SOFTBALL Keely Battaglini, PT, SCS, ATC Courage Kenny Sports & Physical Therapy - Eagan

7/7/2017

DISCLOSURE

BEYOND BASIC REHAB • I have no disclosures AND RETURN TO PLAY: SOFTBALL Keely Battaglini, PT, SCS, ATC Courage Kenny Sports & Physical Therapy - Eagan

July 7, 2017

OBJECTIVES Softball Field Metrics

• Attendee will have knowledge of: • Bases are 60 feet apart • kinetics/kinematics of windmill softball pitch • Pitching “mound” distance to plate: • the unique considerations of working with a softball athlete • 35-40 feet away in youth • injury trends in the softball athlete • 40 feet in high school • interval throwing program specific for position • 43 feet away in college/professional • 46 feet in men’s • Outfield distance from plate: • 200-250’ in college • 225-275’ in men’s. • Distance from home to second: • 84 feet 10 ¼ inches

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Equipment Equipment

• Ball size: • 12” circumference in HS and college and weighs 6.25 oz • 11” ball for youth • Batting Helmet • Most wear face mask • Face mask in the field • Due to distance from batter, more pitchers are wearing face masks. Also other fielders, such as 3B. many youth teams have the entire infield wear face masks

Paige Lowary of Oklahoma Sooners

Speed of Game Kinetics/Kinematics of Pitch

• https://www.youtube.com/watch?v=JG8NOR6Lg2c&featur • Termed “windmill” pitch e=youtu.be • Phases of pitch are described as arm position in relation • Female pitchers, up to 77 mph to time on a clock • Based on reaction time, this would be similar to 105 mph fastball in baseball • Male pitchers, up to 85 mph. • Main difference: • crow-hop and no hips • 2.5 seconds for home to first

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Ground Reaction Forces/Muscle Activity Muscle Activation

• Pitchers aged 17.6 ± 3.47 years • Pitchers aged 17.7 ± 2.6 years, • Ground reaction force on stride foot is 179% body weight • Glute max reached 196.3% max voluntary isometric contraction • Increase velocity increases vertical ground reaction forces (MVIC) • + relationship between ball velocity and ground reaction force • + relationship between ball velocity and non-stride leg gluteus • Glute med was consistent at 101.2% MVIC during SL support of maximus and medius muscle activity phase 3 • Biceps activity was greatest during phase 4 (Oliver GD, et al, J Sports Sci, 2011) • Tricep activation was consistently > 150% MVIC throughout entire • Youth softball pitchers motion • Average ball speed was 25 m/sec (56 mph) • Peak vertical ground reaction force averaged 139% body weight (BW) • Scapular stabilizers most active during phase 2 (170.1% MVIC) • Peak anterior force averaged 24% BW • Medially directed component of ground reaction force averaged 42% (Oliver GD, et al, J Strength Cond Res, 2011) BW • Loading rates to peak force were high for all. (Guido JA Jr, J Strength Cond Res, 2009)

Muscle Activation Forces/Torque

• Biceps muscle activity is greater in a pitch compared to • 8 pitchers overhand throw when normalized (38% versus 19%). • Peak compressive forces at the elbow and shoulder equal to 70- • Highest muscle activity occurred at 9 O’clock phase 98% BW (Rojas IL, et al, Am J Sports Med, 2009) • Shoulder extension and abduction torques equal to 9-10% BW x height • 10 college pitchers analyzed using EMG, motion analysis • Elbow flexion torque was exerted to control elbow extension and initiate elbow flexion • Supraspinatus fired maximally during arm elevation from 6 to 3 O’clock to centralize the HH. • Demand on biceps labrum complex to resist GH distraction and produce elbow flexion makes structure susceptible to overuse. • Posterior delt and teres minor acted maximally from 3 to 12 to continued arm elevation and ER the humerus. (Barrantine SW, et al, J Orthop Sports Phys Ther, 1998) • Pec major accelerated the arm from 12 position to ball release. • Serratus acted to position the scapular for optimal GH congruency • Subscap functioned as internal rotator to protect the anterior capsule (Maffet MW, et al, Am J Sports Med, 1997)

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What are Normal Adaptations to Softball? Softball is easier on the shoulder, right?

• Peak RTC activity during deceleration of pitch is high: 75- • Greater dom to non-dom midshaft humeral bone mass, 93% MCIV – (It is 37-84% in baseball pitching) structure, and estimated strength relative to controls • Peak serratus anterior activity was approx. 60% MVIC • Largest effect was for estimated torsional strength with during pitch (baseball is 69-106%) mean difference (dom to non-dom) of 22.5% compared to 4.4% in controls (Escamilla RF & Andrews JR, Sports Med, 2009) • Summary: Throwing induces substantial skeletal adaptation at midshaft humerus of dom arm. • Looked at pitchers from 1996 Olympic games: rise balls. (Bogenschutz ED, et al, Med Sci Sports Exerc, 2011) • Shoulder distraction stress averaged 80% of BW for Olympic pitchers which is similar to that found in baseball pitchers • (Werner SL, et al, Am J Sports Med, 2006)

Softball is easier on the shoulder, right? Should We Use Pitch Counts?

• Rachel Garcia of UCLA pitched 232 pitches in 11 inning • 53 youth softball pitchers (12-19 yo) win versus Ole Miss in Super Regional in 2017 • Elbow and shoulder joint loads were similar to those found for • She came back and pitched 50 pitches in relief of Ta’amilo baseball pitchers and college softball pitchers Selina the next day to get the win to head to the College • Shoulder distraction stress averaged 94% of BW World Series. • Stride foot ground reaction force patterns not similar to baseball pitchers • On Saturday of the CWS, she pitched 95 pitches in a loss to Texas A&M, and later in the same day pitched 101 • Vertical and braking force components under stride foot were in excess of BW pitches in a loss to Washington. (Werner SL, et al, Am J Sports Med, 2005)

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Should We Use Pitch Counts? Should We Use Pitch Counts?

• Florida’s Kelly Barnhill and Delaney Gourley combined in • Youth pitchers were evaluated for strength and fatigue the first game of the World Series Championship Series changes across 2 separate 3 day tournaments for 249 pitches in 17 innings, but losing to Oklahoma’s • Fatigue rated on VAS and strength testing using HHD Paige Parker and Paige Lowary who combined for 247 • Over course of average day and over the entire tournament: pitches • Significant increase in VAS scores for shoulder fatigue and pain • Delaney Gourley pitched again the next day in relief with • Significant strength loss in all tested motions • Summary: Shoulder pain, fatigue and strength do no fully recover 69 pitches, while Paige Parker started with 44 pitches and between days. Accumulation of shoulder pain and fatigue over Paige Lowary completed the game with 29 pitches course of tournament play were closely correlated.

(Skillington SA, et al, Am J Sports Med, 2017)

Should We Use Pitch Counts? Should We Use Pitch Counts?

• Survey of 181 D1 and DIII softball pitchers. • Sherry Werner, biomechanist and pitching coach for • 131 reported injuries: 32 acute, 92 chronic/overuse, 3 unspecified players such as Jenny Finch, recommends the following • 80 were directly from pitching (33 shoulder related, 16 LB related) pitch count: • Among injured pitchers: 109 took NSAIDs, 140 used modalities, 11 • Softball Pitch Counts had surgery and 95 saw additional specialists • 10U: 60 pitches in a workout/game and 1 day rest after • 12U: 70 pitches in a workout/game and 1 day rest after (Hill LJ, et al, J Strength Cond Res, 2004) • 14U 80 pitches in a workout/game and 1 day rest after • 16U: 90 pitches in a workout/game and 1 day rest after • 18U: 100 pitches in a workout/game and 1 day rest after

(Werner SL, Personal communication, 2014)

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Video Analysis Tools Different Type of Pitches

Hudl technique video analysis of pitching • Fastball • Changeup http://www.hudl.com/technique/video/view/AKZTsgbM • Rise • Curve http://www.hudl.com/technique/video/view/dChQqmgM • Screwball

https://www.bing.com/videos/search?q=curve+ball+amand a&&view=detail&mid=7D968651765D90735CC17D968651 765D90735CC1&FORM=VRDGAR

Different Types of Pitches Fastball

• 10 Collegiate softball pitchers • Assessed MVIC for 6 pitches (Fastball, curveball, dropball, changeup, screwball, riseball) • Pronator teres (PT) • Flexor carpi radialis (FCR) • Flexor digitorum superficialis (FDS) • Flexor carpi ulnaris (FCU) (Remaley DT, et al, Orthop J Sports Med, 2015)

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Curveball Dropball

Changeup Screwball

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Riseball Common Injuries

• Pitchers: • Bicipital tendinitis • Ulnar stress fractures • Thought to be related to too much pitching and not enough rest as well as heavy pronation during specific pitches. Believed to be torsional in nature occurring in mid third of ulna (Tanabe S, et al, Am J Sports Med, 1991) • Case report of complete ulnar shaft fracture in pitcher (Wiltfong RE, et al, Orthopedics, 2017) • Ulnar neuritis • Other: • Sliding MVIC of FCU during riseball was 500%!

Common Injuries Return to Sport

• Collegiate • My return to play criteria • Preseason injury rates were more than double regular season (3.65 • Full ROM required of sport/position versus 1.68 per 1000 athlete exposures. • Full strength • Rate of injury in game was 1.6 times that in practice • No pain • 51.2% of game injuries resulted from “other-contact” mechanisms • Confident • 55% of practice injuries resulted from non-contact mechanisms. • Adequate proprioception and dynamic joint control • In games, ankle ligament and knee internal derangements • Completion of plyometric program accounted for 19% of injuries • Completion of interval-based return to sport program. • 23% of game injuries were due to sliding (most of which were ankle sprains) • In practices ankle sprains, quad and hami strains, shoulder strains/tendinitis, knee internal derangements and LB strains combined accounted for 28% of injuries (Marshall SW, et al, J Athl Train, 2007)

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Interval-Throwing Program Interval-Throwing Program

• Data-Based Interval Throwing Programs for Collegiate Softball Players • Collected data over 220 half-innings on each position • IF/OF • Number of throws • Distance of throws • Intensity of throws • Catchers • Time in squat • Throws to pitcher • Throws to a base • Distance of throw to a base • Intensity of throw to base • # of sprints to first or third • Pitchers • Number of pitches per inning and per game (Axe MJ, et al, J Athl Train, 2002) (Axe MJ, et al, J Athl Train, 2002)

Interval-Throwing Program References

• Axe MJ, Windley TC, Snyder-Mackler L. Data-based interval throwing programs for collegiate softball players. J Athl Train. 2002;37(2):194-203. • Barrentine SW, Fleisig 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 Dec;28(6):405-15. • Escamilla RF, Andrews JR. Shoulder muscle recruitment patterns and related biomechanics during upper extremity sports. Sports Med. 2009;39(7):569-90. • Guido JA Jr, Werner SL, Meister K. Lower-extremity ground reaction forces in youth windmill softball pitchers. J Strength Cond Res. 2009 Sep;23(6):1873-6. • Hill JL, Humphries B, Weidner T, Newton RU. Female collegiate windmill pitchers: influences to injury incidence. J Strength Cond Res. 2004 Aug;18(3):426-31. • Maffet MW, Jobe FW, Pink MM, Brault J, Mathiyakom W. Shoulder muscle firing patterns during the windmill softball pitch. Am J Sports Med. 1997 May- Jun;25(3):369-74. • Marshall SW, Hamstra-Wright KL, Dick R, Grove KA, Agel J. Descriptive epidemiology of collegiate women's softball injuries: National Collegiate Athletic Association Injury Surveillance System, 1988-1989 through 2003-2004. J Athl (Axe MJ, et al, J Athl Train, 2002) Train. 2007 Apr-Jun;42(2):286-94.

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References TO CONTACT ME

• Oliver GD, Plummer H. Ground reaction forces, kinematics, and muscle activations during the windmill softball pitch. J Sports Sci. 2011 Jul;29(10):1071-7. • Keely Battaglini, PT, SCS, ATC • Oliver GD, Plummer HA, Keeley DW. Muscle activation patterns of the upper and lower extremity during the windmill softball pitch. J Strength Cond Res. 2011 Jun;25(6):1653-8. • [email protected] • Remaley DT, Fincham B1, McCullough B, Davis K1, Nofsinger C, Armstrong C, Stausmire JM. Surface Electromyography of the Forearm Musculature During the Windmill Softball • 612-775-2960 Pitch. Orthop J Sports Med. 2015 Jan 22;3(1):2325967114566796. • Rojas IL, Provencher MT, Bhatia S, Foucher KC, Bach BR Jr, Romeo AA, Wimmer MA, Verma NN. Biceps activity during windmill softball pitching: injury implications and comparison with overhand throwing. Am J Sports Med. 2009 Mar;37(3):558-65. • Skillington SA, Brophy RH, Wright RW, Smith M2. Effect of Pitching Consecutive Days in Youth Fast-Pitch Softball Tournaments on Objective Shoulder Strength and Subjective Shoulder Symptoms. Am J Sports Med. 2017 May;45(6):1413-1419. • Tanabe S, Nakahira J, Bando E, Yamaguchi H, Hiroshi Miyamoto H, Yamamoto A, Yamaguchi H, Miyamoto H, Yamamoto A. Fatigue fracture of the ulnar occurring in pitchers of fast-pitch sotball. Am J Sports Med. 1991;19(3):317-321. • Werner SL, Guido JA, McNeice RP, Richardson JL, Delude NA, Stewart GW. Biomechanics of youth windmill softball pitching. Am J Sports Med. 2005 Apr;33(4):552-60. • Werner SL, Jones DG, Guido JA Jr, Brunet ME. Kinematics and kinetics of elite windmill softball pitching. Am J Sports Med. 2006 Apr;34(4):597-603. • Wiltfong RE, Carruthers KH, Popp JE. Completed Ulnar Shaft Stress Fracture in a Fast-Pitch Softball Pitcher. Orthopedics. 2017 Mar 1;40(2):e360-e362.