Thoracolumbar disc degeneration in young fast bowlers in cricket: a follow-up study

doi:10.1016/0268-0033(96)00007-1

Clinical Biomechanics

Volume 11, Issue 6, September 1996, Pages 305-310

https://doi.org/10.1016/0268-0033(96)00007-1 Get rights and content

Abstract

Objective. To determine the progression of thoracolumbar disc degeneration in young fast bowlers in cricket.

Design. Prospective fast bowling technique and MRI follow-up study.

Background. Previous studies on high-performance young fast bowlers have found that lumbar spine pathology was related to the mixed bowling technique.

Methods. Nineteen young male fast bowlers (mean age 13.6 years) underwent MRI scans to detect the presence of intervertebral disc abnormalities. Subjects were also filmed laterally (200 Hz) and from directly above (100 Hz) whilst bowling two maximum velocity deliveries (session 1). Subjects were tested using an identical methodology 2.7 years later (session 2).

Results. At session 1, the incidence of thoracolumbar disc degeneration was 21%; however, at session 2, the incidence significantly (P = 0.008) increased to 58%. Furthermore the increase in the incidence of back pain between session 1 and session 2 was also significant (P = 0.002). The progression of disc degeneration was found to be significantly (P = 0.015) related to the group of fast bowlers who utilized the mixed technique during both session 1 and 2 when compared to those who used this technique during one session only.

Conclusions. Thoracolumbar disc degeneration and back pain increase significantly during the time period examined in this study. Further, bowlers who utilize the mixed bowling technique stand a greater chance of developing degenerative changes of the spine.

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Symmetry, not asymmetry, of abdominal muscle morphology is associated with low back pain in cricket fast bowlers
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Citation Excerpt :
This is particularly relevant for sports such as cricket, in which fast bowlers use asymmetrical motion of the body to accelerate the ball. Fast bowling in cricket is associated with a high risk of lower back injury5,6 and the biomechanics of the bowling action has been highlighted as a major contributor.6,7 Increased counter-rotation of the shoulders during the delivery stride has been highlighted as a variable associated with LBP6,8 and is dependent on control of trunk rotator muscles.
Although abdominal muscle morphology is symmetrical in the general population, asymmetry has been identified in rotation sports. This asymmetry includes greater thickness of obliquus internus abdominis (OI) on the non-dominant side in cricketers. Cricket fast bowlers commonly experience low back pain (LBP) related to bowling action, and this depends on trunk muscle control. This study aimed to compare abdominal muscle thickness between fast bowlers with and without LBP.
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Twenty-five adolescent provincial league specialist fast bowlers (16 with and 9 without LBP) participated. Static ultrasound images (US) of OI, and obliquus externus (OE) and transversus abdominis (TrA) were captured on the dominant and non-dominant side in supine.
Total combined thickness of OE, OI and TrA muscles was greater on the non-dominant than dominant side (p = 0.02) for fast bowlers without LBP, but symmetrical for those with pain. Total thickness was less on the non-dominant side for bowlers with pain than those without (p = 0.03). When individual muscles were compared, only the thickness of OI was less in bowlers with LBP than those without (p = 0.02). All abdominal muscles were thicker on the non-dominant side in controls (p < 0.001) but symmetrical in LBP.
Asymmetry of abdominal muscle thickness in fast bowlers is explained by the asymmetrical biomechanics of fast bowling. Lesser OI muscle thickness in fast bowlers with LBP suggests modified trunk control in the transverse/frontal plane and may underpin the incidence of lumbar pathology. The implications for rehabilitation following LBP in fast bowlers require further investigation.
Lumbar load in adolescent fast bowlers: A prospective injury study
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The relationship between whole body fast bowling biomechanics and injury has received significant attention in the literature, identifying shoulder counter-rotation (SCR) – the change in alignment of the shoulders between back foot contact (BFC) and front foot contact (FFC) – as an observable movement that may be linked to the true mechanisms responsible for low back injury. This increased SCR has been shown to be associated with increased risk of lumbar stress fractures and disc degeneration in adolescent bowlers,6–8 however, a detailed biomechanical analysis of the lumbo–pelvic joint during bowling has thus far not been conducted in a prospective low back injury study. Overuse injuries occur when the load tolerance level of the tissue is exceeded through repetitive application of force.
This study aimed to identify modifiable mechanisms associated with low back injury in adolescent cricket fast bowlers.
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Twenty-five injury free fast bowlers, aged 14–19 years, were assessed prior to the start of a cricket season and observed during the season for low back injuries.
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Bowlers who experience greater lumbar loads during bowling, have reduced back extensor muscle endurance, and demonstrate impaired control of the lumbo–pelvic–hip complex, are at increased risk of low back injury. This combination of strength, control and biomechanical factors may be key mechanical elements of low back injury causation in adolescent fast bowlers.
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To describe the prevalence and nature of lumbar spinal abnormalities in adolescent cricket fast bowlers.
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46 asymptomatic fast bowlers aged 13–18 years participated in the study and were grouped into under-15 (U15), under-17 (U17) and under-19 (U19) classifications. All participants underwent magnetic resonance imaging of the lumbar spine and abnormalities of the pars interarticularis and intervertebral discs were graded according to type and severity. Other abnormalities were also noted.
Fifteen bowlers (33%) had at least one pars interarticularis abnormality. Six bilateral and 10 unilateral defects were identified. Of the 10 unilateral pars abnormalities, 6 occurred on the non-dominant side. Nineteen of the abnormalities occurred at the L5 vertebral level, 2 at L4 and 1 at L3. The most common type of pars abnormality was the subtotal stress fracture, which was found in 38% of bowlers aged 16 years and under. Sixteen participants (35%) were found to have degeneration of at least 1 lumbar disc and the prevalence increased with each successive age group (29% U15, 33% U17 and 43% U19). Of the 25 discs with signs of degeneration, 9 occurred at L4/5 and 7 at L5/S1. Eleven of these were classified as mild degeneration, 13 as moderate, and 1 as severe. Disc bulges were found in 33% of participants.
Lumbar radiological abnormalities are common in asymptomatic adolescent fast bowlers. Acute bone stress reactions of the lumbar pars interarticularis are visible on magnetic resonance imaging and, in some instances, occur before the onset of activity-related pain.
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Low Back Pain and Lumbar Degeneration in Japanese Professional Baseball Players
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Incidence, prevalence and risk factors for low back pain in adolescent athletes: a systematic review and meta-analysis
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PaperThoracolumbar disc degeneration in young fast bowlers in cricket: a follow-up study

Abstract

Clin Biomech

The influence of fast bowling and physical factors on radiologic features in high performance young fast bowlers

Sports Med Train Rehabil

Back injuries to young fast bowlers in cricket: A prospective study

Br J Sports Med

Discs degenerate before facets

Spine

Magnetic resonance imaging and discography in the diagnosis of disc degeneration

J Bone Joint Surg

Imaging of degenerative disk disease

Radiology

Disc degeneration in magnetic resonance imaging: a comparative biochemical, histologic, and radiologic study in cadaver spines

Spine

The thoracolumbar spine in young elite athletes: current concepts on the effects of physical training

Sports Med

Lumbar disc degeneration: Correlation with age, sex and spine level in 600 autopsy specimens

Spine

Spine injuries in gymnasts and swimmers: an epidemiologcal study

Am J Sports Med

Paper
Thoracolumbar disc degeneration in young fast bowlers in cricket: a follow-up study