Back injuries and the fast bowler in cricket.

Here, I review research that has investigated the aetiology of injuries experienced by adolescent and adult fast bowlers. Mechanical factors play an important role in the aetiology of degenerative processes and injuries to the lumbar spine. This is particularly so in fast bowling, where a player must absorb vertical and horizontal components of the ground reaction force that are approximately five and two times body weight at front-foot and rear-foot impact, respectively. Attenuated forces are transmitted to the spine through the lower limb, while additional forces at the lumbo-sacral junction are caused by trunk hyperextension, lateral flexion and twisting during the delivery stride. Fast bowlers are classified as side-on, front-on or mixed. The mixed action is categorized by the lower body configuration of the front-on action and the upper body configuration of the side-on technique. This upper body configuration is produced by counter-rotation away from the batsman in the transverse plane about the longitudinal axis of the body of a line through the two shoulders. Counter-rotations of 12-40 degrees during a delivery stride have predicted an increased incidence of lumbar spondylolysis, disc abnormality and muscle injury in fast bowlers. During the delivery stride, the mixed bowling action also shows: more lateral flexion and hyperextension of the lumbar spine at front-foot impact, and a greater range of motion of the trunk over the delivery stride when compared with the side-on and front-on techniques. The pars interarticularis of each vertebra is vulnerable to injury if repetitive flexion, rotation and hyperextension are present in the activity. Fast bowlers should reduce shoulder counter-rotation during the delivery stride to reduce the incidence of back injuries. When a player is required to bowl for extended periods irrespective of technique, overuse is also related to an increased incidence of back injuries and must be avoided.