Recently a number of adolescent cricketers have been brought to my clinic by their parents for treatment for low back pain. These young cricketers are predominately fast bowlers or as one 14 year old described himself as, “well that kinda bowler”. Two of these cricketers are playing either for their school and club or club and county, so a lot of cricket during the season.
Research carried out in South Africa and presented at the World Congress on Sports Injury Prevention in 2005,showed that fast bowlers are the most prone to injury,especially in the young, and that they are responsible for 60% of all cricket related injuries. Dr John Orchard (2005) found that 16% of elite pace bowlers became injured compared to 4% of spin bowlers and that the risk of injury increased if either had batted first.
Why Fast Bowlers
- Firstly it’s the repetitive nature of bowling, which can be said for many sporting actions.
- Large amount of force and impact through the body, > 5-6 x total body weight with bowling up to 160km/hr.
- Requires trunk flexion, extension and rotation at maximum delivery.
What are the Risks for Adolescents?
- Repetitive micro trauma to tissues combined with fatigue due to an immature musculo-skeletal system. It’s not a single bowl that generally causes damage but the accumulation or workload which exceeds the tissues’ threshold.
- Spondylolysis or stress fracture of vertebrae due to hyper-extension, combined with rotation of the lumber spine. The young spine is still ossifying and therefore the cartilage is vulnerable to compression as the vertebrae do not fully ossify until at least 25 years old. There can also be a genetic factor involved ie. thin vertebrae.
- Sacro-Illiac Joint (SIJ) and Ligament Strain. The SIJ dissipates force/load from the trunk through the pelvis to the legs and is therefore vulnerable to repetitive torsional strain associated with bowling. It is thought that hyper-extension produces the greatest amount of movement through this fairly immobile joint (Sherman 2011). Assymetric movement about this joint can increase risk of instability or stiffness which may lead to leg length difference and further biomechanical complications. The SIJ appears to become less mobile through adaptive changes from 30s on therefore adolescents will still be vulnerable due to instability.
- Iliolumbar Ligaments provide stability to the SIJ and lumbar spine, these powerful ligaments are still immature in the adolescent and therefore they have reduced stability until maturity in the third decade. A strain to these ligaments through repeated forward flexing, twisting or sudden movements can cause low back or even referred groin pain.
How to Prevent or Minimise Injury
Australian Rebecca Denis (2005) from Ballarat University conducted research into repetitive type injuries in cricketers with an aim to prevent injury to fast bowlers. In her research she highlights 3 risk factors for injury:
Dr Orchard (2005) described delivery positions of bowlers as ‘side on’, ‘front on’, ‘semi open’ or a ‘combination’ or ‘mixed’. He proposed that the combination or mixed bowlers were more prone to low back injuries. My technical knowledge of cricket let alone bowling is not good enough to comment on this proposition so I’ll leave this to the cricket coaches out their to do their own research!
It is thought that most injuries are sustained either at the beginning of the season when the bowler is not fully conditioned or at the end of the season due to fatigue. In either case this shows a requirement for pre-season preparation for strength and stamina.
Fast bowlers obviously require a mix of speed, strength and endurance and will also be doing some batting, particularly adolescents who will have to be ‘all rounders’ at this stage. Pre-season is the time to focus on endurance and then strength, concentrating on speed and technique at the beginning and during the season.
Important considerations for adolescents are growth spurts where the body shape is changing. These are vulnerable times for young sportsmen as they are more prone to injury, so a reduction in training is important at this time. Co-ordination may even be a problem during a growth spurt as they get used to their new height/longer limbs. Posture should always be a focus of attention, especially with the hours spent behind a school desk and computers.
Core strength work can be done year round, good ‘pilates’ type exercises to make sure you have good strong abdominals and low back and that your upper back muscles are recruited to prevent a hunched posture. Stretching is really important too. Many young patients that I’ve treated have short hamstrings which will have a negative effect on their low back and restrict their bowling technique.
The research by Dennis (2005) led to proposed workload guidelines for fast bowlers; an example from this research is:
Adults: 40 deliveries a session and 188 a week
Under 19s: 42 deliveries a session and 246 a week
Under 15s: 36 deliveries a session and 132 a week
Under 13s: 30 deliveries a session and 108 a week
Rest days were also a big factor in preventing injuries throughout the season. please read this article for further details.
I hope that you found this blog useful and if you require any further information please reply to this blog or for appointments in Ealing or NW5 email firstname.lastname@example.org or call on 07956 954093. I have experience in treating patients who play a wide range of sports, including cricket and have experience in competing at international level squash.