Prevention of Lumbar Bone Stress Injuries

Youth One Day Match - England Under-19’s v India Under-19’s - India’s Vaibhav Suryavanshi in action Action Images via Reuters/Matthew Childs

Cricket participation continues to increase globally, and there are now many more diverse population groups playing the game. Lumbar bone stress injuries (LBSI) cause the greatest time loss from playing, requiring six to nine months of rehabilitation before athletes can safely return to play. Coaches, parents, and players are often unaware of the signs and symptoms of LBSI. Therefore, they often miss these early stages of the condition, which increases the severity of the injury and the potential for non-union. The cricket community needs a large-scale, global exercise-based injury prevention program (IPP) that also includes an education program for coaches, parents, and players addressing known risk factors for injury and how individuals can increase their capacity to mitigate the risks of injury. 

Prevention

Cricket has become more demanding physically, with athletes playing multiple formats across the year at the elite level. The injury that creates the highest injury burden in cricket is LBSI, especially in adolescents, 18–23-year-old fast bowlers, spin bowlers, and those who participate in other extension-related sports⁽¹⁾. 

Lumbar bone stress injuries most commonly occur in L4 and L5 on the contralateral side to the dominant bowling arm⁽²⁾. They can occur at other levels of the lumbar spine and may occur bilaterally, with a greater risk of progression to spondylolisthesis. The lumbar vertebrae do not fully mature and ossify, or acquire peak bone mineral density (BMD), until around 23 years of age in males and, on average, two years earlier in females⁽³⁾. The fast-bowling action produces high levels of repetitive forces through the immature posterior vertebral arch. In some instances, these forces exceed the bone’s capacity, resulting in an LBSI. They occur along a spectrum from a bone stress response to a stress fracture (see figure 1) using a numerical classification from grade one to four, with higher grade injuries having less healing potential, so early removal from play and diagnosis is essential to maximise opportunity for healing. This window to limit activity and slow down the progression of the injury is often missed due to a lack of awareness of the condition amongst stakeholders.

“…a global shift in injury prevention across cricketing nations…”