Anyone that has spent some time in SE Alaska knows that both softball and baseball are huge here. It’s a funny thing. You would think that indoor sports, or even snow sports would be a bigger draw in a rain forest, and in Alaska in general. But, whatever got deep down inside the souls of us here in little Sitka, AK has continued to grow, and has sent some amazing players out into the world. From the time I could walk I was hanging out at the fields while both of my parents played recreationally. T ball was pretty much a right of passage here, and a large majority of kids continued on from there. Every summer we lived at the fields, and in the mid 90s, while I was in high school, we actually started the high school girls fast pitch program. As adults, one of the most social things you can do in Sitka is join a softball team. The amount of people that play softball blows every other recreational team sport out of the water. That said, how many of us actually train our bodies to handle the stress both baseball and softball place on it?
We have a phenomenal softball program here in Sitka. The coaching staff does such a great job preparing our athletes, but no one can prevent every injury. The more you know the demands placed on your body for these activities, and exercises you can do to help prevent an injury, the less likely you are to develop one. So, let’s start with a myth I hear often:
Fastpitch softball doesn’t cause shoulder injuries like baseball.
Unfortunately, that is far from the truth. Yes, there is less torque placed on the medial elbow and some can argue slightly through the rotator cuff with pitching, but what about our catchers and shortstops? More importantly, studies have shown the “forces on the shoulder and elbow can reach up to 95% of what are experienced in baseball pitchers (1, 2)”. That means girls and women playing fast pitch softball are just as likely to develop some of the injuries we hear so much about with baseball pitchers, and for whatever reason, we just don’t get the hype because there isn’t as much research out there. Also, take into account there is a less restrictive pitch count compared to baseball, as well as continued development of 1 side of your body setting you up for repetitive injuries.
This is where not specializing in 1 sport too early really comes into play. If you or your child is a 1 sport athlete, be aware of the repetitive activities they are performing, and make sure they develop the other side outside of that sport to avoid injury.
So, what can we do to avoid some of these injuries?
Let’s start with pitching.
There was a great study that took EMG findings of the muscles around the shoulder during pitching:
“Shoulder Muscle Firing Patterns During the Windmill Softball Pitch”
Mark W. Maffet, MD, Frank W. Jobe, MD, Marilyn M. Pink,* PhD, PT, John Brault, MS, PT,
and Witaya Mathiyakom, MS, PT
The American Journal of Sports Medicine, Vol 25, No 3; 1997 American Orthopedic society for sports medicine.
ABSTRACT:
“The purpose of this study was to describe the activity of eight shoulder muscles during the windmill fast-pitch softball throw. Ten collegiate female pitchers were analyzed with intramuscular electromyography, highspeed cinematography, and motion analysis. The supraspinatus muscle fired maximally during arm elevation from the 6 to 3 o’clock position phase, centralizing the humeral head within the glenoid. The posterior deltoid and teres minor muscles acted maximally from the 3 to 12 o’clock position phase to continue arm elevation and externally rotate the humerus. The pectoralis major muscle accelerated the arm from the 12 o’clock position to ball release phase. The serratus anterior muscle characteristically acted to position the scapula for optimal glenohumeral congruency, and the subscapularis muscle functioned as an internal rotator and to protect the anterior capsule. Although the windmill softball pitch is overtly different from the baseball pitch, several surprising similarities were revealed. The serratus anterior and pectoralis major muscles work in synchrony and seem to have similar functions in both pitches. Although the infraspinatus and teres minor muscles are both posterior cuff muscles, they are characteristically uncoupled during the 6 to 3 o’clock position phase, with the infraspinatus muscle acting more independently below 90°. Subscapularis muscle activity seems important in dynamic anterior glenohumeral stabilization and as an internal rotator in both the baseball and softball throws.” (1)
This gives us a fairly clear picture of what muscles need to be working, and when, which is what I based some of my exercise recommendations off.
Other studies have shown the most common complaint is pain in the anterior aspect of the shoulder- This is usually the long head of the Bicep Tendon, or the Pec muscles. EMG activity of the Biceps Brachii in fastpitch windmill pitching has been found to be significantly higher than overhead baseball pitching.
Also, in the “pitch delivery phase”, the Pectoralis major and Subscapularis muscles are susceptible to injury as there are significant distraction forces on the shoulder during this time, similar to baseball pitchers. (2,4)
The second most common injury is to the posterior rotator cuff. The rotator cuff is made up of 4 little muscles that sit on the back of the shoulder, on the shoulder blade. They are very important in the stability of our shoulder. All 4 muscles need to work together to help position the head of the humerus in the socket properly. If they are not doing their job, it sets the athlete up for potential Rotator Cuff and Bicep Tendonitis and impingements, as well as instability of the shoulder. The 3 shown to be at risk include the Supraspinatus, Infraspinatus and Teres Minor. Overusing these can lead to dynamic instability of the anterior humeral head. (2,4)
Other Common injuries:
Shoulder: Rotator Cuff Tears, Bicep Tendonitis and impingement, Labral tear
Elbow: Ulnar collateral ligament tears and sprains, Tendonitis
Knee: ACL and MCL tears, Meniscus tears, Anterior knee pain secondary to poor quad/hamstring ratio
Prevention:
* Shoulder and Scapular stability- It is fairly obvious that we need strength through the shoulder as a throwing athlete, but I often see a weakness through the muscles that really count. The Rotator Cuff, but also the scapular stabilizers. This is usually because we don’t do a lot of activities reaching or pulling behind us. In every day life, most everything we do is in front of us, setting us up naturally to be stronger, and tighter anteriorly. The scapular stabilizers are your steady base. I tell people it’s like the difference of trying to walk on flat ground, compared to on a boat with really rough seas. It’s much easier to function when your base is nice and stable. The same is true for your shoulder. If those scapular stabilizers are not doing their job, all the smaller shoulder muscles have to work so much harder.
* Lower Extremity and “core” strength- The majority of our power comes from your hips in both hitting and throwing. If your core is not able to stabilize for that hip power to translate into the arms, once again, you are placing more stress on the shoulder muscles.
* Lower Extremity flexibility - We spend a lot of time keeping the shoulder mobile because it’s obvious we need that during the throwing sport. But it is equally as important to keep the hips mobile. This means the rotators, the hip flexors, and especially the hamstrings so the athlete can quickly, and efficiently get down to field the ball, create more power with hitting, and open up more with pitching.
* Proper pitching mechanics- This is a blog in itself, as there are many factors that contribute to this. Mainly muscles imbalances, flexibility, and balance are large contributions, but also just repetition without feedback. This can be video, coach, force plates, etc.
* Pitching while fatigued. This is controversial, and currently there are no hard restrictions. The best advice is to stop when you start to feel tired. Below is a recommendation for fastpitch softball pitch counts as described by S. Werner, PhD. (3)
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
There are so many exercises to address the above information. Here are 5 of my favorites:
-The Reverse Throw
This is a great way to strengthen the posterior shoulder, which we now know if extremely important from the EMG studies above. Some people look at this as a mechanics drill. Although it is important to perform it correctly to get the right muscles to kick in, it’s more of a strengthening drill than working on mechanics. I would suggest using a 1-2# weight. When athletes start increasing the weight, then I see some of the wrong muscles kicking in. Work more on the power and explosiveness of it rather than trying to increase a lot of weight.

It is pretty much exactly what it sounds like. A throw in reverse. You start in a tall kneeling position. The starting position on the left is with the ball by the opposite ankle. The movement starts with the shoulder blade pulling back, followed by the shoulder moving posteriorly, then the elbow, followed by the wrist, and then finally releasing with trunk rotation. Some key pointers are to:
-Make sure the knee that is bent does not roll in as you release the ball-the knee should be pointing straight ahead.
-That foot should be firmly planted on the ground to help engage the glute.
-The gloved hand should actually be in internal rotation, such as trying to backhand a ball.
-And then starting with the scapula pulling back is where a lot of people get sloppy, and this is very important. The shoulder blade starts the motion!
Stay tuned this week for a video with step by steps for this exercise via my social media accounts.
-Blackburns Scapular Exercises
I give pretty much all of my shoulder patients forms of this exercise. It helps to engage the posterior shoulder and rotator cuff. You can lay on your stomach, lay over a plyoball, bend at the waist, or any other position that allows you to fight gravity. Each position is performed for 60 sec. I usually do 2 sets of 30 sec pulsing, but you can hold the position statically, you can have them go up and down, pulse at the top, and break it up into as small of increments as needed, but a total of 60 sec in each position. Just as in the above exercise, the shoulder blades are what are starting the exercise-not the hand. Think about squeezing shoulder blades back rather than just lifting.




-Single leg RDL
I like this exercise because it combines hamstring and glue strength which is needed for power and explosiveness, but also balance and core stability. Sometimes I find it’s easier to train the athlete with a straight leg to get the hinging motion first, then work into a bent knee, but the important aspect is to keep back straight, shoulder blade pulled back and chest up as you hinge forward at the hip. The other part I see athletes “cheat with” is rotating. Try and think of both hips hinging over a bar or a counter. Everything should be pointing straight forward. The leg that extends back often rotates up towards the ceiling. Check in and see if you can drop that hip slightly. You will often feel the hamstring kick in a bit more when you do this.

-Shoulder External Rotation Progressions
There are way too many versions and progressions of this exercise to describe here, but external rotation strength is imperative to a healthy shoulder for the throwing athlete. A safe, and easy to follow progression is using theraband. Your elbow will always be bent to 90 degrees, and the motion will occur by the shoulder rotating out, not the elbow moving. Start with the most support. Arm at your side, bent to 90 and a towel between the arm and you body. Rotate out and back in through as large of a motion as you can without pain, and without twisting the body, or the elbow starting to straighten. Progressions would be moving the arm out to 45 degrees. This makes it harder to stabilize. Make sure the upper arm is not moving forward and back as you perform the exercise. Then moving up to a 90/90 position. Start with support from a table or your arm, then move to without support. There are lots of variations of this (see Blackburns above), as well as over a ball, and then progressing to a plyometric activity as well.

-Scapular push up
This is a great exercise to engage a muscle called your Serratus Anterior, as well as general stability and endurance of the shoulder. The Serratus Anterior sits on the undersurface of the shoulder blade. It helps to keep the shoulder blade down and stable, so it doesn’t “wing up.”
In the normal population, I’d tell them to keep back flat, rear end tucked in, which is where you start with this exercise. But, because of the recruitment of the serrates anterior with the windmill pitch, shifting back so your arm is close to 100-110 degrees with the Serratus activated is also important (see the last pic).

*Stay tuned to my facebook, Instagram and Youtube channels during Feb 2025 for videos and more in-depth explanations of the above exercises.
YouTube: www.youtube.com/@medicinebymovement
Unfortunately here in Sitka, we actually see quite a few lower extremity injuries as well. Knees, ankles, lack of hip mobility. If you want more info on this, as well as more in-depth information, sign up for my Softball Injury Prevention Workshop scheduled for Wed, Feb 19th from 6:30-7:30 at 311 Price Street. Sign up via the QR code below, or at my website: www.medicinebymovementwellness.com under "book an appointment"

Or, as always, if you have an injury, or want to prevent developing one, I’d love to work with you 1 on 1. Schedule a PT evaluation directly from my website under “book an appointment”
References:
1. Mark W. Maffet, MD, Frank W. Jobe, MD, Marilyn M. Pink,* PhD, PT, John Brault, MS, PT,
and Witaya Mathiyakom, MS, PT. Shoulder Muscle Firing Patterns During the Windmill Softball Pitch. The American Journal of Sports Medicine, Vol 25, No 3; 1997 American Orthopedic society for sports medicine.
2. 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.
3. Leland, G. (Fastpitch Softball TV Show). (2014, April 16). How to Softball Drills & Tips: Softball Pitch Counts. Retrieved from http://www.youtube.com
4. Softball pitching mechanics and shoulder injuries: a narrative review.
Minetos PD, Trojan JD, Brown SM, Mulcahey MK.
Sports Biomech. 2023 Jun;22(6):715-727. doi: 10.1080/14763141.2020.1757142. Epub 2020 May 24.
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