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Back Breaking News for Cricketers
A small percentage of low back pain is caused by defects in part of the lumbar vertebrae.  These defects can be present at birth or can be acquired later in life by either a single traumatic injury, or more commonly by repeated stress to the lumbar spine.  The defect in the bone may be on one or both sides of the vertebrae.

A traumatic cause may be from a fall from a horse, or being kneed in the back in football.  Repeated bony stress is most common in sports people, especially fast bowlers, but also tennis players (serving action) and gymnasts due to repeated arching and twisting movements of the spine.  Last November young fast bowler Pat Cummins was ruled out for a second consecutive Australian summer with a lumbar stress fracture.  Brett Lee, Dennis Lillee and Merv Hughes have also missed considerable cricket over their careers, and in fact a recent Cricket Australia review has shown a 16% incidence of stress fractures in first class fast bowlers over the last 10 years. 

Where a small crack or defect occurs in a thin part of the bony arch protecting the spinal cord, the  technical name SPONDYLOLYSIS is given.  When there is a defect on both sides of a bone, allowing the vertebra to slide forward on the one below, then the term given is a SPONDYLOLISTHESIS (pictured).  

These can generally be diagnosed by a plain X-ray, but in the early stages of bone stress a Radioisotope Bone Scan or MRI may be required.  A spondylolisthesis causes weakness, or instability of the segment of the spine and therefore puts pressure on the associated discs, ligaments and muscles that also provide stability.  People usually complain of a general low back ache, often with referred pain into the buttocks and hamstrings, aggravated by bending backwards, prolonged standing, running, jumping and twisting.  Sitting is usually comfortable, unlike when someone has a lumbar disc injury. 

It is important to realise that unless the slip is extreme, this condition rarely requires surgery, and will not necessarily preclude you from participating in sport.  It does however require intensive rehabilitation and time away from sport for 2-12 months, and so prevention is the best option:  avoid overtraining, or pushing through pain, bowl with a more front-on or side-in action rather than mixed, and consider a screening assessment from a physiotherapist.  They can identify other risk factors that can be addressed such as a leg length discrepancy, poor flexibility or inadequate core muscle control.  Think of firing a cannonball from a rocky boat.  As a fast bowler you will not have powerful propulsion if the trunk and pelvis is not stable.  Improving the muscular stabilisation of the spine through Pilates-type exercises really is the best means of preventing and managing lumbar stress fractures.  Happy bowling!

Peter Biskup 
APA Titled Musculoskeletal Physiotherapist 

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