As we have seen in fastpitch softball in recent years, arm problems are on the rise. All too often, pitchers injure their arms and are often robbed of reaching their potential.

Successful pitching involves highly skilled and coordinated movements. The bones, tendons and muscles of the arm -- and the entire body -- must work in a properly timed order for smooth and efficient function.

Pitching is an inherently unnatural act. The act of throwing any projectile, whether it is a softball, baseball or rock, creates tremendous stress on the muscles and soft tissue of the arm. Even slight flaws in pitching mechanics can lead to injuries. The results of arm injuries are pain, frustration, lost playing time and sometimes surgery.

"Improper mechanics, improper training and generally being out of shape will cause a pitcher to break down," says Nancy Evans, pitching coach at the University of Arizona.

Today, we see injuries to pitchers that affect all levels of athletes. Young pitchers are especially vulnerable as more of them are showing up at doctors’ offices with damaged shoulders and elbows.

Throwing Mechanics
It’s commonly believed that fastpitch softball pitching is less taxing on the arm than baseball pitching. Softball pitchers use an underhand windmill delivery that most consider more natural than the overhand delivery that baseball players use. And the pitching rubber is closer to home plate in softball (40-43 feet) than baseball (60 feet, 6 inches).

But fastpitch softball players may not be at less risk than their baseball counterparts.

Dr. Sherry Werner of the Tulane Institute of Sports Medicine has been researching pitching mechanics for 19 years. She studied windmill pitchers as they performed throwing exercises. Different intervals of the pitch were observed, and kinetic calculations of the shoulder joints were calculated and then compared to those of baseball pitchers. What her research found was the stress placed on the shoulder joints was similar to baseball pitchers.

Pitching competitive fastpitch softball usually involves the mastery of the three main pitches: rise ball, drop ball and screwball. The fastball is not as effective as the other pitches and, therefore, is not thrown as often as it is in baseball.

The kinetic chain of events that transfers energy from the feet through the legs, hips and torso to the arm and finally to the ball allows a pitcher to generate tremendous velocity while throwing. As the energy is transferred from the lower extremities, trunk, and back to the ball, the forces generated are enormous. Two joints -- the hinged elbow and the ball-and-socket shoulder -- bear the brunt of the force. It is the rapid acceleration and deceleration of the arm that causes failure of the soft tissue around the shoulder and elbow areas. The shoulder muscles are especially critical to slowing the arm after the ball is released. If it weren’t for those muscles, the arm would go to home plate with the ball.

Pitching injuries are most commonly due to the accumulation of micro-trauma from this repetitive pitching motion. So how can pitchers remain healthy with such a high-risk motion? Let’s take a look.

Improper Throwing Mechanics
Understanding pitching injuries starts with understanding the pitching motion. Softball pitchers suffer injuries if their mechanics are off. Poor mechanics can also lead to premature fatigue and a drop in performance. Every pitcher has her own unique style and every coach his or her own approach.

"I look for things when they are not working right," says Ann Pederson of Grand Canyon University. "But I also depend on the athlete to know her mechanics and any changes."

The quality of pitching coaches at the high school and college level varies greatly. If these coaches are not qualified to spot and correct improper mechanics in a pitcher, they may miss the beginning stages of the injury cycle.

"You need a good pitching coach," Evans says. "We use video and practice quality repetitions to keep up mechanics."

Coaches may also lack the physiological knowledge of how the body’s muscles, bones and soft tissue are interconnected. Thus if a pitcher suffers a non-pitching injury (injuring her hip when sliding or straining her back while swinging, etc), she may compensate for that injury by placing additional stress on her pitching arm.

Zig Ziegler, a kinesiologist and biomechanics expert with Arizona-based Motion DNA, has been applying motion capture technology to pinpoint flaws in a pitcher’s mechanics for 8 years. "One hundred percent of all injuries are related to motion," Ziegler says. "Either too much or not enough. One or the other causes unnecessary stress on a particular body part and results in an injury. There are some injuries that cannot be prevented, but the risk of those related to mechanics can be significantly reduced."

Werner also recommends the use of motion capture technology or video as a training tool. "With the shoulder, there are six things to look at," Werner says. "For instance, from the side view, if the head sticks out past the hips with a forward lean, that puts the pitcher at risk."

According to Gerald Warner, a pitching coach based in Denver, other poor habits that often result in injuries include 1) bending at the waist at the release of the ball; 2) pitching from an "open" position, with no trunk rotation prior to the release; and 3) involving the shoulder in the rollover drop ball release.

Some experts warn the problem is as simple as an improper foot position.

"The most important link in the functional chain is the feet," Ziegler says. "It is where all movement begins. Try standing on an ice rink and throwing a softball."

Overload
Overload is the result of throwing too many pitches during one outing. Ascertaining a pitcher’s maximum pitch count varies by age group, competition level, and a pitcher’s individual traits (such as arm strength, arm fatigue, arm soreness, etc). A reasonable amount of work for one pitcher may be extreme for another.

"As a rule of thumb, I would recommend that pitchers don’t throw more than 120 pitches in a single workout or session," Werner says.

Coaches should ask the following questions to determine if their pitcher is overloaded:
·Is the pitcher losing her effectiveness?
·Is she still controlling her pitches?
·Has her velocity dropped (no longer popping the catcher’s mitt)?
·Are her mechanics breaking down

Overuse
Overuse is the result of pitching too often and not having adequate rest between pitching assignments. Ascertaining how much recovery time to give a pitcher also varies by age group, competition level and a pitcher’s individual traits.

In many high school and college softball programs, pitchers are often asked to pitch many innings, especially if the pitcher is good. In some cases, she may be asked to pitch game after game -- even two on the same day -- and the only relief she’ll get is an ice pack.

Why can some pitchers handle lots of innings and others can’t? Much of it has to do with preparation, training and mechanics. From her studies on high school pitchers, Werner noted that 90 percent of the girls who underwent surgery were the only pitcher on their high school team. "You need at least 24 hours to let the small tears in the shoulder heal properly," Werner says.

Ice packs and painkillers are not the answers. Coaches need to have an understanding of overuse injuries and heed the warning signs.

Strength and Conditioning
Almost every muscle in the body is used during the pitching sequence. The key areas are the core (hip, stomach and back) muscles, leg and shoulder muscles.
"You need a solid base," Ziegler says. "A well-developed foundation allows for improved force output, increased neuromuscular efficiency, and decreased incidents of injuries."
Leg and shoulder muscles are also critical. Strong legs provide power and endurance to a pitcher while strong shoulders provide control.

Werner recommends more plyometrics and the use of thera-bands for resistance. "Pitchers need to work sports-specific muscles," she says.

Proper conditioning is crucial to a pitcher’s overall health. As a pitcher gets fatigued, mechanics can get out of whack. Fatigue is part of the game, so coaches need to teach players how to pitch while tired. "When your legs get tired, and you start using your arm alone, you put yourself at risk of hurting yourself," Ziegler says. Coaches should implement a stretching and warm-up program that is followed by every pitcher before she throws a ball. "Training programs among high schools and colleges are getting better, but they’re not there yet," Werner says.

Keeping Arms Healthy
Coaches, players and trainers are gaining a better understanding of all the factors that cause a pitcher to break down. It starts with good habits developed early. Parents should be pro-active with their young pitcher’s arms. Instead of waiting for an injury to occur, parents should seek the advice of pitching experts, including someone who can perform an analysis of their mechanics. Checking mechanics early can prevent arms problems later in life.

Communications is also crucial. Coaches need to communicate with their pitchers, trainers, and assistant coaches. Pitchers need to communicate with their coaches, trainers and parents if there are problems with pain or fatigue. Most of all, coaches and players need to keep an open mind.

"Once coaches and athletes are prepared to let go of outdated habits and philosophies, we will see a healthier sport with better performances on the mound and in the field," Ziegler says.