Are you a young fast bowler? Do you have lower back pain?

If you are reading this, you are possibly one of the many young fast bowlers who experience some form of lower-back stiffness or pain, either during or after bowling. While there are many possible sources of pain in the lower back, one of the most common problems seen in this subject group is pain from an injured vertebral bone or bones. It is a problem that could keep you out of cricket for an extended period of time.

Ask yourself the following: Are you a young fast bowler (less than 25 years old)? Do you experience pain or stiffness on the side of the lower back opposite to the arm you bowl with? Is the pain sharp? Does it come on quickly during bowling or does it leave a dull ache? Does the stiffness in the lower back gradually increase as the season progresses? Have you recently been promoted to a more senior side or have you played a lot of cricket this season? Does your coach make you bowl fast for longer that than half an hour or so at training? Do you have a past history of stiffness in the lower back over last two seasons but no pain? Does it hurt when you bend backwards and towards the side of pain (extension)? Are you stiff in the lower back first thing in the morning? Have you been told by a coach that your bowling action is "mixed", where your shoulders and hips rotate in different directions?

If you answered yes to the majority of questions above, you should be suspicious of having some form of "bone stress injury" in the lower back. This could be new or old.

When bowling, significant ground reaction force is transmitted up through the foot to the rest of the body with each delivery. The higher the rate of application of the force, the greater the problem. So if you have a high jump and then land heavily, the forces being transmitted through the lower body and up into the spine will be correspondingly high. Some ground reaction forces have been recorded as being as high as 15 times the body weight. There is a point up to which the body can cope and manage these loads without detrimental effects. However, when your bowling action is less than efficient, when you are bowling excessively, or if a combination of these and other factors exist, then fatigue can occur in the muscles and soft tissues, resulting in the vertebral bones absorbing the bulk of the stress.

When the bone is subject to chronic loads, as a living tissue it will want to adapt and remodel itself to become stronger. But the body is only as strong as it needs to be. For example, astronauts actually lose bone strength/density due to the lack of gravity/load, since without load the skeleton becomes weak. But when the stress is applied faster than the bone can strengthen, at some critical point on this continuum a threshold will be crossed and the stressed area of bone will collapse, resulting in a stress fracture.

Interestingly, there is also a potential risk of injury occurring if there isn't enough bowling load, i.e. insufficient bone adaptation in the lead-up to the sudden load. There is a current thinking that fast bowlers in the IPL might be at risk of actually underbowling during the tournament, especially if they are immediately required to play first-class or Test cricket, where loads will suddenly spike. Cricket Australia sends each of its IPL players specific weekly bowling loads to meet if they are required for national duty after the tournament. Obviously every player is different in what loads they can tolerate and how much of a role their individual bowling actions play.

An active vertebral stress reaction/fracture will generally be progressively painful and eventually make bowling more or less impossible. But given the right environment, if the stress is reduced, it will attempt to heal itself just like any other injured bone in the body. The medical name for this condition is spondylolysis. If you ignore it and continue bowling, the fracture site could widen and eventually fail to heal. The end result can be structural instability in the spine. This is an injury that can cause months or years of rehabilitation or even end one's cricket career.

So what can you do if you suspect a bone injury in your lower back?

It is critical to get an accurate diagnosis, so go and see a sports physician, an orthopaedic surgeon or a qualified sports physiotherapist who has experience working with cricketers. I have met many doctors who dismiss low back pain in a cricketer as a simple muscle strain. But please don't settle for such a diagnosis as it does not usually factor in the demands of the sport on young fast bowlers' spines. A full history of your problem should be taken and your movements assessed. More importantly, they will likely investigate your lower back using a combination of oblique lumbar x-rays, a bone scan, CT scan, or more likely a MRI, which will show more accurately any areas of bone activity. The goal of the investigations is to primarily determine whether there is an active fracture present and whether the body is trying to heal itself.

There are many bowlers out there playing with old asymptomatic (lacking symptoms) lumbar vertebral fractures which have failed to heal. Typically, a fibrotic connection bines the fracture site but this is obviously not the same as bone formation. The importance of making the correct diagnosis is that the management of an acutely active stress fracture will be different to that of a cold stress fracture.

Regardless of the diagnosis, the presence of any lower back pain will require you to reassess a number of issues if you wish to continue as a fast bowler. Consider:

1. The volume of bowling each week and over the season: Depending on your age, research suggests that the number of deliveries should be restricted. Refer to the England board's recommendations.

2. The efficiency and biomechanics of your bowling action: seek the advice of a good coach who may use video analysis to show you what you are doing incorrectly.

3. Your physical conditioning and core stability: Training programmes generally need to be individualized, but refer to the previous articles for ideas on core and functional training.

4. Any biomechanical factors contributing to increased compensatory load through your lower spine: A good sports physiotherapist will be able to assess and treat these and show you how to manage them with home exercises. I'll discuss some of the tricks in my next article.

If a lumbar stress fracture is diagnosed and found to be actively trying to heal, then you have no option but to stop bowling to let it heal. Either way, however, you will need a thorough rehabilitation programme if you wish to return to bowling. There are no "quick fixes", magic therapies or medicines, and failure of the conservative approach will likely require the more invasive option of surgery.

Remember, it's not only about restoring your spine in order to be able to bowl again. There exists the real possibility of further degenerative changes to the surrounding spinal structures if it is not rehabilitated properly. And a life after cricket suffering from chronic lower back pain is not worth the cost of a few extra wickets.

The important thing to remember is that your body will always want to heal initially if it is allowed. So get it checked out now.