Fast bowling in cricket places incredible strain on the lumbar spine, with some studies reporting forces 8 – 10 times body weight being transmitted through the body when landing the front foot. This force loading combined with repetitive lumbar spine extension and rotation results in there being a high prevalence (estimated up to 67%) of stress fractures of the pars interarticularis (Johnson M, Ferreira M, Hush J., 2012).
Pars interacticularis stress fractures
Signs and Symptoms
- Unilateral lower back ache, opposite to the bowling arm
- Pain aggravated by extension activities without a precipitating event
- Reproduction of pain with combined extension and rotation while standing on the affected leg
- Tenderness on palpation over the fracture site
Imaging
If a stress fracture is clinically suggested, a bone scan, CT or MRI scan can confirm the area of injury. X-rays are often not effective in detecting bony stress injuries.
Treatment
Rest from the aggravating activity and sport is of utmost importance to allow the fracture to heal. A physiotherapy program focussing on stretching and core strengthening is essential to ensure the athlete is prepared to return to sport when clinically indicated.
The majority of stress fractures will take at least 6 weeks to recover, which is clinically decided when combined extension and rotation are pain-free and there is no local tenderness.
Returning to Sport
Once the fracture has healed, there should be a gradual return to bowling with loading monitored closely. Net bowling must be pain-free prior to returning to a match situation. This will likely take a period of a further 4-6 weeks if there is no complication.
During this stage, bowling technique should be reviewed and corrected as necessary. A ‘mixed action’ technique is more likely to cause stress injuries than either the ‘side-on’ or ‘front-on’ techniques. Communication with coaching staff may be necessary for this to be achieved.