Pitch Count Research Articles

Risk Factors and Injury Prevention in the Throwing Athlete

Arm injuries are the most common throwing injury, with growing concern as the most severe injuries, such as UCL reconstruction continue to rise. Furthermore, throwing injuries are frequently recurrent suggesting once injured, players are at increased risk for another arm injury. The increase in injury rates and severity has been attributed to increases in pitching volume and year around participation, and specialized training. Thus, initial efforts to prevent arm injuries by USA Baseball and Little League have focused on the extrinsic factor of pitching exposure in the form of pitch counts, yet arm injury rates have stayed constant. Therefore, injury prevention strategies should include extrinsic factors, and address modifiable, intrinsic factors that are associated with arm injury. Collectively addressing factors such as shoulder range of motion and strength deficits, trunk and lower extremity function, and implantation of training programs yields a comprehensive approach to reduce arm injury rates. We will use a directed acyclic graph (DAG) to organize how the internal factors (i.e. fatigue, injury history, ROM and strength) interact with the external factors (i.e. training load and pitching exposure) and how together they are thought contribute to potential injury and inform arm injury reduction strategies. This will provide a roadmap to build adaptable arm injury reduction strategies to improve the modifiable physical factors in context of the external factors that change over time and between throwing athletes. Level of EvidenceLevel V, Expert Opinion

Effects of a Simulated Game and Doubleheader Inning on Peak Kinetics in Softball Pitching Across Pitch Types

Background: Softball pitchers frequently pitch at high volumes. Previous research has demonstrated changes in mechanics, range of motion, and perceived levels of fatigue and pain at high workloads. To date, little research has assessed changes in kinetics at high workloads across pitch types to understand the injury risk. Purpose: To examine changes in peak kinetics of the shoulder, elbow, and wrist of the pitching arm throughout a simulated game and doubleheader inning. Study Design: Descriptive laboratory study. Methods: A total of 19 high school softball pitchers (mean age, 15.1 ± 1.5 years; mean height, 1.6 ± 0.2 m; mean weight, 76.3 ± 16.9 kg) participated. Pitchers threw 4 innings of 25 randomly assigned pitches to mimic a game's high pitch count. Participants then rested for 30 minutes before subsequently proceeding to pitch the first inning of a doubleheader. Each pitcher threw a fastball, drop ball, curveball, and changeup. Peak shoulder, elbow, and wrist kinetics were compared across the first, last, and doubleheader innings and pitch types. Results: Compared with the first inning, significant decreases in kinetics were observed at the shoulder, elbow, and wrist in the last (P < .016) and doubleheader (P < .016) innings, particularly for shoulder and elbow compression force during the drop ball and curveball pitch types and wrist net force for all pitch types but the changeup. Significant decreases in elbow and wrist kinetics were observed during the changeup between the last and doubleheader innings (P < .016). Furthermore, differences in kinetics were observed between pitch types (P < .008); notably, the changeup had reduced kinetics compared with the fastball and breaking ball pitch types (drop ball, curveball) across innings. Conclusion: Across innings, attenuations in select joint kinetics of the pitching arm occurred that were specific to the pitch type. Across pitch types, peak kinetics was often greater during the fastball, while the changeup displayed the lowest peak kinetics. Clinical Relevance: The joints examined in this study are common sites of overuse injuries in pitchers. This work adds to previous findings on decrements in neuromuscular function as well as self-reported fatigue and pain with tournament-style pitching that may increase the injury risk. Collectively, these findings support developing a protocol combining functional testing and player-reported outcomes to aid sports specialists’ decisions for pitchers to continue to pitch or return to play, which may help prevent musculoskeletal injuries and time loss from sports participation.

Give It a Rest: The Impact of Rest Days on Musculoskeletal Injuries Among Starting Pitchers in Major League Baseball.

Examine the impact of rest days on musculoskeletal (MSK) injury incidence in Major League Baseball (MLB) starting pitchers. Descriptive epidemiological study. MLB pitching and injury reports. PARTICIPANTS: MLB starting pitchers. Data (2022-2023) were obtained from Baseball-Reference.com and fangraphs.com. Teams were grouped by average rest days between starts (Group A <5 rest days, Group B >5 rest days). Poisson regression was used to compare main outcome measure incidence rate ratios (IRRs). Number of rest days between starts. Pitches per start, MSK injury incidence, injured list (IL) days for MSK injury. From 2022 to 2023, the average MLB rest days between starts was 4.80. Group A had 54 teams. Group B had 6 teams. The range of average rest days per start by team was 4.56 to 5.73 with a mean of 4.80. Group B pitchers spent 10.7 days on IL for MSK injuries per 1000 pitches, while Group A spent 13.6 days on IL (IRR = 0.78 [95% CI, 0.72-0.85]; P < 0.0001). Group B averaged 0.93 more pitches per start than Group A (P = 0.0164). Group B had a lower number of IL assignments for MSK injuries per 1000 pitches (0.245 vs 0.351, IRR = 0.70 [95% CI, 0.38-1.18]; P = 0.1715). Starting pitchers on MLB teams averaging > 5 rest days between starts spent less time on the IL for MSK injuries than MLB teams averaging < 5 rest days from 2022 to 2023. There was no clinically significant difference in pitch count and no significant difference in the number of IL assignments for MSK injuries.

Increased Utilization of Pitchers in NCAA Women’s Softball Compared to Men’s Baseball

BACKGROUND: Pitch count and rest time guidelines are widely employed in youth baseball to mitigate injury risk among pitchers. Similar recommendations are lacking in youth softball, despite evidence of potential overuse injuries from the underhand windmill pitching motion. This disparity in regulation may heighten injury susceptibility. Additionally, the composition of collegiate softball and baseball rosters differs significantly, with softball teams typically featuring fewer pitchers. This discrepancy may lead to increased pitching demands for individual softball pitchers, potentially exacerbating injury risks. Therefore, understanding the relationship between the number of pitchers, game appearances, and injury incidence is crucial for informing injury prevention strategies in both baseball and softball. We hypothesize that individual softball pitchers will have significantly more game appearances per season and pitch more innings per game and season as compared to baseball pitchers, and that softball rosters will average significantly fewer pitchers per team than baseball rosters. METHODS: A retrospective analysis was conducted of National Collegiate Athletic Association Division I softball and baseball College World Series teams from 2016 to 2021. Individual data consisting of game appearances and season innings pitched facilitated calculations for innings per game. Team data included the number of athletes and pitchers per team. Statistical analysis comparing baseball and softball team continuous variables utilized Student’s t-test. Individual data, characterized by non-normal distribution, was evaluated with the Wilcoxon-Mann-Whitney Test. A significance level of p &lt; 0.05 was applied to all analyses. RESULTS: Softball pitchers had a significantly greater number of innings pitched per season (median 84.1 (21.0-143.2) vs 29.2 (10.0-56.1) p&lt;0.0001), game appearances per season (median 23.0 (10.0-32.0) vs 16.0 (9.0-21.0), p&lt;0.0001), and innings pitched per game (median 3.6 (2.2-4.7) vs 1.6 (1.1-2.8), p&lt;0.0001). Baseball rosters averaged significantly more total players (35.7 ± 3.9 vs 21.5 ± 2.8, p&lt;0.0001), more pitchers (15.7 ± 2.3 vs 4.5 ± 1.1, p&lt;0.0001), and a greater percentage of their roster was made up of pitchers (44.2% ± 6.4% vs 21.0% ± 4.4%, p&lt;0.0001). CONCLUSION: This study highlights a notable difference in collegiate softball pitcher utilization compared to baseball pitchers. Fewer pitchers on softball teams led to a higher cumulative workload per pitcher, with increased innings pitched per season, per game, and more game appearances. While the relationship between pitch count and injury risk is established in baseball, further research is needed to understand its implications for softball pitchers.

Medical advisability of softball youth pitching recommendations on the internet

ABSTRACT Objective Developing softball pitchers are prone to injury due to the repetitive throwing motion. Many children and parents use the internet as a source of medical advice, but this information may not always be aligned with medical guidelines. The purpose of this study was to assess the medical advisability of injury prevention guidelines for developing softball pitchers on websites using Google as the primary search engine. Methods The first 100 websites populated from a Google search using the term softball youth pitching recommendations were evaluated. Each website was categorized as discussing baseball, softball, or both, and as athletic, commercial, or educational. For every website, 16 recommendations described by the American Orthopaedic Society for Sports Medicine (AOSSM) Stop Sports Injuries softball injury prevention guidelines (Table 1) were scored as in agreement (+1), different guideline mentioned (0.5), no mention (0), or discordant (−1). Table 1. Websites with guidelines identical to AOSSM by type of website, by sport, and by order of appearance in google search, AOSSM = American orthopaedic society for sports medicine. ‘*’ indicates p value < 0.05. Results Of the 98 qualifying websites, 57 advised only about softball, while 19 advised about both baseball and softball. Fifty websites had no mention of any recommendation outlined by AOSSM. Websites that were mostly in agreement with AOSSM were educational websites (mean score = 3.9, p = 0.02), websites discussing only softball (mean score = 2.0, p = 0.02), and the first 50 websites (mean score = 2.2, p = 0.04). The most common discordant guideline was differing opinions in pitch count (13 websites). Conclusion The most common category in disagreement with AOSSM was different pitch count guidelines, highlighting a need for websites to provide more consistent information using high-quality resources. Educational websites, websites discussing only softball, and the first 50 websites had the highest scores, indicating that these types of websites are most likely to have the highest amount of medically advisable information. We recommend users conduct targeted Google searches on reliable websites for information on pitching softball recommendations to maximize the validity of Google search results.

Increasing pitch count is associated with increasing elbow flexion angle at ball release in youth baseball pitchers

Baseball is one of the most popular sports among youth athletes in the United States, and among these players, pitchers are at a particularly high risk of sustaining an injury. Overuse of the arm from repetitive pitching is a common mechanism for injury. Despite the attention that overuse injury has received, little is known regarding the mechanism that leads to elbow injury. This study aims to determine the effect of increasing pitch count on elbow flexion at ball release in a youth pitching cohort. The authors hypothesize that elbow flexion would increase as pitch count increases. Study subjects included volunteers from youth baseball players from local teams and public advertisements. Retroreflective markers attached to bony landmarks were placed on the players according to International Shoulder Group recommendations. Pitchers threw an indoor simulated game. Three-dimensional marker trajectories were collected using a 12-camera optical motion capture system, and ball velocity was captured using a radar gun. Voluntary maximal isometric strength of the internal and external rotators was evaluated before and after pitching. Paired 2-tailed t tests were performed to determine if a significant change occurred between the fresh and fatigued sets. Twelve adolescent male pitchers were recruited. Eleven of 12 pitchers completed the prescribed 6 sets of 15 pitches, culminating in a 90-pitch simulated game. The ball speed in the second set was found to be the highest in all pitchers and was considered the "peak set" (P=.021), whereas ball speed was the slowest in the sixth set of pitches and was therefore considered the "fatigue set" (P=.001). There was a moderate but statistically significant inverse correlation between elbow flexion at ball release and maximum internal rotation velocity (P=.005). Elbow flexion at ball release was also significantly positively correlated with shoulder abduction at ball release (P=.004). Elbow flexion at ball release was not significantly correlated with ball velocity (P=.108). In a simulated game laboratory setting, increasing pitch count was associated with increasing elbow flexion angle at ball release in youth baseball pitchers. These findings demonstrate that pitching with fatigue may cause biomechanical changes that have been associated with increased rates of elbow injury in the adult throwing population. Further investigation on the association between elbow flexion angle and elbow injury in the youth baseball population is needed.

The Difference Between Throwing and Practice Volumes in Youth Softball Athletes With and Without Upper Extremity Pain.

Research indicates that mechanics differ between athletes with and without upper extremity pain; however, it is unclear which modifiable risk factors exist for throwing-related pain in softball athletes. To determine whether sport specialization, throwing, practice, and strength and conditioning training volumes vary between youth softball athletes with and without upper extremity pain. It was hypothesized that youth softball athletes with upper extremity pain would participate in softball year-round and have greater throwing, practice, and strength and conditioning volumes compared with those without pain. Cross-sectional study; Level of evidence, 3. A total of 232 youth softball athletes from travel ball, middle school, and high school leagues were invited to complete a survey to assess pain, sport specialization, throwing, practice, and strength and conditioning training volumes. Participants were classified into upper extremity pain and no pain groups based on their survey answers. The responses were compared between groups using Mann-Whitney U and chi-square tests. A total of 101 athletes-with a mean ± SD age of 13.3 ± 2.3 years, height of 161 ± 13.4 cm, and weight of 59.8 ± 14.8 kg-completed the survey and were included for analysis. The response rate was 43.53%, with 22 athletes in the upper extremity pain group and 79 athletes in the no pain group. A significant difference was observed between hours devoted per week to off-season softball practice (U, 626.6; Z =-2; P = .045), where those without upper extremity pain spent 4 fewer median hours (6 hours) practicing softball per week in the off-season compared with those with pain (10 hours). Also, a significant difference was found between the number of throws during an in-season game (U, 457; Z, -2.28; P = .022), where those without upper extremity pain reported 21 fewer median throws (70 throws) during an in-season game compared with those with pain (91 throws). Furthermore, 77% of those who reported upper extremity pain continued to play despite their pain. There were no other significant differences between demographic characteristics, specialization, injury history, and primary position, as well as throwing, practice, and strength and conditioning volumes. Our study demonstrates that youth softball athletes with upper extremity pain had more throws during in-season games and increased hours per week devoted to off-season practice than athletes without upper extremity pain. Our findings support the need for softball stakeholders (eg, coaches, clinicians, parents, and administrators) to engage in further research and recommendations regarding in-season pitch counts and off-season rest.

Unaccounted for Pitch Volume Among Adolescent Baseball Pitchers During a Travel Baseball Season.

The primary aim was to compare differences in live game pitch counts (LGPCs) with all pitch counts (APCs) over the course of a youth baseball season. Prospective longitudinal study. Midwest youth travel baseball. Ten male baseball players part of a youth baseball travel team. Demographic data, pitch counts (practice, game, warm-up, and bullpen), innings pitched, and recommended rest days. Live pitch counts compared with APCs and the relationship to recommended rest days. During the season, 7866 pitches were recorded among 9 pitchers. By using the LGPC method alone, 42.5% of the pitches were unaccounted for. When considering age-specific rest days suggested by Pitch Smart Guidelines (PSGs), there were 104 rest days unaccounted for by using the live game pitch method. There is a high number of unaccounted for pitches and an underestimation of rest days per outing when using live game methods. Revisions to the PSGs that include all pitches should be considered to accurately reflect pitching volume, which may be associated with the rising rate of injuries among these athletes.

Youth Pitcher Fatigue: Medial Elbow Laxity, Ultrasonographic Assessment of Flexor-Pronator Mass Energy Depletion, and Association With Pitch Count.

Ulnar collateral ligament (UCL) injuries in youth pitchers continue to be concerning despite the institution of pitch count limits. Flexor-pronator mass fatigue can lead to diminished dynamic stability, resulting in greater stress on the UCL. To evaluate fatigue of the flexor-pronator mass by assessing changes in medial elbow laxity; noninvasively characterizing alterations in muscle glycogen; and identifying changes in subjective fatigue, strength, range of motion (ROM), pitching velocity, and accuracy with increasing pitches thrown by youth pitchers to their recommended 75-pitch count limit. It was hypothesized that, with increased pitches, medial elbow laxity would increase and that the glycogen content of the flexor-pronator mass would decrease. Descriptive laboratory study. Healthy male pitchers aged 10 years (n = 22) threw 3 sets of 25 pitches with 12 minutes between sets (3 timepoints). Bilateral ulnohumeral joint gapping was measured by applying a standardized valgus force and utilizing ultrasound imaging. Relative changes in muscle glycogen in the bilateral flexor carpi radialis (FCR), and the flexor digitorum superficialis/flexor carpi ulnaris (FDS/FCU) muscles were measured with ultrasound software and recorded as fuel percentiles. Additional measures obtained included subjective fatigue, strength, ROM, velocity, and accuracy. There were no differences in medial elbow joint-line gapping between the throwing and nonthrowing arms or between timepoints. The throwing arm demonstrated a significant decline in fuel percentile of the FCR from baseline to after 75 pitches (P = .05). There were no differences across timepoints for FDS/FCU fuel percentile values. Fatigue measurements for both arms were significantly higher at all timepoints compared with baseline (P≤ .03). Grip strength of the dominant arm after 75 pitches was decreased significantly compared with after 25 pitches (P = .02). Although an increase in medial elbow joint gapping was not demonstrated within the recommended 75 pitch count limit in 10-year-olds, a relative decrease in glycogen stores of the flexor-pronator mass did occur, as well as a decrease in grip strength, with increasing subjective fatigue. This study provides a foundation for further objective testing of physiologic changes that occur with pitching to better guide pitch count limits and improve the safety of young athletes.

Throwing Injuries and Prevention Strategies in Youth Baseball.

The prevalence and severity of baseball-related injuries in the youth athlete population continue to escalate, despite efforts by health care professionals and sports organizations to quell this trend. This article reviews current research that has investigated the risk factors and possible prevention strategies for the most common injuries in young baseball players, including strengthening programs, pitch count guidelines, and throwing analysis.

Workload Risk Factors for Pitching-Related Injuries in High School Baseball Pitchers

Background: Pitch counts are only one measure of the true workload of baseball pitchers. Newer research indicates that workload measurement and prevention of injury must include additional factors. Thus, current monitoring systems gauging pitcher workload may be considered inadequate. Purpose/Hypothesis: The purpose of this study was to develop a novel method to determine workload in baseball pitchers and improve processes for prevention of throwing-related injuries. It was hypothesized that our pitching workload model would better predict throwing-related injuries occurring throughout the baseball season than a standard pitch count model. Study Design: Cohort study; Level of evidence, 2. Methods: This prospective observational study was conducted at an academic medical center and community baseball fields during the 2019 to 2023 seasons. Pitchers aged 13 to 18 years were monitored for pitching-related injuries and workload (which included pitching velocity; intensity, using preseason and in-season velocity as a marker of effort; and pitch counts). Results: A total of 71 pitchers had 313 recorded pitcher outings, 11 pitching-related injuries, and 24,228 pitches thrown. Gameday pitch counts for all pitchers ranged from 19 to 219 (mean, 77.5 ± 41.0). Velocity ranged from 46.8 to 85.7 mph (mean, 71.3 ± 5.8 mph). Intensity ranged from 0.7 to 1.3 (mean, 1.0 ± 0.08). The mean workload was 74.7 ± 40.1 for all pitchers. Risk factors significant for injury included throwing at a higher velocity in game (P = .001), increased intensity (eg, an increase in mean velocity thrown from preseason to in-season; P < .001), and being an older pitcher (P = .014). No differences were found for workload between injured and noninjured pitchers because the analysis was underpowered. Conclusion: Our workload model indicated that throwing at a higher velocity, throwing at a higher intensity, and older age were risk factors for injury. Thus, this novel workload model should be considered as a means to identify pitchers who may be at greater risk for injury.

Fastpitch Softball Injuries: Epidemiology, Biomechanics, and Injury Prevention.

Fastpitch softball is one of the most popular sports among youth and high school female athletes. Despite some similarities to baseball, key differences between the two sports result in different injury patterns, and there is comparatively less literature describing injury epidemiology in fastpitch softball. The purpose of this review is to describe the epidemiology, biomechanics, and injury prevention efforts in regards to fastpitch softball injury with a particular focus on underhand pitching. The injury rate in softball is relatively low and extended time loss injuries in particular are uncommon. Lower extremity injuries are more common overall in softball, but pitchers more often suffer upper extremity injury. Pitchers account for a relatively small proportion of all injuries recorded, but represent a similarly small subset of team rosters, with most teams carrying only a few pitchers in total. The underhand pitching motion exerts significant glenohumeral distractive forces and high stress across the biceps-labrum complex. Core and lower extremity strengthening play an important role in injury prevention for softball pitchers and position players. Fatigue and number of games pitched are tied to increased strength deficiencies and pain in fastpitch softball pitchers, yet pitch count limits are not employed in any major fastpitch softball leagues. While overall injury incidence is low in fastpitch softball players, the potential for overuse injury in pitchers in particular is noteworthy and not nearly as scrutinized as within the baseball community. Critical longitudinal tracking of softball injuries at varying levels of play would be helpful to better understand the sport's injury risk. There are currently no formal pitch count limits enforced in a majority of fastpitch softball leagues. Core and lower extremity strengthening, pre-season conditioning, and monitoring of pitchers for signs of fatigue may be helpful in injury prevention.

Effects of Increasing Pitch Count on Pitch Type Ball Metrics and Release Height in High School Softball Pitchers.

Softball research has investigated changes in physical characteristics, mechanics, and ball speed as elements of fatigue. However, the influence of pitch volume on ball metrics is unclear. The purpose of this study was to investigate the influence of pitch volume on ball performance and release metrics in softball pitchers across different pitch types. As pitch volume increased, there would be a decrease in ball metrics of the fastball and changes in breaking pitches would be observed earlier than the fastball or changeup. Descriptive laboratory study. Level 5. A total of 21 (15.4 ± 1.6 years; 1.6 ± 0.2 m; 76.0 ± 17.2 kg) softball pitchers participated. Procedures consisted of participants pitching a simulated game consisting of 100 pitches, taking a 30-minute break, and then throwing 12 pitches to simulate the first inning of a doubleheader. Participants randomly threw each pitch type (fastball, changeup, curveball, or dropball). Ball performance and release metrics were measured using a Rapsodo portable pitch tracker. A 3 (time) by 4 (pitch type) multivariate analysis of variance revealed that pitch speed was significantly higher in the first inning compared with the last inning and the doubleheader inning. The fastball, curveball, and dropball revealed a significant difference in pitch speed between timepoints. Specifically, the curveball and dropball first-inning pitch speed was significantly greater than the last and doubleheader inning. Alternatively, the fastball had a significant increase in pitch speed from the last inning to the doubleheader inning. The typical 30-minute break given between games for doubleheaders may be sufficient recovery time for the fastball but not for the curveball and dropball. The Rapsodo device is an accessible method of tracking ball performance and pitch release metrics and could be helpful in identifying when a pitcher may be experiencing performance detriments in response to increasing pitch count.

Understanding Shoulder and Elbow Injuries in the Windmill Softball Pitcher.

Although pitching-related injuries in the overhead athlete have been studied extensively, injuries associated with windmill pitching are not as clearly elucidated. Windmill pitching produces high forces and torques in the upper extremity, and studies have shown it creates similar shoulder and elbow joint loads to those reported in baseball pitchers. Studies have shown that the windmill pitching motion generates high levels of biceps activation with an eccentric load, placing the biceps at increased risk for overuse injuries. Although the American Orthopaedic Society for Sports Medicine published prevention guidelines including recommendations for maximum pitch counts in softball, these recommendations have not been adopted by most United States softball governing bodies. The repetitive windmill motion in conjunction with high pitch count demands in competitive softball creates notable challenges for the sports medicine physician. As with overhead throwing athletes, identifying and preventing overuse is crucial in preventing injuries in the windmill pitcher, and prevention and rehabilitation should focus on optimizing mechanics and kinematics, core, hip, and lower body strength, and recognition of muscle fatigue. With more than two million fastpitch softball participants in the United States, it is essential to better understand the etiology, evaluation, and prevention of injuries in the windmill pitching athlete.

Characteristics Associated With Noncompliance of Current Pitch Smart Guidelines in High School Baseball Pitchers Throughout the United States.

Although pitch count and rest guidelines have been promoted for youth and adolescent baseball players for nearly 2 decades, compliance with guidelines remains poorly understood. The purpose of this study was to determine the frequency of compliance with Major League Baseball (MLB) Pitch Smart guidelines as well as the association between compliance and range of motion (ROM), strength, velocity, injury, and pitcher utilization. It was hypothesized that pitchers in violation of current recommendations would have increased strength, velocity, and injury. Case-control study; Level of evidence, 3. This was a prospective, multicenter study of 115 high school pitchers throughout the United States. Pitchers were surveyed about their compliance with current off-season, rest-related guidelines, and history of injury. During the preseason, pitchers underwent standardized physical examinations, and pitch velocity was measured. Pitch counts were collected during the baseball season that followed. Dynamometer strength testing of shoulder forward flexion, and external rotation as well as grip strength was recorded. We compared pitchers who were compliant with recommendations with those who were noncompliant using Student t and Mann-Whitney U tests. Based on preseason data, 84% of pitchers had violated current Pitch Smart guidelines. During the season, 14% had at least 1 violation of the Pitch Smart guidelines. Across both the preseason survey and in-season pitch counts, 89% of players had at least 1 violation of the Pitch Smart guidelines. While there were no significant differences in ROM or strength, the noncompliant group had higher maximum pitch velocity than the compliant group (74 ± 8 vs 69 ± 5 mph [119 ± 13 vs 111 ± 8 kph], respectively; P = .009). Players' self-reported velocity differed significantly from the direct measurement, for both peak velocity (80 ± 6 vs 73 ± 8 mph [129 ± 9 vs 117 ± 13 kph], respectively; P < .001) and mean velocity (73 ± 8 vs 53 ± 27 mph [117 ± 13 vs 85 ± 43 kph], respectively; P < .001). Most high school pitchers were not fully compliant with current Pitch Smart guidelines, and they tended to overestimate their peak velocity by 7 mph (11 kph). Pitchers who threw with greater velocity were at higher risk for violating Pitch Smart recommendations.

Poster 370: Pitcher Utilization Patterns in NCAA Softball as Compared to Baseball

Objectives: Pitch counts have become a hot topic in baseball over the past two decades since being linked with injury risk. While the National Collegiate Athletic Association (NCAA) has yet to enforce a pitch count rule for participating baseball teams, multiple organizations including the MLB’s Pitch Smart provide age-based guidelines for limiting risk of injury in baseball pitchers through utilization of pitch count limits and rest time. These are generally enforced for youth and high school baseball players. No such recommendations exist for softball despite evidence showing that the underhand windmill pitching motion is not nearly as physiologically benign as once thought. The aims of this study were to compare the patterns of pitcher utilization between elite collegiate baseball and softball teams. Methods: Data was collected from the publicly available websites of baseball and softball teams which participated in the NCAA Division I softball and baseball College World Series from the years 2016 through 2021. The year 2020 was excluded due to a shortened season related to the COVID-19 pandemic. Team data collected included total number of athletes and pitchers per team, including only those pitchers listed as having &gt;0 innings pitched for the season. Data collected for each individual pitcher included the season total number of innings pitched and total number of game appearances. Total pitch counts were not available on a majority of publicly available team websites for both softball and baseball. Unpaired student’s t test was used to compare normally distributed data, and a Wilcoxon- Mann-Whitney Test was used for non-normally distributed data. A P value &lt;0.05 was considered statistically significant for all calculations. Results: Forty softball teams and forty baseball teams, with 158 softball pitchers and 612 baseball pitchers were included. Baseball team rosters averaged significantly more total players, more pitchers, and a greater percentage of their roster was made up of pitchers as compared to softball teams, as summarized in table 1. The range of pitchers per team is notable, with baseball teams listing 12 to 24 pitchers as compared to softball with 3 to 7 pitchers per team. The average percentage of baseball rosters comprised of pitchers is more than twice that seen in softball. On an individual level, it is apparent that softball pitchers see considerably more playing time than their baseball counterparts, with significantly more innings pitched and appearances per season, and greater innings pitched per game as summarized in table 2. Again the range within these data points is striking, with a maximum of 134.2 innings pitched in a season by baseball pitchers as compared to a maximum of 287.0 innings in softball. Only 7.35% of baseball pitchers threw more than 100 innings in a season as compared to 43.70% of softball pitchers. Conclusions: This analysis of elite collegiate baseball and softball teams highlights a significant discrepancy in the physical expectations of their respective pitchers. Due to the significantly lesser representation of pitchers on softball rosters as compared to baseball, each individual pitcher sees a higher pitch count overall and per game, and by playing in more total games, sees less recovery time as well. The tie between pitch count and injury risk is well established and respected within baseball, and further injury-based research should be conducted to consider support of similar limitations for softball pitchers. [Table: see text][Table: see text]

Poster 167: Increased Throwing Velocity is Correlated with a Higher Likelihood of Violating Current Pitch Count Recommendations in High School Baseball Pitchers.

Objectives: While pitch count and rest guidelines have been promoted for youth and adolescent baseball players for nearly two decades, compliance with guidelines remains poorly understood. The purpose of this study was to determine the frequency of compliance with Pitch Smart guidelines, as well as the association between compliance and range of motion, strength, velocity, injury, and pitcher utilization. Methods: This study was a prospective, multi-center study of high school pitchers, encompassing each region of the United States. Pre-season pitchers were surveyed about their compliance with current off- season rest-related guidelines and history of injury. Pre-season, pitchers underwent standardized physical examinations and pitch velocity was measured. During the high school season that followed, both pitch counts and injury incidence were collected. Results: One hundred and fifteen pitchers participated. Based upon pre-season data, 84% of pitchers had previously violated current pitch recommendation guidelines. During the season, 14% had at least one instance of a violation of the current pitch counts guidelines. Across both the pre-season survey and in-season pitch counts, 89% of players had at least one violation of the current Pitch Smart guidelines. While there were no significant differences in range of motion or strength, those pitchers who were non-compliant with guidelines in the pre-season had higher max pitch velocity (mean±standard deviation 74±8 miles per hour vs. 69±5 miles per hour, p=0.009). Pitchers self-reported their peak velocity at 7 MPH greater than the actual measured velocity. Only a single injury occurred during the season, precluding a comparison between groups. There were no significant differences in the incidence of a history of injury between those pitchers who were noncompliant with between-season rest guidelines (p=0.285). Conclusions: Most high school pitchers are non-compliant with current Pitch Smart guidelines, and they tend to overestimate their peak velocity by 7 MPH. Pitchers with greater velocity were at the highest risk for violating current pitch count recommendations. Since both increased throwing volume and pitch velocity are known risk factors for injury, these athletes may be at particular risk for subsequent injury. research is necessary to understand whether taking three consecutive month rest between seasons prevents pitching-related injury.

Poster 210: Stride Cross-over and Pelvic Rotation Contribute to Ulnar Collateral Ligament Injury Risk and Pitching Performance in Collegiate Level Baseball Players

Poster 210: Stride Cross-over and Pelvic Rotation Contribute to Ulnar Collateral Ligament Injury Risk and Pitching Performance in Collegiate Level Baseball Players

Early single sport specialization does not improve pitching velocity, motion, strength, or utilization in high school baseball pitchers

The impact of single-sport specialization on performance and injury risk in youth and adolescent athletes remains debated. The purpose of this study was to determine the incidence of single-sport specialization and its association with pitch velocity, pitcher utilization, range of motion, strength, and injury history. High school pitchers in the Northeastern, Southeastern, Midwestern, and Western Regions of the United States were prospectively recruited. Prior to the season, pitchers were surveyed about their basic demographics, sport participation history, and injury history. At this timepoint, a standardized physical examination was performed and max pitch velocity was measured. They were then prospectively followed over the ensuing high school season, where pitch utilization and counts were followed and injuries were tracked. Across the study, 115 pitchers were recruited, of whom 53% played baseball as their only sport and 47% played other sports. Single- position specialization within baseball was uncommon as 90% of athletes played positions other than pitcher. There were no differences in range of motion, strength, or pitch velocity between multisport athletes and single-sport specialists. Within the multisport group, 26% reported a history of injury, while 38% of the single-sport specialists reported a history of injury (P= .179). There were no significant differences in pitcher utilization between multisport athletes and single-sport specialists. Only a single prospective injury occurred in the 115 players. Although single-sport specialization is common, nearly half of all high school pitchers in this study were multisport athletes. While injury history was generally similar between the two groups, single-sport baseball players did not have the following: improved motion, increased strength, higher ball velocity, or greater pitching volumes during the high school baseball season compared to multisport athletes. Accordingly, single-sport specialization did not have a competitive advantage for these high school pitchers based on the performance factors studied. Further prospective studies are necessary to understand the association between single-sport specialization and injury risk in high school baseball players.

Caregiver Awareness of Safe Pitching Recommendations in Youth Fastpitch Softball Pitchers

Although fastpitch softball participation continues to rise, there is a lack of established pitch count guidelines, potentially putting young female athletes at risk of overuse injuries. In addition to coaches, caregivers' ability to recognize and employ safe pitching guidelines plays an important role in athlete safety. The purpose of this study was to assess caregivers' knowledge of their child's pitching practices and their familiarity with softball pitching recommendations. We hypothesized that caregivers would be unaware of safe pitching recommendations in youth fastpitch softball. Cross-sectional study. A 30-question survey was distributed to caregivers of youth fastpitch softball pitchers in age groups 10U (ie, ≤10 years), 12U, 14U, 16U, and 18U. The survey included questions on the demographic characteristics of caregivers and athletes, caregivers' knowledge of safe pitching recommendations, and athletes' pitching background and throwing habits. Comparisons of responses between the age groups were conducted using the chi-square test, Fisher exact test, or 1-way analysis of variance, as appropriate. A total of 115 caregivers completed the survey. Of the respondents, 84% were between 31 and 50 years, and 81.7% had a degree beyond high school. Only 28.1% of caregivers reported participating in youth sports. When asked to estimate the number of pitches they considered a safe amount during a single outing, 28.7% of caregivers (n = 33) did not provide a limit, 4.3% (n = 5) stated no limit was needed, 32.2% (n = 37) suggested 25 to 80 pitches, 21.7% (n = 25) suggested 81 to 100 pitches, 12.2% (n = 14) suggested 100 to 150 pitches, and 0.9% (n = 1) suggested that >150 pitches were acceptable. These data emphasized that only 14.8% of the caregivers were aware of any pitching guidelines. However, 93% of caregivers acknowledged that they would adhere to recommendations if guidelines were made available. The study findings demonstrated that a majority of caregivers are unaware of current youth fastpitch softball pitching recommendations.