Professional Baseball Strength & Conditioning


Management of Acute Injuries in Baseball and Softball Games and Practice

By Nate Shaw and Ryne Eubanks, Arizona Diamondbacks

All sports, including youth and high school baseball and softball, have inherent risks. If you play long enough, nearly everyone will, at one time or another, get injured. For most athletes, it’s not a question of “if you are going to be hurt“, but rather when will it happen and will your coach and/or parents be ready to manage it. All professional and college teams have one or more athletic trainers on hand for every game and practice session to attend to injuries. Unfortunately, that is not the case for many high schools and most recreation and travel teams.

The purpose of this article is to provide basic guidelines that coaches and parents can use to manage common, acute, sports injuries in baseball and softball until medical help can be reached if needed.

An acute injury often occurs as a result of a fall, hit, collision, slide, etc. It is frequently the result of a specific motion, movement or activity, e.g., twisting an ankle when rounding or sliding into a bag, getting hit by a baseball/softball, jamming a finger when fielding a ball, etc. It can also be a non-contact injury, such as, cutting, jumping, landing and twisting a joint, often a knee or ankle. Key indicators of many acute sports injuries include constant pain, significant loss of function and swelling.

Conversely, chronic injuries are usually the result of overuse or repetitive motion, such as pain in the elbow and/or shoulder after throwing too many pitches, wrist or backache after too taking many swings, ankle, knee and/or hip pain after running too many sprints, too much distance or both, etc. Chronic injuries produce stress to musculoskeletal structures and often result in tendonitis. Typically, pain from chronic overuse injuries worsens during activity and may subside during rest when the injured area is not being used.

What’s the first thing to do after an injury? The first thing a coach should do when an injury occurs is to remove the athlete from playing, i.e., protect the athlete and site of injury and have someone look at the injury. Don’t let the athlete try to walk it off or shake it off. In a minor acute injury, the pain will usually subside within a few minutes and the player can often return to the game. Serious injuries, however, will have longer-lasting, more severe pain, and allowing the player to return to the game can make the injury worst.

Approximately 90% of all acute sports injuries are strains, sprains and/or contusions.  Therefore, this post will address proper responses to acute, i.e., sudden onset, of these types of injuries.

What’s the difference between a strain, sprain and contusion? A strain involves muscle tissue and tendons. Common strains in baseball include injuries the hamstrings, quadriceps and muscles of the wrist and hand. Sprains involve ligaments and common sprains include injuries to the shoulder, elbow, knee and ankle joints. Contusions are injuries to the skin and/or underlying tissue in which blood capillaries have been ruptured. Most contusions are the result of being hit by a ball or bat, sliding and collisions with another player or stationary object, etc. Contusions often result in bruising of the skin and sometimes swelling of tissue.

Injury management? While each of these types of injury can have different causes, the acute management of each is relatively the same, RICEP.  Rest the injury. Ice the injury once every hour for 20 minutes. Compress the injury by wrapping it with an ace bandage or immobilize it with a splint. Elevate the injured area above its normal resting position to prevent swelling. Protect the injured area from external forces by limiting movement and immobilizing the body part with a splint, sling or brace. The following steps are recommended for most acute baseball/softball injuries.

  1. REST – Resting an injured area is the first and one of the most important treatment options. Healing occurs faster when stress is reduced.

  2. ICE – The purpose of icing is to constrict the blood vessels in an injured area to slow down swelling and bleeding. Applying ice following a contusion and other musculoskeletal injuries causes vasoconstriction of the local blood vessels, and can help deaden some of the pain, decrease muscles spasm resulting from the injury and allow movement and reconditioning of the injured area to proceed a little faster. While ice tends to be more effective when crushed, placed in a moist towel or plastic bag and applied to the site of injury, commercial cold packs or gel packs are effective and easy to pack. Don’t put ice or ice packs directly on the skin. A plastic bag isn’t enough to protect your skin from ice burn. You should always wrap the ice in a towel or other thin cloth.

  3. COMPRESSION – Compression is used to put pressure on an injured area to help decrease swelling. It is best applied in the form of an elastic wrap. Wrap the ice towel, plastic bag or ice pack with an elastic compression bandage to help control swelling. Using an elastic wrap will allow some expansion in the event of sudden swelling. Apply the wrap in a circular pattern starting at a point near the fingers or toes and wrapping toward the body squeezing gently. Wrapping distal (bottom) to proximal (top) will help prevent the distal collection of extracellular fluid. In wrapping a knee, for example, start 6-7 inches below the knee and finish 6-7 inches above the knee. Don’t wrap the bandage too tight or circulation may be impaired.

  4. ELEVATION – Elevation is also used to inhibit swelling. By elevating an injured area, e.g., ankle, helps combat gravity which tends to pull blood and fluids down to the injured area where they pool. Elevating the injured area can also facilitate the removal of waste and helps restore normal circulation. Elevate the injured area after it has been ice has been applied and the area has been compressed with an elastic bandage.

  5. PROTECTION – Protection means to provide support to the injured area. When the area is not being treated with rest, ice, compression and evaluation, it should be protected by some type of support such as a brace, spline, dry elastic bandage, etc. In order for an acute injury or the recurrence of swelling, use RICE and keep the injured area supported and protected at all times.

 Treatment Time. The treatment of ice, compression and elevation should be used for 20-30 minutes at a time as often as possible during the first 48-72 hours after an injury or whenever swelling is present. Do not use heat at any time.  Heat increases swelling so, there is no place for heat in the treatment of acute injuries. Always use ice unless a medical expert provides different instructions.

Longer is not better, i.e., 40-60 minutes is not better than 20-30 minutes. Longer application times may cause tissue damage. It is better to apply ice several times per day than fewer times of longer duration. When you apply ice, the affected area will go through 4 stages – CBAN. C stands for cold, B for burn, A for ache and N for numb. Twenty to 30 minutes is a general guideline. Some players may not be able to tolerate the full 20-30 minutes. If you are unsure when to stop, use the CBAN method. It provides the body’s feedback to tell you when to remove the ice. When you first apply the ice, it should feel cold. The feeling should progress to a burning sensation. This should only last for a few minutes. Next, the area will feel achy. When the injury starts to feel numb, it is time to remove the ice. This is true regardless of how much time it’s been on the player’s body.

 When should you see a doctor? When injuries are serious or if there is an obvious abnormality of a limb, take the player to the nearest emergency room or clinic. For minor acute injuries, like possible strains and sprains, a more conservative approach might be taken. Coaches/parents should apply RICE and make an appointment with a physician or sports injury clinic to help correctly diagnose and treat these types of injury.

Coaches are encouraged to get certified in First-Aid and Injury Management through local Red Cross and Hospital Programs. On-line course information can be found at:







Nate Shaw, CSCS, ATC is Major League Strength and Conditioning Coach and Ryne Eubanks, ATC is Assistant Major League Athletic Trainer for the Arizona Diamondbacks.

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