Hi there, my name is Josh Wilson of Minlaton District School. Being from the country, sport is a large passion of mine, especially cricket. It struck me however, with the number of local cricketers being affected by back injuries, including my team.

It seemed there was a real lack of awareness for back injuries from fast bowling and I wanted to change this. Help me to raise awareness to reduce the effect of lumbar spine injuries from fast paced bowling in cricket by sharing this website.

Thank you for reading.

How do lumbar spine injuries occur in cricket?

[4]The biggest misconception is that cricket doesn’t require fitness. This misconception can be potentially dangerous. Parents, coaches and players don't understand how physically demanding fast bowling is in cricket. The action of fast paced bowling is a difficult skill to master, bowling effectively requires balance, co-ordination, power and timing. A bowler is expected to bowl a large number of deliveries at maximum effort (depending on what match format for how many balls bowled). 

Pars stress fractures are thought to be caused by repetitive hyper-extension and rotation of the spine[5]. Bowling is very physical, requiring lots of repeated power movements and coordination. [6]Too much bowling is the main reason for cricketers obtaining a lumbar stress fracture, but it should also be mentioned that genetic disorders can also lead to an increased risk of obtaining a lumbar stress fracture. Genetic bone disorders are a very broad field, and more information is at the following website: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6342881/

Physical effect of lumbar stress fractures:

1. Back pain (any back pain felt after bowling should be looked at by a doctor).

2. Pain is felt in the lower back but can also radiate to the sides of back, buttock, thighs and chest.

3. Back pain worsens with activity

4. Muscle spasms

5. Back stiffness

6. Difficulty standing or walking

7. Long term effects of spine stability and function

8. Pressure on the spinal nerve root (this can result in numbness, tingling and potentially paralysis of limbs)

It should be mentioned that the physical affect of lumbar stress fractures can be devastating. Doctors are very cautious to ensure that the spine has fully healed before the cricketer returns to bowling. It is common for cricketers to continue bowling with back pain for many reasons, including; feeling obliged to helping the team as a fast bowler, peer-pressure, not understand that the back pain could be from a stress fracture and because the pain is often minor, bowlers keep bowling until a fracture occurs.

Time lost due to stress fracture:

Early diagnosis of a stress fracture is important to minimise recovery time. [7]That said, the process for a lumbar stress fracture to fully heal takes around 12 to 16+ weeks, which is much longer than most sporting injuries.[8] During this period, no bowling can occur which can have a large impact on the players performance and mental health. Running, swimming and other fitness exercises can still be undertaken, as well as light gym workouts, under professional supervision.

 Interview with the A-grade captain for the Eastern Districts Cricket Club, Troy Goldsworthy:

Josh: Good evening Troy, have you ever sustained a lumbar stress fracture in your career? 

Troy: After having lower back issues off and on for a few months, where naturally the more physical activity I did, the worse it would get and only after a couple of weeks of practically complete rest would things return to 'normal' we finally worked out through an MRI scan that I had a fracture in my L5 vertebrae.  

Josh: how did this impact your cricketing performance?

Troy: I was fortunate in that the doctor I saw at Sportsmed in Adelaide had previously been the team doctor for a state cricket team and had seen it all before. He suggested that due to in-between nature of my bowling action being not fully side or front on that it would continue to wreak havoc unless something was done about it. 

Changing a bowling action isn't something that's easily done as a 14–15-year-old playing club cricket so it resulted in me having a full season off of bowling and becoming almost solely a leg spinner for basically all of the following 2-3 seasons as typically if not straight away but maybe the 2nd week of pace bowling my back would again play up and cause pain that didn't enable me to do a lot of things not just bowl in cricket. It was only really 3-4 years later that I had the confidence to again bowl 'pace' consistently and test myself by trying to bowl at my top speed. Fortunately, I haven't had any issues of this same or a related nature since however it was certainly a while between bowling pace in games and even at training in order to do my best to avoid further and ongoing inflammation of the injury.

Josh: How did this impact your cricketing in the long run?

Troy: It's hard to know how it has affected my bowling long term and for the rest of my career as I simply don't know any different however, I did miss out on bowling to my full ability and potential for a few seasons in my early adult years, so no doubt missed out on some skill advancement.

Due to becoming the EDCC A grade captain the season after my back injury came along aged 15, I also made the decision to stop playing Div 1 colts’ cricket for my final 2 seasons of eligibility to help prevent my back issues which would have and had been quite common when bowling 6 overs in the morning and usually 8-10 overs of an afternoon as well.

(Thank-you to Troy for being willing to be interviewed)

Which technique is deemed as being most dangerous?

It should be noted that the side on action as shown in figure 4 requires the least spinal rotation and is therefore the best technique in terms of safety.[11] However there is insufficient evidence to suggest that all techniques could lead to obtaining a lumbar stress fracture. [12]It has recently been found that small factors such as front foot contact and hip flexion could be the cause for increased rotation of the spine instead of just a mixed action. If bowlers could be diagnosed with having a dangerous technique that could lead to obtaining stress fractures at a young age, technique could be changed easily and the risk of obtaining a stress fracture would be reduced.

Some of the dangerous technique factors:

·      Lateral flexion

·      Shoulder counter rotation

·      Front knee angle

This is a basic list and I recommend contacting a bowling coach for further information. 

Strategies to reduce the number of people sustaining lumbar stress fractures:

Raising awareness for how lumbar stress fractures occur and what ways they can be managed is essential to reduce the number of cricketers being influenced by stress fractures. The best way to reduce the effect of obtaining a stress fracture is by preventing the fracture in the first place. This is why stress fractures are more predominant in country clubs due to the low awareness of stress fractures. 

One of the potential areas for improvement that would increase the prevention of stress fractures is by educating coaches to better manage their players workloads and technique to reduce the chance of them obtaining stress fractures. In country cricket especially, dads and parents take on coaching roles with little awareness of stress fractures and how easily they can be obtained from incorrect technique and the misuse of bowling workloads.

An idea I had was for Cricket SA to run a coaching clinic to educate club level coaches with management and modification of dangerous techniques and management of bowling loads to reduce the number of young cricketers obtaining lumbar stress fractures.

There are two main strategies to reduce the risk of obtaining a lumbar stress fracture:

1. Changing technique:

Changing technique is an effective way to reduce the stress of bowling however it is often difficult to change someone’s technique especially for an older cricketer. Changing the technique of a fast bowler could also affect their performance. Troy Goldsworthy as mentioned above couldn’t bowl pace for a long time due to sustaining a lumbar stress fracture, this impacted his cricketing career and cricketing opportunities. 

Instead of trying to change a technique, a coach who knows the correct bowling technique (side on or front on) should help young cricketers learn a safe but also effective bowling action whilst they are young and their technique is easily changed. 

2. Reducing Bowling Workloads:

Reducing bowling workloads is an effective way of reducing the stress on a bowler by limiting the number of balls and days they can bowl. There are lots of guidelines behind how many balls should be bowled between how many days. Cricket Australia has provided me with the recommended bowling guidelines to hopefully ensure cricketers aren’t over bowling. The cricket guidelines are at the following link: https://www.community.cricket.com.au/clubs/youth-pace-bowling-guidelines

I highly recommend printing out the guidelines and placing them in an easily seen location, perhaps on the cricket nets for everyone to see. 

Early diagnosis helps to reduce the recovery time and ensures the fracture doesn’t turn into spondylolisthesis which in most cases requires surgery and the recovery is often even longer. 

There is also the new prospect in using MRI (magnetic resonance imaging) and CT (computerised tomography) scans can detect a bone stress and bone marrow oedema at an early stage before the bone fractures. This technology could be made more accessible in the future, which would reduce the number of cricketers sustaining a lumbar stress fracture.  

Thanks for reading and spreading awareness.

Appendices:

[1] http://www.orthosports.com.au/pdf-download/CricketInjuries(SM).pdf

2 https://orthoinfo.aaos.org/en/diseases--conditions/spondylolysis-and-spondylolisthesis/

3 https://orthoinfo.aaos.org/en/diseases--conditions/spondylolysis-and-spondylolisthesis/

4 https://cbstc.com.au/line-fast-bowling-injuries/

5 From a credible physiotherapist from Victoria (he has asked for his identity to be kept private)

6 https://orthoinfo.aaos.org/en/diseases--conditions/spondylolysis-and-spondylolisthesis/

7 https://bmjopensem.bmj.com/content/5/1/e000529

8 https://www.youtube.com/watch?v=NNU_IEh3Y5o

9 From a credible physiotherapist from Victoria (he has asked for his identity to be kept private)

10  https://www.youtube.com/watch?v=NNU_IEh3Y5o

11 https://www.quinticsports.com/wp-content/uploads/2016/06/Univ-of-Sydney-Cricket-Hush.pdf