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Lack of softball pitching limits can lead to serious injuries, experts say

By KARA YORIO STAFF WRITER | The Record

The mantra is a myth.

Discussions about softball pitchers always return to the same long-accepted, rarely challenged theory: It's not baseball; the softball pitching motion is safe and natural; a girl can windmill endlessly without physical consequences.

"People told me, 'Oh, you can pitch, you can pitch, you can pitch, you can pitch,' " said Diana Schraer, a 2004 Paramus High School graduate and member of The Record's all-decade team. "Then one day my arm went numb and I'm like, 'Oh, I guess I can't pitch anymore, right?' "

She hadn't started pitching until seventh grade — late for most girls today — but her doctor told her too many pitches resulted in cubital tunnel syndrome that required major elbow surgery the summer after her junior year, before she rehabbed and returned to pitch in high school and college.

Schraer grew up like just about every North Jersey pitcher age 8 to 18. Her world was guided by this "safe and natural" idea that is the rationalization behind pitching one dominant girl multiple games in a day, multiple days in a row, on multiple teams in a season.

It is a myth — and a dangerous one at that, according to several sports medicine experts, pitching coaches and at least two former standout Bergen County high school pitchers.

"It's absolutely a myth," said Dr. Nikhil Verma, an orthopedic surgeon and sports medicine specialist at Rush University Medical Center in Chicago, who has done research on the windmill delivery. "Anything that you do that's repetitive at that level with the type of force and velocity that these girls are generating puts you at risk for injury."

No less an authority than Dr. James Andrews, renowned orthopedic surgeon to the pros, debunked it in his 2013 book, "Any Given Monday," writing, "There is a common belief that throwing underhand is a natural way to keep the player safe from injury, but this definitely is not true. … The repeated movement and velocity of pitches thrown, even in the windmill style, are now even tearing the 'Tommy John ligament,' resulting in a UCL injury. Pitching limits matter in softball as much as they do in baseball."

But pitch count limits don't exist in softball at any level. Innings restrictions put in place by some leagues are meaningless, because a player can throw any number of pitches per inning. Theoretically it can be as few as three, but girls — especially younger girls just getting started — can routinely throw 30 or 40 pitches per inning.

'They just don't want to hear it'

Sherry Werner runs the Sherry Werner Fastpitch Academy in Fort Worth, Texas. She not only coaches young pitchers, she has done research and analysis on the windmill motion, including with U.S. Olympians. She has data showing that the force on a softball pitcher's shoulder and on that of a baseball pitcher's are equivalent, she said.

"It just drives me nuts," said Werner, who has a Ph.D. in biomechanics and has held research positions at the U.S. Olympic Training Center, the American Sports Medicine Institute and Tulane Institute for Sports Medicine. "Every week I hear, 'It's safe and natural.' It's just a myth that is out there, and I think the powers that be … they just don't want to hear it."

The Amateur Softball Association, the leading softball organization in the country, did not return repeated messages seeking comment.

This weekend fall ball will wrap up for most of young North Jersey softball players. Third-graders through high school seniors have spent weekends the last few months on club and town travel teams playing two- and three-day tournaments with four, five or six games for each team.

Indoor winter workouts will soon begin, with many players getting additional personal lessons from pitching coaches.

Brittany Baiunco, The Record's softball Player of the Decade for 2000-2010, started windmilling in second grade and had a pitching coach by fifth. Always a three-sport athlete, she didn't start playing only softball until after her sophomore year in high school, but by middle school was throwing at least 100 pitches at least five days a week, year-round.

The Ramapo High School star pitched in four Bergen County championship games, winning three, and led Ramapo to a state title in 2006, but during a game at the end of junior year she felt something "funky" happen in her shoulder, she says. It was her rotator cuff and posterior labrum tearing.

"I'm probably a testament to the fact that there is absolutely an effect," the 25-year-old said of being over-pitched.

She had surgery, and although she came back and led Ramapo to the 2008 county title her senior year, she says she never felt fully recovered and still struggles with pain and an inhibited range of motion today. She did not go on to pitch in college for various reasons, including feeling like she was never her pre-surgery self.

Her advice to girls now?

"I would just say take care of yourselves, know your limits and don't be afraid to speak up," she said.

Just as every baseball pitcher won't tear his rotator cuff or require Tommy John surgery, not every softball pitcher will suffer an injury either. Many try to say softball pitchers who get hurt had mechanical problems that caused the injury.

"It's not that if you had proper mechanics you'd be fine," said Dr. Stephen Nicholas, orthopedic surgeon and director of the Nicholas Institute of Sports Medicine and Athletic Trauma at Lenox Hill Hospital in Manhattan. "But the amount of stress you place on the body is less and because of that, you do last longer before you go to an overuse situation. … To think we can pitch ad infinitum makes no sense to me."

Softball injuries are coming to light now as more girls get serious about the sport, according to Nicholas. Parents are rushing players to the doctor to get them back on the field — as they have done with baseball players for years. In the past, a girl in pain would sit out for a couple of weeks; now they often pitch through it and suffer a more serious injury, sports medicine specialists say.

Despite doctors reporting more and more softball pitchers as patients, there are no peer-reviewed studies showing cause and effect for softball pitchers, according to Dr. William Levine, orthopedist and co-director of Columbia University's Center for Shoulder, Elbow and Sports Medicine.

"If you have the data, you can be more thoughtful about it, otherwise it becomes more anecdotal," Levine said.

That anecdotal evidence is mounting.

"I've seen more and more rotator cuff [injuries]," said Dr. Jeffrey Dugas, orthopedic surgeon, sports medicine specialist and managing partner of Andrews Sports Medicine and Orthopaedic Center in Birmingham, Ala. "I've seen more Tommy John injuries in softball throwers."

Still, softball pitchers needing surgery are not as numerous as baseball pitchers needing it, a comparison that hurts efforts to get research done that could help put appropriate regulations in place for softball.

"The problem is sports medicine injury counts tend to be at surgery centers and tend to be how many surgeries [are done]," said Glenn Fleisig, Ph.D., research director at the American Sports Medicine Institute in Alabama. "I think that's missing the data on softball, because those injuries aren't typically surgical injuries."

The good news is that the research is under way, according to Dugas.

"There's some really high-end research going on in the softball world," he said, citing Werner's work among others. "There's so many kids doing it and the injury risk is not really well-appreciated, and we need more data.

"We know a lot about baseball. We know a lot about football. We know a relatively fair amount about soccer. Softball, in terms of just the epidemiology of softball, we don't have enough data about that, so there are things under way that I would say over the next five years we'll probably have a lot more data that resembles what we know about the other sports that are well-studied."

'Obsessed with winning'

They should know enough in 5 to 10 years to have an impact, Dugas said. Until then, best-guess recommendations can be put in place to help prevent overuse injuries.

"There should be some regulations for softball pitching to prevent the excess beyond common sense, an overuse injury for these girls who play this one activity year-round," Fleisig said.

But word hasn't made it to the field and pitchers continue to exert incredible force on their shoulder, biceps, elbows, wrists and all ligaments and tendons in between, often on bodies with still-developing muscular and skeletal systems.

Schraer is now a teacher who spends her nights as a pitching coach for North Jersey youth pitchers. She tries to educate parents and keep her girls from being overused.

"In tournament ball, these coaches become so obsessed with winning that they will ride a kid's arm over and over and over again," she said. "I try to educate my parents, as well as my kids, because the more they know, the more they can advocate for their kids."

Nobody has ever told the coaches otherwise, they say.

"I don't want to harm anyone," said Lee Ehlermann, involved in Mahwah softball for nearly two decades and currently the coach of the town's 12-and-under NJ Sparks club team. "You don't get any money for winning. It's not that important. If I was told a girl's arm would fall off or there would be medical issues like there are in baseball ..."

While he knows they're out there, Dugas said he has never met a coach who intentionally does something that could injure a player — and that includes those who send the same softball pitcher out to throw three games in a day.

"That kind of stuff is unwise, but that's the industry standard and that's on us as the medical professionals," he said. "We need to prove that point, and we're in the process of getting there."