This is the first study which describes 3D biomechanical analysis of Indian cricket fast bowlers from an injury risk perspective. The results of this study demonstrate several key areas of injury risk which can be corrected by targeted interventions such as technique modifications and corrective exercises & thus reduce the injury risk.
High pVGRF when not adequately dissipated, is a known direct stressor of the contralateral pars inter - articularis leading to lumbar spine injury (
5,
7). Fast bowlers generate large forces at both feet during the delivery and up to 9 times the body weight at FFC (
2,
8). It was previously thought the bowlers could utilise a higher pVGRF to generate faster bowling speeds. However, a recent study by King and colleagues found no correlation between pVGRF & bowling speed thus proving that a high pVGRF is unnecessary for fast bowling (
9). 45% of bowlers in our study had a pVGRF higher than the mean pVGRF of injured bowlers in Portus’ study indicating injury risk.
Increased lateral trunk flexion also acts as a stressor on the contralateral lumbar spine (
4,
10,
11). In our study, bowlers had a mean lateral trunk flexion of 39.65° ± 7.21 which is very near the injury risk cut off value. 41% of bowlers had LTF higher than 40° placing them at risk of lumbar spine injury.
The mixed - action bowler tends to have more hyperextension, lateral flexion and greater rotation which greatly loads the lumbar spine. In our study, we found that only 23% of bowlers had a “Mixed” type of action and 50% of bowlers had the “Semi Open” type of action. “Side On” action incidence was low which was in agreement with other studies. Thus it can be presumed that a good number of Indian fast bowlers are using a less injurious type of action, though this has to be confirmed by a larger scale cross sectional study.
The front leg acts as a shock absorber to attenuate the ground reaction forces upon front foot impact. The front knee flexion angle has strong correlations with both the lumbar spine rotation and lateral flexion and therefore has an important effect on lumbar spine loading (
11). A more extended front knee during the front foot contact phase has been associated with spondylolysis development (
3,
5). This implies that more knee flexion on FFC leads to better GRF absorption. However, this reduces the ball release height leading to slower ball speeds. Thus, the ‘optimum’ front leg action is considered to be one that lands extended or slightly flexed, followed by a period of flexion to absorb ground reaction forces, before vigorously extending up to the point of ball i.e. Flexor - Extender type (
3,
12).
In our study, bowlers had a mean knee flexion at FFC of 13.5° ± 8°. In a prospective study by Crewe et al., bowlers without lumbar spine stress injury, had a mean KF at FFC of 14.2 ± 6.3° (
4). 55% of our bowlers had a knee angle at FFC higher than 14.2°. This suggests that Indian fast bowlers land with the knee in more extension compared to the other fast bowlers and hence, are at a higher risk of injury. Only 32% of bowlers used the ideal Flexor - Extender type of front knee action, which is efficient and injury free.
Authors have suggested an optimal delivery stride length of 75% - 85% of standing height (
5). A shorter stride length inhibits the ability of the bowler to master a side on position, thus increasing the potential for shoulder counter rotation causing lumbar spine injuries (
5,
13). As stride length increases, there is a greater amount of plantar flexion increasing the risk of posterior ankle impingement (
14). In our study, the mean stride length of 64.5% BH ± 4.93 was much lower than the Western population. All bowlers in this study had a shorter than optimal stride length. Thus Indian fast bowlers are possibly at a comparatively higher risk of posterior ankle impingement as well as lumbar spine injuries. However, we acknowledge the fact that stride length could have been influenced by the nature of indoor lab testing due to factors such as run up length, approach speed, bowling effort, inability to use spiked bowling shoes, artificial turf etc.
In summary, a comparatively higher risk of lumbar spine, knee and ankle injuries was found in this study. Coaching interventions which are aimed at optimising the type of bowling action and technique corrections that help bowlers utilise the Flexor - Extender type of front knee action would help in significantly reducing the potential risk of these injuries.
5.1. Conclusions
Despite possessing an acceptable type of bowling action, a high proportion of Indian fast bowlers are vulnerable to injury with respect to key biomechanical variables. This emphasises role of 3D motion analysis for early identification of injurious techniques and could thus have implications on coaching of fast bowlers in India.