over once the ball is released. “Proper follow-through is preached a lot but I don’t know how much it’s actually practiced,” says Tina Deese, MA, Head Coach at Auburn University. “Pitchers can be successful without a nice, smooth follow-through, but they may not last.
“Some pitchers use big, high, long follow-throughs where the elbow comes back out away from the body and they almost do a second arm circle. But I don’t know if that’s good for the decelerators,” she continues. “I think that can basically wear out the brake pads in the back of the shoulder. With a textbook follow-through, the arm should almost brush the belly all the way up and finish with the fingers touching the throwing shoulder.”
Werner agrees. “Those who follow through with a straight elbow so that the hand raises up above the head, place a lot of stress on their shoulder,” she says. “Those who snap their wrist and elbow, then bend both joints, protect the shoulder better.”
To help diagnose flaws in her pitchers’ mechanics, Deese videotapes each practice and game. She saves footage from her pitchers’ ideal deliveries so she can refer to them later when problems develop. “The tapes came in very handy last year, when one of our pitchers lost her curve ball in the middle of the season,” Deese says. “Thank goodness I had what I called her perfect curve ball recorded. I was able to show her that footage compared to what she was currently doing. We saw a couple of minor flaws that we corrected, and then everything fell back in place.”
There’s another, sometimes overlooked factor, that can increase the risk of arm injuries, and that’s overhand throwing. Many pitchers play another position when they’re not pitching. And even those who only pitch are regularly called upon to make overhand throws while fielding the position. Any deficiencies in the overhand throwing motion can lead to arm injuries that subsequently will affect pitching.
“I have seen instances where kids have a shoulder or elbow problem and the injury was caused by incorrect throwing overhand, not pitching,” Throneburg says. “I think throwing the ball correctly overhand is probably the most neglected skill in softball. If I am doing an hour pitching session, the first 10 minutes are devoted to the correct overhand throwing motion.”
The second cause of chronic injury is overuse, which can be hard to rein in. Unlike baseball, there are few restrictions on how many pitches or innings a softball pitcher can throw.
“I think if every coach would keep a pitch count and set a realistic number of pitches, we wouldn’t see nearly as many shoulder injuries as we do now,” Throneburg says. “The exact number will vary by body shape, size and the physical condition of the pitcher. When my high school pitchers reached somewhere between 100 and 120 pitches, I was usually starting to look to the bullpen.”
Long-term usage patterns ate also critical. “If you pitch on a Monday, we recommend that you take Tuesday off—whether it’s a game or a workout—with no softball activity at all,” Werner says. “We realize that once teams get into playoffs, pitchers may be asked to throw two games in a day, then come back and throw one or two the next day. As long as that happens only once or twice a year, it’s fine. But it can’t happen every weekend.”
Rick Church, MS, CSCS, Head Softball Coach at Blinn College, adds that limits don’t apply only to games. “Even if pitchers have the day off following a game, what the coach does with them during practice is key,” he says. “Are they throwing batting practice and bullpen sessions every day, and then games on top of that? I think the volume of throws during practice can really contribute to overuse.”
Werner offers a caveat for high school coaches whose pitchers may be playing other sports: Be careful that their bodies, especially their shoulders, aren’t overloaded by the cumulative effect of practices and games. “A lot of the kids I worked with in New Orleans were playing volleyball from Monday through Thursday and softball from Friday to Sunday,” Werner says. “You can’t work with that kind of athlete the same way you do with one who is playing only softball. Volleyball, for example, puts a lot of stress on the shoulder. If you have an athlete who is playing volleyball three times a week, you have to treat those sessions as pitching workouts because of the stress they’re putting on the shoulder.”
Detection & Treatment
Even with correct mechanics and carefully monitored usage, injuries are going to happen. What are the signs and treatments for these pitching injuries?
“I commonly see overuse injuries in the rotator cuff and in the biceps and triceps,” says Karen Bloch, MS, LAT, ATC, CSCS, Staff Athletic Trainer at the University of Wisconsin, who has also worked with the Women’s Professional Softball League. “These injuries are characterized by nagging pain, fatigue, decreased performance, and change in an athlete’s attitude.”
Common diagnoses include bicep tendonitis, rotator cuff strains, and impingement syndrome, which is an inflammation of the rotator cuff tendons. Overuse injuries can also affect the lower back and knees.
It’s important to differentiate between the soreness that comes with pitching regularly and the pain of injury. “Soreness is usually general, not focal,” says Bloch, who is also owner of Key Koncepts for Sport Enhancement and Injury Prevention in Madison, Wis. “If there’s one tender point or one spot that you can touch and get pain, then it’s not soreness.”
Robin Gibson, LAT, ATC, Associate Director for Sports Medicine at Florida State University and Head Athletic Trainer for the Seminoles softball team, watches all her pitchers closely for signs for injury. “Any coach or athletic trainer who is in tune with their pitchers can tell when they’re injured because their mechanics change—even their body language and facial expressions change,” she says. “No matter where their heart is and how bad they want to keep pitching, they just can’t hide that.”
But that doesn’t stop them from trying. “I had a pitcher with a stress fracture, and I knew there was no way she could throw,” Gibson says. “But she begged me not to tell the coach. So I just said, ‘Okay, I’ll see you at warmup’ because I knew as soon as she threw a pitch she’d realize there was no way she could keep going. Sometimes they want to be out there so badly that you have to let them see for themselves they can’t do it, rather than arguing with them.”
The main treatment for overuse injuries is rest, which may need to be carefully negotiated. “When you tell a coach in the middle of the season that her number-one pitcher needs rest, it usually doesn’t go over well,” Gibson says. “So instead of taking her out of the lineup, we can cut back on the number of pitches she throws in a game and in practice. We also use ice and anti-inflammatories, even corticosteroids to treat the symptoms.”
In addition to a reduced workload, Bloch uses cross training to help treat overuse injuries. “Cross training in water is one of my favorite tools to use,” she says. “The water helps with lymphatic drainage and reduces impact. They’re able to do all softball motions in the water and get an excellent cardiovascular workout. Other cross-training methods include the bike, stair climbers, and elliptical machines.
“Massage is another key element in treating overuse injuries,” Bloch continues. “I emphasize techniques that improve circulation, re-align the tissue, and enhance muscular relaxation, which in turn promotes healing.”
The last piece of the puzzle in preventing softball pitching injuries is a strength training program. “Once you have good mechanics, strength and conditioning is the critical element,” Church says. “The purpose of mechanics is to optimize your current level of strength and power. And the way to increase power and explosive endurance is through a good solid strength and conditioning program.”
Most experts believe training for softball pitching begins at the core. “You have to strengthen the abductors and adductors because of the torque created by the pitching motion,” says John Williams, SCCC, USA-W, Director of Strength and Conditioning at Baylor University. “The shoulder may seem to be the problem because of soreness or pain there, but it can actually result from over-compensating for a lack of strength or flexibility in the core.”
Although almost any athlete will benefit from a strengthened core, there are some special considerations when it comes to working with softball pitchers. “I use a lot of rotational work because softball pitchers rotate their hips,” Williams says. “We do arc raises, weighted resisted arc raises, and stump busters, which are overhead raises between the knees to get the trunk and hips extended. We do a lot of dynamic throws with the medicine ball, such as rotary release and twist release. We also use lunge throws and physioball exercises like seated physioball overhead shoulder presses.”
In addition to rotational core work, Tim Lang, MS, CSCS, Director of Strength and Conditioning at DePaul University, counts on one-leg work to help make his pitchers stronger. “A lot of our program is about balance,” he says. “When I first got here I was comfortable doing two-legged exercises but the more I watched our athletes, I saw how they jump and throw off one leg. So now we’re doing body-weight deadlifts with one leg. We’re doing single-leg squats with rotation by reach outs with one leg.”
Core and balance work are two of the four building blocks to Bloch’s strength training programs. The other two are range of motion and concentric/eccentric exercises. Bloch likes to use tubing exercises where a pair of players stand front to back facing the same direction. Holding a tube or band, they perform a series of sport-specific exercises at the same time.
“The most common ones mimic the pitching motion,” Bloch says. “I like to cut the windmill motion down and work on half of the pitching arc at a time. So they bring the tubing forward and then back. Another exercise I use a lot is wrist flexion.
“These exercises are important because they concentrically and eccentrically challenge the pitcher’s body through sport-specific planes of movement,” she continues. “Once one arm is exercised with both people facing the same direction and doing the same movement in unison, they turn around and perform the same motion again. When facing one direction, one person will perform a concentric motion, and the other will challenge the eccentric motion. When they turn around, the concentric/eccentric motions will be switched.”
During the offseason, Williams uses a progressive rotator cuff program to prepare his pitchers for the demands of a long season. (See “Rotator Cuff Program”) Once the season starts, the emphasis turns to maintenance instead of building. “In season, we use more rehab-type movements,” he says. “For example, we do more bow-and-arrows, side laterals, and hitchhiker combos.”
Church works a lot on explosive strength with his pitchers. “From the start of the motion to release takes less than a second, so that explosive endurance needs to be simulated in a strength and conditioning program,” he says. “We do a lot of low-impact bounding and medicine ball throws, some of them off a mini-tramp. Two-handed overhead throws and throws through the legs also simulate the pitching motion well. We do anywhere from 10 to 20 reps, and gradually increase the weight of the ball as we progress.
“We have another drill where they push forward in a pitching motion, and we’ll do a series of five to 10 reps at a time,” he adds. “Then we add resistance belts or tubing.”
Church also uses weighted balls to train his pitchers, a technique he admits not everyone subscribes to. “There is some debate in the literature and coaching circles on the use of the weighted ball,” he says. “And you certainly have to be very careful with the volume of work you do with overweight and underweight balls because there is a risk of injury, especially if the mechanics are even a little bit off. We typically do 50 to 75 percent reduced volume two or three days a week in the preseason, which includes both overweight and underweight balls. And I’ve seen some good velocity increases in our pitchers using the program.”
Although weightroom work is a key component of a program, there are some exercises to avoid. There has been a definite shift away from some of the traditional Olympic lifts.
“You do need explosive work, and cleans are fine,” Bloch says. “But as far as snatches, you already have the micro-trauma that comes from throwing every day, so why would you want to add to that with snatches?”
“You want to minimize the overhead lifts,” Church agrees. “I also think there’s been a de-emphasis on bench press in favor of incline presses and body-weight push-up variations. I’m not saying we have to eliminate the bench press entirely, but there’s not much reason for a pitcher to just get down and do a max bench press.”
Werner says a good rule of thumb is to pull, not push. “Stay away from anything that requires pushing weights or resistance away from the body,” she says. “Instead do a lot of pulling. The muscles used when pulling weight toward your body are the ones that will protect the shoulder and the elbow.”
Regardless of the exact program used, Church says it’s important that pitchers continue to work out throughout the season. “There’s a myth that you need to stop your training after preseason,” he says. “You’ll want to reduce the volume because of the load from competition and practice, but you still want to keep the intensity up.”
You also want to keep the intensity up on all of your injury-prevention efforts. From watching their mechanics to counting pitches to checking tender spots, coaches and athletic trainers can reduce overuse injuries in pitchers—while also making these players more effective.
Sidebar: Rotator Cuff Program
The following is an example of the rotator cuff strengthening program used by pitchers at Baylor University.
Warmup (1 lb. DB or 2.5 lb. plate)
- Overhead shoulder presses x 5 each: Palms away, palms together, back of hands together
- Modified French press x 5 each: Palms together, thumbs together, back of hands together
- 45-degree angle front raise x 5 each: Palms down, thumbs up, thumbs down
- Hands-together front raise x 5 each: Palms together up/down, palms together up/back of hands together down, thumbs together up/knuckles together down
- Hitchhikers x 5
Exercises (2.5 lb. plate or 5 lb. DB)
Six reps of each exercise for each side
- Cuban raises: Palms away, thumbs backward, thumbs forward
- Two-handed pitchers: Palms away, thumbs backward, thumbs forward
- Side laterals with hitchhiker combo: Side laterals, side laterals/hitchhikers
- Around the world: Palms together, thumbs together, back of hands together
- Bow-and-arrows (bent over rear delt raises): Thumbs together, palms together, back of hands together
- Modified bow-and-arrows (bent over, hands to chest, tricep extension, down): Palms together, thumbs together, back of hands together
Sidebar: Preseason Strength
The following is a sample week of the preseason strength-training program used by softball pitchers at Baylor University.
- Toes & bows, 1 min.
- Side bridge, 45 sec. each side
- Seated twist x 40
- Leg throws x 30
- Supermans, 5 sec. x 12
- Straight-Leg sit-ups x 15
- Med-Ball partner rotation x 10 each side
- Physioball knee tucks x 15
- Single-leg squat x 15 each
- Crossover touch x 15 each
- Lateral push-offs x 8 each
- Depth jumps x 10
- Lateral shoulder raises, palms in x 10
- Lateral shoulder raises, palms out x 10
- Scarecrow x 10
- Arm circles x 5 each
- 1. (3 times per exercise)
– DB squats x 8
– Lateral box jumps x 3 each
2. Three-way lunges: 3 x 3 each
3. (2 times per exercise)
– One-leg Romanian dead lifts x 8
– Bent rows x 8
4. DB flys 2 x 8
- Plank, 1 min.
- Alternating Supermans x 10 each
- Med-Ball seated twist throws x 15 each
- V-ups x 30
- Side-to-side V-ups x 30
- Bench leg raises with hip raise x 20
- Bench knee rolls x 30
- Eccentric sit-ups (5 sec. down) x 15
Balance/Stability: same as Tuesday
Shoulder Stability: same as Tuesday
- 1. (4 times per exercise)
– DB high pulls x 3
– Box jumps x 3
2. Physioball leg curls: 3 x 8
3. Single-arm DB bench with hold on top: 2 x 8 each
4. (2 times per exercise)
– Rope pressdown x 8
– DB curls x 8