Cricket is one of Australia’s most popular sporting codes. In the 2019-2020 season, there were 709,957 registered participants Australia wide. Overall, cricket is considered a relatively safe sport, with lower injury rates when compared with other sporting disciplines. There are one group of our cricketers that have a higher risk of injury, the pace bowlers. Due to the high impact nature of a pace bowler’s action, they are at a higher risk of low back related injuries when compared with batters and slower/spin bowlers. The most notable injury, and in most cases, the longest recovery, are the stress fractures on the lumbar spine (also known as pars interarticularis fractures).
What are the symptoms?
• Unilateral (single sided) back pain – usually the opposite side to bowling hand dominance.
• Pain aggravated by bowling (lumbar hyperextension).
• Relieved by rest.
• Pain is usually associated with hamstring tightness and lower back stiffness.
What are the risk factors?
• Athlete’s age: The lumbar spine does not reach full skeletal maturity till the age of 25 years, therefore, younger athletes, primarily adolescent fast bowlers are more at risk.
• Bowling technique: Bowlers with side on and front on bowling actions are less susceptible to these injuries when compared with bowlers with mixed bowling actions.
• High workload: The recommended workload varies dependent of the age of the athlete. Factors including number of balls bowled per session, number of sessions per week, days off between bowling sessions/inadequate recovery and workload spikes are all important risk factors.
Please refer to the following link for Cricket Australia Community guidelines for junior bowlers workload at;
https://www.community.cricket.com.au/clubs/running-your-club/-/media/CAD1784F7D604B1FAB0EB50E8203D430.ashx
Junior Bowling Restrictions
With high workloads being a direct risk factor for the low back stress fractures, Cricket Australia have bowling load recommendations for all junior bowlers in U19 competitions and below. These recommendations are then adapted by individual cricketing communities/competitions to ensure the health of their athletes. As seen in the image below, there are two types of restrictions for younger bowlers – daily maximums and individual bowling spells. Not only are bowling loads an important management strategy, but so too is the rest/recovery. It is recommended that in a 4-week rotation, junior bowlers have one easy week (e.g. 1-2 bowling sessions), and a scheduled week off bowling once every 10-12 weeks. For example, a 14-year-old pace bowler should bowl no more than 5 overs in a spell, and 12 or less overs per day to reduce the risk of a stress fracture.
How can Physio Help
Low back stress fractures are generally treated conservatively (i.e. without surgery), including in elite athletes. Rehabilitation for this injury is often slow, on average, recovery can take up to 4-6 months or longer. Your physiotherapist will most likely take an injured athlete through four different phases: 1. Deload; 2. Range of movement and strengthening; 3. Reintroduction of sports specific drills and restoration of normal function; and 4. Return to sport.
Phase 1 - Deload:
Initial rehabilitation relies on the reduction of activity and appropriate rest. This is vital to help with pain management and the initial healing of the injury. In this first 4–6-week period, the inflammatory healing process will be taking place, and it is important to have adequate rest during this time.
Phase 2 – Range of movement and strengthening:
The focus of this phase of the recovery process is restoring normal range of movement, and building up the athlete’s low back, gluteal and hamstring muscle strength. Your physiotherapist with guide you through this process with a gradual progressive exercise program.
Phase 3 – Reintroduction of sports specific drills and restoration of normal function:
This phases focus is the assessment and modification of running and bowling technique of an injured athlete. In some cases, small adjustment strategies to an individual’s running and/or bowling technique will be advised to assist in reducing the risk of reoccurrence. Return to bowling is gradual and should be monitored closely by your physiotherapist and/or trained bowling coaches.
Phase 4 – Return to sport:
Once deemed safe to play by your physiotherapist and/or medical team, the athlete can begin bowling again with full run up and intensity. During this final phase, the body needs time to adapt. It is vital to monitor your workload closely, and gradually build up the bowling load as directed by your physiotherapist/trained coach.
How can we help at Golden City Physiotherapy and Sports Injury Clinic?
If you are a fast bowler who has previously experienced lower back pain or you want to get fitter and stronger for the next season, then we can help. Our team of dedicated physiotherapists can offer:
• A thorough clinical assessment and screening,
• Strength and conditioning exercise prescription, specific for cricketers trying to reduce their risk of injury,
• Advice on how to manage age related workload, fitness, and recovery.
References:
Dr Hussain Khan (OPSMC). (2021). Lower Back Stress Fractures in Cricket Fast Bowlers. Retrieved from https://www.opsmc.com.au/articles/lower-back-stress-fractures-in-cricket-fast-bowlers/