A Narrative Review of Softball Pitching Workload and Pitch Counts in Relationship to Injury

Context: Fastpitch softball is a popular women’s sport in the United States, and participation rates are increasing. There is growing concern about the prevalence of overuse injuries in softball pitchers at all competitive levels. Pitching workload in softball may be a modifiable risk factor and will be discussed in this narrative review. Evidence Acquisition: A review of softball injury research related to workload available in electronic databases, including PubMed, Medline, and EBSCO. Study Design: Clinical review. Level of Evidence: Level 4. Results: There is a paucity of research evaluating workload (inclusive of internal and external risk factors) including pitch counts in women’s softball. In particular, research has shown that pitchers report increasing fatigue and pain over a game and weekend tournament, and that the number of pitches thrown by pitchers varies widely. One study showed that pitchers throwing >85 pitches per game had an increased risk of injury over the season. As of 2023, no established pitch count restrictions exist in the United States or Canada. Further research, particularly at high school and collegiate levels, is needed. Conclusion: Softball pitchers are at an increased risk of overuse injury and further research is needed to recommend specific workload interventions such as pitch counts. Strength-of-Recommendation Taxonomy (SORT): B.