Sloma et al. (2025) published a systematic review to summarize the existing research on clinical and performance outcome measures used to evaluate softball pitchers and identify gaps in the literature. The authors followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and searched four databases (PubMed, Embase, CINAHL, and SPORTDiscus) for studies published since 1990 using the search terms “softball” combined with “pitching” or “injuries.” Studies were included if they examined softball pitchers and reported clinical or performance measures such as range of motion (ROM), muscular strength, anthropometrics, functional testing, body composition, imaging, or patient-reported outcomes. Two independent reviewers screened articles, and disagreements were resolved by a third reviewer. Of 1,963 studies initially identified, 37 met all inclusion criteria and were included in the review. All included studies were judged to have a low risk of bias using the Joanna Briggs Institute Critical Appraisal Checklist.
They found:
The included studies examined:
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Body composition: 4 studies
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Range of motion (ROM): 10 studies
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Strength: 12 studies
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Functional testing: 4 studies
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Patient-reported outcomes: 3 studies
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Numerous imaging and case studies were also summarized.
There is currently no standardized clinical assessment battery for softball pitchers.
Range of Motion (ROM)
The review reported several consistent findings.
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Most healthy pitchers show no meaningful bilateral differences in shoulder internal rotation, external rotation, or total ROM.
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Shoulder and hip ROM change in response to workload, particularly over seasons and doubleheaders.
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Multiple studies reported decreases in:
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Hip internal rotation
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Hip external rotation
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Hip total ROM
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Shoulder ROM following heavy workloads.
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Pitchers with shoulder pain demonstrated less trail hip external rotation than pain-free pitchers.
Hip mobility—especially trail hip ER—appears closely related to shoulder health.
Strength
Strength testing was the most commonly reported clinical assessment.
Key findings included:
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Stronger hip external rotators were associated with better kinetic chain energy transfer.
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Pitchers without upper-extremity pain demonstrated:
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Greater hip strength
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Greater shoulder external rotation strength
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Greater shoulder internal rotation strength.
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Tournament and game exposure consistently produced measurable decreases in:
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Shoulder strength
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Hip strength
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Grip strength
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Forearm strength
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Periscapular strength.
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Fatigue affects the entire kinetic chain—not just the shoulder.
Anthropometrics
Studies showed:
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Pitchers possess greater:
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Lean mass
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Bone mineral content
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Throwing-arm mass
than their non-throwing arm.
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Body composition also influenced ROM, with higher body fat associated with altered shoulder and hip mobility.
Imaging
Medical imaging studies identified several common overuse injuries.
These included:
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Ulnar stress fractures
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SLAP tears
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Biceps tendon injuries
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Scapular dyskinesis
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Rib stress fractures
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Coracoid injuries
Ultrasound studies demonstrated that approximately 60 pitches can produce measurable increases in long-head biceps tendon thickness, indicating an acute inflammatory response.
Imaging confirms that tissue changes occur even during a single pitching outing.
Functional Testing
Functional assessments included:
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Single-leg squat
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Vertical jump
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Athletic Shoulder Test
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Various fatigue assessments
Several studies demonstrated relationships between poorer functional movement quality and altered pitching mechanics or shoulder pain.
Patient-Reported Outcomes
The review identified several commonly used questionnaires:
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Kerlan-Jobe Orthopaedic Clinic (KJOC)
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DASH
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FAST
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Visual Analog Scale (VAS)
Implications: The authors concluded that although research on softball pitchers has increased substantially over the past decade, there remains considerable inconsistency in how athletes are evaluated. Clinical assessments vary widely across studies, making it difficult to compare findings or establish evidence-based screening protocols. The strongest evidence supports routinely evaluating shoulder and hip range of motion, upper- and lower-extremity strength, body composition, functional movement quality, and patient-reported outcomes. The review also reinforces the importance of the kinetic chain, as hip mobility and strength are consistently associated with pitching performance, shoulder loading, and injury risk. Furthermore, imaging studies demonstrate that repetitive pitching produces measurable tissue changes, particularly within the long head of the biceps tendon, even in healthy athletes. The authors recommend developing standardized testing batteries for softball pitchers so clinicians, researchers, athletic trainers, strength coaches, and physicians can consistently monitor performance, fatigue, rehabilitation progress, and injury risk. They also emphasize that softball-specific assessment protocols are needed rather than relying on baseball literature because the injury patterns and pitching mechanics differ considerably between the two sports.
Key Takeaways
This review highlights that the most valuable clinical assessments for softball pitchers include:
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Shoulder and hip ROM
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Hip and shoulder strength
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Functional movement quality
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Body composition
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Imaging (when clinically indicated)
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Patient-reported outcome measures
Together, these assessments provide a more complete picture of pitching performance, fatigue, and injury risk than any single measure alone.
Important Biomechanics Connection
This systematic review strongly supports the kinetic-chain model. Across the literature, deficits in hip mobility, hip strength, trunk function, and shoulder strength were repeatedly associated with altered pitching mechanics, upper-extremity pain, and reduced performance. The review also reinforces previous findings that tissue-level changes, such as increased long-head biceps tendon thickness, can occur after a single pitching outing, emphasizing the cumulative effects of workload. Perhaps the most important conclusion is the need for a standardized softball-specific screening battery, combining ROM, strength, functional testing, and workload monitoring to identify injury risk early and guide performance training. These recommendations line up with what we have covered here on lower-body force production, kinetic chain sequencing, and movement screening.
Also…
If there was a single strength coach that I would adamantly say was the best in baseball, it would be Zach DeChant at TCU. He’s been posting content since before it was cool. Here is a post to check out from him. I highly recommend a follow.
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