Fast Bowling Dilemma's

I have been stewing over the constant thought of injuries to young fast bowlers for the last few months.  And my immediate reason is the number of injuries that the Australian bowlers have encountered.  

The most recent injury being a side strain to, 22 year old James Pattinson, with a previous history of a stress fracture.  Another younger gun, Pat Cummins, at the age of 19 has also had several injuries at his tender age, the most recent being another stress fracture/bone reaction issue to his lower back.  21 year old Josh Hazelwood, who made his debut at the age of 17, also had stress fractures to his lower back.  Shane Watson, has been having recurring injuries particularly to his calves due to 3 previous stress fractures which began in 2003.  In South Africa the most recent lower back injury occurred to 22 year old Marchant de Lange.  This is just to name but a few.......

I have no doubt that stress fractures to the lower back of fast bowlers, occur between the ages of 17-22.  This in the main due to growth plates in the vertebral column that have not developed due to age.  With the front foot stress of the body ( 7-9 times body), repetitive forces and counter rotation occurring during fast bowling, the lower back in particular takes on huge shear forces which can coincide with injury.  Particularly if growth plates are under developed.

Once a stress fracture occurs players become prone to reinjury, if rigorous rehabilitation is not completed as well as injuries to other areas of the body.  Stress fractures have a huge link to side strains, hamstring and calf injuries.  

Fast bowling relies a lot on rotation, particularly that of the counter rotation between the shoulders and hips.  Once a stress fracture occurs, I believe a "weak link" occurs at the vertebral level of injury.  Hence focusing of thoracic and lumbar rotation will alway be important in the maintenance of a fast bowler.  When rotation becomes limited due to fatigue and workload, side strains can therefore occur.

Hamstring and calf injuries are linked to stress fractures, mainly of the lower back due to a neural relationship.  Compressive forces of the vertebral column will always occur during fast bowling, which may lead to degeneration and compression of nerves which stimulate the hamstrings first and then the calf muscles.  Nerves in the body, are required to send movement messages to muscles to preform their function.  If not done adequately impaired messages are sent to muscles causing injury to occur.

The battle many selectors and coaches deal with, is pace.  A cricketing cliche', " you cannot buy pace", goes a long way in understanding why young men that bowl at 140kmph plus are pushed into increased workloads before growth plate development.  

There will alway be debates between scientists and coaches/selectors.  If injuries to young men with great ability continue to occur as mentioned above, holding back young fast bowlers and monitoring workload and technique may become the way forward. 

Achilles Tendon Ruptures

Recently we learnt about the sad news of a South African cricketer, who ruptured his Achilles Tendon in Australia.  Many may ask how and why this may occur:

The Achilles Tendon is a thick tissue which connects the calf muscle to the heel.  The calf is a powerful lower limb muscle made up of the outer  Gastronemuis and the underlying Solues.  When these muscles contract, they pull on the Achilles, which moves the ankle downwards and hence resists it from too much upward movement.  Due to this function it is important for walking, climbing and sprinting.   

Whilst an individual performs all his activities, a tremendous load and force is placed on the thick and sturdy tendon.  Hence putting it at risk to several different problems.  

The Achilles Tendon can be violently ruptured (completely torn), even when strong and healthy.  The injury occurs when the ankle is violently forced upwards, when ones foot is resisting by pushing the ankle downwards.  A rupture can also occur when the knee is forcefully straightened  while the ankle is flexed upward.   When a rupture occurs, the individual normally feels a sensation of being kicking from behind, on the calf area.  Bystanders may often hear a loud snap.

A chronic strain or significant injury, does not always cause a rupture.  Diseases, such as, Rheumatoid Arthritis, Lupus,   gout and TB can result in weakness in the area and hence rupture.  The use of long term steroid medication for inflammation or the injection of cortisone in the tendon, can also weaken the fibers, and could result in a rupture.  Research over the years, state that individuals between the ages of 40-50 are more prone to ruptures compared to those that are younger.

The treatment of a rupture, requires surgical intervention.   Surgery consists of bringing the ruptured two ends together to a position were they are touching.   The ruptured ends are stitched together by a strong non-absorbing suture and the ankle is then locked into a position for 8 weeks to allow healing and the ends to unite.  It is extremely important that the surgery is not delayed , as the tendon can retract up toward the calf hence widening the gap between the two ends.

Patients would then be placed into a brace for 8 weeks and would be asked to use crutches as to not place any weight through the ankle, thus allowing the two ends to heal together.  Rehabilitation is a slow process and will take an individual 4-8 months to recover completely.  As like a Mensical Repair, the Achilles Tendon has very poor blood flow, and healing takes much longer.   If healing does not occur properly and the individual is rushed into play, re-rupture can occur.