Incidence of injuries in high school
softball and baseball players

E, Rauh MJ, Michener LA, Ellenbecker TS. J Athl Train. 2011; 46(6): 648-654 (Full text available for free online)

the last ten years, participation rates have increased in baseball and softball
(3.9% and 8.4% at the interscholastic level, respectively). Despite this rise
in popularity, a dearth of knowledge exists concerning the incidence of injuries
sustained by high school baseball and softball players. Therefore, the authors
conducted a prospective cohort study of high school athletes (247 athletes;
103 female, 144 male) to determine initial and subsequent injury rates; compare
injury rates between sports, practices, and games; and categorize injuries by
body location, type, severity (time lost), season trends (by month), and
position. Injuries and athlete exposures (AE) were documented using two
systems: the Simtrak Mobility and the Athletic Health Care System Daily Injury
Report (DIR) form. An AE was considered one athlete participating in one
practice or game. Incidence rates were calculated per 1000 AE’s for
initial and subsequent injuries, practice vs. game, and severity. Overall, the
injury incidence rate was 4.5 per 1000 AE’s while separately, softball players demonstrated
a higher rate (5.6/1000 AE’s) than baseball players (4.0/1000 AE’s). Initial-injury
rates for baseball players were slightly higher than softball players but the opposite
was true for subsequent-injury rates. Softball players also showed increased
likelihood of being injured in a game compared to baseball. One-third of all
pitchers reported an injury during the season, though baseball position players
had slightly higher injury rates than baseball pitchers. Of the twelve softball
pitchers in the study, six sustained an injury. For entire cohort, the shoulder
had the highest proportion of injuries reported (34.7%) with elbow (28.6%) a
close second. However, baseball players sustained 12 of 14 elbow injuries reported.
The highest injury rates occurred in the first (7.96/1000 AE’s) and third month
(4.72/1000 AE’s) of the season with shoulder rates highest in the first month
and elbow rates highest in the third month. Different patterns for shoulder and
elbow injury emerged, as shoulder injury rates declined for both sports
decisively after the first month but elbow injury rates peaked in the third
month for baseball players.

and softball athletes are often lumped together, despite differences in bat and
ball characteristics, field dimensions, and pitching style. While injury rates
were low in both sports, trends emerged that may promote unique clinical
decisions for each sport. The upper extremity had the highest injury rates, which
emphasizes the demand placed on the shoulder and elbow and the need for
preventive training programs. While injuries rates peaked in the first month of
the season the timing of elbow injuries, whether the result of fatigue over a
long season or poor mechanics predisposing the athlete, were a notable because they
peaked later in the season. This trend, coupled with baseball players suffering
the majority of reported elbow injuries (85%), suggests that clinicians should
closely monitor baseball players for signs/symptoms of elbow pathology as the
competitive season progresses. Though further research with larger samples is
needed, is this trend evident with the baseball and softball athletes that you
see in the clinic or athletic training room? Would this type of data lead you
to tailor preventative or rehabilitative training programs based on position or
point in the season for these athletes?

By:  Laura McDonald
by:  Jeffrey Driban


Shanley E, Rauh MJ, Michener LA, & Ellenbecker TS (2011). Incidence of injuries in high school softball and baseball players. Journal of Athletic Training, 46 (6), 648-54 PMID: 22488191