Dennis Read is an Associate Editor at Coaching Management. He can be reached at: dr@MomentumMedia.com.
Coaching Management, 14.9, October 2006, http://www.momentummedia.com
For a long time, people assumed that softball pitchers didn’t face a risk of overuse injuries. Pitchers threw and threw and threw, stopping only when the game ended. One 1991 game went 31 innings and saw only two pitchers—one for each team.
Recent research, though, shows 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, much less two on one day. In this article, we’ll look at the science behind overuse injuries in pitchers and ways to avoid them, including strength and conditioning programs that can help make pitchers not only healthier, but more effective.
While there is limited research into the windmill motion currently used by almost all softball pitchers, most researchers agree that the movement puts pitchers at risk of injury. One of the first studies looked at pitchers from the 1989 NCAA Division I championships and found that 20 of the 24 pitchers studied 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 nearly three-quarters (73 percent) suffered at least one injury during the 2001-02 season. The vast majority of those injuries(70 percent) were classified as chronic or overuse and 52 of those sidelined the pitcher or affected her performance.
Sherry Werner, Director of the Center for Motion Analysis at the Texas Metroplex Institute for Sports Performance in Grand Prairie, has been researching 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. “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. Shoulder distraction stress levels averaged about 80 percent of the pitcher’s body weight.
The elbow faced an average maximum compression force of 61 percent of body weight near the release point. At its fastest point in the delivery, the arm was moving at 2190 degrees per second, fast enough to complete six rotations in one second.
“Coaches need to have an open mind to what the science is telling us,” she continues. “The stresses on the shoulder and elbow are very high, and I think it’s something everybody needs to think about because we are all accountable to the athletes.”
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 for 22 years in high school 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. “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, whether it’s a pitching coach watching them live or just looking at videotape,” Werner says. “If we can get the mechanics straight, we can give 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 is ensuring our pitchers make a perfect circle with proper shoulder rotation,” Throneburg says. “Most injuries are caused by an improper circle. The next most common fault I see is improper hip rotation.”
Through her studies at Tulane, Werner found hip rotation is indeed a common cause of injury. “Probably the biggest flaw we see in many pitchers is where their hips are 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 dissipate that large amount of force.”
Stride length is another area where may pitchers err, 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 leaves the hand. Mechanical flaws plague the follow-through as well. “Proper follow-through is preached a lot but I don’t know how much it’s actually practiced, especially at the high school level,” says Tina Deese, 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 shoulders. 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 where 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.”
The work is far from over once proper mechanics are established. Pitching is a complex motion and small, unintended changes can have a significant effect. “It’s easy to develop a flaw,” Deese says. “It’s funny how kids can be going along great and then all of sudden lose a curve ball or lose the good crisp snap at the end of the motion.”
To help diagnose these small flaws, Deese videotapes each practice and game. She saves footage from 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, and we found a couple of minor flaws. 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 make numerous overhand throws while doing so. 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 may appear to come from pitching.
“I have seen instances where kids have a shoulder problem or an elbow problem and the injury was caused by incorrect throwing overhand, not pitching,” Throneburg says. “Throwing the ball correctly overhand is probably the most neglected skill in softball. In my pitching camps, if we do 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. This means it’s up to coaches to decide how much is too much.
“If every coach kept 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 usually started to look for the next pitcher.”
But just as even the most fit athlete isn’t going to run a marathon every day, pitchers need to consider their long-term usage patterns. “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, that’s fine. But it can’t happen every weekend.”
Deese shows her pitchers the importance of time off. “Nothing can replace rest,” she says. “So during the fall, I’ll talk them into taking a couple of days off, then when they come back, they’re fresh and their ball is moving well. Sometimes, I’ll put them on the gun and show them their speed is up or show them on videotape how their ball is moving. Then they begin to trust that their timing won’t leave them, and the rest will actually help.”
Rick Church, Head Softball Coach at Blinn College, adds that limits don’t only apply to games. “Even if pitchers have the day off following a game, what the coach does with that pitcher during practice is the key,” he says. “Are they throwing batting practice and bullpen sessions every day, and then games on top of that? The volume of throws during practice sometimes has more bearing on overuse.”
Werner offers a caveat for high school coaches whose pitchers may be multi-sport athletes: Be careful that their bodies, especially their shoulders, aren’t overloaded by the cumulative effect of practices and games in different sports. “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 as 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 as pitching workouts because of the stress they’re putting on the shoulder.”
At all levels of the game, coaches need to expand their pitching staffs. “As coaches, we have got to take away that reasoning of ‘I only need one pitcher,’” Throneburg says. “To do that, we have to develop more pitchers, and then we have to use those pitchers.
“Sometimes, there will be one dominant pitcher on the team, and the other players will think, ‘She’s our pitcher, so I’ll just play another position,’” he continues. “We’re not emphasizing enough that we need two, three, or four pitchers on a team. People tend to ride that one girl who can throw really well rather than take time to develop additional pitchers.”
The process of making sure a team has enough pitching should begin with the final out of the previous season. “You have to start in the offseason,” Throneburg says. “You have to look at your team and say, ‘Here are the three or four kids I’m going to use as pitchers next year.’ Then tell them they’re going to pitch next season and suggest that they work with a pitching coach so they’re ready. Don’t wait until the season starts and then say, ‘Man, I don’t have enough pitching.’ That’s too late. You have to figure that out before you pick your team.”
Detection & Treatment
Even with a full staff of pitchers and carefully monitored usage, injuries are going to happen. What are the signs and treatments for these overuse pitching injuries.
“I commonly see overuse injuries in the shoulder, specifically in the rotator cuff, as well as in the biceps and triceps,” says Karen Bloch, 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, decrease in performance, and change in an athlete’s attitude.”
“As a coach I can usually tell if a pitcher is injured because she alters her motion to compensate for it,” Throneburg says. “It may be the circle isn’t as big as it usually is or maybe she’s not using any leg drive because her back hurts.”
But 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. “The legs are sore or there’s soreness in one arm. But if there’s one tender point or one spot that you can touch and get pain, then it’s not soreness.”
Soreness also tends to dissipate with work while injury pain does not. “With soreness, they can warm up and the pain goes away,” says Robin Gibson, Associate Director for Sports Medicine at Florida State University and Head Athletic Trainer for the Seminoles softball team. “But if they have an injury, they can warm up and the pain won’t disappear. Athletes sometimes have a hard time with this, especially freshmen. They’re often hitting the weightroom hard for the first time and they’re out practicing every day. They’ve built up a lot of lactic acid, and their muscles are sore. They think they’re injured, but it’s soreness.
“If the pain does not disappear after they’ve properly warmed up, you shouldn’t try to push them through the pain,” Gibson continues. “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. No matter where how badly they want to keep pitching, they just can’t hide that.”
The main treatment for overuse injuries is basic: rest. But it is not always simple. “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 icing and anti-inflammatories, even corticosteroids to treat the symptoms. But those just help them manage their pain so they can continue pitching.”
In addition to a reduced workload, Bloch uses cross-training and massage to help treat overuse injuries. “Cross-training in water is one of my favorite tools to use in recovery,” she says. “The water helps with lymphatic drainage and has less impact on the body. They’re able to do all softball motions in the water and get an excellent cardiovascular workout as well. Other cross-training methods can include the bike, stair climbers, and elliptical machines.
“Massage is another key element in treating overuse injuries,” Bloch continues. “I emphasize massage techniques that improve circulation, re-align the tissue, and enhance muscular relaxation, which in turn promotes healing.”
With treatment of overuse injury usually limited to a choice of resting the pitcher completely or getting her through the rest of the season, the wisest option is to try to prevent the injuries from occurring in the first place. Assuming their mechanics are sound, pitchers can reduce their chance of injury through strength and conditioning work, which will also help them become better pitchers.
“Once you have good mechanics,” Church says, “strength and conditioning is the critical element. The purpose of mechanics is to optimize your current level of strength and power. And the way to increase strength power and explosive endurance is through a good solid strength and conditioning program.”
Most experts believe training for softball pitching begins at the core. “The most effective pitchers will be the ones who have the strongest legs and core, not the ones with the strongest arms,” Werner says. “The muscles in the core are significantly bigger than those in the arm, and we want to use the big muscles to produce more of our velocity. Obviously, the arm has to be strong, but if you were going to cut one thing out of a training program for time reasons, I’d cut the upper extremity work before the core or legs.”
John Williams, Director of Strength and Conditioning at Baylor University, agrees that core work should be a vital part of any pitcher’s strength and conditioning program. “You have to strengthen the abductors and adductors because of the torque created by the pitching motion,” he says. “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 special considerations when it comes to working with softball pitchers. “I use a lot of rotational work because softball pitchers rotate their hips a lot,” 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.”
Core and balance work are two of the four building blocks to Bloch’s strength training progams. The others 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.
“The importance of these exercises is to concentrically and eccentrically challenge the pitchers’ 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 rotator cuff program to prepare his pitchers for the demands of a long season. “When you strengthen muscles, the fibers are torn and then rebuilt with a little more size,” he says “If you build the muscle up in the offseason, then they have more protection around the tendons during the season. So we do traditional hypertrophy work like internal/external rotation with dumbbells and bench scap squeezes.”
Once the season starts, the emphasis turns to maintenance instead of building. “In season, we use more of the 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 between 10 and 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.”
Although weightroom work is a key component of a pitcher’s strength and conditioning program, there are exercises they should 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 have already the micro-trauma that comes from throwing every day, so why would you want to add to that with snatches?"
Church agrees. “You want to minimize the overhead lifts,” he says. “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 are going to 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. “But you don’t abandon your program once your season starts. You’ll want to reduce the volume because of the load from competition and practice, but you still need to keep the intensity up.”
The proper balance of pitching, practicing, and training will let you get the most out of your pitchers while avoiding overuse injuries. Even if it means pitching fewer innings than it did 20 years ago.
Sidebar: Preseason Strength
The following is a sample week of the inseason 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. DB squats x 8
Lateral box jumps x 3 each
2. Three-way lunges 3 x 3 each
3. 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. 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. Rope pressdown x 8
DB curls x 8