Lumbar spine stress fractures are a common and persistent injury among cricket fast bowlers, particularly adolescents. The repetitive and high-intensity nature of the bowling action can put huge stress on the lower back, leading to the development of stress reactions and possibly stress fractures in the lumbar vertebrae.
Over the past few years as both a cricket coach and a physio I have seen an increase in the number of these injuries, particularly amongst those fast bowlers who are playing representative cricket.
I can count 10 of my sons' team mates over the past few seasons who have succumbed to season ending low back injuries and a couple who ended up missing close to two seasons because they came back too early.
Why are adolescent lumbar spines so susceptible to these injuries?
Compared to adult spines, adolescent lumbar vertebrae are still 'soft' and therefore do not cope with repetitive stresses as well. If you hammer a young green tree it will bruise more easily than a seasoned bit of timber. The repetitive nature of lumbar extension, lateral flexion and rotation of the bowling action puts increased load on the lower lumbar vertebrae leading to a bony 'bruise', stress reaction and then if it continues a stress fracture.
DID YOU KNOW THAT ITS NOT ONLY FAST BOWLERS WHO CAN INUURE THEIR LUMBAR SPINE? SPIN BOWLERS CAN TOO!
When do we see these injuries?
Often it's now - in the pre season or start of the season.
Bowling loads ramp up quickly after a winter break, as pre season training commences. Rep trials, Rep team practice, Green Shield Practice, Academy Training etc all contribute to an increased load and often none of the respective teams are talking to the others about your child's bowling load - they all want your child bowling as much as possible for them
What does it feel like?
For right hand bowlers, it starts as a low level ache on the lower left part of the lumbar spine. Usually after bowling, but it settles with rest. As the injury worsens towards a stress fracture, you will feel the pain while you are bowling and then during other activities in the day. Rest may not completely resolve the pain. The pain becomes sharper until you eventually cannot bowl because of the pain.
How do you prevent it from happening?
Quite simply, by not allowing the lumbar sine to become overloaded. Cricket Australia, along with expert researchers, have developed guidelines for young fast bowlers around how much they should bowl during a week etc.
Some bowling actions are also more susceptible to placing increased load on the lumbar spine. Mixed bowling actions, where the top half is front on and the bottom half side on, in particular place a greater amount of strain on the lumbar spine. Getting some good advice and coaching from a specialist bowling coach can help reduce the load on the lower back.
Recognising the early symptoms can also help preven the injury getting worse. Seeing an experienced physio or sports physician when sympytoms begin can certainly help prevent a stress fracture from developing. Each cricketer I see with these symptoms is referred early for an MRI and placed on a program relevant to the seriousness of the injury. That could mean complete rest or batting only.
Check out the Cricket Australia Junior Bowling Guidelines at this link
Treatment of Lumbar Stress Injuries
The management of lumbar stress fractures requires a comprehensive approach. Initially, rest and avoiding activities that exacerbate the pain are essential to allow the bone to heal. A period of complete rest from bowling, coupled with appropriate pain management is usually recommended. A structured rehabilitation program focusing on core stability, flexibility, and strengthening exercises on the lumbar spine, pelvis and lower limbs is crucial for a safe return to bowling. Once a player is pain free and has reestablished the requisite physical attributes, a graduated bowling plan is established.
Talk to one of our expert physiotherapists if you are feeling any soreness in your lower back during or after bowling. Getting the right advice and rehabilitation early on could save you a lot of ache and loss of playing time!
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