Understanding the "side strain" in cricket fast bowlers: Your guide to rehabilitation
Cricket is a game that demands immense physical prowess, especially from fast bowlers who generate incredible power during the delivery stride. However, it is this intensity that can often lead to injuries, with side strains being a common condition among cricketers. In this blog, we will discuss the causes, prevention, and rehabilitation strategies for cricket fast bowler side strains, shedding light on the often vital role of physiotherapy in ensuring a successful recovery and return to play.
What is a side strain
Side strains, also known as intercostal muscle strains, typically occur due to the rapid rotation and forceful actions involved in fast bowling. The repetitive and high-intensity nature of this movement can lead to fatigue and ultimately a single incident leads to a tear of the intercostal and or oblique (more frequently internal oblique) muscles. It is these muscles that are responsible for aiding in generating stabilisation of the rib cage and force generation during the powerful trunk rotations during bowling actions. A side strain is characterised by the onset of pain and localised tenderness over the lateral trunk near or over the rib cage, usually on the opposite side to the bowling arm. It is often felt after a single delivery when the front arm "pulls" down during the delivery action. Side strains require rehabilitation and often significant time spent away from sport. In fact, side strains are the second longest injury that keeps a player out of cricket other than a lumbar stress fracture.
The early part of the competitive playing season has been associated with relatively higher incidence of side strain injury, particularly in younger bowlers. Those that are returning from a different injury that has limited their bowling loads are also at risk. Fast bowlers, as opposed to spin bowlers are at a much higher risk given the higher forces associated with fast bowling. Finally, those who have sustained a side strain are also more likely to re-injure that same season.
Diagnosis of side strain is based on the athlete's clinical history and physical presentation. An MRI may also be utilised to confirm the diagnosis. Clinical features include acute pain over the outside thoracic wall over one or more of the lowest four ribs. There is also pain on activation of the oblique muscles in activities such as resisted side bending or rotation. Deep inhalation can sometimes be an aggravating factor.
The goal is to allow the injured intercostal muscles to heal fully, regain strength, and gradually reintroduce sports-specific movements before returning to full competitive play. On average, it may take upwards of 4-5 weeks to return to sport. More severe side strains can take longer to heal, typically requiring 6 to 8 weeks or even more. However, early management and loading of the side can improve prognosis and return to play timeframes. It is important to graduate from low level exercise through to more challenging sport specific exercise (shown below). It is also important to cross train wherever you can so that you maintain as much lower body conditioning as possible.
In summary, fast bowling is tough work so your body has to be strong and resilient. Good structured strength training helps! If you do suffer a side strain, patience, adherence to rehabilitation protocols, and close monitoring are essential for a successful recovery from a side strain.
If you would like to learn further about side strains / would like to prevent injuries or have a suspected side strain - book in to chat to one of our Praxis Physios today!!
Until Next time,
Praxis what you Preach
Nealon, A. R., Kountouris, A., & Cook, J. L. (2017). Side strain in sport: a narrative review of pathomechanics, diagnosis, imaging and management for the clinician. Journal of Science and Medicine in Sport, 20(3), 261-266.