Physical Therapy for Softball Injuries
Softball is a dynamic modified form of baseball that is played on a smaller field with a larger, softer ball using underarm windmill pitching. The windmill pitch is an underhand throw that places significant stress on the shoulder and elbow of the athlete, which can lead to overuse injuries like shoulder and wrist tendinitis, rotator cuff tears, and elbow injuries. Physical therapists can help softball players prepare for the season with a targeted strength and conditioning program as well as treat in-season softball injuries with manual therapy, targeted strengthening and therapeutic exercise, and functional sport-specific training.
Common Softball Injuries
Softball is an increasingly popular women’s sport with more than 2 million female athletes playing the sport between ages 12 to 18 in the United States. However, like baseball, softball players can be prone to injuries in the shoulder, back, neck, elbow, forearm, wrist, and knee. One unique aspect of softball is the windmill pitch which places significant stress on the pitcher’s shoulder, back, forearm, and wrist. The stresses at the shoulder and elbow occur most during the delivery phase of windmill pitching as the shoulder and elbow must resist the increasing amount of force as the pitcher releases the ball. The windmill pitch also generates more torque than the baseball overhead pitch, particularly during abduction and extension.
Softball injuries can be caused by throwing too much or too hard, repetitive movements such as the windmill pitch or squatting (as the catcher) without sufficient rest or recovery, incorrect technique throwing or pitching, sliding or diving into base with too much force, improper equipment, or being hit by the ball or bat. The majority of pitching-related injuries are overuse injuries due to repetitive pitching that places recurrent stress on the tissues, muscles, and tendons of the shoulder, arm, and wrist over time.
Common softball injuries can include:
Shoulder tendinitis: This is most common overuse injury in pitchers, involving inflammation of the shoulder tendons, causing pain through the shoulder, neck, back, and elbow.
Rotator cuff tears: Because softball pitchers use intense underhand movement when throwing the softball, the rotator cuff can become strained and stressed, causing significant wear and tear on the rotator cuff muscles and tendons. The rotator cuff is a group of muscles and tendons that hold together the three shoulder bones and allow you to lift and rotate the arm. If a player doesn’t address rotator cuff pain or tendinitis, she can experience a tear in the rotator cuff and subsequent surgery.
Elbow injury: Due to the stress of pitching or overhead throwing in softball, neuritis of the elbow, or cubital tunnel syndrome, can occur when the ulnar nerve in the arm becomes irritated and compressed. This can cause numbness, tingling in the little finger or ring finger, and a weakened grip. Pitchers may also develop tennis elbow or injury to the ulnar collateral ligament that attaches at the elbow and extends through the forearm.
Wrist pain: Wrist tendinitis or a wrist tendon sprain can occur due to swinging the bat or from repetitive stress on the wrist when pitching, causing pain throughout the forearm, wrist, and hand.
Neck Pain: High-impact throwing can place significant strain on connective tissues of the cervical area of the spine, causing pain in the neck, shoulder, and down the arm.
Risk factors for throwing-related injuries can include:
Lack of overhead shoulder mobility due to muscular tightness, limited shoulder joint mobility, or decreased mobility of the thoracic spine.
Decreased internal rotation range of motion and decreased combined total shoulder internal and external range of motion.
Weakness in the rotator cuff and scapular stabilizing muscles which decreases shoulder function, stability, and power.
Fatigue and insufficient rest and recovery, especially between pitching games.
Physical Therapy for Softball Injuries
Physical therapists can help softball players prepare for the season with a targeted strength and conditioning program as well as treat in-season softball injuries. The physical therapist performs a thorough evaluation of the softball player and their injury, screening for any areas of musculoskeletal weakness or dysfunction that contributed to the injury. As the therapist designs a custom treatment or strength and conditioning program for the athlete, the therapist also considers how many times a week the athlete pitches, how many games in a tournament she may throw, what her practice and game warm up is, how long she pitches during practice, and what her current conditioning program involves.
For treatment of shoulder, wrist, and elbow injuries like shoulder or wrist tendinitis or a rotator cuff tear, the therapist utilizes manual therapy and range of motion exercises to restore range of motion in the the shoulder; targeted strengthening exercises of the shoulder, upper trunk and scapular muscles, and wrist, elbow, and forearm muscles; and functional sport-specific training. For ankle sprains, the therapist incorporates lower leg, ankle, and foot muscles strengthening and balance and proprioceptive training. The therapist then progresses the athlete through a return to play program, focusing on a progressive return to throwing program for softball pitchers.
A physical therapist can design a strength and conditioning program tailored to the athlete to address specific muscle deficits or weaknesses and prevent future injury. A softball strength and conditioning program can include lower body strengthening, core strengthening, and shoulder and scapular muscle stability and strengthening.
Lower body strengthening of the legs, hips, and gluteal muscles is important for proper transfer of the kinematic force from the lower body through the trunk to the shoulder and arm for softball pitching. This begins with activation of the gluteal muscles controlling the pelvis; the kinematic force then moves through the core, shoulder, elbow, and wrist for a powerful pitch. Targeted strengthening of the core is critical for strength and stabilization of the pelvis and spine and movement of power from the lower body to the upper body for a strong pitch. Lastly, the scapular and shoulder muscles not only need proper strengthening to withstand the force of the pitch but should also be trained with dynamic range of motion exercises for full movement and stability in the throwing arm.
To prevent softball injuries, especially in pitchers, teams should rotate pitchers and use age-appropriate max pitching guidelines to avoid fatigue and subsequent injury to the shoulder. It’s important that players warm up properly with stretching and throwing programs to keep muscles flexible. The focus should be on proper pitching mechanics, control and accuracy over speed and power. Pitchers should also gradually increase the volume of their pitching so that the shoulder and arm muscles can adapt to the stresses of pitching over time.
Physical therapists can help you recover from softball injuries and prepare for a successful softball season. Work with a physical therapist today!
