1. The Incidence of Nerve Injuries 1
Running Head: THE INCIDENCE OF NERVE INJURIES
The Incidence of Nerve Injuries in Windmill Style Softball Pitchers
Andrew S. Clark
Wheeling Jesuit University

2. The Incidence of Nerve Injuries 2
Windmill style pitching is a popular style among nationwide softball players of all
ages. However, improper body mechanics while pitching can lead to injuries ranging
anywhere from Grade I muscle strains to peripheral nerve injuries, such as, neurapraxia,
axonotmesis, and neurotmesis. It is unequivocally important to practice proper pitching
mechanics with emphasis on examining the entire kinetic chain in order to avoid further
damage. Nevertheless, if an injury happens to occur, it is crucial to seek proper treatment
and allow for sufficient time to heal.
In a research study by Hill, Weidner & Newton 2004, female softball athletes
were examined in order to determine the prevalence of injuries from chronic pitching
overuse in the NCAA divisions (I-III). Windmill pitching proved to play a dynamic roll
in losing playing time due to sustained injuries. Humphries states, “Out of 1,309 athletes
surveyed, 72.8 percent of the population are sustaining injuries from windmill pitching”
(Hill, Weidner & Newton, 2004). Overuse injuries are prevalent among these athletes.
Humphries states, “Although there was a significant amount of overuse injuries caused
from pitching, most injured pitchers had been hitting and playing other positions that
place them at high risk for acute injuries” (Hill, Weidner & Newton, 2004). In an
additional study by Barrentine 2004, placed emphasis on injury prevalence in windmill
style pitchers. It was found that most of the injuries that occurred were related to overuse
and accumulated stress at the shoulder and elbow (Barrentine, 2004). To support his
claim, Barrentine suggests that forces and torques experienced during underhand pitching
are similar to those experienced when overhand throwing. He states,
During the first half of the delivery phase, flexion torque is exerted to generate a
shoulder flexion velocity that reaches over 5,000 degrees per second…At this

3. The Incidence of Nerve Injuries 3
time, an internal rotation torque is exerted to generate internal rotation for release
of the ball…The magnitude for this torque relative to body weight appears to be
greater for underhand throwing than overhand throwing (Barrentine, 2004).
This article provides solid evidence that the underhand pitching style actually require
more flexion torque velocity than overhand style pitchers. Thus, it is apparent why
injuries are acquired when windmill style pitchers use a strong force with improper form.
In addition, types of injuries from windmill pitching are correlated with overuse and
accumulative stress at the elbow; therefore, injuries to the upper extremity are likely
related to maintaining joint stability while following through with every pitch
(Barrentine, 2004). Overall, it is speculated that pitching too many games without
adequate rest causes the majority of injuries that affect windmill style pitchers.
In a research study by Rosen & Tripp 2013, mechanics of the windmill pitch were
examined with association a valgus extension overload injury. This research article
examines the mechanics of windmill style pitching, thus diagnosing stressors that cause
injuries among pitchers. These injuries normally occur in overhead throwing athletes;
nevertheless, there is incidence in windmill pitchers where overuse occurs (Rosen &
Tripp, 2013). She states, “Although valgus extension overload injury is rare in windmill
pitching athletes (1.6%), repetitive stress may lead to osteochondral changes and valgus
instability of the elbow joint” (Rosen & Tripp, 2013). In this particular case, the athlete
suffered an ulnar nerve injury, (cubital tunnel syndrome), as well as reported
pain/parasthesia in the fourth and fifth digits. “The athlete suffered posterior elbow pain
during full extension and decreased sensation along the distal ulnar nerve
distribution…The clinical diagnosis was right elbow valgus extension overload with a

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medial ulnar collateral ligament (UCL) tear” (Rosen & Tripp, 2013). Again, it is apparent
that the valgus extension overload injury has been overlooked in the windmill style-
pitching athlete. However, refraining from the activity that caused the injury is the best
treatment method to heal a valgus extension overload syndrome.
Most importantly, proper body mechanics are key to preventing injuries
associated with windmill style pitchers. Nadya Sweden, a medical director for La Palestra
Center for medicine suggests that, “Pitching and throwing mechanics should be examined
with particular attention to the entire kinetic chain, because injuries to the lower back and
shoulder can result in increased stress placed on the elbow during pitching or throwing”
(Sweden, 2001). However, if a valgus extension overload injury occurs, the most
effective treatment is refraining from the activity that caused it, as well as, utilizing pain
relievers, such as, NSAIDS and prescribed analgesics (Sweden, 2001).
In a study by DeFranco & Schickendantz, 2008, an isolated musculocutaneous
nerve was examined in relationship to an injury in a professional fast-pitch softball
player. Nerve compression at the C5-C6 nerve level involves motor weakness in the
biceps function, and wrist extension, a decrease in the brachioradialis reflex, as well as an
abnormal sensation along the radial aspect of the forearm (DeFranco & Schickendantz,
2008). The article states,
During the course of the game, she felt a sharp pain in the right antecubital fossa
after throwing a fastball…Further attempts to throw were ineffective, and she
removed herself from the game…she initially had mild, diffuse swelling of the
right arm and numbness of the entire volar forearm (DeFranco & Schickendantz,
2008).

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The study found that windmill pitching places the upper extremity under significant stress
and fatigue awareness is essential for preventing overuse injuries. DeFranco states,
“Overall, the combination of repetitive muscle contraction and distraction force during
windmill pitching may exceed the physiologic threshold of normal musculocutaneous
nerve function and lead to significant clinical sequelae” (Defranco & Schickendantz,
2008).
Pharmacology should not be excluded when discussing softball related injuries.
NSAIDs are commonly used to mask the effects of injuries; however, neuropathic pain is
difficult to treat (Panesar, 2012). In today’s world of athletics, abuse of NSAIDs and
analgesics are abused. Hill states, “NSAID use was extremely high, ranging from 80-
100% of injured pitchers reported to be frequently taking these drugs” (Hill, Weidner &
Newton, 2004). Ultimately, pharmacology pain relief is a commonly used method of pain
relief noted in windmill style softball pitchers suffering injuries.
In summation, it is crucial to examine the entire kinetic chain when ruling out
injuries and determining the direct causes of them. In addition, teaching the proper
technique from a young age is the most effective way to prevent injury. Pharmacology
needs to be utilized in moderation and monitored more closely in the future in order to
prevent further bodily complications. In the final analysis, it is formulated that, there is a
correct way to pitch in order to avoid injuries and promote individual success in windmill
style softball pitching.

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References
Barrentine, S. (2004). Underhand pitching: A biomechanical examination of the softball
pitching motion. Sports Research Intelligence Sportive, 4-7.
DeFranco, M., & Schickendantz, M. (2008). Isolated musculocutaneous nerve injury in a
professional fast-pitch softball player: A case report. The American Journal of
Sports Medicine, 36(9), 1821-1823. doi: 10.1177/0363546508317966
Hill, J., Humphries, B., Weidner, T., & Newton, R. (2004). Female collegiate windmill
pitchers: Influence to injury incidence. Journal of Strength and Conditioning
Research, 2004, 18(3), 426–431.
Panesar, K. (2012). Management of nerve injuries. US Pharm. 2013;38(4):HS8-HS12.,
1-8.
Rosen, M., & Tripp, P. (2013). Valgus extension overload injury in a division i collegiate
softball pitcher. International Journal of Athletic Therapy & Training , 18(3), 28.
Sweden, N. (2001). Women's sports medicine and rehabilitation. (1st ed. ed., Vol. 1).
Gaithersburg : Wolters Kluwer Health.