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Is it Time for Pitch Counts in High School Softball?

By Phil Hurley, M.D.; Ben Kibler, M.D.; and George Randolph on October 06, 2021 hst Print

Once upon a time, way back in the 20th century, it was unusual for a sports medicine provider to see a softball pitcher with shoulder problems. At that time, the game was slow pitch, there were no softball clubs and the better athletes played multiple sports.

Now, the following scenario is becoming all too common: a 13-year-old girl is seen during the winter for chronic shoulder pain in her pitching arm. She recently pitched eight games in two days for her club team and plays only softball 10 – 12 months a year. Her parents expect the problem to be cured because “softball will pay for her college education.”

Softball coaches want their pitchers to be healthy and pitch effectively. This requires the ability to manage the workloads and pitching exposures in order to achieve these goals. The following is intended to provide information, based on the latest available research, to help coaches develop the best programs for their athletes. First, some background information based upon this data and the opinions of a nationally recognized sports shoulder expert.

  • Pitching shoulder injuries are the most common injuries in softball pitchers. A pitcher has three times the risk of being injured compared to other positions. These injury rates are similar to baseball rates, and they can have significant consequences. About 27 percent of shoulder injuries result in more than 10 days of lost competition, and between 5 and 10 percent of the injuries required surgical treatment. Think what this can mean if it happens during the postseason.
  • Every pitch in fast-pitch softball generates forces across the shoulder that are similar to the overhand baseball pitch. Therefore, fast-pitch softball pitchers have a similar risk for shoulder fatigue and injury as their baseball counterparts.
  • One of the known major risk factors for shoulder injury is the total amount of exposure to the forces of pitching. A common method of calculating the risk for injury is to total either the innings pitched or the actual number of pitches. Much work has been done in baseball to document this and it is now accepted almost universally. Injured pitchers were found to have thrown between 24 and 40 percent more pitches per game and per season than non-injured pitchers.
  • Another major risk factor is the amount of recovery time between exposures. Throwing creates adaptive responses in flexibility, strength and endurance that usually return to their pre-throwing status within 24-48 hours. Pitching during this period of recovery can have adverse effects on the shoulder.
  • A good study has documented that softball pitchers experienced a significant increase in shoulder pain and fatigue, both as a result of a single game and also over an entire season. In baseball, pitching while fatigued increases injury risk four-fold, and decreases performance capability (pitch velocity and pitch location). There are concerns that the risks of fatigue, decreased performance and subsequent injury are as true in fast-pitch softball as they are in baseball. Also, playing multiple sports gives the shoulder needed rest and recovery.
  • Athletes vary in their response to pitching exposures. Factors such as age, muscle strength, muscle flexibility, skill level and general conditioning will modify the responses but will not eliminate the fact that a response occurs. Younger athletes are less capable of withstanding the same level of exposure as their older teammates.

Many feel that experience is a great teacher. With that in mind, following are some recommendations from a longtime softball coach who has won Kentucky state titles in both slow and fast pitch as well as the currently available data.

  1. Try to develop as many pitchers as possible.
  2. Make sure that each pitcher is using the most efficient throwing mechanics.
  3. Athletes should follow a dedicated softball-specific conditioning program that places an emphasis on leg, hip, core, shoulder blade, and general shoulder strength and flexibility.
  4. Strongly consider monitoring pitch counts (see the chart above) and innings pitched to manage the applied load exposure and reduce shoulder fatigue and lost time injuries. Under age 13, they should not pitch more than seven innings per game (with one complete calendar day of rest if they do pitch more than seven), no more than 12 innings per day, and no more than two consecutive days. Above 13, they should not pitch more than three consecutive days. Ideally, there should be two days of rest for all ages following pitching.
  5. Ice shoulders and elbows after pitching.
  6. Strongly encourage your athletes to play more sports than just softball. More and more studies are showing that multi-sport athletes perform at a higher level and with fewer problems such as injury and burnout.
  7. Finally, if you cannot get them to participate in multiple sports, then do your best to get them to take a softball break. One recommendation is no team activities for the first 4-5 weeks of the school year and between Thanksgiving and the start of the second semester in January.

It is hopeful this will stimulate thoughtful discussion and further research on whether or not it is time to consider instituting pitch counts for softball similar to what has been done in baseball. We suggest that fast-pitch softball in the 21st century is as stressful for a pitcher’s shoulder as baseball. However, the NFHS Sports Medicine Advisory Committee (SMAC) is currently reviewing injury surveillance data and the latest research on this topic. At this time, the SMAC does not believe the available injury data warrant the implementation of pitch or inning limitations for high school softball, but it will continue to review new data as it becomes available.

Resources:

1. AOSSM Stop Sports Injuries website www.stopsportsinjuries,org.
2. Little league website www.littleleague.org.
3. Lear A. Softball pitching and injury. Current Sports Medicine Reports 2016; 15:336- 341.
4. Robinson TW. Shoulder injuries among high school athletes. Pediatrics 2014; 133:272- 279.
5. Shanley E. Shoulder range of motion, pitch count, and injuries among softball pitchers. International Journal of Sports Physical Therapy 2012; 7:548-557.
6. Yang JS. Fast pitch softball pitchers experience a significant increase in pain and fatigue during a single high school season. Journal of the Hospital for Special Surgery 2016; 12:111- 118.