• Cricket Back Problems

    Research findings from South Africa that were recently presented at the 1st World Congress on Sports Injury Prevention in Olso, have indicated that young fast bowlers are the players most prone to injury. The ‘Gentleman’s game’ is far from genteel, with the athleticism and intensity of modern cricket leading to greater strain on player’s bodies.

    The findings of the Nelson Mandela Metropolitan University researchers found that bowling (41%), fielding and wicket keeping (30%), and batting (16%) accounted for the majority of the injuries. The primary mechanism of injury in these cricketers was found to be the delivery and follow through of the fast bowler (26%), fielding (23%), overuse (17%), ball impacts (7%), training (4%), and participation in other sports accounting for 3%.

    Dr John Orchard has published the most in depth investigations on cricket injuries. His findings show that overall there is a relatively low incidence of injury in cricket when compared to other sports. His study of elite Australian cricketers showed that the average seasonal incidence was around 18-19 injuries per squad (25 players) per season (20 matches).

    Orchard reported injury prevalence (the percentage of players missing through injury at any given time) as 14% for pace bowlers, 4% for spin bowlers, 4% for batsmen, and 2% for wicket keepers. Bowlers who had bowled more than 20 match overs in the week leading up to a match had an increased risk of sustaining a bowling injury, and this risk was further increased if a player is bowling second in a match – that is, batting first.

    Lower back pain is particularly common in younger fast bowlers. Previous research has reported that these injuries occur in up to 60% of cricket players. The reason for such a high incidence of back injury has been attributed to a combination of factors. These include inadequate physical and physiological preparation, relatively reduced bone density following a ‘growth spurt’, postural defects, biomechanical aspects of the bowling technique, rapid escalation in training frequency, duration of bowling spells in matches, and the repetitive nature of movements.

    Stress fracture of the lumbar spine is a common injury in young fast bowlers. Fast bowling in cricket requires a combination of spinal hyperextension (bending back) together with rotation and side flexion of the trunk. This puts a lot of stress on an area of the vertebra called the ‘Pars Interarticularis’ and this is where stress fractures develop.

    Lower back stress fractures are usually characterised by an ache in the lower back which is exacerbated by sporting activities and eased by rest, although a small percentage of people with a stress fracture can be pain free. Typically it is sore when the patient bends backwards, particularly if standing on one leg. If a lower back stress fracture is suspected, a doctor may decide to refer the patient for a scan to confirm the diagnosis.

    In most cases, complete rest from sport is the treatment of choice. This would usually be for a period of 6 weeks to allow the bone to heal. During this period a progressive exercise program may commence, under the supervision of a chartered physiotherapist. This usually starts with exercises to increase the muscular stability in the lower back. Research has shown that a lack of muscular stability in the lumbar and pelvic regions can lead to low back pain.

    Research has shown that specific exercises can be effective in relieving back pain and restoring normal function. These exercises are most effective for what is called ‘mechanical low back pain’, where the problem is caused by poor postural habits and the pain resulting from by disc problems. Once the correct technique has been mastered, these exercises are very easy to do. They are not too vigorous and they can be done by people of all ages.

    The principle behind the exercises is that if certain specific muscles can be recruited or contracted, the spine will have much better support. This prevents postural faults which can predispose a person to back pain.

    In order to understand how these exercises are effective, it is necessary have a brief introduction to how the back is supported by muscles. The first muscle we are concerned with is called Transversus. This muscle arises from the middle of the tummy and goes right around the midriff, attaching itself to the spine.

    The Transversus muscle acts as a natural corset and provides stability for the lower back.

    The second muscle involved in this exercise programme is the Multifidus. This muscle lies deep in the spine and attaches in between each vertebra. When it contracts it increases the stability of the spinal column.

    If you can contract the Transversus muscle, the Multifidus muscle is also contracted automatically. This improves spinal stability and can relieve back pain.

    The ‘Stabilizer’ was developed by physical therapists at the University of Queensland. Its prototype was a modified blood pressure cuff, and the Stabilizer works as what is called a pressure biofeedback device. Depending on the pressure exerted on the air filled chamber the reading on the dial changes. This means that when placed against specific muscles the muscle action causes a change in the readout on the dial.

    The Stabilizer is a simple device that can be used by patients to provide feedback to ensure quality and precision in exercise performance. The Stabilizer can be used at home to relieve back pain and neck pain.

    The stabilising muscles of the lumbar spine and pelvis (Transversus and Multifidus) can be recruited using the Stabilizer Pressure Biofeedback unit.

    The three chamber pressure cell of the Stabilizer is placed under the abdomen with the patient lying face down. The pressure cell is inflated to the baseline pressure level of 70 mmHg.

    The patient gently contracts the Transversus and Multifidus by drawing in the abdominal wall without moving the spine or pelvis. This subtle movement should not be confused with breathing in and holding, or contracting the ‘six pack’. During the contraction of the Transversus and Multifidus, the dial should drop to between 60 and 65 mmHg.

    The contraction of Transversus and Multifidus should be maintained for 10 – 15 seconds whilst continuing to breathe normally. The patient should aim for 10 repetitions to start with.

    Maintaining a steady contraction may be difficult at first, but with practice as the muscle control improves the needle on the dial becomes more steady. The patient should progressively increase the duration of the contraction before progressing on to using the Stabilizer in more functional positions.

    Gregory, P.L., Batt, M.E., and Kerslake R.W.(2004) Comparing spondylolysis in crickete rs and soccer players British Journal of Sports Medicine . Vol 38, page 737 – 742.

    Orchard, J., James, T., Alcott, E., Carter, S., Farhart, P., and  Newman, D. (2002) Injuries in Australian cricket at first class level 1995/1996 to 2000/2001. British Journal Sports Medicine Vol 36, page 270 – 274.

    Stretch, R.A. and Orchard, J. (2003) Cricket injuries: a longitudinal study of the nature of injuries to South African cricketers British  Journal of Sports Medicine , Vol 37: page 250 – 253.

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