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Fastpitch Softball Injury Treatment & Prevention

Spring is in full swing and we are right in the middle of Fastpitch softball season, one of my favorite times of the year. Along with the good, we sometimes as healthcare practitioners see the bad. This time of year, particularly in the early season, we begin to see the overuse injuries that are common with the sport.

A lot of emphasis is put on the prevention of injury in baseball players, and I couldn’t agree more with what we do in the field of sports medicine to prevent and treat those injuries. We are getting better at identifying risks for injury and are addressing them to a higher degree in baseball.

I do feel we can do a better job for fastpitch softball players. Pitchers in fastpitch softball have repetitive use of the pitching and throwing arm, and are at risk for injury just as our baseball players are. There is a misconception that pitching a softball is somehow “safer” and less problematic than pitching a baseball. As time goes on, we are discovering that this is really not true. Forces on the shoulder and elbow can reach up to 95% of what are experienced in baseball pitchers (1, 2). Girls and women participating in fastpitch softball are susceptible to similar injuries in the shoulder and elbow as our baseball players.

Common Injuries/Painful Areas:

Anterior shoulder pain (pain in front)

–       During the softball pitching motion, when the arm is in the “pitch delivery phase”, there are significant distraction forces on the shoulder which make the Pectoralis major and Subscapularis muscles susceptible to injury. The Pectoralis Major is a large anterior chest muscle and the Subscapularis is part of the Rotator Cuff. These forces are similar to the forces seen in baseball pitchers.(1)

Elbow Pain

–       Distraction forces at the elbow make those tissues susceptible to overuse injury

Posterior Shoulder pain (pain in back of shoulder)

–       The posterior shoulder muscles (deltoid, infraspinatus, and teres minor) are injured while contracting to decelerate the arm during delivery of the pitch. Shoulder joint laxity can be a problem that leads to this type of pain problem. (1)

Prevention & Treatment: Bullet Points to Recognize as Factors

–       Proper pitching mechanics- Many factors can affect the ability to maintain good pitching mechanics. Musculoskeletal restrictions, weakness, and problems with balance can contribute to break downs in mechanics.

–       Pitching while fatigued. There are pitch counts available for baseball for different ages to help as a guideline to prevent arm fatigue. Best advice is to stop throwing when arm fatigue starts, regardless of pitch count. Below is a recommendation for fastpitch softball pitch counts as described by S. Werner, PhD.

–       Lower Extremity and “core” strength- Hip position and lower body control is important in the ability to produce force during the pitching movement. Weakness in the lower body can result in more reliance on the arm for force generation, and can lead to injury.

–       Shoulder and Scapular stability- strength and stability in the arm is important, but in addition to that, there must be adequate strength in the muscles that stabilize the shoulder blade. If scapular stability is not present, that again results in smaller shoulder muscles generating and controlling forces.

–       Treatment of the softball athlete and return to play must consider all of these issues. Video Throwing and pitching analysis is an integral part of diagnosis and treatment of the “causes” of painful conditions. A thorough musculoskeletal and entire body functional analysis is important to identify restrictions that can lead to upper extremity overuse. Rehabilitation of the throwing athlete should include hands on treatment, video analysis and biomechanical analysis, and a progressive return to overhand throwing- followed by return to pitching. Missing any of these components can put an athlete at risk at developing another injury.

Fast pitch softball pitch count recommendations as suggested by SL Werner, PhD based on her research (3):

▪       10U – 60 Windmill pitches per day max followed by one day rest

▪       12U- 70 pitches per day max followed by one day rest

▪       14U- 80 pitches per day max followed by one day rest

▪       16U- 90 pitches per day max followed by one day rest

▪       18+- 100 pitches per day max followed by one day rest

Dr. Jennifer Allen is a Physical Therapist, Board Certified Clinical Specialist in the Areas of Orthopaedic and Sports Physical Therapy, as well as a Certified Hand Therapist. Sports Programming at Bodycentral Physical Therapy includes Biomechanics assessment, video movement assessment, Injury Prevention, and individual and team performance enhancement. For more information visit www.BodycentralPT.netor call 520-325-4002.


  1. Barrentine SW, Feisig GS, Whiteside JA, Escamilla RF, Andrews JR. Biomechanics of windmill softball pitching with implications about injury mechanisms at the shoulder and elbow. J Orthop Sports Phys Ther 1998;28: 405-414.
  2. Werner SL, Murray TA, Levy M, Smith SL, Plancher KD, Hawkins RJ. Reports to the coaches: softball pitching at the 1996 Olympic Games (monograph on the Internet). Steadman Hawkins Sports Medicine Foundation; 2001 Available from:
  3. Leland, G. (Fastpitch Softball TV Show). (2014, April 16). How to Softball Drills & Tips: Softball Pitch Counts. Retrieved from