The First Decade of Web-Based Sports Injury Surveillance: Descriptive Epidemiology of Injuries in US High School Girls' Softball (2005-2006 Through 2013-2014) and National Collegiate Athletic Association Women's Softball (2004-2005 Through 2013-2014)

A Model for Causality of Pitching-related Overuse Injuries in Women's Fastpitch Softball

Fastpitch softball is a popular women's sport, and athletes, particularly pitchers, are at high risk for overuse injury. Softball-related injury rates are low; however, the prevalence of overuse injuries is high. Injuries at the high school and collegiate levels occur early in the season, and approximately 50% of shoulder and elbow injuries in softball are attributable to overuse. Survey research showed 77% of high school pitchers pitch with pain, and 73% of collegiate pitchers reported an overuse injury in the previous season. Modifiable and non-modifiable intrinsic and extrinsic risk factors contribute to injury risk in a model that can be used in history taking, clinical examination, and management of softball-related injuries. In this manuscript, we present a scoping review of fastpitch softball injury research by competitive levels from 1990 to present. We also introduce a model for overuse injury causality in this athlete population. With this information, clinicians will be able to identify risk factors related to injury in softball pitchers. More research is needed to make evidence-based recommendations for injury prevention in this athlete population.

Results of a National Survey on Sport Specialization Behavior and Throwing Arm Injury in Youth Softball Players

BACKGROUND

There are few data on throwing arm and shoulder injury in youth softball athletes, and no data on the influence of sport specialization on injury in softball.

HYPOTHESIS

We hypothesized that highly specialized athletes, and pitchers in particular, demonstrating various sport specialization behaviors would be more likely to report an upper extremity overuse injury in the previous 12 months.

STUDY DESIGN

Cross-sectional survey.

LEVEL OF EVIDENCE

Level 4.

METHODS

An online, anonymous, cross-sectional survey was distributed to a national sample of female youth softball players between the ages of 12 and 18 years in fall 2021. Topics included were indicators of sport specialization and self-reported injuries to the throwing arm.

RESULTS

A total of 1309 participants (mean age, 15.1 ± 1.7 years) completed the survey; 19.4% (N = 254) scored as highly specialized, 69.7% (N = 912) as moderately specialized, and 10.9% (N = 143) with low specialization. Of all participants, 27.3% (N = 357) pitched in the previous year. A minority of all players (43.7%; N = 572) reported arm injury in the previous 12 months, with 45.9% of pitchers (N = 164) reporting the same. Multivariate regression showed increased adjusted odds ratio (aOR) of injury history for athletes playing >30 games per year (aOR, 1.74; 95% CI, 1.26-2.40), participating on a club team (aOR, 3.36; 95% CI,1.85-6.07), and in pitchers participating on club teams (aOR, 2.97; 95% CI, 1.18-7.45). Decreased aOR of injury was noted in those participating in >8 months of softball per year (aOR, 0.25; 95% CI, 0.12-0.51) and in pitchers who were moderately specialized (aOR, 0.39; 95% CI, 0.17-0.92) and playing >8 months per year (aOR, 0.33; 95% CI, 0.11-0.96).

CONCLUSION

This sample provides a large proportion of athletes classified as high or moderately specialized in youth softball (89%). A large proportion (43.7%) of subjects reported arm injury in the past year, and insight into injury risk is provided. The results present conflicting data on the risk versus protective effect of specialization in youth softball athletes.

CLINICAL RELEVANCE

This project is a first step toward understanding sport specialization behavior and its influence on injury in youth softball.

Estimating the Relationship Between the Symptom-Free Waiting Period and Injury Rates After Return-to-Play from Concussion: A Simulation Analysis Using CARE Consortium Data

BACKGROUND

A key component of return-to-play (RTP) from sport-related concussion is the symptom-free waiting period (SFWP), i.e., the period during which athletes must remain symptom-free before permitting RTP. Yet, the exact relationship between SFWP and post-RTP injury rates is unclear.

OBJECTIVE

We design computational simulations to estimate the relationship between the SFWP and rates of repeat concussion and non-concussion time-loss injury up to 30 days post-RTP for male and female collegiate athletes across 13 sports.

METHODS

We leverage N = 735 female and N = 1,094 male post-injury trajectories from the National Collegiate Athletic Association-Department of Defense Concussion Assessment, Research, and Education Consortium.

RESULTS

With a 6-day SFWP, the mean [95% CI] rate of repeat concussion per 1,000 simulations was greatest in ice hockey for females (20.31, [20.16, 20.46]) and American football for males (24.16, [24.05, 24.28]). Non-concussion time-loss injury rates were greatest in field hockey for females (153.66, [152.59, 154.74]) and wrestling for males (247.34, [246.20, 248.48]). Increasing to a 13-day SFWP, ice hockey for females (18.88, [18.79, 18.98]) and American football for males (23.16, [23.09, 24.22]) exhibit the greatest decrease in repeat concussion rates across all sports within their respective sexes. Field hockey for females (143.24, [142.53, 143.94]) and wrestling for males (237.73, [236.67, 237.90]) exhibit the greatest decrease in non-concussion time-loss injury rates. Males receive marginally smaller reductions in injury rates for increased SFWP compared to females (OR = 1.003, p ≤ 0.002).

CONCLUSION

Longer SFWPs lead to greater reductions in post-RTP injury rates for athletes in higher risk sports. Moreover, SFWPs should be tailored to sport-specific post-RTP injury risks.

Common Injuries in Female Competitive Softball Players

The popularity of softball is rising among female athletes with more than two million players between the ages of 12 and 18 competing per year. As participation rates increase, the frequency of injuries related to softball is on the rise. Softball injuries can differ from baseball injuries, and only a small amount of current literature focuses exclusively on softball injuries. Orthopaedic surgeons need to be prepared to evaluate, diagnose, and treat common injuries sustained while playing softball. The purpose of this study is to investigate the mechanisms of injury that are commonly encountered by female athletes in competitive fast-pitch softball and review current safety initiatives that have been implemented to aide in injury prevention.

Advancements for the Future: A National Survey of Fastpitch Softball Coaches' Perspectives on Injury Prevention Programming

Background

Approximately 50 percent of softball injuries are the result of overuse or chronic conditions. However, research exploring preventative measures for softball players is limited and usage of injury prevention strategies among softball coaches is unknown.

Hypothesis/Purpose

This survey aimed to investigate if softball coaches are implementing injury prevention programs to reduce injury and improve the performance of their players. The secondary purpose was to identify barriers to the implementation of injury prevention programs. Finally, this survey explored the coaches' knowledge of injury risk factors and their views on design and usage of preventative programs.

Study Design

Descriptive cross-sectional survey.

Methods

A 35-item survey was sent to approximately 14,000 high school and collegiate fastpitch softball coaches throughout the United States. Data were collected over a three-month period with an overall response rate of 1.2%.

Results

Among responding coaches, 45.9% (n=79/172) reported implementing injury prevention programs. Coaches who implement injury prevention strategies most frequently utilize team-based programs (68.8%, n=52/93) compared to group-based (19.0%, n=15/93) or individualized programs (15.2%, n=12/93). Coaches who do not use preventative programming reported that being unsure of what program to perform (53.8%, n=50/93) and not having enough staff (20.4%, n=19/93) were the greatest barriers to implementation. Although over 50% of coaches recognized arm fatigue/overuse (27.9%, n=48/172) and decreased core strength (22.7%, n=39/172) were important risk factors, 36% (n=94/172) "disagree" that softball pitchers should adhere to pitch counts and 90% (n=83/92) believe that preventative programming for pitchers and position players should be similar.

Conclusion

Less than 50 percent of softball coaches implement exercise programs to prevent injury. Limited familiarity with effective program design, inadequate staffing, and inconsistent risk factor awareness are the major contributors to lacking implementation. Collaboration between rehabilitation professionals and softball coaches regarding preventative programming should be considered.

Level of Evidence

Level 3©The Author(s).

Differences in the Medical Advisability of Online Pitching Recommendations for Youth Softball Players Based on Website Source

Background

Guidelines regarding injury prevention in fast-pitch softball pitchers have yet to be widely adopted, risking the online dissemination of misleading advice.

Purpose/Hypothesis

The purpose of this study was to assess the source and medical advisability of online pitching recommendations for youth softball players and highlight the risk of misinformation. It was hypothesized that many popular websites would contain content discordant with current medical guidelines regarding windmill softball pitching recommendations.

Study Design

Cross-sectional study.

Methods

A Google search using the phrase "youth softball pitching recommendations" was performed. Up to 100 websites were extracted and analyzed for website source type (commercial, medical/educational, or athletic organization) and informational quality (advisable, neutral, or discordant). The latter was determined with respect to the STOP Sports Injuries guidelines for arm injury prevention in youth softball players. Descriptive and inferential statistics were used to assess potential associations between website source type and the informational quality of content therein.

Results

A total of 86 websites were included in the analysis. Website source type was significantly predictive of informational quality (P = .018). Among the 3 source types, medical/educational websites had the highest proportion classified as advisable (12/24 [50.0%]) and the lowest proportion classified as discordant (3/24 [12.5%]). Only 17.6% (6/34) of commercial websites were advisable, and advisable websites as a whole were more likely to be from medical/educational sources than athletic organization (P = .016) or commercial (P = .026) sources. The advisability rate among all websites was 25.6% (22/86). Although there was a significant association between position in the search results (first 10 vs remaining 76) and website source type (P = .006), there was no association between position and informational quality (P = .116). The first 10 websites, which trended toward greater advisability than the remaining 76 websites (P = .060), were more likely than the remaining websites to be medical/educational sources (P = .002).

Conclusion

Website source type was significantly predictive of medical advisability. Medical/educational websites were the most advisable, while commercial and athletic organization websites were especially poor in their advisability. The overall advisability rate was only 25.6%. When making recommendations to patients, sports medicine providers should highlight the prevalence of discordant online softball pitching guidelines and take the opportunity to share medically advisable resources.

The Epidemiology of Youth Sport-Related Shoulder Injuries: A Systematic Review

Background

Youth around the globe place their shoulders at risk for injury when participating in sports. Shoulder injuries may vary in severity, produce the potential for time-loss from sport, and result in functional disability. We sought to explore sport-related shoulder injuries in youth by identifying injury rates, risk factors, injury mechanisms, and injury prevention strategies.

Methods

All relevant full-text articles were identified by searching MEDLINE, EMBASE, CINAHL, Sport Discus, and the Cochrane Controlled Trials Registry. No date restrictions were used. All full-text studies reporting original research describing sport-related shoulder injury among female and/or male youth from 5 to 18 years old were included.

Results

Of 3,889 studies screened, 97 described shoulder injury in youth sports. Shoulder injuries were identified in 24 unique sports. The median seasonal prevalence of shoulder injury was 10.9% (range 1.2-28.2%). The most common injury mechanisms identified were contacted with another player, contact with the playing environment, and falling to the ground. Risk factors for shoulder injury identified were side-to-side strength imbalances, weak external rotator muscles, and scapular dyskinesia. One study evaluated a successful training strategy to prevent shoulder injuries, but two other interventions demonstrated no effect.

Conclusions

Sport-related shoulder injuries are prevalent among youth athletes. Injury risk factors identified included modifiable intrinsic factors such as strength, range of motion, and training load. The most common injury mechanism was direct contact with either another person or an object in the playing environment. Innovative shoulder-specific strategies are needed to reduce shoulder injuries in this population. Trial Registration: PROSPERO ID: CRD42020189142.

Pediatric Softball Injuries Presenting to Emergency Departments

INTRODUCTION

This study sought to characterize the mechanisms of injury responsible for common softball-related injuries in recent years.

METHODS

The National Electronic Injury Surveillance System database was queried for all pediatric softball-related injuries presenting to participating US emergency departments from 2010 to 2019. Patients were classified by age as children (7-12 years), adolescents (13-18 years), or young adults (19-21 years). The case narrative of each injury was used to establish the mechanism of injury: hit by bat, hit by ball, sliding into base, collision with another player, catching, running, and throwing. Statistical weights provided by the Consumer Product Safety Commission were used to produce national injury estimates.

RESULTS

There were an estimated 511,117 pediatric softball injuries presenting to the emergency department over the study period, with a mean patient age of 14.3 years (95% confidence interval [CI], 14.1-14.4 years). The head/neck was the most commonly affected body part, making up 30.2% of cases (95% CI, 28.2%-32.2%). Injuries to the head/neck were most often caused by being hit by the ball (78.4%; 95% CI, 76.4%-80.3%) and most commonly resulted in a superficial injury (36.9%), internal injury (22.2%), or concussion (16.3%). Foot/ankle injuries were most frequently caused by sliding into base (51.5%; 95% CI, 47.0%-55.2%) and typically resulted in a sprain/strain (65.5%). The most frequent causes of shoulder/elbow injuries were being hit by the ball (33.3%; 95% CI, 28.6%-38.3%) and throwing the ball (27.6%; 95% CI, 22.8%-32.9%). These resulted most frequently in a sprain or strain (39.5%), followed by a superficial injury (28.2%). The proportion of softball injuries affecting the shoulder and elbow and the lower extremities increased with athlete age, whereas the proportion of injuries affecting the remainder of the upper extremities decreased with athlete age.

CONCLUSION

Being hit by the ball was the most common mechanism of injury, especially in the head/neck region, and shoulder/elbow injuries increase with athlete age. Coaches and leagues may consider mandating helmets for infielders and pitch counts for pitchers, especially among adolescent athletes.

Trends in pediatric baseball and softball injuries presenting to emergency departments

BACKGROUND

Millions of youth participate in baseball and softball in the United States and these youth account for a large number of pediatric sports injuries. This study sought to characterize annual, seasonal, and age-related trends in pediatric softball and baseball injuries presenting to the Emergency Department (ED).

METHODS

The National Electronic Injury Surveillance System (NEISS) database was retrospectively examined for all softball and baseball injuries from 2010 to 2019 involving pediatric patients aged 7-21 years. Patients were classified by age as children (ages 7-13), adolescents (ages 14-18), or young adults (ages 19-21). Case narratives were used to assign mechanisms of injury. National injury estimates were calculated using statistical weights provided by the Consumer Product Safety Commission.

RESULTS

An estimated 1,372,573 pediatric softball and baseball ED visits occurred from 2010 to 2019. The mean age of the patient population was 13.6 years old (95% CI = 13.5-13.8 years), and baseball athletes were younger than softball athletes (13.2 years and 14.3 years) (p < 0.01). Moreover, baseball athletes hit by the bat were younger than their softball counterparts (11.8 years and 13.4 years). Most baseball and softball injuries were the result of being hit by the ball (52.8% and 54.2%) or sliding into a base (13.1% and 15.8%). The annual number of injuries decreased during the studied time period by 41.1% for baseball injuries and by 38.3% for softball injuries. The annual number of injuries related to all injury mechanisms decreased over the studied time period for both sports, with the exception of baseball throwing injuries, which increased by 8.6%. Baseball and softball injuries were both most likely to be present to the ED on Sunday (16.3% and 17.9%) and during the Spring (53.2% and 55.3%).

CONCLUSION

Safety guidelines should focus on reducing the prevalence of injuries acquired by younger baseball and softball players during practice and educating coaches and players on existing pitch count guidelines.

Rehabilitation in Overhead Athletes With Thoracic Outlet Syndrome

Thoracic outlet syndrome (TOS) is a clinical diagnosis resulting from the impingement of neurovascular structures between the clavicle and first rib. Effective prevention and nonoperative treatment in high-performance athletes with TOS are not well documented. The objective of reporting this case was to discuss the symptom progression, relevant clinical findings, and rehabilitation of an overhead athlete with diagnosed neurogenic TOS. Numerous rehabilitative techniques may be used to treat an athlete with TOS, with an emphasis on restoring full shoulder mobility, motor control, and normalized scapular mechanics in a throwing athlete, as well as improving functional thoracic range of motion. Modalities such as neuromuscular electrical stimulation and targeted muscle exercises are incorporated in the process. In the case presented, a collegiate-level throwing athlete returned to full participation at her previous level of play within 18 weeks of rehabilitation initiation. This report details the clinical findings and treatment options available to address pathology in an overhead athlete with a diagnosis of TOS. The clinical case example shows techniques that may help guide the clinician in establishing effective nonoperative or postoperative treatments for TOS.

Level of Evidence

Level V, expert opinion.

Epidemiology of Pediatric Baseball and Softball Player Injuries

Background:

Baseball and softball are popular sports in the United States and are responsible for a large number of youth sports injuries each year.

Purpose:

To investigate recent differences in youth baseball and softball injuries evaluated in nationwide emergency departments.

Study Design:

Descriptive epidemiology study.

Methods:

The National Electronic Injury Surveillance System (NEISS) database was examined for softball and baseball injuries in pediatric patients (age, 7-21 years) from 2010 through 2019. Patients were classified as children (age, 7-13 years), adolescents (age, 14-18 years), or young adults (age, 19-21 years). Case narratives were used to categorize injuries as contact injuries (hit by bat or ball), field injuries (sliding into base, collision with another player, catching, or running), throwing injuries, or other.

Results:

An unweighted total of 24,717 baseball injuries and 13,162 softball injuries were recorded. A nationwide estimate of 861,456 baseball injuries and 511,117 softball injuries were sustained during the studied time period, with estimated respective injury rates of 86,146 and 51,112 per year. Injured softball players were most commonly adolescent (47%) and female (92%), while injured baseball players were most commonly children (54%) and male (90%). There was a greater proportion of baseball-related injuries involving the head/neck (41%) as compared with softball-related injuries (30%) (P < .01). Conversely, a greater proportion of softball-related injuries involved the lower extremity (32%) as compared with baseball-related injuries (19%) (P < .01). When comparing diagnosis, softball injuries were more often sprains/strains (28%) than baseball injuries (18%) (P < .01). When comparing mechanisms of injury, baseball athletes were more likely to be evaluated with contact injuries than were softball athletes (49% vs 40%, P < .01).

Conclusion:

Youth baseball athletes were more likely to be injured through contact mechanisms and had a higher proportion of injuries related to the head/neck/face, whereas softball injuries more frequently involved the lower extremity and resulted in a sprain/strain. League guidelines should focus on reducing contact injuries within youth baseball, and injury-prevention programs should focus on reducing lower extremity injuries in youth softball.

The Relationship between Landing Error Scoring System Performance and Injury in Female Collegiate Athletes

BACKGROUND

The Landing Error Scoring System (LESS) is a standardized tool used to identify aberrant biomechanical movement patterns during a jump-landing task. Prior authors have examined the value of the LESS in identifying ACL injury risk in athletic populations. Yet, no study has evaluated the association between LESS performance and incidence of any type of lower extremity injury in female collegiate athletes across multiple sports.

PURPOSE

The purpose of this study was to examine the association between LESS performance as measured with a markerless motion-capture system and lower extremity injury in female collegiate athletes.

STUDY DESIGN

Prospective cohort study.

METHODS

One hundred and ten DI female collegiate athletes (basketball, n=12; field hockey, n=17; gymnastics, n=14; lacrosse, n=27; softball, n=23; volleyball, n=17) completed a jump-landing test prior to the start of their sport seasons. The LESS was automatically scored using a Microsoft Kinect sensor and Athletic Movement Assessment software (PhysiMax®). Participants were tracked throughout one competitive season for incidence of time-loss lower extremity injury. A Receiver Operating Characteristic curve determined the optimal cutpoint for the total LESS score for predicting injury. Pearson's Chi squared statistics examined the association between injury and LESS total scores >5. The Fisher exact test evaluated group differences for the frequency of receiving an error on individual LESS test items.

RESULTS

Female collegiate athletes with LESS scores >5 were not more likely to be injured than those with scores ≤5 (χ2=2.53, p=0.111). The relative risk of injury to this group was 1.78 (95% CI=0.86, 3.68) while the odds ratio was 2.10 (95% CI=0.83, 5.27). The uninjured group was more likely to receive an error on lateral trunk flexion at initial contact than the injured group (p=0.023).

CONCLUSION

The LESS total score was not associated with an increased odds of lower extremity injury in this cohort of female collegiate athletes. Future studies to examine the association between individual LESS item scores and injury are warranted.

LEVEL OF EVIDENCE

1b.

Relationship Between Pitch Volume and Subjective Report of Injury in High School Female Fast-Pitch Softball Pitchers

BACKGROUND

The relationship between pitch volume and injury is well-represented within baseball literature. However, the impact of softball pitch volume on injury epidemiology is limited.

HYPOTHESIS

The purpose was to determine if increased pitch volumes in high school-aged softball pitchers are related to increased rates of subjectively reported pain/injury. We hypothesized that pitchers with increased volumes would have higher pain/injury rates.

STUDY DESIGN

Cross-sectional study.

LEVEL OF EVIDENCE

Level 4.

METHODS

A total of 28 female softball pitchers (aged 14-18 years) completed an online survey of questions pertaining to pitching history, pitch volume, and subjective report of pain or injury in the back, shoulder, and elbow. An independent-samples t test was used to (1) compare pitch volumes in those who reported pain in individual body regions (shoulder, elbow, back) compared with those who did not; (2) compare pitch volumes in those who reported pain in 0 or 1 of the regions of interest compared with 2 or 3 regions; and (3) compare the reported percentage of the past year that players reported playing through pain in players who averaged >85 compared with <85 pitches per game. Chi-square analysis was used to compare those who pitched either >85 or <85 pitches per game with regard to frequency of shoulder pain, elbow pain, back pain, seeking of medical attention, and actual injury diagnosis. Type I error was set at α = 0.05.

RESULTS

Weekly and yearly pitch counts were higher in those reporting pain or injury (YES) than those who did not (NO) in the shoulder (pitches per week: NO = 219 ± 35; YES = 429 ± 101; P = 0.027) (pitches per year: NO = 8876 ± 946; YES = 19,195 ± 4944; P = 0.022) and back (pitches per week: NO = 188 ± 16; YES = 426 ± 90; P = 0.014) (pitches per year: NO = 8334 ± 793; YES = 18,252 ± 4340; P = 0.027). Similar results were observed for those with pain or injury reported in 2 or 3 regions compared with 0 or 1 regions (pitches per week: NO = 220 ± 38; YES = 414 ± 95; P = 0.039) (pitches per year: NO = 8765 ± 1010; YES = 18,661 ± 4623; P = 0.028). Those reporting shoulder pain or injury also reported higher pitch counts per game (NO = 71.4 ± 5.2; YES = 83 ± 4; P = 0.049), and those reporting back pain also reported playing more games per week (NO = 2.7 ± 0.2; YES = 5.2 ± 1.1; P = 0.034). Those with pitch counts of >85/game were more than twice as likely to see a physician regarding pain/injury (P = 0.027) and reported playing through pain a higher percentage of the year (>85, 49.3% ± 10%; <85, 25.2% ± 6%; P < 0.05).

CONCLUSION

High pitching volumes commonly prevalent in high school-aged softball pitchers may be associated with increased pain/injury and appear related to cumulative volume.

CLINICAL RELEVANCE

This study provides recommendations for cumulative pitch volume guidelines in softball pitchers.

Epidemiology of Injuries in National Collegiate Athletic Association Women's Softball: 2014-2015 Through 2018-2019

CONTEXT

Women's softball athletes account for approximately 9% of all female athletes competing within the National Collegiate Athletic Association (NCAA).

BACKGROUND

Routine surveillance of NCAA women's softball injuries is important for identifying the emerging injury patterns in this sport.

METHODS

Exposure and injury data collected during competitive seasons in the NCAA Injury Surveillance Program during 2014-2015 through 2018-2019 (5 years) academic years were analyzed. Injury counts, rates, and proportions were used to describe injury characteristics; injury rate ratios (IRRs) were used to examine differential injury rates.

RESULTS

The overall injury rate was 3.92 per 1000 athlete exposures. Practice and preseason injury rates increased during 2015/16 through 2018/19. Most injuries were shoulder (15.2%), hand/wrist (11.8%), knee (11.2%), and head/face injuries (11.2%) and were classified as contusions (14.2%), sprains (14.1%), and inflammatory conditions (14.1%). Concussion (6.8%) was the most commonly reported injury, and concussion incidence fluctuated during 2014-2015 through 2018-2019.

SUMMARY

Results indicate an increasing trend in practice and preseason injury incidence. Findings also suggest that workload accumulation in the shoulder and the mechanisms of concussion warrant further attention in this population.

Data-Driven Risk Classification of Concussion Rates: A Systematic Review and Meta-Analysis

BACKGROUND

Concussion is a growing public health concern and generating concussion prevention programs depends on identifying high-risk sports and characteristics. Identifying the roles of sport, sex, and participation level (e.g., high school versus collegiate athletics) in concussion risk would facilitate more informed decision-making regarding sports participation and generate better targeted prevention strategies.

OBJECTIVES

The current study's objectives were to: (1) determine the magnitude and hierarchy of sports-related concussion (SRC) risk across an array of events and (2) evaluate the modifying roles of sex, participation level, and session type on SRC rates.

METHODS

A literature search was conducted on PubMed, searching concussion studies published between 2001 and December 2019. Inclusion criteria for studies required: (1) concussion occurred during sport, (2) that the SRC was clinically diagnosed, and (3) athlete exposures and concussions could be extracted or estimated. A study was excluded if it: (1) was not an original research article, (2) was not written in English language, (3) was an animal study, (4) did not have enough data to calculate SRC rates, (5) included professional or youth sample, and/or (6) contained data collected prior to 2001. The meta-analysis and meta-regression analyses were fit using a random effects model.

RESULTS

Search results returned 2695 unique research articles, with 83 studies included in analyses. Sport, sex, participation level, and session type all significantly influenced SRC rates. Overall, rugby had the highest concussion rate and was classified as the highest risk sport (28.25 concussions per 10,000 athlete exposures). Overall, females had a higher concussion rate than males. Only lacrosse demonstrated a higher concussion rate for males compared to females. Collegiate athletes had higher concussion rates than high school athletes. Games were associated with 2.01 more concussions per 10,000 AEs than practices.

CONCLUSIONS

This meta-analysis demonstrated rugby has the highest concussion risk, followed by American Football, ice hockey, and wrestling. Concussion risk was influenced by sport, sex, participation, and session. Identifying the factors and environments that influence concussion risk can facilitate risk reduction and prevention strategies.

Injury Prevention Programs for Throwing Injuries in Softball Players: A Systematic Review

CONTEXT

Throwing-related injuries occur commonly in softball players. Preventative programs can be implemented to assist in identifying and correcting risk factors that could potentially lead to injury and therefore time missed from both practice and games.

OBJECTIVE

The purpose of this study was to determine if position-specific injury prevention programs have been developed to decrease the risk of throwing-related injuries in softball players.

DATA SOURCES

A systematic review was performed using the PRISMA (Preferred Reporting Items of Systematic Reviews and Meta-Analyses) guidelines. PubMed, PMC, and EBSCO were searched for articles on injury prevention programs using the following key terms: softball, injury prevention, throwing injuries, pitcher, and shoulder.

STUDY SELECTION

Studies that involved fast-pitch softball and included female participants as well as rehabilitation programs were included. Articles that highlighted slow-pitch softball or did not include female participants were excluded.

LEVEL OF EVIDENCE

Level 1.

DATA EXTRACTION

The initial search identified 1605 articles. After implementing a filter, 131 articles remained. Thirteen articles were screened out as duplicates. After screening for inclusion criteria, 7 articles remained and were included in the systematic review.

RESULTS

Decreased range of motion (ROM) in both the upper and the lower extremities, unbalanced muscular strength, and fatigue were identified as risk factors for throwing injuries in softball players. Within the upper extremity, strength and ROM of the rotator cuff muscles, biceps, and extensors of the forearm were emphasized. The main focus of the lower extremity was the strength of the gluteal muscles and ROM of the lumbopelvic-hip complex. Only 1 study detailed an injury prevention program for softball players. The prevention program outlined was generalized for all softball players and was not position specific.

CONCLUSION

There is a paucity of information about injury prevention programs for softball players. Of the evidence analyzed, balanced strengthening of the upper and lower extremities while maintaining dynamic range of motion was frequently utilized in developing an injury prevention program.

Epidemiology of Sport-Related Concussion

Sport-related concussions are common in the United States. Concussion rates have increased over time, likely due to improved recognition and awareness. Concussion rates vary across level (high school vs college), sex, and sport. Concussion rates are the highest among men, particularly in football, wrestling, ice hockey, and lacrosse where collisions and contact are inherent to the sports, although girls'/women's soccer rates are high. In gender-comparable sports, women have higher concussion rates. Continued data collection will increase understanding of sport-related concussion and provide areas for targeted prevention in the future.