Post by sogasoftball on Jul 11, 2014 7:11:21 GMT -6
Hello... New here, so I apologize if this has already been discussed. My daughter is a pitcher, and after a game two weeks ago, she developed a deep bruise on her inner elbow from hitting her side at release. By inner elbow I mean the (ulnar) bone that protrudes out on the outside of the funny bone nerve. It was very tender to the touch. I took her to the an Orthopedic Dr.
So, the area of the bruise is still very tender to touch. She had an X-ray. Growth plates looked good per the Dr. She has an MRI scheduled for next week. Have any of you ran into this before? Do you mind sharing the results? I know each case is different.
Please do not hesitate to give me some advice since I've already taken her to the Doctor. We're all looking to educate ourselves and get her the best treatment possible. I'm looking for things I should ask or discuss with her Doctor.
Finally, I realize she needs to change something in her delivery to prevent this if she goes back to pitching.
Post by Kiran Kanwar Golf Pro on Jul 13, 2014 16:53:00 GMT -6
What research tells us about softball pitching biomechanics and injury potential
By an ASMI student researcher
One study by Loosli et al, in which 8 collegiate softball teams (in 1989) were surveyed, found that 24 of the 26 survey-respondents reported injury, of which 17 were for upper-extremity (ie. including elbow and shoulder).
Based on the results of the above, another study (Barrentine, Fleisig et al) hypothesized that stresses on the shoulder and elbow generated during underhand (windmill style) softball pitching are similar to the stresses of overhand throwing.
Although it is difficult to determine how the forces and torques involved relate to the incidence of injury, the types of injuries reported by Loosli et a1 appear to be related to overuse and the accumulative stress at the shoulder and elbow. Tendinitis, rotator cuff and tendon strain, and ulnar nerve damage were the majority of injuries reported for all grades of injuries.
Typically, a female's upper torso and arms possess less muscle mass and strength than the male. At the elbow, the carrying angle is larger, and there is often more ligamentous laxity in the female. Grip strength and hand sizes are usually less for women, and the softball is larger and heavier than a baseball. While a starting baseball pitcher seldom pitches in a game without 3-4 days of rest, a female windmill pitcher may pitch 2 days in a row or twice in one day during a tournament.
Softball pitchers often are required to pitch multiple games in one day and or pitch consecutive days throughout the season. Thus, even with perfect pitching mechanics, overuse type injuries can occur. Loosli et al reported that pitchers reporting grade I or I1 type injuries (did not result in missed games or practices) on average pitched more innings per season than uninjured pitchers.
Ulnar nerve neuritis can occur in windmill pitching; is attributed to poor mechanics; and occurs as the medial elbow contacts the hip just before ball release.
Another study by (Powell and Barber-Foss) reported a significantly higher - 27% - injury rate for girls involved in softball when compared to that of boys participating in baseball. In softball, practices accounted for 55.9% of the injuries. This paper too concluded that given the excessive number of games/pitches thrown in softball, the windmill pitch is a potentially harmful throwing motion
In conclusion, it is beneficial to control how much pitching is undertaken during any given game or practice session. Perhaps some good quality coaching might be beneficial to prevent future poor-mechanics injury, which appears to be the case, if one goes by the many internet articles by softball coaches which give recommendations for how to prevent the throwing elbow from brushing the hip!
References: 1. Loosli AR, Requa RK, Garrick JG, Hanley E: Injuries to pitchers in women's collegiate fast-pitch softball. Am 1 Sports Med 20(1):35-37, 1992 2. Barrentine, SW, Fleisig, GS, Whiteside, JA, Escamilla, RF, Andrews, JR. Biomechanics of eindmill softball pitching with implications abour injury mechanisms at the shoulder and elbow. Journal of Orthopedic and Sports Physical Therapy, 1998. 3. Powell JW, Barber-Foss, KD. Sex-related injury patterns among selected high school sports. The American Journal of Sports Medicine, 2000. Vol. 28, No 3.
Post by Kiran Kanwar Golf Pro on Jul 14, 2014 7:59:06 GMT -6
From an ASMI student researcher: Some more information you might find useful, from blogs of pitchers and coaches:
This article - www.softballperformance.com/softball-pitching-critical-information-you-must-know/ - gives a lot of very pertinent tips, and also states that, " Improper hip rotation has been shown to be another common cause of injury. The biggest flaw seen in pitchers is how their hips move when they release the ball." The website is from Marc Dagenais, a very well-known Canadian Coach with great credentials.
Finally, this link www.discussfastpitch.com/softball-pitching/456-elbow-injuries.html is to a forum called discussfastpitch.com, and gives the opinions of a lot of people on all aspects of softball. Obviously a great place to ask technical questions regarding softball issues, but I could not find any information on the credentials of those offering the information.
Post by sogasoftball on Jul 15, 2014 7:06:52 GMT -6
There are a couple of issues with her fastpitch mechanics, and I believe there is a solid plan in place to rectify those problems when she's able to return. Specifically, she's concentrating on leading the downswing with her elbow, and her hips are closing early. I was wondering if there is any feedback on common diagnosis as a result of the repeated banging of the elbow? She goes for the follow up to her MRI this week. Will the MRI confirm ulnar nerve problems? Thanks for the replies.
Post by Jeff Westerfield, MD on Jul 15, 2014 12:57:18 GMT -6
I think you are on the right path with getting evaluation from Orthopedic Sports Physician. An MRI is not an unreasonable test at this point. We often see this injury in our High School and collegiate throwers. Once you rule out any injuries that could be addressed with physical therapy and/or surgery, we find a way to pad the medial aspect of the elbow. I have seen posterior elbow pad turned sideways (medial) and have seen felt taped to the medial elbow. Continue working on mechanics to address underlying cause.
Post by sogasoftball on Jul 16, 2014 6:49:20 GMT -6
Thank you for the replies. MRI results showed fluid/swelling in the joint - joint effusion, edema. No ligament damage. Good news! She is relieved and committed to resting as the Doctor requested. Thanks again for all of the replies.