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Finish First Insider, Issue #78
October 26, 2009
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Please enjoy another issue packed with evidence-based information about sports performance training and news about current events at Finish First Sports Performance. If you find value in this e-newsletter, please forward this message to your teammates, coaches, or other parents of hard working athletes.

Shoulder Injuries for Softball players

By Emily E. Novitsky, BS, CSCS, Finish First Sports Performance Athletic Performance Specialist

As a former softball player at the youth and collegiate level I have seen an abundance of shoulder injuries over the years of my career. Luckily for me they were not my injuries, but rather many were the injuries of my teammates (still unfortunate).

They ranged from shoulder dislocations, to tendinitis, and rotator cuff issues. Since I becoming a strength coach, I frequently have athletes that approach me about pre-existing shoulder problems. It seems that shoulder injuries do not discriminate and you don’t have to be a seasoned veteran to have one.

More importantly, the game of fast pitch softball has changed dramatically. More females are involved in softball now than ever before. There has been an increase in the numbers of games played in a day, week and an entire season, not to mention the increase in the length of the season itself. The level of play is also more competitive. With the increase of all these facets of the game the other numbers that keep escalating (in addition to the others mentioned) is the total number of injuries.

Here at Finish First Sports Performance we use scientific evidence based research on every exercise program we create. For every individual athlete we take in consideration the sport, sport position, level of play, past injuries, and the individual goals of the athlete.

In this particular article we will be discussing shoulder injuries (overhand/underhand) and then discussing programming for prevention of the shoulder injuries. I want to first state that if any athlete is feeling any form of pain or has had a previous shoulder injury – s/he should consult a family physician or a specialist prior to beginning an exercise program. This intent of this article is to inform the athletes, coaches and parents about the current research, the recent increase of injuries, and how all of this affects performance programming for a softball player.

As mentioned before, shoulder injuries have been around as long as the sport of softball itself. However, since then, there has been a drastic increase in frequency of play/competition/practice and therefore unfortunately there has been a drastic increase in injury rate. According to Meyers “The increasing prevalence of overtraining syndrome among athletes has been attributed to an unclear definition of an optimal training zone, poor communication between player and coach, and the limited ability of bone and connective tissue to quickly respond to match the demands of the sport.” Therefore with the increase in play and not enough time for the body to recovery there will be a higher risk for injuries.

Meyers continues to say “This has led routinely to arm, shoulder and lumbar instability, chronic no steroidal anti-inflammatory Drug (NSAID) use and time loss injuries in 45% of pitching staff during a single season.”

Meyers also mentions in his research that “sport-specific training and conditioning will reduce the risk, rate and severity of injury.”

With the proper preparation for this ever increasing long season it is more imperative now than ever for athletes to perform a specific training program. This sport specific program (Softball) should also have an emphasis on injury prevention to the most common current overuse injury in the softball--which is the shoulder complex.

Let’s take a closer look at the shoulder and the rate of injury.

According to Meyers, 38% of all upper extremity injuries are specific to the shoulder in softball. When compared to the number of other injuries, shoulder injuries are currently the number one upper extremity injuries in softball. On that note, some sports media have claimed (anecdotal) that the fast pitch motion (underhand pitch) in softball is safer on the shoulder joint (than overhand). However, the research suggests that under- and over- hand throwing both add similar stress to the shoulder. (1,2,4) Nevertheless the majority of the stress for over hand throwing is in the deceleration movement (release portion of the throw) which puts the most stress on soft tissues and connective tissues involved in external rotation of the shoulder.(4)

In underhand throwing the majority of stress is in acceleration movement (windup of windmill pitching) and internal rotation.(4) Other interesting research involved the notion that softball players may be predisposed to injury due to the decreased joint position (flexibility) of the shoulder joint during external rotation. (1) Also mentions in the same article that a certain degree of looseness within the shoulder joint to compete at the higher levels. (1) Therefore if the joint is able to move in a more optimal degree of motion the athlete would have a decreased risk of injury.

Typically the locations of shoulder injuries are both on the anterior and posterior (front and back of shoulder), and signs/symptoms include joint pain, inflammation, instability, and increasing weakness due to overuse. Softball players are known for various muscle strains of the shoulder that would involve the trapezius, biceps, pectoralis and rotator cuff.(2,3)

The Pectoralis major is the shoulder’s power generator in both over and underhand throwing.(2) The muscles located anterior (front) of shoulder are mainly involved with the stabilization of the over hand and underhand throw. (2) The serratus anterior is involved in the synchronization of the shoulder in both forms of throwing also.(2) With knowledge of the anatomy of the shoulder and of the particular muscles that are affected by shoulder injuries, we are able to create a specialized injury prevention program.

Here at Finish First Sports Performance we take pride in our duty to help prevent these numerous shoulder injuries. As professionals we not only train athletes to prevent these injuries but we also train to fix the muscle imbalances with corrective exercises and also strengthen the entire body or Kinetic chain.

It is very important to have a healthy strong body from the bottom (feet) up (Shoulder).

The specific softball target areas of strengthening concern would involve the rotator cuff, and other muscles that stabilize the shoulder girdle (traps, pecs, bi, lats), and the core (abdominals, low back, hips). An example of the exercises that would be oriented toward softball shoulder injury prevention would be band shoulder (rotator cuff) internal rotation, band shoulder (rotator cuff) external rotation, scarecrows with weight, and bench or stability ball ATY. The ATY exercise is mainly a scapular stabilization movement. The scarecrow movement is for strengthening the rotator cuff and for increase in flexibility at the shoulder joint. Then lastly the band internal and external shoulder rotation is for increasing strength and flexibility in the rotator cuff/shoulder joint.

In conclusion the risk of shoulder injury is so prevalent in softball players that it is extremely important to have a well balanced strength program to reduce the risk of injury. At Finish First Sports Performance we automatically build an injury prevention program into every single athlete’s program, specific to each athlete and his/her sport (ie. softball players and shoulder injuries). If you have any further questions or concerns about Softball shoulder injuries feel free to contact Emily or Jeremy at or 412-787-5070.


1. The Science of Softball: Implications for Performance and Injury Prevention. Sports Medicine [serial online]. July 2006; 36(9):797-816. Available from: Academic Search Complete, Ipswich, MA. Accessed October 23, 2009.

2. Meyers M, Brown B, Bloom J. Fast Pitch Softball Injuries. Sports Medicine [serial online]. January 2001;31(1):61-73. Available from: Academic Search Complete, Ipswich, MA. Accessed October 23, 2009.

3. Hill J, Humphries B, Weidnier T, Newton R. FEMALE COLLEGIATE WINDMILL PITCHERS: INFLUENCES TO INJURY INCIDENCE. Journal of Strength & Conditioning Research (Allen Press Publishing Services Inc.) [serial online]. August 2004;18(3):426-431. Available from: Academic Search Complete, Ipswich, MA. Accessed October 23, 2009.

4. Rojas I, Provencher M, Bhatia S, et al. Biceps Activity During Windmill Softball Pitching: Injury Implications and Comparison With Overhand Throwing. American Journal of Sports Medicine [serial online]. March 2009;37(3):558-565. Available from: Academic Search Complete, Ipswich, MA. Accessed October 23, 2009.

Monitoring Iron Deficiency Anemia in Athletes

By Heather R Mangieri, MS, RD, CSSD, LDN Finish First Sports Performance Nutrition Advisor

Iron is a trace mineral important for both athletes and non-athletes alike. Most of the iron in the body is a component of two proteins, hemoglobin or myoglobin. The hemoglobin in RBC carries oxygen from the lungs and delivers it to tissues in our body. Myoglobin carries & stores oxygen for the muscles. Iron helps these proteins to hold and carry the oxygen and then release it when necessary. But that’s not all iron is responsible for.

Iron also plays a role in immune function, making new enzymes, and also making new cells, hormones, amino acids and neurotransmitters.

Prevalence rates for iron deficiency in athletes vary based on method, sport, age and nutritional status. Results are further compromised by the laboratory data used to assess the iron levels. While some studies report that athletes and non-athletes alike have similar incidence of iron deficiency, other studies report different findings.

DiSantolo, et al looked at the incidence of anemia and iron status in young fertile non-professional female athletes as compared to non-athletes (controls). They found that while the frequency of anemia and iron deficiency anemia was not different in athletes as compared to their non-athlete counterparts, athletes were threefold more likely than controls to have a low serum iron status (1). This shows that physical exercise has an impact on iron status.

While that study was looking at recreational exercise, others have studied the iron status in competitive athletes who participate in more strenuous activity and have reported different results. Risser, et al reported 31% of female athletes had a ferritin concentration below 12 ng/mL, transferring saturation less than 16% or both (2), indicating that iron deficiency may be more of a concern in competitive athletes than recreational athletes. Van Heest, et al showed (in multiple studies) rates exceeding 45% in elite competitive female swimmers using a combination of RBC, Hb, Hct, ferritin, and iron criteria (3-4).

These findings lead one to believe that monitoring competitive athletes, especially females, may be an important component in performing an overall nutritional analysis. Iron deficiency and anemia are generally not concerns in the male population. However, more recent studies are showing that male athletes who engage in strenuous physical activity are known to be at increased risk for what is termed “sports anemia” (5).

The bottom line is, while female athletes may be more “at risk” than males, both can develop iron deficiency, both with or without anemia and may be more susceptible than their non-athlete counterparts.

So why should athletes care about iron status? It is well known and accepted that iron deficiency anemia impairs performance. When iron deficiency anemia is present, VO2 max (aerobic capacity) declines as a result of impaired oxygen transport. Further, the brain relies on oxygen transport and without enough one will begin to feel fatigued and irritable, leading to decreased concentration.

Aerobic capacity has not been shown to decline in those with iron deficiency that has not progressed to anemia (6). Therefore, it is important to identify when an athlete is suffering from iron deficiency before it progresses to anemia.

Determination of iron deficiency requires an understanding of what warning signs to look for. The symptoms may include loss of endurance, chronic fatigue, high exercise heart rate, frequent injury, recurring illness and irritability. These are important to identify so that one can seek testing to determine diagnosis and ultimately seek treatment.

Once an athlete has been found to have iron deficiency, treatment should occur immediately. If iron deficiency anemia is present, supplements may be recommended along with any dietary attempts. Be aware that iron supplements should not be consumed without being monitored as iron toxicity can occur and can be dangerous.

The DRI for iron will vary depending on age, gender and other factors and should be determined. Identifying iron rich food sources to incorporate in your diet will be necessary.

When looking at a list of iron rich foods it appears that red meats and other animal based products are not much different from plant based sources, however it is important to evaluate the bioavailability of the iron in foods. The most bioavailable form of iron (heme iron) is found in meat rather than plant-based foods. Because non-heme iron absorption is lower in those consuming a predominant plant-based diet (vegetarians), iron requirements are 1.8x higher than in those consuming meats.

The following is a list of iron rich foods to consider adding to your diet:

Food Item / Mg. of iron
3 oz. Red meat / 4 mg
1 cup strawberries / 1.5 mg
3 oz. Poultry or fish / 2-3mg
¾ cup Bran flakes / 18 mg
3 oz. Shellfish / 4-5 mg
¾ cup Prune juice / 7.4 mg
4 oz. Tofu / 2.3 mg
½ cup cooked green leafy vegetables / 3 mg

If you are not sure of your iron requirement, how to incorporate iron rich foods into your diet or wish to find out more information on iron deficiency or iron deficiency anemia, email Heather at


1. DiSantola M, Stel G, et al: Anemia and iron status in young fertile non-professional female athletes. Euro J Appl Physiology, 2008, 102:703-709.

2. Risser WL, Lee EJ, Poindexter HB, et al.:Iron deficiency in female athletes: its prevalence and impact on performance. Med Sci Sports Med 1998, 20:116-121.

3. Van Heest JL, Ratliff K: Hematological and hormonal challenges in elite female swimmers. Med Sci Sports Exerc 1998, 30:S70.

4. Van Heest JL, Ratliff K: Incidence of poor iron status in national caliber swimmers. Med Sci Sports Exerc 1197, 29:S217.

5. Merkel, D, Huerta M, et all: Incidence of Anemia and Iron deficiency in Strenuously Trained Adolescents: Results of a Longitudinal Follow-Up Study. Journal of Adolescent Health. 2009, 45:286-291.

6. Haas, J.D. & Brownlie 4th, T. (2001). Iron deficiency and reduced work capacity: A critical review of the research to determine a casual relationship. Journal of Nutrition. 131(2S-2), 676S-688S; discussion 688S-690S.

Motivational Quotes

"Leadership is the challenge to be something more than average. "
-- Jim Rohn

"A man too busy to take care of his health is like a mechanic too busy to take care of his tools. "
-- Spanish Proverb

"Before thirty, men seek disease; after thirty, disease seeks men."
-- Chinese Proverb

"Prevention is better than cure. "
-- Desiderius Erasmus

Thank You for Your Support

Thanks again for subscribing to this free e-newsletter. I hope you enjoy reading it as much as I enjoy writing it. I look forward to your feedback as I continue to research to bring you the most current scientific training information available.

Should you have any specific article requests or questions, email me at Please visit for detailed sports performance training information and programs offered exclusively by Finish First Sports Performance.

Yours In Training,

Coach Jeremy S. Hoy, CSCS, USAW, Jump Stretch, Inc. Certified,
Elite Performance Scientist

Finish First Sports Performance

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