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Poster 181: Pitching Regimens and Prevalence of Injuries in Youth Fastpitch Softball Windmill Pitchers

Objectives: Female youth fastpitch softball pitchers experience stresses to their pitching arms similar to overhand baseball pitchers, placing them at increased risk of overuse injuries. However, they continue to have demanding pitching regimens without tracking of pitch counts or dedicated days of rest. Unlike youth baseball, there is scarce literature documenting incidence of injuries and pitching regimens of female youth fastpitch softball pitchers. Our purpose was to perform an analysis of youth fastpitch pitchers reported pitching regimens, levels of competition and injuries to each major joint of both the upper and lower extremities. Methods: Institutional review board approval was obtained for this survey study. This approval included a waiver of parental or informed consent. A 2-part survey was created; the first part focused on pitching regimens while the second part focused on reported injuries. The web-based survey was managed by an online survey software system (Version 1.0, 2021 SurveyPlanet, LLC). Surveys were distributed to coaches and USA softball state commissioners with available email addresses found of the USA Softball website. they were then distributed to youth fastpitch softball pitchers age 7 to 21 years old. Responses were analyzed as a whole as well as broken up into four separate age groups; less than 10 years old (Group A), 10-13 years old (Group B), 14-17 years old (Group C) and 18-21 years old (Group D). Statistical analysis was performed with a univariable and multivariable regression analysis. Results: Regarding pitching regimens in all participants, more than 89% were right handed pitchers. Greater than 90% played on a travel team, year round and participated in private pitching lessons. The majority also pitched 3-4 days per week until the 18-21 age group. The number of innings pitched per game, pitches thrown per game and total games pitched per season increased with age. Days of rest per week decreased from 2-3 days to 0-1 day over the age of 18 (Table 1). From the reported pitching injuries per age group, no injuries were reported in pitchers under 10 years old, however injuries were reported in 51% of participants age 10-13, 80% age 14-17 and 96% age 18-21. More than 85% of all pitchers with reported injuries played on a travel team, year round and participated in private lessons. The majority pitched 3-4 days per week (B 89%, C 71%), increasing frequency especially in the 18-21 age group (D 59%). Greater than 65% of pitchers with reported injuries in all age groups threw 60-100 pitches per game. More than 50% of pitchers reported pitching in 21-30+ games per season, comparable to a starting position. Days of rest per week also decreased from 2-3 days to 0-1 day over age 18 (Table 2). The most common reported injury was to the shoulder. Elbow, knee, foot and ankle as well as back injuries were also reported in up to 40% of participants. Surgeries were reported only in participants over 14 years old about the shoulder, elbow and knee (Figure 1). Other important trends in pitchers with reported injuries were greater than 60% starting pitching before age 9 (B 89%, C 62%, D 64%). 62-68% of pitchers over 14 years old threw five or more different pitches. Unfortunately, approximately 10% (8/85) of injured pitchers did not return to pitching following their injury. Statistical analysis demonstrated pitchers were approximately two times more likely to have an injury if they threw 60-100 pitches per game (P 0.16, P 0.25). However, pitchers age 14-17 were 5-6 times more likely to have an injury than younger groups (P <0.001) and pitchers age 18-21 were 28-30 times more likely to have an injury than younger groups (P 0.002) As a single variable, participants who began pitching at less than 9 years old were two times more likely to have an injury than participants beginning over 10 years old (P 0.14, P 0.97) (Table 3). Conclusions: The windmill motion of fastpitch pitchers is not as benign as once thought. Young female pitchers are experiencing injuries at an exponentially increasing rate with age. These athletes are pitching more frequently at younger ages on year-round travel teams without concern for pitch counts or time for rest and recovery. As softball continues to grow in popularity and participation, the focus needs to turn to protecting youth pitching arms to allow for high level competition beyond high school without significant injury. A prospective study following regimens and pitch counts as well as injury surveys will help to identify risk of injury and provide guidelines for youth pitchers and coaches. Table 1. Pitching Regimens in All Participants Table 2. Pitching Regimens in Injuried Participants Figure 1. Table 3. Univariable and Multivariable Regression Analysis (Outcome = Any Type of Injury)