Symmetry Blog

Injury of the week - Lumbar Stress Fractures

Symmetry Physio - Wednesday, July 10, 2019

If you are watching World Cup Cricket you are bound to see some fast bowlers suffering from this.

 

Injury of the week - Lumbar Street Injuries

As the cricket world cup comes to a close and the final game being played on Sunday we take a look at lumbar stress fractures which are prevalent in cricket fast bowlers.

Risk factors

Three risk factors have been identified for development of stress injuries.

  1. Age of the player with younger players at higher risk.
  2. The players bowling technique. The bowling technique involves a combination of twisting the trunk, arching and side bending the back. When this is done repeatedly it can lead to overloading the lumbar spine and can eventually result in stress injuries particularly at the lower lumbar vertebrae. The more the bowler extends their back and rotates the higher risk of injury.
  3. Spikes in workload (bowling number and frequency)

Types

There are a few classifications of stress injuries that can occur. In young fast bowlers there tends to be a stress reaction or stress fracture that may eventuate in circumstances where the player dramatically increases their workload over a short period of time. This may be seen when young players go from state to international squads increasing the demands and number of balls bowled. In these players conservative management means keeping them out for many months. Full bone healing is closely monitored before returning to specific exercises, training and then games. The younger player needs to be fit and strong and fully recovered from injuries so there is no compromise on technique that will risk re-injury. The use of imaging such as high quality MRI can aid with confirming the injury then later to assess the resolving bone oedema and indicate healing.

The other stress injuries that occur are acute on chronic and chronic. These are generally seen in the older player when workloads may have not been managed appropriately e.g. going from T20 cricket only requiring bowling 4 overs to a Test match requiring 50 overs without adequate time to build up. It can also happen as a result of another injury in another area of their body that may have altered their bowling technique leading to a change in pressure through the spine. For example following an ankle sprain. With these types of flare ups anaX older player may be able to return a little earlier as they seem to cope better with loading given some baseline tolerance they may have.

Symptoms

  • Pain in the lower back generally in the opposite side to the bowling arm
  • Pain worsening with activities such as bowling, throwing and running.
  • Pain with back arching
  • Pain improved by resting

 

Management

Often physiotherapists are the first to identify potential cases of stress injuries and once confirmed in conjunction with medical doctors and coaches, physiotherapists will assist in the management. Firstly, an important step is identifying the potential cause of the stress injury. Looking at the change in bowling workloads and assessing the type of bowling technique the player has is important to identify possible reasons for onset.

In all cases bowling will most likely be restricted and any other aggravating activities such as running or throwing will be cease or limited for approximately 6-8 weeks. Other forms of safe exercise will be encouraged based on the individual to maintain strength and fitness.

Once bone healing and resolution of bone oedema has occurred a gradual return to strengthening working on any muscular weakness particularly around the legs, hips and pelvis and trunk and cricket specific activities such as net batting, fielding and throwing will be closely monitored. Lastly return to running and finally bowling will be monitored with use of the the recommended Cricket Australia age specific guidelines for bowling numbers and frequency when getting back into full training and games.

Return to play will be longer if they are required to get back to the longer game format e.g. Tests compared to the shorter format of T20.

Kim Garland                                                                                                                                  Symmetry Physiotherapy


 

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