Neck sprain? See a doc

In need of shoulder rehab, or just curious about Tendulkar's tennis elbow injury? Your questions answered


Sachin Tendulkar practises ahead of the Challenger Trophy, Mohali, October 9, 2005
An elbow brace helps Tendulkar avoid the pain that can occur from overloading the forearm © AFP
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Can you advise an exercise/rehab schedule for a relocated shoulder? asked SouthPaw
When any joint dislocates, there is associated ligament/joint capsule trauma involving many anatomical structures. This ultimately results in a compromised structural stability and an increased likelihood of recurrent joint dislocation and further trauma in the future. The conservative approach to the management of these injuries aims to improve neuromuscular "control" over the joint in addition to functional "strengthening" to compensate for this structural weakness. The shoulder, in particular, is challenging because of its inherent unstable architecture, as mentioned last week, and often surgery is required to correct any anatomical deficits.

As much as I would like to give you a set of exercises to follow, you really should be assessed by an orthopaedic medical professional to ensure that any exercises prescribed are appropriate for the type of dislocation that you experienced. Rehabilitation is more than just providing recipes for certain conditions, and much finesse is required in trying to get the correct muscles to activate in the correct order to ensure the best outcomes.

Is there a way for sports physios or other analysts to measure the force that a bowler's foot absorbs at the point of landing? asked Jack Easton
The biomechanical testing of athletes and sportspeople used to be confined to the laboratory, where many different extraneous factors could be monitored and controlled to obtain accurate, reliable and valid data. The force plate was, and likely still is, the gold standard in terms of accurate measuring of vertical impact forces for this reason. Bowlers would run in and land on the force plate, which was positioned in the ground at either rear or front foot landing. Peak impact forces could then be measured accurately. Modern improvements in technology, in particular the miniaturisation of testing apparatus, such as GPS units, have allowed certain data measuring to be conducted on the field of play without impeding the movement of the athlete. The physical relationship between force, mass and acceleration means that ballpark impact figures could in theory be calculated from the accelerometers in GPS devices - in particular, data mining for spikes in acceleration at the time of delivery. I don't know of anyone doing it yet, and whilst not as accurate as the gold standard force plates, it could provide the ballpark field measures that you are looking for.

I cricked my neck badly when I turned to look at the batsmen while fielding the ball. It has healed now, but what would be your emergency steps when a player twists his neck and can't move it without feeling pain on the field? asked Azaan J
I know the game of cricket is a religion to a lot of people out there, but to be honest, it is still just a game and common sense must prevail. Any injury that could possibly put the current or future health of the player at risk needs to be assessed in context. Neck or cervical injuries are serious because of the potential for neurological compromise. In layman's terms, a lot of important nerves exit between the joints in the neck, and any interference to them can cause a lot of pain and disability, potentially for the rest of the sufferer's life.

In your case it sounds like you suffered from an acute wry neck. I would have performed a thorough neurological examination, which only takes a couple of minutes but is necessary to test the nerves coming out of the neck and establish a baseline should the injury progress. Pain is the body's way of letting you know there is something wrong, so if you couldn't turn your head in one or more directions I would have taken you off the field immediately and treated you as I would for any other sprained joint.

Cervical joints are very small and can easily be sprained, as can the small intervertebral discs. The resulting pain and protective muscle spasm can be debilitating. There is no real "quick fix" for these injuries but they generally do settle in a few days. However, an acute "locked" wry neck, where stiffness but not pain existed, and which occurred after a sudden head movement, might have been treated with an appropriate manipulation of the locked joint. This treatment gaps the joint and allows whatever is blocking the movement to relocate. Movement is often instantly restored. This, however, should only be performed by a formally trained medical professional.

There was a recent story about how the injuries to some of Australia's young fast bowlers could be related to the boots they wore. How important are the right type of shoes in cricket, and in particular, bowling, for an injury-free experience? asked Clyde Beecham
This is a good question and one that sports physios face regularly in practice. To give you some context, there has been a recent paradigm shift in the role of sports shoes. Debate is occurring in the running world about the trend towards "minimalist" over "traditional" footwear. Minimalist shoes are lower in profile and have minimal cushioning and foot-control technology in them. The theory is that traditional shoes have changed our biomechanics and weakened the lower limb structures. A gradual move toward minimalist shoes reportedly helps improve these areas, running efficiency, and ultimately minimises injury. This obviously has implications on the ongoing debate about the role of prescription orthotics, support devices, in prevention of lower limb injury.

I raise these points because it demonstrates a lack of consensus in the complex area of prescribing footwear. I, however, still consider myself "old school" on shoe and orthotic prescription, especially when it comes to the fast bowler. The fast bowler is not a "runner" per se and generally lands on the rear or a flat foot during the delivery stride, experiencing ground reaction forces many times his bodyweight. In this respect, I think it is critical that the shoe used has a number of elements: excellent rear-foot cushioning to dissipate these ground reaction forces; flexibility at the fore foot and not at the mid-foot; stability around the back of the heel cup; some form of lacing/Velcro strap to prevent the foot sliding forward inside the shoe; an upper part that is strong enough to resist lateral movement of the foot within the shoe - i.e. more of a cross-trainer type shoe; and a spiking pattern that doesn't cause pressure points on the foot within the shoe from below.

In terms of foot control and support, even small movements away from a neutral position will load some areas of the kinetic chain more than others. Add high ground-reaction forces and these compensations are magnified. In this regard, corrective shoe inserts (orthotics) are usually worn by elite bowlers with an expectation to help prevent injury. These are not actually arch supports but motion control devices. They are expensive, but when you consider how much income a player stands to lose through injury, it's a wise investment.

One more thing to consider is the lifespan of the shoe and potential for injury. The fast bowler needs to be careful not to use the shoe for too long as it will lose a lot of its cushioning and stability long before it looks worn out. How long each shoe last depends on factors such as the weight of the player, the bowling technique, and the number of deliveries bowled. The shoe might begin to feel "flat" or heavy when it starts to wear out, and small horizontal creases will also appear in the EVA (used as shock absorbers in shoes) midsole, indicating the material is becoming compressed.

I am currently travelling with Brett Lee for the Kolkata Knight Riders, and he carries a kit bag full of bowling shoes which he rotates to prolong their lifespan. My advice is that once you find a shoe that has the above characteristics and feels good, buy up a few pairs. Brands often change seasonally and not necessarily for the better.


Allan Donald changes his boots, Western Australia v South Africans, WACA, 3rd day, December 9, 2001
Change your boots often © Getty Images
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Could you tell us in some detail how Sachin Tendulkar suffered from a tennis elbow, what he did to continue playing through the pain, what you did, and what treatment succeeded eventually? asked Parry Das
Tennis elbow is a relatively common injury that can affect anyone from housewives to elite sportsmen. It is also an injury that currently does not have consensus on its most appropriate treatment. Of course, there will be practitioners out there who proclaim their method works best, but research tells us that the jury is still out.

For medico-legal reasons it's inappropriate for me to comment specifically on Sachin's case, but his started like most people's, by doing too much too soon after an extended rest period. In simple terms, he overloaded the forearm by batting for excessively long periods in the nets prior to going on tour. This set up an acute reaction in the wrist extensor tendon. Whilst this initial episode actually settled relatively quickly with conservative management (i.e. active rest, joint mobilisation techniques and specific exercises) it tended to recur intermittently to the extent that he eventually required surgery. This is one of the problems of tendon injuries - they can be pain-free yet develop areas of degeneration within them. Despite the successful surgery, he still needs to perform exercises involving wrist extension and rotation movements to keep the forearm/elbow conditioned. A brace worn around the elbow also offloads the tendon to provide great relief from pain and lets Sachin continue playing.

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