In Australia summer means alot of things; beach, BBQ’s, sunshine, mangoes… BUT if your truly Australian Summer means cricket… and lots of it! I think I do pretty well for a female, I’m by no means glued to the television screen but I must admit I do enjoy having a test match on in the background.
As a physio I’m always interested in the injuries that athletes in different sports suffer. If you have read the sports section of any paper recently you will more than likely have read something on ‘cricketers side strain’. Some are referring to it as a ‘right of passage’ as a young fast bowler to suffer from this injury. Take youngster James Pattison for example who left the field early on the 3rd day of the second test in Adelaide, the most probable diagnosis a side strain, or Ben Hilfenhaus ruled out on the 3rd day in Hobart with a similar injury. Peter Siddle, Jason Gillespie, Brett Lee, Glen McGrath have all suffered this injury at least once in their career. ‘Side Strain’ sounds trivial but persistent side strains can sideline these guys for a long time.
This injury is almost unique to two patient populations; fast bowlers and javelin throwers. In fast bowlers its usually seen on the side of the non bowling arm and is due to repetitive strain of one or more of the abdominal muscles at their attachment to the lower ribs (11,10th and 9th rib). Most commonly the internal oblique is the injured muscle, however external oblique and the transverse fascia can also be involved.
The mechanism of injury is largely related to the action of bowling. On the non bowling side a forcible contraction takes place as the bowling arm is cocked in preparation to bowl. This contraction is ‘eccentric’ (meaning the muscle is lengthening under tension) and is quickly followed by a maximal contraction in the opposite direction as the bowling arm comes through to let go of the ball. This stress can cause repetitive micro tearing and eventually rupture or damage of the muscle fibres. Watch a fast bowler in slow motion you will see exactly what I’m talking about.
This injury can usually be diagnosed purely through clinical history and area of tightness and/or tenderness over muscle’s rib attachment. Leaning away from the injured side and deep breathing/coughing will often elicit pain. Further investigations such as MRI can assist with more accurate diagnosis and give an indication of how long they will spend on the sideline.
Treatment involves rest from bowling, followed by gradual strengthening before returning to the demands of fast bowling. Coaching/advice on bowling technique may be warranted in those with persistent injury.
The question being asked is why are we seeing more and more of this injury? Are these bowlers starting too early, is it their technique, are coaches asking too much? There has been alot of debate around this topic and many think as guys get to international level these injuries are due to a manifestation of what they have done over the last 8-9 years. We need to look at what is happening at the grass roots level and there needs to be more focus on fast bowling injury prevention from a young age.