Biomechanics And Rehabilitation Of Cricket Injured Player
DEFINITION
Sports injuries result from acute trauma or repetitive stress associated with athletic activities. Sports injuries can affect bones or soft tissue (ligaments, muscles, tendons). Professional dancers are increasingly recognized as performing athletes, and many of the treatments and preventive measures utilized in sports medicine are now applied to dance-related injuries. It is also important to remember that many types of injuries that affect athletes may also occur in workers in certain occupations; for example, many people in the building trades develop tennis elbow or golfer's elbow. The principles of sports medicine can be applied in the treatment of most common musculoskeletal injuries.
OR
The contentious issue of injury definition dominates discussions about sports injury epidemiology. Definitions include injuries resulting in an insurance claim, hospital treatment, time lost from sporting participation and assessment by the team physician; consequently inter-study comparisons are often difficult. Although a standard injury definition for all sports and all levels of participation would improve comparability, it may be unsuitable for individual sports populations. For example, a single definition based on absence from competition and training may not be appropriate for both amateur and professional cohorts, as the incidence of injury may be affected by the frequency of training and competition. It is necessary, therefore, to ensure that the definition is appropriate for the population studied and the surveillance objectives of each epidemiological study, and where comparisons are made between sports and groups that the definitions are compatible.
Common mechanism of cricket injury
Bowling injury
Rotator Cuff InjuryThe rotator cuff is a group of muscles which work together to provide the Glenohumeral (shoulder) joint with dynamic stability, helping to control the joint during rotation (hence the name). The rotator cuff muscles include:
[*] [*]
[*] [*] Teres Minor
[*]
[*] Supraspinatus and Infraspinatus are the most commonly injured rotator cuff muscles. Due to the function of these muscles, sports which involve a lot of shoulder rotation – for example, bowling in cricket, pitching in baseball, swimming, kayaking – often put the rotator cuff muscles under a lot of stress. Problems with the rotator cuff muscles can be classed into two categories – Tears of the tendons/muscles, and inflammation of structures in the joint.
Acute Tear
This tends to happen as a result of a sudden, powerful movement. This might include falling over onto an outstretched hand at speed, making a sudden thrust with the paddle in kayaking, or following a powerful pitch/throw.
The symptoms will usually include:
Sudden, tearing feeling in the shoulder, followed by severe pain through the arm. Limited movement of the shoulder due to pain or muscle spasm. Severe pain for a few days (due to bleeding and muscle spasm) which usually resolves quickly. Specific tenderness (“x marks the spot”) over the point of rupture/tear If there is a severe tear, you will not be able to abduct your arm (raise it out to the side) without assistance
Chronic Tear
A chronic tear develops over a period of time. They usually occur at or near the tendon, as a result of the tendon rubbing against the overlying bone. This is usually associated with an impingement syndrome. Usually found on the dominant side more often an affliction of the 40+ age group. Pain is worse at night, and can affect sleeping. Gradual worsening of pain, eventually some weakness. Eventually unable to abduct arm (lift out to the side) without assistance or do any activities with the arm above the head. Some limitations of other movements depending on the tendon affected
Seek medical attention if:The pain persists for more than 2-3 days you are unable to work due to the pain/limitations. You are unable to reach up or to the side with the affected arm after 2-3 days. You are unable to move the shoulder and arm at all. For any acute injury where you are unable to move the injured shoulder as well as the uninjured shoulder.
What should we expect when we visit a healthcare professional with a possible Rotator Cuff problem?A detailed history of your general health, past problems and injuries, and what happened to cause this injury will be taken Both shoulders will be looked at and compared (you will need to partially undress for this) both visually and using palpation (feeling). Your neck, elbows and wrists will be checked to make sure they are not contributing to the problem. Range of movement will be assessed, you’ll be asked to do certain movements and the clinician will observe and ask you to report any pain (but will not be done if a fracture is suspected) Passive range of movement will be assessed – you will be asked to lie on a couch while the clinician moves your shoulder (but will not be done if a fracture is suspected) Sensation and strength in the arm will be assessed. Some specific tests will be done which can help to identify which tendon is causing the problem and confirm if it is a rotator cuff tear, or due to inflammation or some other cause.
What can we do to help our rotator cuff muscles recover?Treatment for an Acute Rotator Cuff Tear.
Apply ice to reduce swelling
Control the pain with appropriate medications
Rest the arm – a sling can sometimes be quite useful if you still need to go to work/school, which can be removed at night
You may require imaging studies (x-ray, MRI, CT Scan) to identify what the problem is and rule out any fractures Consider consulting a physiotherapist who can assist you with rehabilitating the injury. If the injury is quite severe and you are young and active, you might require an operation to fix the tear.
Indications include:
Under 60 years old Complete tears of the tendon/muscle Failure of other treatments after 6 weeks Professional/keen sports people. If your job requires constant shoulder use
Treatment for a Chronic Rotator Cuff Tear
Control pain Apply ice as above. Alternating heat and ice may also be benficial. Sometimes you might be referred for an injection of steroid medication directly into the site of the problem to help reduce any inflammation and allow you to proceed with rehabilitation. Shoulder exercises which can be provided by a physiotherapist. You may require surgery, with the indications as above
[subscapularis] How long will it take to get better? [infraspinatus]
Depending on several factors, conservative treatment has a 40-90% success rate at fixing the problem. Surgery often has good results, with some studies citing a 94% satisfaction rate with the surgery, resulting in lasting pain relief and improved function. Very extensive tears often have a poor surgical outcome; however this injury is thankfully quite rare. If you are older, it will take you longer to heal due to changes in your physiology.
Shoulder DislocationShoulder dislocation is a very common traumatic injury across a wide range of sports. In most cases, the head of the humerus (upper arm bone) is forced forwards when the arm is turned outwards (externally rotated) and held out to the side (abducted). This causes an anterior dislocation, which make up approximately 95% of all shoulder dislocations.
The shoulder joint is particularly prone to dislocations due to its high mobility, which sacrifices stability. It is the most commonly dislocated joint, with elbow, knee, finger and wrist dislocations occurring far less regularly.
Although some consider this to be a minor injury, most shoulder dislocations cause tears to the glenoid labrum. This is a ring of cartilage which deepens the glenoid fossa and acts as a cup, in which the humerus rests, forming the Glenohumeral (or shoulder) joint – which can cause an injury known as a Bankart Lesion, and may even cause a fracture to the attached bone (a Bony Bankart Lesion). There may also be damage to the surrounding ligaments, tendons, nerves, blood vessels and fractures to other bones.
Shoulder dislocations commonly become a reoccurring problem, with many people learning how to reduce (re-position) them on their own. This is only the case in those with highly unstable glenohumeral joints. A thorough rehabilitation program can help most individuals to prevent the shoulder repeatedly dislocating.
What are the symptoms of a dislocated shoulder?
The injury is usually acute, caused by direct or indirect trauma such as a fall or forced abduction and external rotation. There is a sudden onset of severe pain, and often a feeling of the shoulder 'popping out'. The shoulder will often look obviously different to the other side, usually loosing the smooth, rounded contour. The patient will usually hold the arm close into their body and resist abducting and externally rotating the shoulder. If there is any nerve or blood vessel damage there may also be pins and needles, numbness or discoloration through the arm to the hand. There is usually quite severe pain associated with a dislocation.
What should the athlete do about their dislocated shoulder?Immediate treatment for a dislocated shoulder has two stages. Firstly to protect the shoulder joint and prevent further damage (e.g. rest in a sling), and secondly to seek medical attention as soon as possible. The shoulder should be reduced (put back in) by a trained medical professional as soon as possible, never attempt to pop it back yourself as you may cause further damage! Ideally an X-Ray should be sought prior to reduction to rule outfractures. If this is not possible a post reduction X-Ray must always be sought.
What can a doctor or sports therapist do?If you sustain a dislocation, it is vitally important to seek medical attention, even if the shoulder pops straight back into position on its own. There is a strong likelihood that you will need some rehabilitation to help you regain both the function of the shoulder, and to prevent it from dislocating again. Some cases may even require surgery if the shoulder is regularly dislocating, or if there is an associated fracture. If the reduction is difficult it may be necessary to conduct the procedure under anesthetic.
Following a reduction you will usually be advised to:
Rest and immobilise the shoulder in a sling for 5-7 days. If there are complications such as fractures or soft tissue damage, immobilisation may be over a longer period. You may be prescribed NSAIDS such as ibuprofen to ease pain and inflammation. After the period of initial immobilisation you should be directed to gradually increase your range of pain free movement. You will also need to strengthen the rotator cuff muscles which support the shoulder joint to prevent reoccurrences.
[*] Exercises using resistance band are excellent for this in the early stages.
When is Surgery an option?Surgery is sometimes necessary following a shoulder dislocation if there has been extensive damage to muscles, tendons, nerves, blood vessels or the labrum. Surgery is then usually performed as soon as possible after the injury.
[anterior shoulder dislocation image]
In cases of recurrent shoulder dislocations, surgery may be offered in an attempt to stabilise the joint. There are a number of procedures which can be performed. The decision over which procedure to use depends largely on the patients lifestyle and activity. Some procedures result in reduced shoulder external rotation and so are not suitable for athletes involved in throwing or racket sports as this would affect performance.
Tennis elbow / Lateral epicondylitisTennis elbow or lateral epicondylitis is an extremely common injury that originally got its name because it is a frequent tennis injury, appearing in a large proportion of tennis players. Nevertheless it commonly manifests in a vast proportion of people who do not play tennis at all.
Lateral epicondylitis occurs most commonly in the tendon of the extensor carpi radialis brevis muscle at approximately 2cm below the outer edge of the elbow joint or lateral epicondyle of the humerus bone.
Specific inflammation is rarely present in the tendon but there is an increase in pain receptors in the area making the region extremely tender.
Signs and symptoms of tennis elbow / lateral epicondylitis:
Pain about 1-2 cm down from bony area at the outside of the elbow (lateral epicondyle)
Weakness in the wrist with difficulty doing simple tasks such as opening a door handle or shaking hands with someone.
Pain on the outside of the elbow when the hand is bent back (extended) at the wrist against resistance.
Pain on the outside of the elbow when trying to straighten the fingers against resistance.
Pain when pressing (palpating) just below the lateral epicondyle on the outside of the elbow..Other injuries and conditions with similar symptoms:
[*] The symptoms for this injury are very similar to Entrapment of the radial nerve which we recommend you also have a look at.
[*] It is important to have the neck examined as well, as elbow pain can be referred from problems in this region. See the neck pain page for further details.
Causes of tennis elbowTennis elbow is often caused by overuse or repetitive strain caused by repeated extension (bending back) of the wrist against resistance. This may be from activities such as tennis, badminton or squash but is also common after periods of excessive wrist use in day-to-day life
Tennis elbow may be caused by:
[*] A poor backhand technique in tennis.
[*] A racket grip that is too small.
[*] Strings that are too tight.
[*] Playing with wet, heavy balls.
[*] Repetitive activities such as using a screwdriver, painting or typing.
Two types of onset are commonly seen:
Sudden Onset: Sudden onset of tennis elbow occurs in a single instance of exertion such as a late back hand where the extensors of the wrist become strained. This is thought to correspond to micro-tearing of the tendon.
Late Onset: This normally takes place within 24-72 hours after an intensive term of unaccustomed wrist extension. Examples may be a tennis player using a new racket or even a person who's spent a weekend doing DIY.
Tennis elbow management and treatmentNo single treatment has been shown to be totally effective, however a combination of the treatments below are known to resolve tennis elbow over time. Each individual will react differently to different treatments.
What can the athlete do?
Apply ice or cold therapy to the elbow (15 mins up to six times a day). This will help reduce pain and inflammation if present.
Rest – an extremely important component in the healing of this injury.
Wear a brace or support (Play video) to protect the tendon whilst healing and strengthening, particularly when returning to playing / equivalent. The brace should not be put on the painful area but rather approximately 10cm down the forearm.
As with all soft tissue injuries a comprehensive rehabilitation program should be carried out.
Fig: tennis elbow.
Concussion
A concussion is an injury to the head caused by a direct or indirect blow to the head. It is defined as a complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces. Simply put concussion is an injury to the brain caused by imact against the skull. It can often involve a loss of consciousness but does not in all cases. Concussion can be mild, moderate or severe.
Mild concussion
[*] Slight mental confusion.
[*] Possibly some memory loss.
[*] Mild tinitus (ringing in the ears).
[*] Mild dizziness or headache.
[*] Pain in the area of the trauma.
The athlete will however have normal balance and will not have lost consciousness from a mild concussion.
Moderate concussion
[*] Mental confusion.
[*] Post traumatic memory loss.
[*] Moderate tinitus (ringing in the ears).
[*] Moderate dizziness or headache.
[*] Moderate balance disturbance.
[*] Possible nausea and vomiting.
[*] Loss of consciousness no longer than 5 minutes.
Symptoms of a severe concussion
[*] Mental confusion lasting 5 minutes or more.
[*] Severe tinitus, dizziness or headache.
[*] Prolonged retrograde amnesia (memory loss of events before the accident).
[*] Loss of consciousness longer than 5 minutes.
[*] Possible increase in blood pressure with decrease in heart rate.
What should be done?
[*] The athlete should be removed from the competition immediately.
[*] The athlete should not be left alone.
[*] Professional medical advice and evaluation should be done.
[*] Avoid contact or collision sports for at least 3 weeks.
[*] Repeated concussions may indicate retirement from contact sports altogether.
What about returning to sport?
This should be a gradual process and should be done under the supervision of qualified people. When the athlete does not have any symptoms then they may be able to do light exercise, stationary cycling or walking.
The next step is to to do sports specific activity without contact for or example running. If there are any symptoms returning then take a step back.
Next step is on field practice without contact. Again, any symptoms indicate a return to the previous stage.
When a medical doctor has given the go ahead onfield practice with contact can begin. The time taken to get to this stage will depend on the severity of the concussion.
Torn Anterior Cruciate Ligament / ACL Knee Injury
Definition
A torn ACL is an injury or tear to the anterior cruciate ligament (ACL). The ACL is one of the four main stabilising ligaments of the knee, the others being the Posterior Cruciate Ligament (PCL), Medial Collateral Ligament (MCL) and Lateral Collateral Ligament (LCL). The ACL attaches to the knee end of the Femur (thigh bone), at the back of the joint and passes down through the knee joint to the front of the flat upper surface of the Tibia (shin bone).
It passes across the knee joint in a diagonal direction and with the PCL passing in the opposite direction, forms a cross shape, hence the name cruciate ligaments.
The role of the Anterior Cruciate Ligament is to prevent forward movement of the Tibia from underneath the femur. The Posterior Cruciate Ligament prevents movement of the Tibia in a backwards direction. Together these two ligaments are vitally important to the stability of the knee joint, especially in contact sports and those that involve fast changes in direction and twisting and pivoting movements. Therefore a torn ACL has serious implications for the stability and function of the knee joint.
How does a torn ACL occur?
A torn ACL or acl injury is a relatively common knee injury amongst sports people. A torn ACL usually occurs through a twisting force being applied to the knee whilst the foot is firmly planted on the ground or upon landing. A torn ACL can also result from a direct blow to the knee, usually the outside, as may occur during a football or rugby tackle. This injury is sometimes seen in combination with a medial meniscus tear and MCL injury, which is termed O’Donohue’s triad.
Anterior cruciate ligament injuries are more frequent in females with between 2 and 8 times more females suffering a rupture than males, depending on the sport involved and the literature reviewed. The reason for this is as yet unknown, however areas of current research include anatomical differences; the effect of oestrogen on the ACL and differences in muscle balance in males and females.
Symptoms of a torn ACL
There may be an audible pop or crack at the time of injury
A feeling of initial instability, may be masked later by extensive swelling.
A torn ACL is extremely painful, in particular immediately after sustaining the injury.
Swelling of the knee, usually immediate and extensive, but can be minimal or delayed
Restricted movement, especially an inability to fully straighten the leg
Possible widespread mild tenderness
[*]
[*] Positive signs in the anterior drawer test and Lachman's test.
[*] Tenderness at the medial side of the joint which may indicate cartilage injury.
[*]
[*] Treatment for an Anterior Cruciate Rupture
What can the athlete do?
[*] Immediately stop play or competition
[*] Apply RICE (Rest, Ice, Compression, Elevation) to the knee immediately
[*] Seek medical attention as soon as possible.
What can a Professional do?
A Doctor or Sports Injury Professional can assess the knee joint to confirm a torn ACL
Diagnose any additional injuries
If unsure you may be sent for an MRI scan or X-ray
Refer for ACL Surgery if required
[*] Provide a pre-surgery rehabilitation program in order to strengthen the knee and reduce the swelling in preparation for surgery. This will help produce the best results following surgery.
What does surgery involve?
Surgery involves either repairing or reconstructing the torn ACL. With a repair, the exisiting damaged ligament is sutured (stitched) if the tear is in the middle. If the ligament has detached from the bone (avulsed) then the bony fragment is reattached.
Surgical reconstruction of the torn ACL is performed using either an extraarticular technique (taking a structure that lies outside the joint capsule such as a portion of the hamstring tendon) or an intraarticular technique (using a structure from within the knee such as part of the patellar tendon) which will replace the anterior cruciate ligament.
When is Surgery Required?
Surgery is performed more often than not following Anterior Cruciate ligament tears
The decision on whether to operate is based on a number of factors, including the athletes age; lifestyle; sporting involvement; occupation; degree of knee instability and any other associated injuries
Older people who are less active and perhaps injured their ACL following a fall as opposed to during sport would be unlikely to undergo surgery
A younger, fit person who regularly plays sport and would be more likely to adhere to a complex rehabilitation program is very likely to be offered surgery
How long will the athlete with a torn ACL be out of action?
[*] This largely depends on your surgeon or physiotherapists approach to rehabilitation. Some therapists advocate an accelerated rehabilitation programme returning the athlete to full competition within 6 months, others prefer a 9 month rehabilitation period.
More information on rehabilitation of an acl knee injury can be see on our anterior cruciate ligament rehabilitation page.
Which types of knee brace are available?
A knee support or knee brace provides protection and support. They prevent injury to healthy joints and support unstable joints.
Hinged Knee Braces
A hinged knee brace is likely to provide the best support for the knee and contains metal reinforcements in the sides which are connected by a hinge in the middle. Some knee braces use a geared hinge system in the middle which means the pivot point of the support moves as the knee bends (because the pivot point of the knee changes as it bends) providing a more snug fit.
This provides excellent lateral support to protect the medial and lateral ligaments and knee joint in general. No support can guarantee protection to the anterior cruciate ligament as it only requires just a few degrees of twisting to damage it.
Stabilized Knee Supports
A stabilized knee support has reinforced side panels to provide extra support over the standard knee support – again helping to provent sideways stress on the knee ligaments. Stabilized knee supports may have flexible steel springs sewn into the material at the side or may have elastic straps which wrap around the side for additional support.
Stabilized knee supports will provide less lateral support for the knee joint but will often be less bulky than a full hinged knee support.
Basic Knee Supports
A simple neoprene heat retainer will not usually have any additional springs, stays or supports. Some are open patella and have a hole for the patella to fit through. This can decreases the pressure on the kneecap or patella. A padded knee support will be closed and have additional padding over the patella to protect from knocks or minor impact as well as pressure from the ground when kneeling for long periods or landing on the knees for example in volleyball.
These will provide only very moderate support and are not usually sufficient to provide protection to joints where ligament injury has occured or is a risk.
[acl knee injury]
Medial Cartilage Meniscus Injury
Medial Cartilage Meniscus
Each knee joint has two crescent-shaped cartilage menisci. These lie on the medial (inside) and lateral (outside) of the upper surface of the tibia (shin) bone. They are essential components of the knee, acting as shock absorbers as well as allowing for the proper interaction and weight distribution between the tibia and the femur (thigh bone). As a result, injury to either meniscus can lead to critical impairment of the knee itself.
What is a Medial Meniscus Injury?
The medial meniscus is more prone to injury than the lateral meniscus as it is connected to the medial collateral ligament and the joint capsule and so is less mobile. Hence, any forces impacting from the outer surface of the knee, such as a rugby tackle, can severely damage the medial meniscus. In addition, medial meniscal injuries are often also associated with injuries to the anterior cruciate ligament. Other mechanisms of injury may be twisting the knee or degenerative changes that are associated with age. Any of these circumstances may lead to tearing of the medial meniscus, which in serious cases may require surgical intervention.
What are the Symptoms?
[*] A history of trauma or twisting of the knee.
[*] Pain on the inner surface of the knee joint.
[*] Swelling of the knee within 48 hours of injury.
[*] Inability to bend knee fully- this may be associated with pain or a clicking noise.
[*] A positive sign (pain and/or clicking noise) during a "McMurrays test".
[*] Pain when rotating and pressing down on the knee in prone position – "Apley's test"
[*] "Locking" or "giving way" of the knee.
[*] Inability to weight bear on the affected side.
Types of Meniscal Tear:
[*] Longitudinal Tears: This is a tear that occurs along the length of the meniscus and can vary in length
[*] Radial Tears: These tear from the edge of the cartilage inwards.
[*] Bucket-Handle Tears: This is an exaggerated form of a longitudinal tear where a portion of the meniscus becomes detached from the tibia forming a flap that looks like a bucket handle
[*] Degenerative Changes: This may lead to edges of the menisci becoming frayed and jagged
Treatment
What can the athlete do:
[*] Apply RICE to the injured knee.
[*] Wear a knee compression support.
[*] Try to keep the knee moving using our mobility exercises.
[*] Gentle exercises to maintain quadriceps strength, although care should be taken not to aggravate the symptoms.
[*] Take a glucosamine / joint healing supplement.
[*] Consult a Sports Injury Specialist.
A sports injury specialist may:
[*] Assess the knee to confirm the injury.
[*] Refer you for an MRI scan.
[*] Decide if conservative treatment will be effective or if surgery may be required.
1.Conservative Treatment
This may be indicated in the case of a small tear or a degenerative meniscus and may involve:
Ice, compression and recommendation of NSAID's e.g. Ibuprofen.
Electrotherapy i.e. ultrasound, laser therapy and TENS.
Massage to decrease swelling and relax surrounding muscular tension.
Manual therapy
[*] Once pain has subsided, exercises to restore the range of movement, improve balance and maintain quadriceps strength may be prescribed. These may include: squatting, single calf raises and wobble-board techniques.
2. Surgical Intervention
In the event of more severe meniscal tears such as a bucket handle tear, arthroscopic surgical procedures may be necessary to repair the lesion. The aim of surgery is to preserve as much of the meniscus cartilage as possible. The procedure itself will normally involve stitching of the torn cartilage. The success of the surgery depends not only on the severity of the tear but also on the age and physical condition of the patient. Younger and fitter patients are known to have better outcomes.
Following surgery a rehabilitative exercise program will be outlined for the patient which may include mobility strengthening and balance training. Full co-operation with the rehabilitative technique will be necessary to maximise recovery.
[medial mensicus tear] [rehabilitation]
Tight hamstrings
Many people suffer with tight hamstrings. Most of the time they will not cause a problem but can be more prone to bad tears and also limit sporting activity. The hamstring muscles consist of the semitendinosus, semimembrinosus and biceps femoris.
Tight hamstrings can also be responsible for postural problems and other back problems as they will tend to pull the pelvis out of normal position.
Why do we have tight hamstrings?
[*] Genetic reasons. You can be born with naturally short hamstrings when some people are naturally supple.In general women and children are more supple than men.
[*] Not enough stretching. If you participate in a lot of sport and do not stretch properly then you are more likely to have your hamstrings tighten up. It is especially important to stretch properly after exercise as this is when the muscles are warm and more receptive to stretching. If you tend to make a beeline for the bar after your game of football think about spending 20 minutes stretching first.
[*] Problems in your lower back can put pressure on your sciatic nerve which runs down the legs and cause muscles to tighten.
What can we do about it?
Even if you are not naturally supple you can still improve your flexibility by stretching.
Types of stretching include dynamic, static, passive, PNF and CRAC. A full description of these can be seen here.
Avoid ballistic stretching which is bouncing and forcing the muscle to go further than is comfortable and will damage it.
Sports massage can help in loosening tight muscles. Have a regular sports massage on the legs.
What problems can tight hamstrings cause?
[*] More susceptible to tearing. If you force a muscle to go further than it can normally go at speed it is likely to tear.
[*] Tight hamstrings can cause the hips and pelvis to rotate back flattening the lower back and causing back problems.
[*] If your muscles have tightened up then blood has been squeezed out of them therefore your muscles are working at less than 100 % of capacity and your performance will be down as a result. Regular sports massage and stretching to improve muscle condition will not only reduce the likelihood of injury but may improve performance.
Quadriceps Muscle Strain
Quadriceps strain?
The quadriceps muscles are the muscles on the front of the thigh. They consist of the Vastus lateralis, Vastus medialis, Vastus intermedius and the Rectus femoris. A strain is a tear in the muscle. These can range in severity, from a very small tear to a complete rupture.
Tears to the quadriceps muscles usually occur following an activity such as sprinting, jumping or kicking. Any of these muscles can strain (or tear) but probably the most common is the Rectus femoris. This is because it is the only one of the four muscles which crosses both the hip and knee joints. This make it more susceptible to injury. The most common site of injury is around the musculotendinous junction (where the muscle becomes tendon), just above the knee.
Injuries that occur following a direct impact to the muscle, such as being hit by a ball or other hard object, are more likely to be contusions and should be treated slightly differently.
Muscle strains are graded 1, 2 or 3 depending on the severity of the damage. It is important you understand what grade of injury you have suffered to be able to treat it appropriately.
Grade 1 thigh strain:
Symptoms?
[*] A twinge in the thigh is usually felt.
[*] A general feeling of tightness in the thigh.
[*] Mild discomfort on walking.
[*] Probably no swelling.
[*] Trying to straighten the knee against resistance may be uncomfortable
[*] An area of local spasm may be felt at the site of the suspected tear.
What can the athlete do about it?
[*] Apply the R.I.C.E (rest, ice, compression, elevation) procedure for the first 24 hours.
[*] Apply cold therapy as soon as possible and every 2-3 hours.
[*] Use a compression bandage until you feel no pain.
[*] Rest for at least 72 hours before commencing light training
[*] If there is no pain, continue with training.
[*] See a sports injury professional.
What can a sports injury specialist do?
[*] Use sports massage techniques to speed up recovery (very important).
[*] Use ultrasound and electrical stimulation.
[*] Prescribe a rehabilitation programme.
Grade 2:
Symptoms?
[*] A sudden sharp pain when running, jumping or kicking.
[*] Unable to play on.
[*] Pain affects walking.
[*] The athlete may notice swelling or even mild bruising.
[*] Pain on feeling the area of the tear.
[*] Straightening the knee against resistance causes pain
[*] Unable to fully bend the knee.
What can the athlete do about it?
[*] Use the R.I.C.E procedure as above.
[*] Apply cold therapy straight away and every 2-3 hours for 48 hours.
[*] Wear a compression bandage and rest with the leg elevated.
[*] Use crutches if necessary.
[*] See a sports injury specialist.
What can a sports injury specialist do?
[*] Use sports massage techniques to speed up recovery (very important).
[*] Use ultrasound and electrical stimulation.
[*] Prescribe a rehabilitation programme.
Grade 3:
Symptoms?
[*] Sudden, severe pain in the thigh.
[*] Unable to walk without the aid of crutches.
[*] Bad swelling appearing immediately.
[*] Bruising usually appears within 24 hours.
[*] A static contraction will be painful and might produce a bulge in the muscle.
[*] Expect to be out of competition for 6 to 12 weeks.
What can the athlete do about it?
[*] Stop play immediately.
[*] Rest with the leg elevated, using a compression bandage.
[*] Apply cold therapy immediately.
[*] Seek medical attention. It is important you do this if you suspect a grade three strain. If you do not you may be permanently injured or weakened.
What can a sports injury specialist do?
[*] Use sports massage techniques to speed up recovery (very important).
[*] Use ultrasound and electrical stimulation.
[*] Prescribe a rehabilitation programme and monitor it.Operate if needed (rare).
Groin Strain (Adductor muscle tear)
Groin strain?
A groin strain is a tear or rupture to any one of the adductor muscles. There are five adductor muscles, the pectineus, adductor brevis and adductor longus (called short adductors which go from the pelvis to the thigh bone) and the gracilis and adductor magnus (long adductors which go from the pelvis to the knee).
The most common muscle to be injured is the adductor longus muscle which connects from the pubic ramus (part of the lower pelvis) to the medial (inner) surface of the femur (thigh bone).
The main function of the adductors is to pull the legs back towards the midline, a movement called adduction. During normal walking they are used in pulling the swinging lower limb towards the middle to maintain balance. They are also used extensively in sprinting, playing football, horse riding, hurdling and any sport which requires fast changes in direction.
A rupture or tear in the muscle usually occurs when sprinting, changing direction or in rapid movements of the leg against resistance such as kicking a ball. Repetitive overuse of the groin muscles may result in adductor tendinopathy.
Grade 1, 2 or 3?
Groin strains, as with all muscle tears, are graded 1, 2, or 3 depending on how bad they are. Grade one is a minor tear where less than 10% of fibres are damaged. Grade 2 is a moderate tear and can be anything from 10 to 90% of fibres torn. For this reason, grade 2 injuries are often termed 2+ or 2-. Grade 3 injuries are the most serious being either partial or full ruptures.
Symptoms of a groin strain
Grade 1
[*] Discomfort in the groin or inner thigh. This may not be noticed until after exercise stops.
[*] The groin muscles will usually feel tight.
[*] There may be an area which is tender to touch
[*] Walking is normal, discomfort may only be when running or even just on changes in direction.
Grade 2
[*] A sudden sharp pain in the groin area or adductor muscles during exercise.
[*] Tightening of the groin muscles that may not be present until the following day.
[*] There may be minor bruising or swelling (this might not occur until a couple of days after the initial injury).
[*] Weakness and possibly pain on contracting the adductor muscles (squeeze your legs together)
[*] Discomfort or pain on stretching the muscle
[*] Walking may be affected. Running is painful.
Grade 3
[*] Severe pain during exercise, often on changing direction suddenly when sprinting.
[*] Inability to contract the groin muscles (squeeze your legs together).
[*] Substantial swelling and bruising on the inner thigh within 24 hours.
[*] Pain on attempting to stretch the groin muscles.
[*] It may be possible to feel a lump or gap in the muscles
Groin strain treatment
What can the athlete do?
[*] Apply R.I.C.E. (Rest, Ice, Compression, and Elevation) immediately.
[*] Use crutches if needed.
[*] Gently stretch the groin muscles provided this is comfortable to do so.
[*] See a sports injury professional who can advise on rehabilitation of the injury.
[*] For a suspected grade 3 strain seek professional help immediately.
What can a sports injury specialist or doctor do?
[*] Use ultrasound or laser treatment.
[*] Tape the groin to take the pressure off the area.
[*] Use sports massage techniques after the acute phase. This is extremely important.
[*] Operate if the muscle has torn completely.
[*] Advise on a rehabilitation programme consisting stretching and strengthening exercises
[Groin strain]
Low back pain / muscle strain
muscle strain?
Low back pain/ muscle strain or ruptures can occur in the back just like they can anywhere else in the body. A muscle strain (or tear) in the back is usually caused by a sudden movement or trying to lift something that is too heavy. The low back pain however is often a long time coming on as the muscles in the back gradually tighten up due to bad posture and overuse.
These muscles go into spasm and do not get enough blood through them resulting in weakness. So when someone complains of low back pain when they bend down to pick up a piece of paper and tear a muscle in the back, it is not just the piece of paper that caused it but a gradual build up of tension over weeks and months.
If you have suffered a direct blow to a muscle, particularly one near a bone then you must treat it as a contusion.
Symptoms include:
[*] A sudden sharp pain in the back.
[*] Possibly swelling or bruising over the area of the rupture.
[*] Difficulty in moving – bending forwards, sideways or straightening.
Muscle tears are graded 1, 2 or 3 depending on how bad the tear is:
Grade 1 What does it feel like?
[*] Tightness in the back.
[*] May be able to walk properly.
[*] Probably won't have much swelling.
What can the athlete do?
[*] See a sports injury professional or therapist who specializes in back problems.
[*] Use a heat retainer until you feel no pain.
[*] Ease down training for a week or two but no need to stop unless there is getting pain.
What can a Sports Injury Specialist or Doctor do?
[*] Use sports massage techniques to speed up recovery (very important).
[*] Use joint manipulation techniques.
[*] Use ultrasound and electrical stimulation.
[*] >Prescribe a rehabilitation and strengthening programme.
Grade 2 What does it feel like?
[*] Probably cannot walk properly.
[*] May get occasional sudden twinges of pain during activity.
[*] May notice swelling.
[*] Pressing in causes pain.
What can the athlete do?
[*] Rest.
[*] See a sports injury professional for rehabilitation advice.
What can a Sports Injury Specialist or Doctor do?
[*] Use sports massage techniques to speed up recovery (very important).
[*] Use ultrasound and electrical stimulation.
[*] Prescribe a rehabilitation programme of mobility, stretching and strengthening exercises.
Grade 3: What does it feel like?
[*] Unable to walk properly.
[*] In severe pain.
[*] Bad swelling appearing immediately.
[*] A static contraction will be painful and might produce a bulge in the muscle.
[*] Expect to be out of competition for 3 to twelve weeks or more.
What can the athlete do?
[*] Seek medical attention immediately.
[*] (Rest, Ice, Compress, Elevate.)
[*] Use crutches.
[*] Follow a rehabilitation plan as directed by the sports therapist.
What can a Sports Injury Therapist or Doctor do?
[*] Use sports massage techniques to speed up recovery (very important).
[*] Apply joint manipulation techniques.
[*] Use ultrasound and electrical stimulation.
[*] Prescribe a rehabilitation programme and monitor it.
[*] A surgeon will operate if indicated.
If you suspect a grade two or three injury it is recommend you see a Sports Injury or back Specialist immediately.
[Low back pain]
Carpal Tunnel Syndrome (pressure on the median nerve)
Carpal tunnel syndrome?
Carpal tunnel syndrome is caused by compression of the median nerve in the wrist. The median nerve is one of the nerves which supplies the hand (shown opposite). It passes through the wrist in a narrow channel called the carpal tunnel, along with the flexor digitorum superficialis and flexor pollicis longus tendons.
caused
[*] Traumatic wrist injury such as sprains and fractures.
[*] Repetitive use of the wrist (Carpal tunnel syndrome is a form of RSI).
[*] Pregnancy – causing fluid retention in the wrist.
[*] Use of vibrating machinery.
[*] Congenital – some people naturally have a smaller, narrower carpal tunnel.
[*] .
All of these conditions can cause a narrowing of the space through which the median nerve passes. The cause may be structural such as with a fracture or congenital cases, or due to swelling, inflammation or fluid retention.
Carpal tunnel syndrome is three times more common in women, probably because they have a smaller carpal tunnel. It also has a higher prevalence in people with diabetes and other conditions which directly affect the nervous system. It usually occurs firstly and sometimes solely in the dominant hand, where it is also more painful. Some professions are more at risk of developing carpal tunnel syndrome, especially people working on an assembly line, who are continually repeating the same movement.
Symptoms of carpal tunnel syndrome?
Symptoms usually increase gradually and may initially only be present at night. Carpal tunnel syndrome may be in one or both wrists.
[*] A dull ache in the wrist and forearm.
[*] Pain which radiates into the thumb and four fingers (excluding the little finger).
[*] Sensations of tingling or burning in the hand or four fingers.
[*] Pain which is worse at night.
[*] Pain may radiate into the forearm, elbow or shoulder.
[*] Weakness in the fingers and hands.
How is carpal tunnel syndrome diagnosed?
If you suspect carpal tunnel syndrome you should visit your Doctor as soon as possible. They will ask you about your symptoms and examine your hand and wrist for tenderness, sensation, warmth and colour. They will often try to get you to reproduce your symptoms by performing an aggravating movement, or one of the following tests:
Tinels sign – Tapping with two fingers over the palm side of the wrist. The test is positive if any of the symptoms are reproduced.
Phalens test – Place your hands in front of you at chest height with the fingers of the two hands touching. Flex the wrists so that you put the backs of your hands together. Hold this position for a minute. Reproduction of any symptoms is a positive result.
Investigations may also be performed to confirm the diagnosis. You may be offered an MRI scan, ultrasound imaging, electromyography or a nerve conduction study.
Carpal Tunnel Syndrome Treatment
Treatment of carpal tunnel syndrome should initially be conservative and led by your Doctor. The first period of treatment should include complete rest for the wrist, which is normally immobilised in a splint, as shown above. If there is inflammation and swelling present, using a form of cold therapy will help to relieve this. Your Doctor may also prescribe anti-inflammatory medication such as ibuprofen to reduce inflammation, or diuretics to clear fluid retention .
Following a period of immobilisation, stretching and strengthening exercises can be used to help prevent a reoccurrence of symptoms. All exercises should be performed pain-free. If pain occurs, go back a step. Firstly you should aim for a full, pain-free range of motion, before moving on to strengthening. Resistance bands are excellent for performing wrist strengthening exercises.
Other, more alternative treatments, which may be worth trying include acupuncture and yoga, which have been linked to an improvement in carpal tunnel syndrome symptoms.
If symptoms do not improve following rest and anti-inflammatories, other options include Corticosteroids or lidocaine injections. If all of this treatment fails and symptoms persist over a 6 month period, surgery may be required.
What does surgery involve?
A carpal tunnel release is a very common operation, which involves cutting the carpal ligament to make more space for the median nerve. This can either be done as an arthroscopic operation (keyhole), or as an open release, where a 5-6cm incision is made. It is a straightforward procedure which is usually carried out on an outpatient basis. Your hand and wrist will be bandaged and may be placed in a sling for a few days to help it rest and reduce swelling.
[Wrist supports can be beneficial in immobilising the wrist in many different sporting injnuries]
de Quervains Tenosynovitis
Tenosynivitis?
Tenosynivitis is inflammation of the sheath that surrounds a tendon as opposed to inflammation of the actual tendon itself (tendinitis or tendonitis). de Quervain's tenosynivitis is inflammation of the synovium of the abductor pollicis longus and extensor pollicis longus muscles as they pass through the wrist (on the thumb side of the wrist). It occurs more frequently in racket sports such as tennis, squash or badminton as well as canoing and ten pin bowling. It also occurs in golfers (left thumb of a right handed golfer and vice versa). Tendon injuries such as this are often labelled with the umbrella term RSI (repetitive strain injury).
Symptoms of de Quervain's tenosynovitis
[*] Tenderness and swelling on the thumb side of the wrist where the tendons pass.
[*] Creptius may be felt (a creaking of the tendon as it moves).
[*] Finkelstein's test may be positive (thumb is placed in the palm of the hand and wrist moved laterally towards the little finger to stretch the tendons – pain may be felt).
Treatment
[*] Rest, splinting if necessary.
[*] Using an extra thick pen may help as this reduces the stretch on the tendons when writing.
[*] Ice or cold therapy to reduce pain and inflammation.
[*]
[*] Stretching and strengthening.
[*] A cortisone injection may be given
[*] In rare cases surgery may be indicate
[Abductor Pollicis Longus]
Fractured Rib
Fractured rib?
This injury is common in contact sports and usually occurs when you have a hard impact to the chest such as an elbow.
Fractured rib symptoms include:
[*] Pain and swelling at a particular point in the ribs.
[*] Pain when you breathe in deeply or when you cough or sneeze.
[*] Pain at a specific point when someone presses in over the whole of your rib cage
What can the athlete do?
Rest is all you can do.
If it is very severe then you should seek medical attention to ensure no damage has been done inside the rib cage. If you have a severe fracture of the ribs I think you would know about it!
What an a sports injury specialist or doctor do?
There is not much a sports injury specialist can do except confirm the diagnosis and advise rest.
A doctor can X-ray the ribs and rule out any internal damage.
How long will it take to heal?
If it is not a severe fracture then you should be back in action from between 3 to 6 weeks so long as you rest.
[Rib support belt]
Sacroiliac Joint Pain
Sacroiliac Joint?
The Sacroiliac joints are located at the very bottom of the back. You have one either side of the spine. The Sacroiliac joints help make up the rear part of the pelvic girdle and sit between the sacrum (vertebrae S1-S5) and the Ilia (hip bones).
The function of the SI joints is to allow torsional or twisting movements when we move our legs. The legs act like long levers and without the sacroiliac joints and the pubic symphesis (at the front of the pelvis) which allow these small movements, the pelvis would be at higher risk of a fracture.
The concept of the SIJ causing lower back pain is now pretty well understood. However, due to the complex anatomy and movement patterns at the joints and area in general, evaluation and treatment of sacroiliac dysfunctions is still controversial.
SIJ dysfunction is a term which is commonly used when talking about sacroiliac injuries. This dysfunction refers to either hypo or hyper mobility (low or high respectively). Or in other words, the join can become 'locked' or be too mobile. This can then lead to problems with surrounding structures such as ligaments (e.g. Iliolumbar ligament) and muscles, which means SIJ problems can cause a wide range of symptoms throughout the lower back and buttocks, or even the thigh or groin.
Symptoms of SI Joint Injury?
Pain located either to the left or right of your lower back. The pain can range from an ache to a sharp pain which can restrict movement.
The pain may radiate out into your buttocks and low back and will often radiate to the front into the groin. Occasionally it is responsible for pain in the testicles among males.
Occasionally there may be referred pain into the lower limb which can be mistaken for sciatica.
Classic symptoms are difficulty turning over in bed, struggling to put on shoes and socks and pain getting your legs in and out of the car.
Stiffness in the lower back when getting up after sitting for long periods and when getting up from bed in the morning.
Aching to one side of your lower back when driving long distances.
There may be tenderness on palpating the ligaments which surround the joint.
Causes of Sacroiliac Pain
Causes of Sacroiliac joint pain can be split into four categories:
[*] Traumatic
[*] Biomechanical
[*] Hormonal
[*] Inflammatory joint disease
Traumatic
Traumatic injuries to the SIJ are caused when there is a sudden impact which 'jolts' the joint. A common example is landing on the buttocks. This kind of injury usually causes damage to the ligaments which support the joint.
Biomechanical
Pain due to biomechanical injuries will usually come on over a period of time and often with increased activity or a change in occupation/sport etc. The most common biomechanical problems include:
[*] Leg length discrepancy
[*] Overpronation
[*] 'Twisted pelvis'
[*] Muscle imbalances
Hormonal
Hormonal changes, most notably during pregnancy can cause sacroiliac pain. In preparation for giving birth, the ligaments of the pelvis especially increase in laxity. Combining this with an increase in weight putting extra strain on the spine, may lead to mechanical changes which can result in pain.
Inflammatory joint disease
Spondyloarthropathies are inflammatory conditions which affect the spine. These include Ankylosing Spondylitis which is the most common inflammatory condition to cause SI joint pain.
Treatment of SIJ Pain
What can you do to treat sacroiliac joint pain yourself?
[*] Rest from any activities which cause pain.
[*] If the surrounding muscles have tightened up, use a warm-pack to help them relax.
[*] Don't heat if an inflammatory condition is suspected.
[*] Anti-inflammatory medications such as ibuprofen may be helpful. Always check with your Doctor first.
[*] Try wearing a sacroiliac belt
What can a sports injury specialist or doctor do?
[*] Use diagnostic tests to discover the cause of the problem.
[*] Rule out medical diseases such as Ankylosing Spondylitis.
[*] Treat the cause as well as the symptoms.
[*] Use electrotherapy equipment to treat affected tissues.
[*] If indicated and safe to do, level the pelvis via manipulation.
[*] Sports massage will help relieve any soft tissue tension in the area.
[*] Advise you on a rehabilitation program to correct any muscle imbalances.
[*] If the above treatment fails, a Corticosteroid injection into the SIJ may be used [Sacroiliac joint inflamed]
L Injury in Australian elite cricket
Prevention of cricket injury
According to research conducted by John Orchard into cricket injury, 9% of cricketers are injured at any point in time. Fast bowlers are at increased risk of injury as well, with 15% of them falling susceptible to injury at any given time. Some cricket injuries can abbreviate careers of good cricketers like Ian Bishop-who had persistent back injuries. Clearly, knowing how to prevent injuries during a cricket match can save your career or even your life.
Cricket is a multi-dimensional sport where players engage in a wide range of activities (batting, bowling and fielding). Therefore, there are myriad ways of preventing injury during a cricket game that include:
i) Wearing proper protective equipment
ii) Using additional strain-minimizing gear
iii)Training properly
iv) Avoiding overload
Wearing protective equipment ==
In modern cricket, protective equipment reduces and prevents the occurrence of serious injury. A hard ball at high pace can do considerable damage to susceptible areas of the human body. The first port of call for any cricketer is to wear as much protective equipment as possible. In many cases, it is not just enough to have the equipment but to have quality protection.
a) Helmets: Batters and close-in fielders should wear helmets. Having a helmet is far better than having none but it is advisable to use a helmet with a grill that protects the face as well as the head. In the past batters played without helmets (notably Viv Richards). That requires tremendous skill and is a serious risk that few could and should take. Wicketkeepers often come up to the stumps without helmets, although it is clearly not an injury-proof practice.
b) Pads and guards: Batters must wear pads when batting because a hard ball delivered at 90 miles or even 50 miles can damage your shin and knees. Wicketkeepers also wear specially designed and less cumbersome pads as part of their necessary equipment. Close-in fielders should opt to wear shin guards. Batters should also reduce injury-risk by using use arm guards, thigh guards, chest guards and 'box' guards.
c) Gloves: Batting gloves help with gripping the bat, but they also help protect against injury to the hand. Batters should ensure that the gloves are properly padded- especially around the fingers.
Using strain-minimizing optional equipment ==
Fielders, bowlers and batters have the option of wearing additional aids that reduce wear, tear and stress on joints, ligaments and tissues. Ankle braces, shock-absorbing insoles, specially designed cricket boots, knee straps and compression shorts are just some of the aids to minimize strain. While protective gear seeks to prevent serious injury and impact injuries, strain-minimizing gear seeks to prevent recurrent, minor injuries that can become lingering problems over time.
Proper training ==
Proper training is important for cricket since the modern game requires a higher degree of athleticism. Batsmen and fielders must be able to sprint, fielders have to throw and bowlers have to deliver with an action that naturally places stress on certain body parts. Improper execution of these can increase the risk of injury.
Before any match or training activity, cricket players must warm up to get the muscles more flexible and joints accustomed to movement. It is also critical for players to train consistently between games, since cricket requires sudden, intense activity over long periods.
Bowling is a very unnatural act for the human body. It is no surprise that side strains, back pain and hamstring injuries are the most common cricket injuries. Fast bowlers have many stress fractures- particularly in the lower back. The type of bowling action of a fast bowler and his physical characteristics determine his susceptibility to injuries. Even spin bowlers can develop shoulder injuries, wrist and finger injuries.
The type of bowling that a cricketer does should influence his exercise routine. Fast bowlers must place emphasis on core-strengthening exercises and proper rotator-cuff action. Spinners normally bowl many overs and rely more on their shoulder and wrists. Rotator-cuff exercises should be done gradually, with a view to avoiding excessive activity.
Avoiding overload or unnecessary risks ==
Captains also have a role in preventing injury during a cricket match by properly rotating their bowlers. A single spell of 12 overs can do more damage to a fast bowler than two spells of 8 overs with a fair break in-between. Fielders can sometimes get exuberant during cricket matches in attempting to save runs- especially on the boundary. While fielding near the boundary, fielders must be mindful of advertising boards and the boundary rope. Ramnaresh Sarwan of the West Indies ruled himself out of the West Indies 2007 tour of England by sliding into an advertising board.
Even with the best methods and equipment, injuries can occur in sports from time to time. In an odd sport like cricket, many 'freak' injuries can occur as well. The most important thing to note is that you can minimize or prevent certain injuries. Many cricketers cut corners or take chances with their equipment and methods on the field of play. To avoid injury during a cricket match it is important to control what you do and wear on the field and even off of it.
Darrell Victor is a freelance writer and cricket enthusiast from the West Indies. For more articles on West Indies cricket, read: Reasons for the decline of West Indies cricket:
COMMON MANAGEMENT OF CRICKET INJURY
COMMON MANAGEMENT OF CRICKET INJURY
With the cricket season now in full swing, injuries are already making their way through our doors.
Some of the more common injuries incurred by cricketers are simple muscle strains or joint sprains. Hamstring and calf muscles are often “pulled” when taking off for a quick single or going for a catch in the outfield. These acute injuries must be managed in the first 48 hours with, Rest, Ice, Compression and Elevation (R.I.C.E.). Once the acute management has commenced the injuries should be assessed by a professional qualified to assess and treat sports injuries, these include a Sports Medicine doctor or a physiotherapist.
Early assessment and appropriate treatment planning will reduce the risk of a simple injury blowing out to become a complicated chronic injury.
The more complex injuries are those that come on slowly over time, these could include injuries such as shoulder rotator cuff injuries, stress fractures in the low back and shin splints.
These types of injuries are often characterized by:-
1. Bowling too many overs without the appropriate conditioning.
2. Technique faults in the bowling action.
3. Inadequate recovery time.
4. Inadequate muscle flexibility and strength
5. Previous injury
Simple tips to avoid injury:-
1. Ensure correct conditioning which includes appropriate flexibility and strength to allow you to bat, bowl or wicket keep for the duration of a match.
2. Correct any technique or biomechanical faults. Speak to your coach and have your action video analysed.
3. Do not push through pain. PAIN is our bodies warning system to say that something is wrong.
If you develop musculo-skeletal pain, a sports physiotherapist is well positioned in the management and prevention of cricket related injuries. The key to the prevention of chronic pain from injury is in the early detection, management and correction of faults.
Rehabilitation
Rehabilitation Protocol
Sports Massage for the Hamstring Muscles
Sports massage applied to the back of the thigh is excellent for helping reduce hamstring strains. Blood is flushed through tight knots and muscle spasm, loosening what would be potential week points in the muscles.
Technique 1: Effleurage
Aim – light stroking to warm up the area in preparation for deeper techniques.
With the hands stroke lightly but firmly upwards from just above the back of the knee to the top of the hamstring muscle (image 1).
Always stroke upwards towards the heart as this is the direction of blood flow. The other way can damage veins.
Then lightly bring the hands down the outside of the leg (image 2) keeping them in contact but do not apply pressure.
Repeat the whole movement using slow stroking techniques, trying to cover as much of the leg as possible.
Repeat this technique for about 5 to 10 minutes, gradually applying deeper pressure on the up strokes.
Technique 2: Petrissage
Aim – kneading movements to manipulate and loosen the muscle fibres more. There are a number of different types or methods of petrissage massage techniques. A couple of simple ones are described below:
With the hands apply a firm, kneading technique. Try to pull half the muscle towards you with the fingers of one hand whilst pushing half the muscle away with the thumb of the other hand (image 3).
Then reverse to manipulate the muscle in the other direction.
Work your way up and down the muscle, trying to cover as much of the surface as possible.
Apply this technique for around 5 minutes, alternating with light stroking (above) occasionally.
Another slight variation on this and a very commonly used technique is a circular kneading action.
Techniques 3 and 4: Stripping the muscle and Circular frictions.
Aim – to apply sustained pressure to the muscle, ironing out any lumps, bumps and knots.
With the thumb of the right hand (for the left leg), apply deep sustained pressure along the full length of the muscle (image 4).
This technique should be slow and deliberate to 'feel' the muscle underneath.
Repeat this 3 to 5 times in a row, alternating with petrissage for 5 to 10 minutes.
This technique can be applied to the whole muscle group with the forearm (image 5).
If the therapist comes across and tight, tender knots in the muscle (usually at the point of strain or rupture), these can be worked out with deep circular frictions to the knot (image 6).
Massage should be deep but not so deep that the athlete tightens up with pain.
Finishing off
Complete the hamstring massage by finishing off with a effleurage techniques
[Effleurage to the hamstrings]
Effleurage to the hamstring muscles
Sports Massage for the Calf Muscles
Technique 1: Effleurage
Aim – light stroking to warm up the area in preparation for deeper techniques.
With the hands stroke lightly but firmly upwards from just above the heel to the back of the knee (image 1).
Always stroke upwards towards the heart as this is the direction of blood flow. The other way can damage veins.
Then lightly bring the hands down the outside of the leg keeping them in contact but do not apply pressure (image 2).
Repeat the whole movement using slow stroking techniques, trying to cover as much of the leg as possible.
Repeat this technique for about 5 to 10 minutes, gradually applying deeper pressure on the up strokes
Technique 2: Petrissage
Aim – kneading movements to manipulate and loosen the muscle fibres more.
With the hands apply a firm, kneading technique. Try to pull half the muscle towards you with the fingers of one hand whilst pushing half the muscle away with the thumb of the other hand (image 3).
Then reverse to manipulate the muscle in the other direction.
Work your way up and down the muscle, trying to cover as much of the surface as possible.
Apply this technique for around 5 minutes, alternating with light stroking (above) occasionally.
Technique 3: Stripping the muscle
Aim – to apply sustained pressure to the muscle, ironing out any lumps, bumps and knots.
With both thumbs together, apply deep pressure up the middle of the calf muscle aiming to separate the heads (sides) of the big gastrocnemius muscle (image 4).
This technique should be slow and deliberate to 'feel' the muscle underneath.
Repeat this 3 to 5 times in a row, alternating with petrissage for 3 to 5 minutes.
Another similar technique is applied with a single thumb, which can be reinforced with a couple of fingers from the other hand if more pressure is required (image 5).
A great deal of pressure can be applied with this technique. Massage should be deep but not so deep that the athlete tightens up with pain.
Aim to cover all the muscles in the lower leg, feeling for all the lumps and bumps.
Techniques 5 and 6: Circular frictions and Trigger points
With either a single thumb, a reinforced thumb as shown (or fingers as shown in video clip), apply pressure in a circular pattern to any tight spots, lumps or bumps (image 6).
Apply 10 to 20 circular frictions at a time and alternate with stripping and petrissage techniques.
Frictions can be applied to a specific point in the muscle, or applied over a small area of muscle moving gradually.
Again, pressure should be firm but not so deep as to cause the muscle to tighten up with pain.
If the therapist finds any lumps and bumps or particularly sensitive spots then apply deep, sustained pressure to these points using the thumbs. A trigger point is a localised, highly sensitive point in the muscle.
Increase the pressure on the trigger point until it ranks 7/10 on the pain scale (10 being painful). Hold this pressure until it eases off to 4/10 on the pain scale (usually about 5 seconds).
Without easing off with the pressure, increase again until it reaches 7/10 on the pain scale once more. Hold until it eases, repeat once more.
This technique is very hard on the thumbs. It is important to keep the thumb slightly bent (flexed) when applying pressure to avoid damaging the joints.
Finishing off
The therapist can finish off with more petrissage techniques and then finally effleurage again. The whole process should not last more than half an hour.
Massage therapy can be applied every day if it is performed lightly however deeper techniques may result in a days recovery period to allow tissues to 'recover'.
For rehabilitation of muscle strains, sports massage is very important in softening / preventing scar tissue forming at the site of injury and re-aligning the new healing fibres in the direction of the muscle fibres. This will help prevent re-injury.
[Effleurage to the calf muscles]
Fig: Effleura
Sports Massage for the Front Thigh
Technique 1: Effleurage to front of the whole leg
Aim – light stroking to warm up the area in preparation for deeper techniques.
With the hands stroke lightly but firmly upwards from the ankle up the whole leg to the hip and then down the side of the leg. (image 1)
Try to cover as much of the surface as possible with the hands but avoid going directly over the patella (knee cap).
Apply this technique 5 to 10 times before moving on to concentrate just on the thigh area (image 2).
Technique 2: Deep effleurage to thigh
Aim – light stroking to warm up the area in preparation for deeper techniques.
With the hands stroke lightly but firmly upwards from just above the patella to to the top of the thigh. Try to cover as much of the surface as possible with the hands (image 2).
Always stroke upwards towards the heart in the direction of blood flow. Veins have valves which prevent blood from flowing back the wrong way. Forcing it through with massage can damage the veins.
Then lightly bring the hands down the outside of the leg (image 3) keeping them in contact but do not apply pressure.
Use slow, smooth movements. Many beginners tend to rush the massage techniques.
Repeat the whole movement using slow stroking techniques, trying to cover as much of the leg as possible.
Repeat this technique for about 2 to 5 minutes, gradually applying deeper pressure on the up strokes.
Technique 2: Petrissage
Aim – kneading movements which mobilise and manipulate muscle tissue. There are a number of different types or methods of petrissage massage techniques but it is not the quantity of techniques but the quality of how they are performed. A couple of simple ones are described below:
With the hands apply a firm, circular kneading technique. Try to pull half the muscle group towards you with the fingers of one hand whilst pushing half the muscle away with the thumb of the other hand (image 4).
Then reverse to manipulate the muscle in the other direction (image 5).
Work your way up and down the muscle, trying to cover as much of the surface as possible.
Apply this technique for around 2 to 5 minutes. This technique can be alternated with light stroking or effleurage (above) occasionally to add variety
Another slight variation on the above technique is a forwards and backwards type technique rather than circular movements.
The overall aim of these techniques is to mobilise and manipulate the muscle tissues making them soft, supple and easy to work with.
Aim to keep as much of the hand in contact with the skin at all times.
Techniques 3 and 4: Stripping the muscle and Circular frictions.
Aim – to apply sustained pressure to the muscle, ironing out any lumps, bumps and knots.
With the thumb of the right hand (for the left leg), apply deep sustained pressure along the full length of the muscle (image 6).
This technique should be slow and deliberate to 'feel' the muscle underneath. A good therapist will gradually build up a mental picture of exactly where the tension and scar tissue is in the muscle.
The thumb can be reinforced using the thumb or two fingers of the other hand, as shown in image 7.
Repeat this 3 to 5 times in a row, alternating with petrissage for 5 to 10 minutes.
If the therapist comes across any tight, tender knots in the muscle (usually at the point of strain or rupture), these can be worked out with deep circular frictions to the knot (image 8).
Massage should be deep but not so deep that the athlete tightens up with pain.
Technique 4: Stripping the Iliotibial Band
Apply sustained pressure with the heel of the hand along the length of the iliotibial band. This technique can be uncomfortable or even painful so start gently (image 9).
Technique 5: Trigger points
Any lumps and bumps or particularly sensitive spots can be treated with deep, sustained pressure to these points using the thumbs. Increase the pressure on the spot until it ranks 7/10 on the pain scale (10 being painful). Hold this pressure until it eases off to 4/10 on the pain scale (usually about 5 seconds).
Without easing off with the pressure, increase again until it reaches 7/10 on the pain scale once more. Hold until it eases, repeat once more.
This technique is very hard on the thumbs. It is important to keep the thumb slightly bent (flexed) when applying pressure to avoid damaging the joints. Finger nails need to be short to apply this technique correctly.
Finishing off
The therapist can finish off with more petrissage techniques and then finally effleurage again. The whole process need not last more than half an hour.
Massage therapy can be applied every day if it is performed lightly however deeper techniques may result in a days recovery period to allow tissues to 'recover' just like they would after a training session.
For rehabilitation of muscle strains, sports massage is very important in softening / preventing scar tissue forming at the site of injury and re-aligning the new healing fibres in the direction of the muscle fibres. This will help prevent re-injury.
[Effleurage to the front of the leg]
Fig:Effleurage to the front of whole leg
Sports Massage for the Knee
Technique 1: Circular frictions
Apply small circular frictions around the side of the knee joint starting from the front of the patella and working round.
This technique can be useful for breaking down and reducing firm swelling around the knee joint.
It may take many treatments to effect long term swelling around the knee.
Technique 2: Patella tendon
With the thumb apply gentle cross frictions to the patella tendon.
A more vigorous form of this technique can be applied to the patella to treat jumper's knee or patella tendinitis. The knee would be bent placing the tendon on stretch for best results.
[Circular frictions to the sides of the knee]
Fig: Circulator friction to the knee
Sports Massage for the Lower Leg & Shin
Technique 1: Effleurage
Light stroking movements from the ankle moving up to the knee then down the sides of the leg returning to the start position (image 1).
Try to cover as much of the area as possible with the hands.
Apply firmer pressure on the up strokes and very light contact on the down strokes.
Apply effleurage for 2 to 5 minutes gradually increasing pressure.
This can also be done with one hand as shown in the video clip below.
Technique 2: Stripping
Placing the hand over the leg as shown in apply sustained pressure from the ankle, along the full length of the muscle.
Apply gradually deeper pressure alternating this technique with effleurage for variety.
When massaging the inside of the leg stay well away from the bone. Massaging the muscle attachments to the bone may cause or increase inflammation of the periostium (a sheath that surrounds the bone).
Technique 3: Cross frictions to the tibialis anterior
With both thumbs apply cross frictions to the tendon of the tibialis anterior gradually working up the tendon.
Either repeat this technique concentrating on the tendon only or continue further up the full length of the tibialis anterior muscle.
[Effleurage lower leg]
Fig: Circular friction to the knee
Hamstring Taping
The following guidelines are for information purposes only. We recommend
seeking professional advice before beginning rehabilitation.
The aim of this taping is to provide compression to a strain or contusion
in the acute stage.
What is required:
Adhesive spray
Under wrap
1.5 inch non stretch oxide tape
6 inch non adhesive elastic bandage bandage
Step 1
The athlete should be standing. Ideally the hair should be shaved from the
back of the thigh.
Apply adhesive spray and under wrap starting at the bottom and work up.
Step 2
Apply a pressure pad over the site of the injury.
Using 2 inch non stretch zinc oxide tape apply one anchor strip on the
outside of the injury and another on the inside.
Step 3
Using 2 inch non stretch tape again apply the first compression strip from
just below the site of injury on the inside anchor upwards and across at 45
degrees.
The next supporting strip goes from the outside anchor just below the
site of injury and crosses the first strip as it passes upwards to the inside
of the thigh again at 45 degrees.
Step 4
Repeat the above overlapping each strip by half working upwards until the entire area is covered.
Note the strips do NOT go completely around the thigh as this would stop circulation of blood.
The taping is covered with under wrap to help prevent it from moving.
Step 5
Close the entire taping with 6 inch crepe type compression bandage. Starting at the bottom wrap the tape around working upwards at 45 degrees applying a tug on the bandage at the 45 degree angle. Then as it comes around the thigh and back down at 45 degrees apply another tug. Work upwards crossing at 45 degrees all the way. Ensure the athlete tenses muscles in the thigh when this is being done to allow for muscle expansion after the job is finished.
Treatment therapies for cricket injury
Treatment Therapies for Sports Injuries
Sports Massage
Sports massage is a deep tissue form of massage which is excellent for treating soft tissue injuries …..
[Aromatherapy]
Ultrasound
Ultrasound is a common treatment for sports injuries which uses sound waves to provide a 'micro-massage' within the tissue
[Ultrasound]
[line]
TENS
TENS is transcutaneous electrical stimulation and can be used mainly for pain-relief
[TENS]
[line]
Heat Therapy
Heat therapy is the use of warm packs and heat retaining supports in the treatment of long-standing chronic injuries
Ultrasound Therapy
Therapeutic ultrasound?
Therapeutic ultrasound as a treatment modality that has been used by therapists over the last 50 years to treat soft tissue injuries. Ultrasonic waves (sound waves of a high frequency) are produced by means of mechanical vibration of the metal treatment head of the ultrasound machine. This treatment head is then moved over the surface of the skin in the region of the injury. When sound waves come into contact with air it causes a dissipation of the waves, and so a special ultrasound gel is placed on the skin to ensure maximal contact between the treatment head and the surface of the skin.
effects of therapeutic ultrasound?
The effects of therapeutic ultrasound are still being disputed. To date, there is still very little evidence to explain how ultrasound causes a therapeutic effect in injured tissue. Nevertheless practitioners world wide continue to use this treatment modality relying on personal experience rather than scientific evidence. Below are a number of the theories by which ultrasound is proposed to cause a therapeutic effect.
Thermal Effect:
As the ultrasound waves pass from the treatment head into the skin they cause the vibration of the surrounding tissues, particularly those that contain collagen. This increased vibration leads to the production of heat within the tissue. In most cases this cannot be felt by the patient themselves. This increase in temperature may cause an increase in the extensibility of structures such as ligaments, tendons, scar tissue and fibrous joint capsules. In addition, heating may also help to reduce pain and muscle spasm and promote the healing process.
Effects on the Inflammatory and Repair Processes:
One of the greatest proposed benefits of ultrasound therapy is that it is thought to reduce the healing time of certain soft tissue injuries.
Ultrasound is thought to accelerate the normal resolution time of the inflammatory process by attracting more mast cells to the site of injury. This may cause an increase in blood flow which can be beneficial in the sub-acute phase of tissue injury. As blood flow may be increased it is not advised to use ultrasound immediately after injury.
Ultrasound may also stimulate the production of more collagen- the main protein component in soft tissue such as tendons and ligaments. Hence ultrasound may accelerate the the proliferative phase of tissue healing.
Ultrasound is thought to improve the extensibility of mature collagen and so can have a positive effect to on fibrous scar tissue which may form after an injury.
Application of Ultrasound:
Ultrasound is normally applied by use of a small metal treatment head which emits the ultrasonic beam. This is moved continuously over the skin for approximately 3-5 mins. Treatments may be repeated 1-2 times daily in more acute injuries and less frequently in chronic cases.
Ultrasound dosage can be varied either in intensity or frequency of the ultrasound beam. Simply speaking lower frequency application provides a greater depth of penetration and so is used in cases where the injured tissue is suspected to be deeply situated. Conversely, higher frequency doses are used for structures that are closer to the surface of skin.
Contraindications For Use:
As ultrasound is thought to affect the tissue repair process and so it is also highly possible that it may affect diseased tissue tissue in an abnormal fashion. In addition the proposed increase in blood may also function in spreading malignancies around the body. Therefore a number of contraindications should be followed when using therapeutic ultrasound:
Do not use if the patient suffers from:
Malignant or cancerous tissue
Acute infections
Risk of haemorrhage
Severely ischeamic tissue
Recent history if venous thrombosis
Exposed neural tissue
Suspicion of a bone fracture
If the patient is pregnant
Do not use in the region of the gonads (sex organs), the active bone growth plates of children, or the eye.
Transcutaneous Electrical Nerve Stimulation (TENS)
TENS?
Transcutaneous electrical nerve stimulation (TENS) is a method of providing pain relief. As the name suggests, it involves the application of electrical current to the affected area. This is achieved via a number of electrodes that can be fixed to the skin.
TENS relieves pain mainly by stimulating the pain gate mechanism. When tissue becomes damaged, the pain nerve fibres in the area become irritated and increasingly sensitive which leads to a heightened perception of pain in that area. However, in that region there are also a number of mechanoreceptors which respond to touch. Stimulation of these nerve fibres can override the pain impulses from that area- this is known as the pain gate mechanism. These mechanoreceptors can stimulated by an electrical current at certain frequency (usually 90-130 Hz) as provided by the TENS machine which in turn causes a pain relieving effect.
The use of TENS is an extremely popular method of pain relief. It is relatively cheap, easy to use and the side effects are minimal when compared to some oral pain killers. It is thought that TENS can provide pain relief in the region of almost 70% of cases suffering from an acute injury.
Application of TENS:
TENS machines can now be purchased quite readily from certain retail specialists
and are easy to apply. However a certain amount of care should be taken as a small proportion of patients suffer from an allergic reaction to the conductive gel, the electrodes themselves or the tape used to secure them in place. Most newer machines come with self-adhesive electrodes that can be changed after each application to decrease the risk of cross infection if more than one person is using the machine.
As each patient's symptoms are different the settings on the TENS machine need to be adjusted to suit the individual. We always recommend that you follow the instructions that come with machine or seek professional advice. TENS machines usually have 3 main variable settings:
1. Frequency
Most machines offer a frequency of approximately 2-200 Hz. To stimulate the mechanoreceptors the frequency should usually be in the region of between 90-130Hz.
2. Intensity
The intensity of the current is also adjustable and most machines will be able to reach intensities of between 80-100mA.
3. Pulse Width
This setting controls the period of time that electrical current passes through the electrodes. Many professionals place less emphasis on this setting than the intensity and frequency while some machines do not even have this particular control.
Will TENS hurt?
TENS machines should not cause discomfort but it will be possible to feel a slight tingling sensation when the machine is on. Again, as each person is different adjusting the above settings is highly important to gain the maximal effect from the machine.
Electrode position:
As with the above settings the position of the electrodes may be varied in response to the individual's symptoms. Usually an electrode is placed either side of the painful area however any number of variations may be possible. Some practitioners focus on targeting a particular peripheral nerve or acupuncture point.
Care should be taken when:
If the area of skin has abnormal sensation.
If the patient suffers from seizures or epilepsy seek professional advice
Using TENS machines in children- this is due to the fact that the child's growth regions may be affected by electrical current
If the individual is pregnant always seek professional advice prior to using.
TENS should NOT be used if:
The patients has a pacemaker
Patients have an allergic reaction to the electrodes, gel or adhesive strapping
The patient has any skin conditions such as eczema
Patients with open wounds in the area
Patients who have circulatory problems
Application to the neck and upper trunk region.
Heat Therapy
Heat treatment is used as a treatment for many sports related musculoskeletal injuries. There are many forms of heat treatment, with the most effective often depending on the injury in question. Time scale is also an important factor when deciding whether to use heat therapy.
What are the Benefits of Heat?
Heat acts to:
reduce pain
reduce stiffness
decrease muscle spasm
increase blood flow to the area which promotes healing
When Should I Use Heat Therapy?
Heat therapy should be used on chronic injuries and late stage acute injuries. A chronic injury is one that has persisted for a length of time and is usually due to overuse and biomechanical issues, as opposed to a traumatic incident. Heat can be used before exercise to warm the muscles, but should be avoided after exercise.
How Can Heat be Applied at Home?
At home the easiest way of applying heat to an injury is by using a widely available heat pack. These can be made of varying materials, often gel or wheat based which either require heating in a microwave or submerging in hot water. Wrapping such an item in a towel and applying it to the injuy is perfectly suitable. This should be applied be 15-20 minutes at a time. Warm, damp towels, warm baths and heat rubs can also be easily used at home although may not be as effective at warming deeper tissues.
What are the Contraindications to Using Heat Therapy?
The following are contraindications (times when heat treatment is not suitable) which apply to heat therapy:
Sensory changes (cannot feel if it is too hot)
Heat injury
Hyper or hypo-sensitive to heat
Circulatory problems
During the acute phase of injury
DVT
Infections
Malignant tumours
Most of these are due to the massive increase in blood flow to the area. With conditons such as infection or malignant tumours, heat would increase the risk of spreading the infected or cancerous cells in the much increased blood flow.
A reusable hot and cold pack
Stretching exercises
Here is a list of stretches for the entire body. Static stretches such as these can be
used with great effect in improving flexibility in both injury prevention and rehabilition.
All of these s tretches should be held (without bouncing) for 20-30 seconds.
Stretching can be performed from cold provided it is gentle initially and you
gradually move further into the stretch. Click on a stretch to view a picture, description,
muscles being stretched and related injuries.
Neck Stretches
[Lateral neck flexion stretch]
Lateral neck flexion
[Forward neck flexion]
Forward neck flexion
[Neck rotation]
Neck rotation
[scm stretch]
Sternocleidomastoid stretch
Chest and Shoulder Stretches
[line]
[Anterior shoulder stretch]
Anterior shoulder stretch
[Anterior shoulder 2 stretch]
Anterior shoulder stretch 2
[Posterior shoulder]
Posterior shoulder stretch
[Supraspinatus shoulder exercise]
Posterior shoulder stretch 2
[supraspinatus]
Supraspinatus stretch
[Internal rotation of the shoulder partner stretch]
Internal rotation stretch
[external rotation shoulder stretch partner]
External rotation stretch
[Chest stretch using a wall]
Chest stretch
[Chest with a partner]
Partnered chest stretch
ArmStretches
[line]
[Wrist flexors for golfers elbow]
Wrist flexor stretch
[Tricep back of the arm]
Tricep stretch
[wrist extensors for tennis elbow]
Wrist extensor stretch
[Tennis elbow]
Tennis elbow stretch
Back and Abdominal Stretches
[Back stretch]
Back stretch
[Latissimus dorsi]
Lat dorsi stretch
[Latissimus dorsi in the kneeling position]
Lat dorsi stretch 2
[Cat exercise for the back extensors]
Back arch stretch
[slump stretch]
Back slump stretch
[Spine rotation]
Rotation stretch
[Abdominal ball stretch]
Abdominal stretch
[Abdominal stomach stretching exercise]
Abdominal stretch 2
[side stretch]
Side stretch
Hip and Groin Stretches
[Gluteus Maximus]
Gluteus maximus stretch
[Outer hip muscles]
Outer hip stretch
[ITB]
Standing outer hip stretch
[Piriformis muscle]
Piriformis stretch
[gluteal]
Gluteal stretch
[Short adductors including pectineus]
Short adductor stretch
[long adductor or groin muscles]
Long adductor stretch
[Standing groin or adductor muscles]
Standing groin stretch
Thigh Stretches
[Standing quadriceps]
Quadriceps stretch
[Quads in a laying position]
Laying quad stretch
[Hip flexor muscles such as iliopsoas]
Hip flexor stretch
[hamstrings in a sitting position]
hamstrings stretch
[hamstring muscle group in a standing position]
Standing hamstring stretch
[Hamstring partner]
Partnered hamstring stretch
[Quad stretch]
Kneeling quad stretch
Lower leg Stretches
[Shin anterior lower leg]
Shin stretch
[shin muscles including Tibialis Anterior]
Standing shin stretch
[Advanced shin]
Advanced shin stretch
[GAstrocnemius stretch]
Gastrocnemius stretch
[Advanced gastrocnemius stretch]
Advanced gastrocnemius stretch
[soleus stretch]
Soleus stretch
[soleus stretch 2]
Soleus stretch 2
[calf stretch with a bent knee for soleus]
Advanced
soleus stretch
Foot and Ankle Stretching
[Plantar fascia]
Plantar fascia stretch
[peroneals]
Peroneal stretch
Types of stretching
Static Stretching
Static stretching is the type of stretching where you take a muscle to its outer range, until you can feel a gentle stretch in the muscle belly, and hold it at that point. Stretches are usually held for between 20 and 60 seconds and should be pain-free.
Static stretches work because as you hold the position, with the muscle under tension, a stretch reflex causes muscle relaxation. When this occurs the muscle can be stretched a little further, without pain or discomfort. If there are feelings of pain or discomfort then the stretch should be reduced to prevent over-stretching and muscle damage.
Static stretching is the most commonly performed type of stretching, partly due to it being the safest method of stretching due to the relatively low levels of tension developed.
Static stretches can be either active or passive. Active stretches involve the athlete moving the joint through its range of motion and holding it at the point of stretch themselves. Passive stretching is sometimes also known as partner stretching and involves a partner moving the joint to the point of tension in the muscle and holding it for the athlete, whilst they relax! If using this type of stretching, communication is important to ensure the partner is aware of any discomfort in the muscle and eases off accordingly.
Dynamic Stretching
Dynamic stretching is sometimes also known as active stretching and is now being seen as a replacement for static stretching during a warm-up as it replicates the kind of movements which are common in most sports, and can be adapted to suit the sport and individual. Dynamic stretches involve taking a muscle through its entire range of motion, starting with a small movement and gradually increasing both movement range and speed. Examples of these types of drills include high knees, cariocas and lunges.
In a warm-up, dynamic stretches are usually performed following an initial period of CV exercise (jogging/cycling etc) and usually include a minimum of 5 of this type of drill, each performed 6-8 times at slow, medium and fast speeds. All movements should be under complete control.
PNF Stretching
PNF stands for Proprioceptive Neuromuscular Facilitation and can take on several forms including hold-relax; contract-relax; and rhythmic initiation. PNF started to become popular in the 1960's and has since become a common treatment for many physiotherapists and other sports injury professionals.
PNF can be either completely passive (meaning the therapist moves the limb through its ranges of motion) or active assisted, in which the athlete plays a role in the treatment. In this case it requires an isometric contraction before the stretch. So for example, to a use hold-relax PNF technique on the hamstrings, the athlete would lay on the back and raise the straight leg up off the bed (contracting the hip flexors Rectus Femoris and Iliopsoas) to the starting position. From here, the therapist or partner provides resistance as the athlete isometrically contracts the hamstrings (as if trying to push the foot back down to the floor) for a minimum of 6 seconds. Following this the athlete contracts the hip flexors again to raise the leg higher and further stretch the hamstrings.
This works on the theories of reciprocal inhibition (or innervation) and post-isometric relaxation. Reciprocal inhibition is based on a reflex loop, controlled by the muscle spindles. When an agonist muscle contracts (for example the quads, causing knee extension), the antagonist muscle is inhibited, causing it to relax (in this example the hamstrings), allowing the full movement of the antagonist muscle (knee extension). Post-isometric relaxation is thought to be controlled by the golgi tendon organs, sensors within the muscle which are sensitive to muscle tension. When a muscle is contracted isometrically for a period of time, this results in an inhibition of the muscle, resulting in relaxation.
PNF can also be used for treatments other than stretching, for example muscle strengthening in a rehabilitation setting. PNF in this sense involves spiral-diagonal movements, as are used in most daily and sporting activities. Very few activities use only one plane of movement, there is usually an combination of two or all three planes (flexion/extension; adduction/abduction; and rotation). For this reason, PNF incorporates these spiral-diagonal movements to help train the body in the way in which it is most often used.
Muscle Energy Techniques
Muscle Energy techniques (or MET's) are another form of active-assisted stretches, similar to PNF, and developed around the same time, in the world of Osteopathy. Like PNF, MET's use an isometric contraction of the agonist prior to stretching. The difference is in the force of the isometric contraction, which in MET's are a lot lower. An MET stretch is performed in the following way, using the hamstrings as an example:
The therapist moves the hip into flexion, with the athlete on their back, until they encounter the point of resistance – where the movement stiffens, due to tightness in the hamstrings. They hold this position for 15-20 seconds. They then ease off slightly from the stretch and ask the athlete to try to push the leg back down to the couch, which causes an isometric contraction of the hamstrings. In MET's, this contraction should be a maximum of 20% of the athletes total strength. This contraction is held for around 10 seconds, before the therapist asks them to relax and pushes the limb further, increasing the stretch, until resistance is felt once more. The process is usually repeated 3-5 times for each muscle.
Ballistic Stretching
Ballistic stretching is the bouncing type of stretching, where you take the muscle to near its limit and then bounce to stretch it further. For example reaching over to touch your toes and bouncing to increase the range. This type of stretching is rarely recommended due to the injury possibilities and no beneficial effect over other, safer, forms of stretching such as PNF and dynamic stretches.
Neural Stretching
Neural stretching refers to stretching the structures of the nervous system. This is necessary in injuries where there is excess neural tension or restriction of movement of neural structures, commonly around the neck and shoulder girdle, or pelvis area. Neural stretches are adaptations of neural tension tests, such as the slump test and the upper limb tension test. The limb is taken to the point of stretch and held for a maximum of 10 seconds, although initially this may be as little as 3-4 seconds to avoid causing damage to the nerves. This kind of stretching should only be performed under the supervision of a qualified therapist.
[Hip flexor static stretch]
Static stretch
[dynamic hamstring stretches]
Dynamic stretching
Play video
Benefits of stretching
There are many benefits to be gained from a regular stretching programme:
[*] Increased flexibility and range of motion
[*] Injury prevention
[*] Preventing DOMS
[*] Improved posture
[*] Improvements in sports performance
[*] Stress relief
Increased flexibility and range of motion
This is the most obvious benefit of regular stretching and usually the reason that people start a startching programme. However, reasons for stretching ususally go much deeper than this. For example, why do you want to increase your flexibility? Is it to improve your sporting performance, posture, or prevent injury?
Injury Prevention
Being flexible can help to prevent injuries. This can include acute injuries, such as a hamstring strain and overuse injuries such as IT band syndrome of plantar fasciitis.
Stretching has been used in the warm-up process for many years. It is thought that having flexible muscles can prevent acute injuries by gently stretching the muscle through its range before exercise. Dynamic (active) stretches are now recommended for warm-ups, over the traditional static stretch.
Preventing DOMS
Delayed Onset Muscle Soreness (DOMS) occurs 24-48 hours after exercise. It is thought to be due to microscopic tears in the muscle. Stretching before and after training is thought to minimise this damage.
Improving Posture
In many cases of poor posture which has developed over time, muscle imbalances are to blame. A good example is the chest muscles becoming shortened in people who slouch over a computer for long periods. Stretching these muscles can help to improve posture.
Improving sporting performance
Many sports obviously require high levels of flexibility, for example athletics and gymnastics. But even athletes in sports such as Rugby, where flexibility is not immediately thought of as a key component, can improve their performance by becoming more flexible.
In order to have healthy muscles, they must be flexible. This will help to prevent injuries as already discussed, but it will also allow you to develop strength through the full range of motion at the joint. This gives an advantage over someone who has a limited range.
Stress relief
Muscle tightness is often associated with stress – we tend to tighten up when stressed. For example the neck muscles. Stretching relaxes these muscles and you at the same time!
Resistance Band Exercises
Here is a list of exercises which can be performed using resistance bands.
Click on an exercise to view a description, video, the muscles being worked and related injuries.
All Resistance band exercises should be performed slowly and under control. Begin with the b and at the start of tension which increases as you perform the exercise. To make the exercise more difficult, shorten the section of band you are using to increase the tension over the range of motion.
Upper Body
[Bicep curl]
Bicep Curl
[tricep extension]
Tricep Extension
[triceps extension overhead]
Overhead Tricep Extension
[pronation]
Pronation
[Supination]
Supination
[wrist extension]
Wrist Extension
[wrist flexion]
Wrist Flexion
[upright row]
Upright row
[band lateral raise]
Lateral raise
[lat pull down]
Lat pull down
[pec fly]
Pec fly
[press up]
Push up
[reverse fly]
Reverse fly
[seated row]
Seated row
[Pullover]
Pullover
[chest press]
Standing chest press
[internal rotation]
Internal rotation
[front raise]
Front raise
[External rotation]
External rotation
[Shoulder press]
Shoulder press
Lower Body
[line]
[hip flexion with a resistance band]
Standing hip flexion
[abduction]
Standing abduction
[seated hip flexion]
Seated hip flexion
[laying hip abduction]
Laying hip abduction
[hip extension]
Hip extension
[hip adduction]
Hip adduction
[Band knee flexion]
Knee flexion
[Eversion]
Eversion
[knee extension]
Knee extension
[inversion]
Inversion
Trunk
[line]
[crunch]
Crunch
[sitting twist]
Sitting twist
[standing twist]
Standing twist
[woodchop]
Woodchop
Free Weights Exercises
Free weights exercises usually incorporate one or two dumbbells, a barbell or a medicine
ball or kettle bell. They are great for people who have already built up a base of
strength using resistance machines, body weight or resistance band exercises.
The most important thing with free weights is to get the technique of each exercise right.
It is very easy to start off right and loose your form as your muscles fatigue. Always
think about your posture when performing strength exercises and start with a light
Weight and gradually build up.
Upper Body
[Bench press free weights strengthening exercise]
Bench Press
[Pec fly]
Pec Fly
[Dumbbell pullover]
Dumbbell Pullover
[Single arm row]
Single Arm Row
[Bent over row]
Bent Over Row
[Lateral raise]
Lateral Raise
[Front raise]
Front Raise
[Bent over raise]
Bent Over Raise
[Internal shoulder rotation]
Internal Shoulder Rotation
[external shoulder rotation]
External Shoulder Rotation
[upright row]
Upright Row
[shrugs]
Shrugs
[Chest Press]
Chest Press
[military press]
Military Press
[shoulder press]
Shoulder Press
[bicep curl]
Bicep Curl
[hammer curl]
Hammer Curl
[concentration curl]
Concentration Curl
[extended bicep curl]
Extended Bicep Curl
[tricep kickback]
Tricep Kickback
[french press]
French Press
[jaw breaker]
Jaw Breaker
[wrist flexion]
Wrist Flexion
[wrist extension]
Wrist Extension
Lower Body
[line]
[dead lift]
Dead Lift
[good morning]
Good Morning
[straight leg deadlift]
Straight Leg Deadlift
[front squat]
Front Squat
[clean]
Power Clean
[snatch]
Snatch
[Squat]
Squat
Abdominals
[line]
[side bend]
Side Bend
[med ball twist]
Medicine Ball Twist
[medicine ball crunch]
Medicine Ball Crunch
[medicine ball reverse crunch]
Medicine Ball Reverse Crunch
[v-up]
Single Leg V-Up
Resistance Machine Exercises
Resistance machines (or weights machines) are the pieces of equipment usually
found in a gym which incorporate a weight stack and pulley system to provide
resistance against a fixed movement. They are excellent pieces of machinery
for beginners especially, to help develop strength and co-ordination before progressing
to free-weights. They are also effective for use in rehabilitation following injury.
When using a resistance machine, all movements should be slow and under
control, maintaining an emphasis on technique and posture throughout.
Inbetween repetitions the weight being lifted should not return to meet the rest
of the stack. This maintains continuous tension on the muscles.
Upper Body
[chest press]
Chest Press
[pec fly]
Pec Fly
[Bicep curl]
Bicep Curl
[bench press]
Bench Press
Pull Over
[shoulder press]
Shoulder Press
[Triceps push down]
Tricep Push Down
Assisted Dips
Lower Body
[line]
[knee extension]
Knee Extension
[knee curl]
Knee Curl
[leg press]
Leg Press
[adductor inner thigh resistance machine]
Inner Thigh (adductors)
[abductor machine]
Outer Thigh (abductors)
Seated Calf Raise
[calf raise]
Standing Calf Raise
Trunk
[line]
[seated row]
Seated Row
[lat pull down]
Lat Pull Down
[chin-ups]
Assisted Chin-ups
Suggestion/follow up
SHOULD A CRICKET PLAYER GO ABOUT IMPROVING ALL THESE AREAS?
Suggested methods of improving the following areas of conditioning include:
FITNESS COMPONENT
SUGGESTED METHODS
OTHER CONSIDERATIONS
Aerobic Endurance
Unit Running
Repeated Sprint Drills
Running technique and form
Heart rate monitoring
Speed
Understand injury profile of player
Strength
Body weight exercises
Free weights
Machine weights
Correct technique
Protocols (i.e. choice & order of exercise, sets, repetitions, rest periods, resistance…etc)
Training loads (i.e. volume vs intensity, training age…etc)
Movement patterns, types & speed of contraction.
Understand injury profile of player
Power
Plyometrics
Acceleration drills
Weight training
See above
Flexibility
Static, dynamic, PNF
Yoga
Feldenkrais
Alexandra Technique
Correct technique
Mental concentration & focus
Warm-up & warm-downs
Understand injury profile of player
Core Stability
Lumbar stabilisation
Scapula stabilisation
Shoulder stabilisation (rotator cuff)
Correct technique
Mental concentration & focus
Body, muscular & motor pattern awareness
Balance, co-ordination & skill of movement
Choice of exercises & progression
Understand injury profile of player
Agility
Acceleration and deceleration drills
Changing direction drills under various speeds
Drills requiring rapid changes of pace, direction and non-linear type movements
Balance, co-ordination & skill of movement
Understand injury profile of player
POSITION
GENERAL PERFORMANCE OBJECTIVES
GENERAL INDICATORS OF POOR CONDITIONING
FAST BOWLER
The ability to sustain blistering pace for a number of overs.
Capable of bowling 10-15 consecutive overs (less for under age players) at 80-90% max speed.
The inability to maintain a fast pace
The inability to bowl for long periods
The inability to maintain good line & length
SPIN BOWLERS
The ability to consistently spin the ball.
Capable of bowling in excess of 20 consecutive tight overs.
The inability to maintain consistent "turn"
The inability to bowl for long periods
The inability to maintain good line & length
BATSMAN
The ability to occupy the crease continuously for 2 hour periods (longer in one day matches) without fatigue affecting speed in running between the wickets, reaction time, movement speed and scoring opportunities.
Reluctance to run quick singles
Poor recovery after running 2+ runs
Concentration lapses and poor skill execution throughout a session
Inability to score
WICKET KEEPER
The ability to sustain a concentrated effort for 6 hours without fatigue affecting running speed, reaction time and movement time.
Capable of explosive bursts at any given time.
Slow to get to the stumps to take returns.
Lack of agility.
Concentration lapses and poor skill execution throughout a session.
FIELDER
The ability to sustain a concentrated effort for a 6 hour period without fatigue affecting motor co-ordination.
Capable of explosive bursts at any given time – whether ground fielding, throwing or catching.
Slow moving towards the ball
Slow chasing the ball
Lack of agility & flexibility
Concentration lapses and poor skill execution throughout a session
Inability to maintain explosive actions throughout sessions
EXAMPLE OF A TRAINING YEAR PLAN
May – July
General Preparation
Core Stability
Flexibility
Endurance
Strength & Power
Speed
Specific localised stabilisation training
Develop body awareness
Develop aerobic base
General preparation
Develop speed components
July – Sept.
Specific Preparation
Core Stability
Flexibility
Endurance
Strength & Power
Speed
General trunk stabilisation training
Increase range of movement; static stretching
Increase stamina and volume of work in duration.
Specific development, increase intensity, contraction speed.
Specific development, acceleration, agility
Sept. – Oct.
Pre-Competition
Core Stability
Flexibility
Endurance
Strength & Power
Speed
Functional stabilisation training
PNF stretching and dynamic flexibility
Develop anaerobic threshold through repeated high intensity workloads
Develop power, plyometrics, speed of contraction
Specific drills, acceleration, deceleration, agility, turning speed
Nov – March
Competition
Maintain
Maintain
Suggestion/follow up
Long barrier method of fielding
This is used when the fielder does not want to miss the ball in case it rolls over the boundary. The fielder runs to a position where he is in line with the oncoming ball. If he is running to his right-hand side he puts his right foot down and then his left knee, which should touch the heel of his right foot.
The lower left leg is then flat on the ground forming a long barrier which will stop the ball should the fielder miss it with his hands. Make sure that the left ankle is also flat on the ground so that the ball has no escape route.
The fielder then scoops the ball up and throws it to the wicket keeper using an overarm throw. At this stage accuracy and distance is more important.
Practical suggestion
Make this fun and by constructing a boundary of sorts, using a skipping rope or something similar. Challenge the child by encouraging him to reach and field the rolled ball before it crosses the boundary line. Should the ball cross the boundary before they field it, then you, the “batsman” gets 4 runs (this is game related).
Bowling
Place the ball in the best hand, grasping it with the middle and fore fingers extended over ball (the ball faces backwards). Place the best foot square behind a line and the front foot pointing forward at a target. The other arm is slightly bent and points upwards so that the child can look over the shoulder of this arm at the target.
The bowling action is similar to that of a windmill where the front arm is pulled down past the outside of the front leg while the bowling arm (absolutely straight) is brought past the head shaving the ear en route and the ball is released in the direction of the wickets. The bowler keeps his eyes on the wickets throughout.
Practical suggestion
Make this fun and challenging by placing a target about eight meters in front of the child. See how many times out of 12 attempts he hits the wickets; in other words, see how many batsmen he can dismiss in two overs.
Make this more progressive by introducing a few approach steps and later a short run up before bowling.
Batting
Place the bat flat on ground and pick it up as one would an axe – retain that grip. Place the best foot square behind a line (the popping crease) while the front foot points forward in direction of the opposite wicket. The bat is swivelled back so that the toe of the bat points at the batsman’s own middle stump. The bat is horizontal to ground and the arms form a circle with the hands on the handle just below the belly button.
The best hand must grip tightly, while the other hand relaxes. During batting action the other elbow leads forward and up while the best hand pushes forward in the direction of ball. Bat in an upright vertical position throughout the forward stroke. At the end of this position, follow through with the other elbow pointing upwards and the toe of the bat in the direction that the ball has been hit. Arms maintain a circular position for a split second after the stroke.
Practical suggestion
Start the batting by placing a large plastic ball on a bean bag in the front and slightly towards the best side of the batsman. The batsman steps towards ball and places the other foot next to the ball and hits ball forward with a straight bat. Maintain the finishing position for the adult to check if it’s correct.
Later the adult can roll a big ball straight towards the batsman. The batsman watches carefully and steps next to ball, leans forward and drives the ball forward at a slight angle. These later progresses to actually throwing tennis ball underarm to the batsman.
A fun idea is continuous cricket – a game in which a minimum of three people are needed. The batsman stands in front of wicket and the adult stands about four meters away and throws the ball underarm to the batsman. The batsman bats the ball and runs around a beacon that is set up about three meters away square to the batsman (behind him).
The fielder retrieves the ball and throws it back to the bowler as quickly as possible. As soon as the bowler receives the ball he bowls, regardless of whether the batsman is ready or not. If he hits the wicket, the batsman and fielder change positions. This is also called “tip-and-run” where the batsman has to run even if he only touches the ball. See how many runs are scored before being bowled or caught out.
Running between the wickets
In order to score a “run” cricketers have to run from the crease on one side of the pitch to the crease on the other side of the pitch.
Practical suggestion
As a warm up or fun running activity, the adult can place two beacons about eight meters apart. The adult can be the batsman on one side and the child the batsman on the other. When the adult shouts, “yes”, they run towards and past each other to the opposite wicket. Remind the child to stick to his side of the pitch as batsmen are never allowed to crash when scoring runs.
The players could score two or three runs at a time and see who gets back to their crease first. This teaches them how to run economically by turning sharply and just touching over the crease line with the bat as they turn for the next run.
Catching
To teach a child to catch low balls, you could play “leggy” with those who are five years and older. An adult and a child stand about three meters apart with feet wide apart. The adult tries to roll the ball through child’s legs and vice versa. Should the ball go through either one’s legs, the other scores a point. This is lots of fun when there are about four versus four players. Scoring can be done any way you choose.
Conclusion:
Cricket is a major international sport played in more than 60 countries. The laws of cricket were drawn up by the London Club in 1744, formalising a game that had been played for a hundred years before. While its popularity spread throughout the countries of the British Empire and Western Europe, it was not until the mid-19th century that cricket gained its international status and regular international matches were played between touring teams.
The first recorded international took place in 1844, at St George’s Park, New York, between the United States and Canada. Canada won. The inaugural test match was played between Australia and England at the Melbourne Cricket Ground in 1877. Professionalisation and more recently, media coverage have led to a huge expansion and popularisation of the game as we know it today. Ten nations are full members of the International Cricket Conference, and 45 more are associated or affiliated members.
Although strictly a non-contact sport, injuries in cricket are common, and have been documented as far back as 1751, when Frederick, Prince of Wales (son of George II), expired suddenly from an abscess in his head as a consequence of a blow he’d received from a cricket ball. For one of the widely popular team sports, there have been relatively few publications in the medical literature on cricket injuries. This article reviews the injuries occurring commonly in cricket and describes measures to prevent or minimize them.
Bibliography
Bibliography
References
1. Med & Sci in Sports & Ex 2005; 37 (1): 108-113
2. Clinical Biomechanics 2005; 20: 1072-1078
3. BMC Musculoskeletal Disorders 2001; 2:5
4. Gait & Posture 2007; 25: 236-242
5. Eur J Appl Physiol 2002; 87: 556-561
6. Metabolism 2008; 57: 226-232
7. Osteoporosis Int 2001; 12: 152-157
8. Int J Sports Med 2007; 28: 773-779
9. J Biomech 2007; 40: 1946-1952
10. FASEB J 2006; 20: 811-827
11. J Am Acad Ortho Surg 1999; 7: 291-299
12. Gene 2007; 391: 1-15
13. J Musculoskeletal Neuronal Interact 2006; 6 (3): 217-225
14. Molecular Systems Biol 2007; 3 (124): 1-11
15. Br J Sports Med 2007; 41: 241-246
16. Scan J Med Sci Sports 2003; 13: 150-154
17. Am J Physiol Cell Physiol 2007; 294: 467-476
18. Clin J Sports Med 2002; 12: 3-5
19. Scand J Med Sci Sport 2007; 17: 61-66
20. Sports Med 2008; 38 (2): 139-160
21. J Ortho Research 2000; 18: 524-531
22. Scand J Med Sci Sport 2008; 18 (1): 40-48
23. Am J Sports Med 2006; 34: 1297-1306
24. Am J Sports Med 2007; 35: 1269-1276
25. Br J Sports Med 2004; 38: 26-30
26. Brain 2004; 127: 2339-2347
27. Pain 2007; 132: 169-178
28. J Ortho Sports Phys Ther 2004; 34 (3): 116-125
29. J Sports Sciences 2005; 23 (10): 1101-1109
30. Biomechanics 2005; 38: 445-452