Stress Fractures in Cricket

Posted by SportsMed NQ, 13 January 2015

Stress Fractures in Cricket (Spondylolysis)MJ #1

Cricket injuries at elite level in Australia have been demonstrated to occur at a rate of around 18 injuries in total for a squad of 25 players who play twenty matches in a season.  On average, around 9% of cricketers have an injury at any given time, although in fast bowlers over 15% are injured at any given time.

There are very different physical demands involved in different types of cricket, which has meant the injury profile is slightly different between five day Test Matches, weekend to four day matches and one day matches. The launch of Twenty20 cricket has placed a new physical requirement on cricketers, although it is too early for the effects of these demands to be analysed in sports injury research.

Low back pain is particularly prevalent among younger fast bowlers. The repetitive action of bowling for long spells places excessive stress (extension, rotation and lateral flexion) on the structures of the lower back, where stress fractures of the vertebra (spondylolysis or spondylolisthesis) can develop.

 

What is Spondylolysis?Cricket - lower back pain

Spondylolysis is a stress fracture to the back. It is a common cause of back pain in children, adolescents and active young adults. Spondylolysis is a non-displaced stress fracture of a spinal vertebra, also known as a pars stress fracture.A spondylolysis most commonly results from a defect or excessive stress in the pars interarticularis of the vertebra. The pars interarticularis is the part of the vertebra between the upper and lower facets of the verterbra.Most cases of spondylolysis occur at the L5 level and the stress lesion usually completely heals. In some of the cases where fracture non-union occurs, a fibrous mesh of connective tissue is laid down rather than bone. Spondylolysis is classified as dysplasic (congenital), isthmic (stress fracture from sport), degenerative (older adults), or traumatic.If your spondylolysis worsens and allows the vertebral body to move forwards, it is known as a spondylolisthesis. A spondylolisthesis is more common in individuals with bilateral spondylolysis, mechanical instability and females.

What are the symptoms of Spondylolysis?

  • Sudden onset, of one sided back pain
  • Aggravated by arching, twisting, standing or high impact activities
  • Pain may radiate to buttock or thigh.
  • Pain eased by rest.
  • Exaggerated lumbar arch, tight hamstrings, hip flexors or gluteals

How is Spondylolysis Diagnosed?

Your physiotherapist will take a comprehensive history of your injury and complete an objective physical assessment to help guide their diagnosis of the cause of your pain. If your history and clinical signs indicate that spondylolysis may be present your physiotherapist will likely refer for an X-ray of you lower back (in some cases further imagery like a bone scan, CT or MRI may be necessary).

Spondylolysis Treatment

The treatment for spondylolysis is initially conservative and aims to reduce your pain and facilitate healing. Your physiotherapist will help to manage your pain and inflammation using an array of techniques which may include soft tissue release, deload taping, dry needling, electromodalities, ice/heat, stretching targeted muscle groups.

As your pain settles your physiotherapist will help guide you through a program aimed at restoring normal muscle length, joint range, posture, and coordination/conditioning of your core muscles. They may recommend that you complete an ultrasound guided exercise program where you can view your deep core muscle contractions on a monitor (Please see our blog on real-time ultrasound, http://sportsmednq.net.au/real-time-ultrasound/ ). As you improve one method of further challenging /maintaining good core strength may be clinical pilates.

What is the Prognosis for Spondylolysis?

The treatment results for spondylolysis is based on your history and symptoms. In most cases, spondylolysis symptoms will resolve within 6 to 12 weeks.

Non-surgical conservative treatments successfully relieve pain in approximately 80-85% of children and adolescents with acute spondylolysis. However, the potential for recurrence is high in individuals who do not address the risk factors that led to the initial injury. If you suspect you may have any potential signs of lower back stress reactions or stress fracture, or even if you wish to discuss your injury, Kyle works out of our Bayswater Rd (Phone: 07 4771 3650) and North Shore (Phone: 07 4774 2860).

Written by Kyle WhebellIMG_2477_1

 

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