My take on lumbar stress fractures in fast bowlers

Lately, there has been a lot of criticism in the media about how the BCCI has handled the injury and recovery of Indian fast bowler Jasprit Bumrah. Bumrah was first diagnosed with a lumbar stress fracture in 2019 during a routine scan and as a precautionary measure, he was rested and was out of action for the next three months. The injury recurred in august 2022 and for the next few months, he was rehabilitated at the NCA. He was pronounced fully fit in January and was included in the ODI squad for the series against Sri Lanka, but unfortunately, the pain recurred after playing only one match and he was back at the NCA for his rehabilitation. So what is a lumbar stress fracture? how does it happen? what makes it so difficult to treat? and why is there such a high chance of its recurrence?

A lumbar stress fracture, also known as spondylolysis is a small fracture of a bone structure called the pars interarticularis, which connects the facet joints of the spine. There are three main scenarios where stress fractures happen, firstly it can be due to biomechanical factors, a general bowling action has the components of spinal side flexion, spinal extension and spinal rotation in it, also research shows that the forces that go through the body of a fast bowler when the front leg lands are 6x to 8x the body weight. Now combine these two components, 6 to 8 times body weight going through the spine and side flexion, extension and rotation of the spine occurring together, you can imagine the sheer forces around the facet joints. Secondly, sudden increases in the bowling workload after a layoff or high workloads over a long period which doesn’t give enough time for bones and muscles to recover can cause stress fractures. Thirdly the combination of both the above factors, incorrect biomechanics and workload mismanagement can also be the cause of lumbar stress fractures.

Considering the above factors, what makes lumbar stress fractures hard to treat? If the reason for the stress fracture is incorrect biomechanics, then the course of action would be to identify the components of biomechanics which are causing the injury and then incorporate correct interventions to rectify that. Here we need to understand that the athlete has bowled thousands of balls in his current bowling technique and to change that would mean first unlearning the old patterns, and muscle memory and then learning the new corrective patterns which will take a considerable amount of time. Also considering the athlete is fit to return to sport, can bowl and hold the new technique at high intensities, for long periods and pain-free, making sure the interventions have worked, making sure the interventions have not compromised the bowling speed and consistency and all this while understanding that it’s a highly ingrained muscle memory that we’re trying to change while simultaneously trying to bring back the athlete to the high performing scene of international cricket. Secondly, if the cause of the stress fracture is due to workload mismanagement then the athlete must go through a structured rehabilitation program, get back to full fitness and then slowly increase the bowling workload for several weeks or even a few months to get back to being match fit. Research has shown that the bone mineral density on the contralateral side of the spine relative to the bowling arm (the left side for a right arm bowler or the right side for a left arm bowler. The side most susceptible to stress fractures ) is much higher than that of the bowling side due to the forces on the joints over a long career. The bone adapts and becomes stronger, but when an injury occurs there is a considerable amount of time that the athlete lays off from bowling and the research shows that this bowling layoff decreases the bone mineral density. So to get back to being match fit, the athlete needs a considerable amount of overs under his belt with careful monitoring and overloading progressively. 

Lastly, why are there such high chances of it recurring? Simply because there are soo many variables to be taken care of and it could go wrong at any step along the way. like, the athlete wasn’t given enough time to recover, biomechanical changes didn’t work, the biomechanics changes worked but the athlete slowly went back to his or her old habits, the workload was increased way too quickly, there wasn’t enough workload, has the athlete has enough overs under his belt? excessive pressure on physios and s&c from the board to bring back the player etc. And all this considering every athlete is different and every athlete heals at a different pace, every athlete learns at a different pace. So there are high chances of something going wrong along the way which makes the chances of recurring high.

So what is the way forward? In my opinion, the way forward is to have an individualised approach to each athlete, understanding the biomechanics of their bowling actions, making sure the athlete is getting the right interventions, making sure the athlete is given enough time to work on the interventions, closely monitoring workload but also not under bowl the athletes and evenly spacing out the cricket season and giving them enough time to recover. 

Steffan Jones with “Pace lab” has brought in a lot of input and resources about biomechanics and workload management. He has some amazing inputs on all things fast bowling and I strongly feel Pace Lab is the future of fast bowling.

Finally, I’d like to finish by saying, don’t go passing away judgements and trolling BCCI on social media cause the physios and S&Cs know what they’re doing, there’s a reason they are called experts, let's be kind and give them the time they need.

Wondering who’s this guy babbling about lumbar stress fractures. I’m Battula Sai Vignesh, I’m a certified strength and conditioning coach, I’m an athlete( fast bowler) and I’ve had multiple stress fractures. You can reach me by email at  vigneshbattula.vb@gmail.com.