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Softball Injuries

Phase I of a study on the costs, causes and prevention of recreational softball injuries

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 Causes
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 Injuries

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 Costs
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.

Prevention
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

  1. Rules changes to outlaw sliding.
  2. Increasing the level of instruction in safe sliding techniques at all levels of the sport.
  3. 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.

Recommendations
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.

Researchers
David H. Janda, M.D.
Director, Institute for Preventative Sports Medicine
Orthopedic Surgery Associates, P.C.
Ann Arbor, MI

Edward M. Wojtys, M.D.
Section of Orthopaedic Surgery,
University of Michigan, Ann Arbor, MI

Fred M. Hankin, M.D.
Community Orthopaedic Surgery, P.C.
Huron Valley Hand Surgery
Ypsilanti, MI

Milbry E. Benedict, M.A.
Former Head Baseball Coach,
Department of Recreational Sports
University of Michigan, Ann Arbor, MI

Published as:
"Softball Injures: Cost, Cause and Prevention:"
American Family Physician,
33:143-144, 1986;
D.H. Janda, F.M. Hankin, F.M. Wojtys.

It is possible to order a copy of this published article


Copyright 2001 The Institute for Preventative Sports Medicine. All rights reserved.