Many elite cricket teams now have Sports Chiropractors as part of their support team working alongside physiotherapists and sports medicine doctors. This is due to the realisation by the sporting community that Chiropractic is different from physiotherapy, and offers a unique and valuable perspective on the diagnosis and management of common sports injuries – especially spinal injuries in cricket bowlers. Professional sports organisations, such as Major League Baseball, the National Football League, the US PGA, NRL teams and many Olympic associations around the world, have chiropractors well entrenched in their medical and sports science staff. Cricket organisations in New Zealand seem to have a way to go in realising the value of having a Sports Chiropractor as part of the Sports Medicine Team. Perhaps this article will encourage athletes, coaches and managers to consider having a Sports Chiropractor on their sports medicine team.
Spinal Stress Fractures In Young Cricketers
This common and debilitating injury in cricket bowlers is primarily due to overloading the spine of a young bowler that is not skeletally mature. However, it can be effectively prevented, treated and rehabilitated with the addition of advance biomechanical principles to the treatment plan for the athlete.
Skeletal maturity will vary due to genetics and gender. Girls reach skeletal maturity at about age 12-15, whereas boys do not reach skeletal maturity until 18-21. This would include the end plates and facets in the vertebra of the spine (see diagrams). Having said that, whether it is 18 or 21 doesn’t really matter. A young bowler does not simply turn up to The Oval to play elite level cricket for the first time in their late teens. Therefore, while their spines are still immature and growing, these fast bowlers are loading their spines excessively and repetitively, causing overuse injury. However, not all bowlers sustain spinal stress fractures. Why is that?
Leg length inequality and faulty foot or lower extremity biomechanics are a major contributing factor to spinal injuries in cricket bowlers.
There are many variables that contribute to setting up a bowler for this type of injury. You first must appreciate that young bowlers often are not training in the elite conditions available to national sides. They’re also often playing on poor pitches. Some wear poor footwear, which adds abnormal forces on a young spine and leads to biomechanics stress throughout the body. This stress comes primarily from biomechanical imbalance from the ground up.
Chiropractic treatments balance the biomechanics in the pelvis and relieves some of the stress in the spine. However, it is often not as simple as adjusting the pelvis and spine back into balance. The pelvis is often out of balance due to problems in the feet. This can lead to a leg length inequality, which is a big issue. Leg length inequality and faulty foot or lower extremity biomechanics are a major contributing factor to spinal injuries in cricket bowlers. If you know how to identify whether the leg length difference is functional vs anatomical, you can correctly use either a heel lift or custom functional orthotics (or both), which stabilizes the underlying biomechanical weakness, rather than just treating the pain. Flat feet can increase the stress in the lower back and custom orthotics, prescribed based on a detailed biomechanical assessment and gait analysis, is critical to success. Furthermore, understanding how the foot orthotic will impact the entire kinetic chain is critical in getting the prescription of the orthotics right. This requires dynamic as well as static analysis of the posture, and gait.
Misalignment of the pelvis, or in any part of the spine, causes the forces of the bowling motion to be transmitted to areas not designed to cope with those forces. As a result of that, your supporting structures (facet joints, vertebral discs / endplates, muscles, ligaments and nerves) are all affected. It’s devastating for a young player as it can lead to chronic pain that just will not resolve, despite good sports medicine and physiotherapy.
Many believe these injuries to be a simple muscular problem, but that is often not the case. If it was, the bowlers would respond to standard physiotherapy and recover. It is important to note that is not a criticism of physiotherapists. Soft tissue therapy and core rehab is critical to a successful outcome. However, if you are doing too much core exercise daily, you can get too strong in the abdominal muscles, and not use your back muscle properly. It’s often not a simple back muscle problem, it’s a much more complex biomechanical problem, due to a leg length inequality, that is often due to faulty foot mechanics.’
The addition of chiropractic treatment could help fast bowlers stay on the field and prevent spinal stress fractures from occurring in the first place. Chiropractors are able to adjust the pelvis and spine, and thereby restore proper alignment and function. However, we can also look at the underlying biomechanics of the entire kinetic chain, from the foot to the neck, to see where the weak link in the chain is – and do something to effectively manage the cause rather than simply treating the symptom. The alternative is that this condition progresses until the only option is medical intervention, which is a surgical procedure to stabilise the spine. This is usually a career-ending treatment. Therefore, early assessment, preventive measures, proper treatment and biomechanical support, may well save a young bowler from suffering a debilitating injury.
Dr. Cherye Roche is available to address cricket clubs, coaches, parents, physiotherapist, sports medicine doctors or other groups interested in learning how they can better serve their athletes. You are welcome to contact the clinic to schedule an individual consultation or contact Dr. Roche directly for information about conducting a seminar or workshop for your group.