Softball injuries have become increasingly popular with the 14 years of NCAA research showing injury rates during preseason practice as double the rates during midseason practice. Injury rates are higher during games than practice and a majority of game injuries were from contact with the balls, bases, or ground. The research found that the most dangerous game activity is not batting or pitching, but base running.

The three most common softball injuries are ankle sprains, shoulder instability, and overuse injuries.

Ankle Sprains

Ankle sprains are the most common injury and can occur from quick stops and starts of base running or running in the outfield along with sliding into base. This condition occurs when the ankle is twisted, rolled, or put into an abnormal position with stress applied. In most cases, the ankle is rolled inward and it is the ligaments on the outside of the ankle that are involved which include the anterior talofibular ligament, calcaneofibular ligament, and the posterior talofibular ligament.These motions cause excessive stretching and tearing of the ligaments in the ankle, which in turn, causes instability of the ankle joint. Preventing ankle sprains is an integral practice strategy on base running game plans and proper sliding techniques. Breakaway bases may also decrease sliding injuries. Having a strong core and lower extremity strength will allow for better reaction strategies to obstacles in the field and lower the risk of injury. Dynamic balance activities facilitate the intrinsic muscles of the foot and strengthen the ankle making sprains less vulnerable. If an ankle sprain does occur, the best treatment is RICE (rest, ice, compression, and elevation).

Shoulder Instability

In addition, shoulder instability is seen when the ball of the joint is not properly supported within the shoulder socket. It is also seen when the scapulothoracic musculature is not strong enough to control the way the shoulder blade and shoulder joint move together. The rotator cuff consists of four muscles and its main job is to stabilize the ball in the socket. The shoulder relies on tendons and muscles to keep the shoulder stable and if scapular stability is not present, that too, results in smaller shoulder muscles generating and controlling forces. Instability can be prevented by strengthening the rotator cuff, shoulder girdle, core and lower extremity muscles.

Overuse Injuries

Instability can lead to overuse injuries as softball players can play multiple games in a day with two hands worth in a weekend. Overuse injuries occur over time due to stress of the muscles, joints, and soft tissues without proper time for healing. Rotator cuff and impingement syndrome are common overuse injuries where there is inflammation in one or more of the tendons of the muscles in the rotator cuff or in the subacromial bursa. Poor mechanics and “overthrowing” can lead to the upper extremity muscles and joints overpowering the lower extremity. Also, weakness in the lower body can result in more reliance on the arm for force generation which can lead to injury. Overuse injuries can be prevented if you’re a pitcher by rotating your position, avoiding pitching for more than one team in the same season, and not pitching in more than two consecutive games until age 13. With pitching, it is important to use your legs to throw. Lower extremity and core strength and control are important in the ability to produce force during the pitching movement. If the upper body overpowers the lower body, the muscles are simply too small to take the load leading to overuse symptoms, particularly in the early season. If you are playing other positions, warm up properly by running, stretching, and throwing at incremental distances, do not play year round, and never play if you are in pain. Be sure to adequately strengthen the rotator cuff and the muscles that stabilize the shoulder blade. A thorough musculoskeletal and entire body functional analysis is important to identify restrictions that can lead to upper extremity overuse. Assessing biomechanics through video is an integral part of diagnosis and treatment of the painful conditions. Rehabilitation of the throwing athlete should include hands on treatment, video analysis, and a progressive return to overhand throwing, followed by return to pitching.