Pitching injury prevention to baseballers and softballers: A review of the literature

Monash University Accident Research Centre - Report #106 - 1996

Authors: C. Finch, G. Valuri & A. McGrath

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Abstract:

Baseball and softball are popular non-contact, non-collision team sports in Australia. Although softball originated as an indoor version of baseball, the two games have evolved into separate sports with different sets of rules and playing conditions. Both sports involve four main activities or skills: throwing, including pitching and fielding; catching; batting; and base running. The major difference in how the games are played is the technique by which the ball is pitched to the batter. In baseball, the ball is pitched in an overarm or sidearm action, whereas in softball an underarm action is used. Over the past twelve years there have been few studies published describing the epidemiology of baseball/softball injuries, particularly outside the US. Baseball and softball are associated with the largest number of injuries leading to an emergency room visit than any other sport in the United States. In Australia, baseball/softball is ranked as the 13th most common sport and recreational activity leading to an emergency department injury presentation for children and the 16th amongst adults. There are four main mechanisms of injury in softball/baseball: sliding (into a base); jamming or collisions (including hits by a ball or bat and collisions with other players); fails; and overuse. The overall aim of this report is to critically review both the formal literature and informal sources that describe injury prevention measures for baseball and softball. Most of the identified literature is from US studies, given the popularity of the sport in that country. However, a brief overview of the epidemiology of baseball and softball injuries, particularly from an Australian perspective, is given to set the scene for the subsequent discussion of countermeasures. Countermeasures for preventing baseball/softball injuries include the use of break-away/quick release bases; protective equipment such as helmets and chest protectors, ball design; safe playing environments eg padded walls and back stops; stretching, conditioning and technique programs before commencing play; adequate rehabilitation; and prompt treatment of injuries. Recommendations for further countermeasure research, development and implementation include additional research into the biomechanics of playing techniques and the mechanisms of injury; epidemiological studies to identify risk factors; further controlled evaluations of the effectiveness of countermeasures, use of break-away bases; further development of protective equipment; improvements to ball design; and improved player education.

Executive Summary

Over the past twelve years there have been few studies published describing the epidemiology of baseball/softball injuries, particularly outside the US. Baseball and softball are associated with the largest number of injuries leading to an emergency room visit than any other sport in the United States. In Australia, baseball/softball is ranked as the 13th most common sport and recreational activity leading to an emergency department injury presentation for children and the 16th amongst adults.

There are four main mechanisms of injury in softball/baseball: sliding (into a base); jamming or collisions (including hits by a ball or bat and collisions with other players); falls; and overuse. Because of the similarities between baseball and softball, the countermeasures for preventing these injuries are the same in the two sports.

The overall aim of this report is to critically review both the formal literature and informal sources that describe injury prevention measures for baseball and softball. Most of the identified literature is from US studies, given the popularity of the sport in that country. However, a brief overview of the epidemiology of baseball and softball injuries, particularly from an Australian perspective, is given to set the scene for the subsequent discussion of countermeasures.

Unlike other reports of baseball and softball injuries, this report does not focus specifically on the epidemiology of these injuries. Rather, it presents a detailed examination of the range of countermeasures promoted to prevent such injuries. Nevertheless, a brief overview of the epidemiology of baseball and softball injuries, particularly from an Australian perspective, is given to set the scene for the subsequent discussion of countermeasures.

Countermeasures for preventing baseball/softball injuries include the use of breakaway/quick release bases; protective equipment such as helmets and chest protectors, ball design; safe playing environments eg padded walls and back stops; stretching, conditioning and technique programs before commencing play; adequate rehabilitation; and prompt treatment of injuries.

This report has discussed the full range of injury prevention activities for preventing baseball and softball injuries. Recommendations for further countermeasure research, development and implementation have been based on the review presented here as well as discussions with experts acknowledged in this report.

Many of the recommended countermeasures have yet to be proven to be effective and more attention to controlled studies "in the field' are needed. More effort directed to basic scientific studies to better understand the biomechanics of baseball and softball, the mechanisms of injury and the role of various risk factors in causation are also required. Indeed, the evidence for the effectiveness of certain countermeasures such as warming-up, ball design, limiting the numbers of pitches and protective body padding remains equivocal.

RECOMMENDATIONS FOR FURTHER COUNTERMEASURE IMPLEMENTATION, RESEARCH AND DEVELOPMENT

Base Design

Baseball and softball facilities in Australia should replace the standard stationary bases with breakaway or impact bases. As part of this program several studies are desirable.
The injury prevention potential of the Australian safety base and the .easybase" should be formally evaluated.
The effectiveness of break-away bases for preventing injury amongst young children needs to be determined.
The injury prevention potential of Hollywood Impact bases and the breakaway bases should be compared in a controlled evaluation.
The strongest evidence is for break-away bases but there is little evidence on the Australian version of these. An estimate of the number of injuries that would be eliminated by the adoption of the US design in Australia is needed before recommendations could be made in this regard.
Injuries with the break-away bases appear to occur only when they fail to break away. This is more hazardous as the player slides into the base and expects it to give way. Failure rates on break-away bases, whether due to instalment, maintenance or manufacture should be determined.
An audit of the types of bases used in Australia across the full range of participation levels should be undertaken, as part of a study to measure effectiveness of the program of replacement of conventional stationary bases.
The role of other factors involved in sliding injuries, such as judgement errors and poor technique, need to be investigated further. Education and coaching programs aimed at addressing these factors should be developed and evaluated.

Ball Design

The 16 inch ball should not be used in softball games.
Baseball and softball games should be played with softer balls, meeting the standards, than harder core balls.
Further research into the risk of death from chest impacts from balls of various hardness needs to be conducted (not necessarily in Australia).
Further basic research into suitable models for testing the impact of balls should be undertaken (not necessarily in Australia).
The evidence on soft versus hard baseballs is equivocal and better test procedures need to be developed (not necessarily in Australia).
Baseball and softball associations should work with manufacturers to ensure that they comply with safety specifications for balls and bats.

Preventing overuse injuries

Coaches should conduct pre-season stretching/strengthening programs.
Coaches should evaluate and correct the pitching techniques of their players
Coaches should limit the number of pitches per week for each player.
Coaches should limit the number of pitches thrown by an individual player and enforce rest periods between pitching sessions, particularly for junior players.
Information about warm-up, cool-down and stretching techniques specifically for baseball and softball should be developed and widely promoted to improve specific knowledge of techniques.
Players should undertake pre-season stretching/strengthening programs to assist in the prevention of overuse injuries associated with pitching.
Further basic scientific research into the mechanisms of overuse injuries should be undertaken.
The effectiveness of stretching and strengthening programs to prevent overuse injuries to the shoulder and wrist needs to be evaluated.
More research into the role of warm-up as an injury prevention measure for baseball and softball is needed.
Research should be undertaken into the benefits of different types of warming-up, cooling-down and stretching practices.
Research into the optimal duration and frequency of warm-up should be undertaken.

Protective Equipment

Players should wear good quality, double eared helmets with face protectors.
Players should wear energy absorbing chest padding when batting, pitching or catching to distribute any blows from a baseball impact over a broad area of the chest.
Catchers should always wear shin protection, breast plate and a helmet with a mask and throat protection.
Youth players, aged less than 1 9, should wear shin and knee protection.
Male players should wear properly fitted genital protectors at all times in the field.
Players should wear mouthguards to prevent dental injuries
The evidence for other forms of protective equipment, rules and practices in the game seems to be largely anecdotal or based on convention. More developmental research into this is needed.
Further detailed research into the mechanisms of ball-impact injuries, particularly to the chest, head and face, should be undertaken.
The epidemiology of ball-impact injuries should be closely monitored in relation to the use of protective equipment
Further development of protective headgear and chest protectors needs to be undertaken.
Appropriate models for the testing of protective equipment, particularly chest padding, need to be developed.
The efficacy of sliding pant' should be formally evaluated.

Modified Rules

Children should be encouraged to play Tee ball as a means of developing baseball and softball skills.
Older children should participate in modified softball as promoted by Aussie Sports and the Australian Softball Federation.
Child and adolescents should be taught correct pitching techniques and playing procedures, including limiting the number of pitches and taking appropriate rest periods.

Sliding technique

The relationship between different types of sliding techniques and injuries should be explored.
Further studies into the biomechanics of sliding are needed to gain an understanding of different sliding techniques before introducing modifications.
Players should be instructed to slide in the correct manner.

Education and coaching

Coaches should undergo regular re-accreditation and yearly updates.
Coach education schemes should be updated regularly to ensure they provide the most up to date information about injury prevention.
Children should not play softball or baseball unless they are supervised. This is particularly important when several balls are moving around at once.
Instruction clinics for the wider community should be developed and widely disseminated.
Education resources for informal baseball and softball need to be developed and disseminated.
The best means of disseminating this information should be determined.

Playing Environment

Drinking water should be provided at all baseball and softball events.
Baseballers and softballers should ensure they drink adequate water, before and during games.
Baseballers and softballers should always use a broad spectrum sunscreen and wear a hat and/or sunglasses when appropriate.
Baseball and softball events should not be planned for times when there is a likelihood of extremely hot, humid conditions. Whenever possible, such events should also be cancelled if such weather conditions eventuate.
Baseball and softball fields should be regularly checked and maintained to eliminate hazards such as potholes, sprinkler pop-ups, loose debris, rubbish, etc.
Baseball and softball fields should have protective padding around fences and posts, which a player may collide with during play
Protective screening should be used to protect players in dugouts and on benches.

First aid and rehabilitation

Softballers and baseballers should seek prompt attention for their injuries from a person with first aid qualifications.
Organisers of events should ensure that there are qualified first aid personnel at all events.
Injured baseball and softball players should ensure that they allow enough time for adequate rehabilitation before returning to their pre-injury level of activity.
Research into the effects of rehabilitation programs for softballers and baseballers needs to be undertaken.

Other

Improved data collection about the occurrence of baseball and softball injuries and their associated factors needs to be developed and maintained.
Data collections should conform to guidelines for sports injury surveillance being developed and promoted nationally.
Information about preventing baseball and softball injuries should be disseminated widely through baseball/softball broadcasts, baseball/softball equipment points of sale, baseball/softball magazines and more general magazines.
A detailed epidemiological study of baseball and softball injuries in Australia should be undertaken to describe the injury profile amongst cases that do not present to emergency departments. This should also identify risk factors for injuries.

Guidelines for minimum safety requirements for baseball/softball events (including the need for mobile phones, telephone contacts, first aid kits, etc) should be developed and widely disseminated.

Sponsor: Sport and Recreation Victoria