Phase I of a study on the costs, causes and prevention of recreational
See the Abstract
Each year, more than 40 million
Americans of all ages, experience, and fitness levels participate in an
estimated 23 million softball league games. Softball is the nation's most
popular sport - it is also the leading cause of all recreational sports
injuries. No national figures have been collected on softball related injuries,
but acute care medical practitioners have long recognized them as a most common
injury, affecting a significant proportion of recreational athletes. In this
retrospective study, community and hospital records in a medium-sized
metropolitan area, with approximately 8,500 recreational softball league
participants, were reviewed to determine the type, frequency and the costs of
treating game-related injuries.
The review showed a variety of injuries occurring in
softball play, serious enough to require medical attention at a hospital or
private practice physician (see Table I). Injuries
included abrasions, sprains, ligament strains and fractures. Seventy-one percent
of game injuries were related to base-sliding - a significant concentration.
This figure correlates well with other studies in which base sliding has shown
to contribute a significant percentage of all game-related injuries.
Table I : Distribution and Frequency of Softball
Mechanism Type of Injury Percent of Total Injuries
Sliding Ankle Fracture 6.8% -
Sliding Ankle Dislocation 2.7% |
Sliding Ankle Sprain 13.7% |
Sliding Knee Sprain 9.6% | Injuries due to
Sliding Finger Dislocation 9 6% | sliding = 71.1%
Sliding Shoulder Dislocation 1.4% |
Sliding Lacerations/Abrasions 13.7% |
Sliding Closed Head Injury 6.8% |
Sliding Wrist Sprain 6.8% -
Collision Finger Dislocation 11.0%
Collision Lacerations/Abrasions 5.5%
Fall Knee Sprain 9.6%
Fall Ankle Sprain 2.7%
The direct medical-care costs of these typical injuries
varies. Ankle and knee sprains, which make up the largest aggregate percentage
of injuries, required treatment averaging $200 to $400 per injury. The costs of
care and rehabilitation for fractures in the study group were as high as $5,000
per injury. Knee sprains and attendant rehabilitation can drive total costs as
high as $10,000. Multiplying the percentage of players injured, the frequency of
various types of injuries, and their treatment costs yields staggering figures
when applied on a national basis. The complete costs of a sports-related injury
go beyond direct medical costs. It includes other tangible, but difficult to
document, losses such as lowered work productivity or lost work time and wages.
Temporary or long term functional impairment, and restriction in athletic
activity are also common. The average lost work time following internal fixation
of an ankle fracture is 10 days. But for certain job types medical leaves of two
to three months may be required.
Base sliding, as a leading cause of injuries, is at
least an identifiable candidate for preventative measures (it is hard to imagine
reliable methods that could be designed to keep players from falling down or
colliding with one another- the other primary injury mechanisms). The cause of
injuries in base sliding is straightforward: the rapid deceleration of the base
runner impacting a stationary base (which requires in excess of 3,500
foot-pounds of force to disassociate) results in loading of a poorly positioned
limb, typically the lead leg or arm, causing the injury.
Three avenues of preventative action are possible
- Rules changes to outlaw sliding.
- Increasing the level of instruction in safe sliding techniques at all levels
of the sport.
- Modify the design of bases in one of two ways to reduce the hazard of
impacting the base itself:
- Change to recessed bases, similar in design to home plate.
- Change to "break-away" bases, having the same profile as current bases, but
designed to give way under lower impact forces than current stationary bases.
The results of our study sample correlate well with
other available data, indicating that softball injuries probably affect more
than a million amateur athletes annually. The fact that most injuries are the
result of a single, definable mechanism - base sliding - indicates that
preventative measures are likely to be both practical and capable of yielding
significant reductions in the injury rate and health care costs. But since
baseball and softball are steeped in their traditions, outlawing one of the more
dynamic elements of the game (base sliding) is unlikely to be acceptable to
players or fans. Increasing the level and quality of instruction on the subject
of base sliding would be difficult, if not impossible, to systematize. The study
recommends that primary consideration be given to the development of modified
bases as a means of introducing passive preventative mechanism that can operate
independent of the athletes' judgment, physical conditioning, training, or field
conditions. Modified bases represent the best opportunity for significant
reductions in softball-related injuries. Their development and deployment at all
levels of baseball and softball could have a dramatic affect on the health and
fitness of athletes and the reduction of health care costs nationally.
David H. Janda,
Director, Institute for Preventative Sports Medicine
Surgery Associates, P.C.
Ann Arbor, MI
Edward M. Wojtys, M.D.
Section of Orthopaedic Surgery,
Michigan, Ann Arbor, MI
Fred M. Hankin, M.D.
Community Orthopaedic Surgery, P.C.
Milbry E. Benedict, M.A.
Former Head Baseball Coach,
University of Michigan, Ann Arbor, MI
"Softball Injures: Cost, Cause and
American Family Physician,
Janda, F.M. Hankin, F.M. Wojtys.
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