I have been an avid follower of cricket for many years from Durban, South Africa and the Natal Dolphins to the QLD Bulls and beyond and as a physiotherapist I have naturally been interested in the injury scene when it comes to cricketers, in particular the bowlers.
It has become apparent over the years that injuries to bowlers are becoming ever more frequent, despite the latest ‘science’ in sports injury management and prevention.
What frustrates me more is the fact these injuries often occur in the same bowler more than once, or they suffer an injury to another part of their body which could have a similar cause to the other injuries.
Take what has recently happened to Cummins (heel), and now Watson (calf) in the Australian squad. These are not uncommon injuries for bowlers, but I feel it is accepted too easily that these are part and parcel of cricket.
Having been a teacher to other physios on muscle strength diagnostics and how this relates to injury, I know how physios are taught these days, and that there is a serious lack of knowledge of functional anatomy.
By this I mean how one muscle can affect another, how tightness can cause muscle weakness and how weakness causes compensatory actions and more tightness, eventually ending in injury, often nowhere near the original imbalance.
As examples, both the Cummins and Watson injuries most likely have the same cause, i.e. weakness of the hip muscles on the affected limb. Now this is where it gets a bit tricky.
The common school of thought seems to be (and this is my opinion) that weakness anywhere in the body is the result of one thing, lack of use.
I say this because the common treatment for this is strengthening. If someone injures a hamstring or calf, for example, there is an immediate focus on strengthening the muscles involved as if this is going to prevent injury.
My belief – and this comes with almost 20 years of work in this area – is that this approach could not only be ineffective, but could force the body to further compensate, thus increasing the symptomatic map.
This can result in another area of the body becoming tight, and later becoming symptomatic.
How many players have you seen who originally have heel/foot pain, then later in their career it is the knee, then the hip…all on the same side.
This is because the true cause of the problem is not being assessed, and thus not treated.
From my work, I have realised that the most common cause of these types of injuries is weakness in the hips caused from overuse, thus resulting in tightness of the soft tissues around the muscles, causing weakness due to the muscles lacking space in which to contract.
This weakness then results in the hip ‘giving way’ as in a limp, loading up more weight into that leg, thus causing the stress to increase on the lower parts of the leg, i.e. knee and ankle and the muscles that control them.
This compensatory action leads to stiffness and eventually pain.
Just treating the ankle, calf, knee or hammy, is not enough. The cause needs to be sought out, namely the hip imbalance.
I will put my professional head on the block and say that there is most likely weakness in the hips of both Cummins and Watson, and their resultant compensatory actions are manifested in heel and calf pain.
Treating these areas and attempting to strengthen the muscles in the area will not be sufficient. You will still be left with the original imbalance, which if it does not result in the same injury again, will cause another to surface at some stage.
Just because these players spend so much time in the gym does not mean their muscles are strong.
If there is any form of overuse, tightness in the fascia occurs, which will cause weakness, and this cannot be remedied with strengthening exercises.
In my opinion, flexibility is the key to preventing injury, not strengthening. Get out of the gym (or at least reduce it greatly), back on the field and stay injury free.
So one tip for the medical staff, if in doubt, test the hip, it is the most common cause of lower limb injuries.
physiomitch
Roar Rookie
True, positional posturing will alter fascial patterns, ie the body adapts to whatever position or action it gets put into. Repetetive actions result in fascial shortening, as do fixed postures. How many people do you see walking with a posture the shape of a chair, ass out, chin forward, knees bent...adaptability is what fascia is all about. Maintaining some form of movement, moving out of common active positions and keeping flexible will have a better chance of preventing injuries than strengthening will. As you say, all these little quirks such as leaning on the bat on one leg will slowly but surely result in changes of the fascial patterns, and this can lead to stiffness and weakness. My take on fatigue is somewhat different, having worked with the autonomic nervous system a lot. I believe that muscle fatigue is the body's indicator that autonomic nerve cell fatigue has begun, thus not being able to control the blood flow rate to the muscles. This I think is an emergence mechanism to prevent possible injury, but if overlooked or ignored can result in permanent nerve cell fatigue, thus poor blood flow to muscles causing weakness, and again this cannot be treated with exercise. But I agree, both overuse and fatigue play a part but could also be part of a process resulting from overuse and insufficient rest (48 hours) after exercise. I firmly believe we do not need to train as much as people think, and without sufficient rest, the body will suffer. I heard a very good comment from a sports science bloke in the UK; 'You don't get fir through exercising, you get fit through recovering from exercising'. The break and recuperation is more important than the exercise itself. I have to admit, I have never been a fan of muscle recruiting, as again I feel it blames the muscles too much as if they are in charge of the recruitment. Find out what is behind their dysfunction, correct that, and the muscles will do the rest automatically. But this is just my opinion. Give muscles what they need and let them go!
physiomitch
Roar Rookie
Hi Stu The thinking about gluts med is correct, but it is not isolated. However, my major concern is that the CAUSE of the weakness is not being correctly diagnosed. The common treatment for this gluts med weakness is to isolate and 'strengthen' the muscle, yet the weakness is often caused by overuse and thus reacting tightness in the fascia surrounding these muscles, which then results in weakness as the muscle does not have the relevant space in which to fully contract. It is commonly found that weakness is in the inner range of the muscle and can be overlooked if not testing in inner range. If weakness is a result of overuse, does it make sense to use exercise as a treatment when exercise caused the weakness in the first place? I fail to see the logic although I can understand the thinking, but unfortunately, weakness is not mostly due to a lack of exercise. I definately think this is a problem with the cricketers as is the case with many sportspersons. I find it to be a common denominator in many non-traumatic sports injuries, and in the majority it is a release of the fascia around these muscles which allows strength to return IMMEDIATELY, no exercises necessary! The goal is to give the muscles what they require to be able to function as normal, ie good blood flow (sympathetic control), good nerve supply and good space in which to work (fascial flexibility). Once these are restored, muscles amazingly work, within seconds. The muscles are not to blame, it is their environment that alters, not allowing them to function they way they want to. We need to focus on what is stopping them from functioning instead of flogging the muscles trying to force them to work in an environment that is not suitable.
Micah
Guest
I too agree that there is weakness in the hips. Cricketers spend long periods of time in a shortened position (crouched over to bat, running in to bowl). During the course of a day, these shortened positions are further compromised by fatigue. To complicate matters, I am not sure that they understand what good postions are, particularly when they are in rest postions (standing at the non strikers end, or out in the field). Leaning on the bat, one leg dominant standing positions while fielding are all compromised positions that allow the muscles that help you to stabalize turn off. Learning how to stand correctly for the first time takes a fair amount of concentration to not fall back into long developed bad habits. Learning what muscles should be recuited for optimal positioniing and then learning how to activate them - during rest periods to start with and then increasingly under practice and then match conditions - could be part of a multi pronged approach to overcoming this injury curse. There are some excellent mobility sites available that educate and give individuals the tools to become more self aware, in conjuction with professional care.
Stueyd
Guest
Mitch interesting post, as a physio myself I can see where you are coming from. Although not dealing with any athletes or many sporting injuries at the moment i do see a fair share of leg dysfunction. The thinking seems to focus on glut med weakness/decrease activity, do you think that this is the case with the cricketers as well, or do you have another line of thought? -- Comment left via The Roar's iPhone app. Download The Roar's iPhone App in the App Store here.