Kolkata memories, and injury nightmares

I was reading about VVS Laxman and Rahul Dravid's partnership in the Kolkata Test of 2001. It seems you were summoned on to the field several times to tend to them. And you must have had your hands full during the session breaks too. Could you give us a description of the epic partnership from the physio's point of view? asked Tim Marsh
This Test match, and in fact the entire series, was very memorable for me for so many reasons and reminds me of why I love my job. Every member of a support staff likes to believe that they contributed in some small way to the performance of a player and/or team, hence we enjoy the victories as much as the players. On this occasion these two guys were batting all day in the heat and humidity of the Eden Gardens. Not only were the environmental conditions against them, but the Aussies were unrelenting in their bowling. So it made for a great contest to watch.

Rahul has a tendency to cramp even in mild conditions. So the battle with him was to ensure regular fluid and electrolyte intake. We were carefully monitoring what he was given throughout the day, but it is always a mission in Test cricket getting drinks out to the batters, since the umpires see it as slowing down the game. So despite our best efforts, we were never going to be able to match the fluid intake with the rate of dehydration, and toward the latter part of the day the cramps did begin.

When an athlete is even slightly dehydrated, the metabolic and physiological processes are going to be affected. Mentally, decision-making processes can also be affected. Every effort was also taken to try to keep Rahul's core temperature down. There were no ice vests or other cooling "technology" available in Kolkata, so towels were cut into strips, dipped in iced water and wrapped around their necks. We also got them into a wheelie-bin ice bath in the dressing room during each break.

Laxman fared better in the heat but he had developed a lower-back problem at the start of the Test that caused him to stiffen up and list over to one side. Time was spent each session working on his back, trying to get him loose (and straight) again. These session breaks were almost busier for the players than when they were out in the middle.

I play cricket at the club level but find it extremely difficult to maintain stamina. What is the best way to build and maintain stamina? asked AzyS
I wish there was a recipe to give everyone that outlined exactly what you need to do in order to achieve a certain level of fitness. Unfortunately we are all individuals with different physiques, ages, strengths, weaknesses, and we place different demands and expectations on our bodies. A "one-size-fits-all" is not going to work.

What you have told me, however, is that you experience fatigue when playing cricket, and this means that you need to do a lot more physical conditioning training than you are already doing.

A good generic session involves shuttle runs. Place two cones 20 metres apart and run back and forth between them in any combination of sets and repetitions to target different energy systems. For example, 10 x 30-second shuttles with a 30-second recovery is a tough session - but aim to run six shuttles in each 30-second interval. If you can do this then I would consider you to have a good level of speed-endurance. As you get fitter, perform two sets of this, i.e. 20 repetitions.

Alternatively, perform sets of one to three minutes to target the aerobic energy system, with the same length of time for recovery between sets, i.e. two-minute effort followed by two minute-recovery. Your goal would be to achieve 12 shuttles per minute. Shuttles may be boring but they work on your ability to accelerate, decelerate and turn. Try doing them padded up and with a bat in hand as well. This type of training also targets your ability to recovery quickly between efforts - exactly what you need for cricket.

Who did you think was mentally the most superior among the KKR players? Gambhir, Kallis, Narine, Lee, or someone unexpected like Balaji? asked Bong_in_Chennai
You should ask this question to our resident psychologist, Dr Rudi Webster. He worked with the team this season and would have a much better idea from a mental perspective. But even he would be hesitant to label any player publicly. Trust between a medical practitioner and player is paramount to them opening up and being able to discuss issues that perhaps take an inappropriate place in their psyche.

Generally speaking, time and again players surprise me with their ability to overcome both physical and mental challenges that are thrust upon them at the elite level - but that's why they get to play at this level.

In the final, the Knight Riders needed nine off six deliveries, and Manoj Tiwary did it with a couple of balls to spare. Sitting in the dugout, I was incredibly tense - so many thoughts, both positive and negative, about winning or losing after such a long season and five years of trying. This is the layman's thought process. The mentally tough players are able to block out all of the "noise" and maintain their focus when it is needed. That's what makes a great player, and this skill is achieved through years of practice, in addition to having some inherent mental strength.

I am a right-arm fast bowler with an efficient action. So I have never had back problems, but my landing (left) ankle becomes sore after bowling. In the recent past it started hurting more, so I have decided to rest it for another four to six weeks. Could you please give me some tips on working the ankle better? Please note that I do not have the same problem with my right ankle. asked Harry_RAF
There are quite a few common injuries to the front-foot ankle in fast bowlers. In fact, many of the world's elite quicks have, at some stage or another, had surgery to correct a problem. Toe tendon injuries, metatarsal stress fractures, posterior/anterior impingement syndromes, ankle sprains, bone bruising are all possible injuries, so it is worth getting the problem checked by a suitable sports medical practitioner. The reasons for the various injuries are a combination of poor biomechanics, poor sports technique, and overload. Pain is typically localised to the anatomy at fault instead of referred, but investigations are often required to determine the degree of injury.

If I were to give generic tips to protect the fast bowler's ankle, my first would be to get your feet checked by a sports podiatrist for good biomechanical function. Overly flat feet can be a big issue, as can overly high-arched feet. Both extremes of foot posture bring their own unique issues.

Poor ankle stability is a second problem: having a history of sprains can actually predispose you to impingement-type ankle pain. Single-leg progressive balance work can be beneficial, utilising the traditional wobble board or foam mats to challenge the balance systems of the leg. Zig-zag hopping and landing training are also beneficial.

Another tip would be to stretch the ankle into dorsiflexion regularly (i.e. calf stretch with knee bent and straight) as restriction of this movement leads to increased over-pronation (an excessive inward rolling motion of the foot).

Calf strength and power is probably my final bit of advice. You should be able to rise up and down on your toes (one leg) off of a step at least 25 times with good technique.

What one cricketing injury gives you nightmares - you pray it doesn't happen to any of your charges? asked Lauren Daly
Definitely recurrent hamstring strains, because they can occur despite clinical and functional testing being normal. Unfortunately, this happened to me recently in the IPL when a player sustained a mild hamstring injury that kept him out of the tournament for about three weeks. He did an excellent rehabilitation and returned to the game without any pressure after passing all of our testing. In fact, he played the next three matches and bowled well, not once complaining of any stiffness, soreness or weakness. Then about two weeks after his return, the injury recurred when he bowled an effort ball - one that required slightly more bending of his back.

Hamstring strains are prone to recur in all sports. There are various theories as to why this happens and it always has the medical team scratching their heads in disbelief and frustration. In hindsight, it may have been the compact play/travel nature of the IPL, placing a compromise on the ongoing rehabilitation programme. Once he returned to bowling, his strength must have dropped off. In the end this was a huge disappointment to everyone.

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