LUMBAR SPONDYLOLYSIS

player to be out of action for at least eight months. It is during this time that the practitioner has a chance to address issues such as muscle imbalances; core strength and core stability; flexibility of hamstrings; pelvic control including gluteal activation and a number of other issues that may present themselves. It is valuable to check and correct thoracic rotation mobility, hip rotational mobility, not to mention footwear and possibly orthotics if necessary.

While the player is not allowed to bowl, they may still work on their cardio-vascu- lar system by swimming, cycling and row- ing - as long as none of these exacerbate the symptoms.

If core stability is poor, it is important to progress this from the basic matwork type exercises to more functional activities. It is no good just being able to stabilise while lying down on the floor or on a plinth, they will also need to work on their stability while standing up, running and delivering a ball at pace. An example of this type of functional stability would be for the player to stand on one leg on a sit-fit or foam cushion, perform the arm action of the bowling technique with a ball which is attached to a theraband which in turn is attached to wall bars.

There is very little that a therapist can ‘treat’ with such an injury and it is a case of getting out of the clinic and into the gym; get away from hands on treatment and focus on functional rehabilitation; take the player down to basics and build them up again one step at a time. The purpose of treatment is to make the play- er more flexible, stable and more able to absorb the enormous amount of stress that the body has to deal with every time they land on their front foot during the delivery stride of the bowling action.

It can be a long and arduous task to keep the player motivated during the journey back to recovery and so working towards small achievable goals is one way of main- taining momentum and compliance. It is important to note that there are some players who never do return to their pre- vious level of performance and have had to give up the sport, but these tend to be in the minority.

So if a player with a stress facture of the www.sportex.net

THOUGHT PROVOKERS

1) Why if coaches are addressing the incorrect bowling action and young fast bowlers are being protected against over bowling while they are still developing, isthe inci- dence of lumbar spondylolysis still as high as ever?

2) Those involved in research now are looking more at the front foot landing and the absorption of the shock through the system rather than the bowling position when on the back foot, what treatment techniques would be useful to help with this absorp- tion issue?

Have your say by logging in to www.sportex.net and visiting Issue 30 sportEX Medicine on our new discussion forum.

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lower back walks into your clinic, make sure that you have a confirmed diagnosis and then be prepared to support them for many months to come as there is no bet- ter feeling than seeing a fast bowler who once suffered from a stress fracture return to the sport and frighten the opposition with fierce fast bowling whether they play County level cricket or just turn out for their local pub team.

THE AUTHOR Caryl Becker is a chartered physiotherapist who qualified at Stellenbosch University in South Africa. She has worked full time in sport for the past 11 years including a five year spell at a County Cricket club where she saw a number of these injuries first hand. She is presently rehabilitation man- ager at the Olympic Medical Institute, a residential rehabilitation unit for elite sports men and women in London.

REFERENCES 1. Hollenberg MD, Beattie PF, Meyers SP, Weinberg EP and Adams MJ. Stress reactions of the lumbar pars interarticularis. Spine 2002;27(2):181-186 2. Gregory P, Batt M and Wallace W. Comparing injuries of spin bowling with fast bowling in young cricketers. Clinical Journal of Sports Medicine 2002;12(2):107-112 3. Wiltse LL, Newman PH and Macnab I. Classification of Spondylolysis and Spondylolisthesis. Clinical Orthopaedics 1976;23-29 4. Gregory PL, Batt ME and Kerslake RW. Comparing spondylolysis in cricketers and soc- cer players. British Journal of Sports Medicine, 2004;38(6):737-742 5. Bell PA. Spondylolysis in fast bowlers: Principles of prevention and a survey of aware- ness among cricket coaches. British Journal of Sports Medicine 1992;26:273-275 6. Stretch R. The seasonal incidence and nature of injuries in schoolboy cricketers. South African Medical Journal 1995;85: 1182-1184

7. Elliott B and Foster D. A biomechanical analysis of the front-on and side-on fast bowl- ing techniques. Journal of Human Movement

Studies 1984;10:83-94 8. Foster D, John D, Elliott B, Ackland T and Fitch K. Back injuries to fast bowlers in cricket: A prospective study. British Journal of Sports Medicine 1989;23:150-154 9. Nigg BM. The load on the lower extremities in selected sports activities. In Collected Papers on Sports Biomechanics (edited by G. Wood). University of Western Australia Press 1983. ISBN 0909751803 (pages 62-72) 10. Burnett A, Barrett C, Marshall R, Elliott B and Day R. Three-dimensional measurement of lumbar spine kinematics for fast bowlers in cricket. Clinical Biomechanics 1998;13,574- 583 11. Bartlett RM, Stockill NP, Elliott BC and Burnett AF. The biomechanics of fast bowling in men’s cricket: A review. Journal of Sports Science 1996;14:403-424 12. Elliott BC. Back injuries and the fast bowler in cricket. Journal of Sports Sciences 2000;18:983-991 13. Wheatherly C, Hardcastle P, Foster D and Elliott B. Cricket. The Spine in Sports pages 414-429. Mosby 1995. ISBN 0801675022 14. Letts M, Smallman T, Afanasiev R and Gouw G. Fracture of the pars interarticularis in ado- lescent athletes: A clinical-biomechanical analysis. Journal of Pediatric Orthopaedics 1986;6:40-46 15. Elliott BC, Hardcastle PH, Burnett AF and Foster DH. The influence of fast bowling and physical factors on radiologic features in high performance young fast bowlers. Sports Medicine Training and Rehabilitation 1992;3:113-130 16. Noakes TD and Durandt JJ. Physiological requirements of cricket. Journal of Sports Sciences 2000;18:919-929 17. Engstrom C, Walker D, Kippers V, Hunter J and Buckley R. A prospective study on back injuries and muscle morphology in junior crick- et fast bowlers. In Abstracts of the Fifth IOC World Congress, Sydney. Sports Medicine Australia 1999 18. McGill S, Juker D and Kropf P. Quantitative intramuscular myoelectric activity of quadratus lumborum during a wide variety of tasks. Clinical Biomechanics 1995;11:170-172 19. Marras WS, Davis KG, Heaney CA, Maronitis AB and Allread WG. The influence of psychoso- cial stress, gender and personality on mechan- ical loading of the lumbar spine. Spine 2000; 25(23):3045-3054

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