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Metatarsal stress fractures in cricket fast bowlers

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Craig Payne, Aug 11, 2012.

  1. Craig Payne

    Craig Payne Moderator

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    I recently had the opportunity to participate in a high performance cricket conference at the AIS. Met stress fractures are becoming a big problem in fast bowlers, so I was asked to give a presentation and some ideas on it.

    As part of preparing for that I got to look at a number of videos. Here is one of them. Watch the forefoot contact and hyperextended knee .... and they wonder why there are so many metatarsal stress fractures!

     
    Last edited by a moderator: Sep 22, 2016
  2. Admin2

    Admin2 Administrator Staff Member

  3. DaVinci

    DaVinci Well-Known Member

    Paynie, what did they end up doing about this?
     
  4. Craig Payne

    Craig Payne Moderator

    Articles:
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    I also cringe when you see what the back is going through in those bowlers - they also get a lot of back problems!
    The solution to the problem of met stress factors I suggested was deal with the following (the first two are obvious!):
    1) Make sure bone health was ok (ie no osteorprosis or underlying problem)
    2) Increase the ability of the bone to take the load (ie progressive overload and adaptation)
    3) Decrease the forefoot/metatarsal dorsiflexion moments (ie change 'form' & foot plant; orthotic intervention)

    The orthotic intervention is going to be a challenge as it needs to incorporate design features that decrease that forefoot dorsiflexion moment and/or increase the rearfoot dorsiflexion moment ...... but given the forefoot contact in the above video, that ain't going to work too well.

    Changing the 'form' & foot plant is also going to be a challenge as these guys are elite athletes - do you want to tamper with the 'form' that made them elite?
     
  5. Craig:

    When treating runners with a history of metatarsal stress fractures, I have had good results with foot orthoses that have a 2-3 mm anterior edge thickness to increase the ground reaction force (GRF) on the metatarsal necks where the bending moments on the metatarsals are greatest. This orthosis modification will also decrease the GRF plantar to the metatarsal heads, which further decreses the metatarsal bending moments. The same orthosis modification (which will need to individualized for each athlete) should work quite nicely for these cricket players also, with minimal expected change in performance or break-in period.
     
  6. Bruce Williams

    Bruce Williams Well-Known Member

    Craig;

    It would seem this is an issue of breaking and shear forces as well. Is it mandatory for the bowler to throw with a straight leg for it to be legal?

    Bruce
     
  7. Craig Payne

    Craig Payne Moderator

    Articles:
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    It's not mandatory; but they all do it. These guys are lethal; they bowl really fast - you do not want to be facing them. To bowl that fast they generate the high forces that are causing all the met stress fractures (and low back problems).
     
  8. Bruce Williams

    Bruce Williams Well-Known Member

    In baseball the pitcher is allowed to push from the fixed rubber in the pitching mound. Seeing how cricket bowlers get a running start it would make sense, to me anyway, for them to pivot over a fixed straight leg to generate the most power for delivery. That should lead to tremendous braking forces at the foot on the pivot. The bowler video you posted above has a hyperextended knee as you stated and this should be in response to his attempting to stop the ankle from pivoting as well. very interesting!

    The only thing I might suggest beyond what you and Kevin suggested would be a heel lift, but i'm not really sure that would be affective in this instance. It seems the bowler is fighting to keep the foot planted to the ground, in a way like a pole from pole vaulting? I think the lift would help to decrease the knee hyperextension, but the bowler might not find that helpful.

    Nice post Craig! Thanks
    Bruce
     
  9. W J Liggins

    W J Liggins Well-Known Member

    Hi Craig

    I'm no expert in this area; however, there are a couple of points which intrigue me. Is the affected met most frequently the 2nd? Do you ascribe the # purely to the braking and shear forces or do you feel that the inversion twist on the immediate follow-through might be involved here? I'm really thinking from the point of view of the anatomy of the 2nd TMTJ and the effects of a twist to that area. (For those of our colleagues who do not have the good fortune to be aware of the niceties of the game, the bowler is strictly banned from running straight down the pitch, hence the necessary twist following delivery of the ball (however, Australians have been known to do this!)

    All the best

    Bill
     
  10. Boots n all

    Boots n all Well-Known Member

    We did a mod for fast bowler about 2-3 years ago, it involved increased heel pitch(6mm), a full length metal shank(carbon fiber he felt was not rigid enough) orthosis and a rocker sole, overall a sole increase of 12mm.

    Besides helping reduce his injury, his theory was that as a shoe flexed and his foot distorted, he lost some the power/speed he delivered through to the ball?

    He had sesamoid and some muscle damage, l believe he is still bowling in them with no more issue...it did change his run up approach for the first few weeks and he had to change shoes for fielding and bating.
     
  11. Bruce Williams

    Bruce Williams Well-Known Member

    Brillian David! Accentuate the motion of the shoe and minimize the motion of the foot.
    Nice!
    Bruce
     
  12. markjohconley

    markjohconley Well-Known Member

    Bill, that hurt ...... we also bowl underarm occasionally (but only to our close 'cousins', those of the 'Great White Cloud').
     
  13. W J Liggins

    W J Liggins Well-Known Member

    Hi Mark

    Be of good cheer

    I am old enough to remember when Tony Gregg (an SA mecenary - and we have a few of those now) did similar for England!
     
  14. efuller

    efuller MVP

    A very interesting motion for throwing. It appears the foot that is planting just before the release is always plantar flexed. It also appears that the plantar flexion is attempt to stop forward motion of the lower extremity to allow the upper body to pivot over the lower body to get some more angular velocity into the throw. I'm assuming that folks, over the years, have experimented with different deliveries and the video demonstrates the "best" delivery.

    Anyway, it appears in the run up to the relaese, there is plenty of dorsiflexion of the ankle. It would appear that the plantarflexed position at the release is a choice and part of the delivery. Therefore, I would not recommend a heel lift as the person will just have to plantar flex their ankle more to get the desired effect. I'm going to assume that the stress fractures occur in the plant foot that is plantar flexed at the release. I'd be willing to bet that the metatarsal that gets fractured is the longest one. Assuming that this is correct, for treatment you would need a way to get even force distribution across the metatarsals when the foot is plantarflexed in the the throwing position. Hopefully this doesn't screw up the run up to the release.

    Just some thoughts.
     
  15. Craig Payne

    Craig Payne Moderator

    Articles:
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    (I could crack a joke about cricket not being played in the USA.....)
    The ball reaches speeds close to 100mph/160kmh. Even looking at the photo in the wikipedia page below - look how high they jump for that last step before planting the front foot.

    Fast bowling

    Fast bowling is one of the three main approaches to bowling in the sport of cricket, the others being spin bowling and medium-pace or swing bowling. Practitioners of pace bowling are usually known as fast bowlers, quicks, or pacemen. They can also be referred to as a seam bowler or a 'fast bowler who can swing it' to reflect the predominant characteristic of their deliveries. Strictly speaking, a pure swing bowler does not need to have a high degree of pace, although dedicated medium-pace swing bowlers are rarely seen at Test level these days.

    The aim of fast bowling is to deliver the ball in such a fashion as to cause the batsman to make a mistake. This is achieved by making the hard cricket ball deviate from a predictable, linear trajectory at a speed that restricts the amount of time in which the batsman can compensate for it. For deviation caused by the ball's stitching (the seam), the ball will bounce off the pitch and deflect either away from the batsman's body, or inwards towards them. Swing bowlers on the other hand also use the seam of the ball but in a different way. To 'bowl swing' is to induce a curved trajectory of the cricket ball through the air. Swing bowlers use a combination of seam orientation, body position at the point of release, asymmetric ball polishing, and variations in delivery speed to affect an aerodynamic influence on the ball. The ability of a bowler to induce lateral deviation or 'sideways movement' obviously make it difficult for the batsman to address the flight of the ball accurately. Beyond this ability to create an unpredictable path of ball trajectory, the fastest bowlers can be equally potent by simply delivering a ball at such a rate that a batsman simply fails to react either correctly, or at all. A typical fast delivery has a speed in the range of 137–153 km/h (85–95 mph).

    Fast bowler Graham Onions bowling for Durham against Lancashire in the 2012 Friends Life t20
    Scotland's fast bowler John Blain hits the wicket of India's Yuvraj Singh, 2007
     
  16. markjohconley

    markjohconley Well-Known Member

    A different, but very effective, technique was used by Jeff Thomson, a 'slingshot' style
    http://www.youtube.com/watch?v=m8tFgtzeA2M
    was one of the quickest ever.
    Please note I didn't select this because it was the English cricket team on the receiving end.
     
  17. For you Americans that think that cricket means a bunch of men in white suits wating around for something exciting to happen, and for all of you other folks across the pond who think baseball makes no sense at all, here is a good article on the similarities and differences between these two "bat and ball games".

    http://en.wikipedia.org/wiki/Comparison_of_cricket_and_baseball

    And, by the way, Craig, cricket is played in the USA, but very infrequently since baseball is still very, very popular here (that was the first sport I loved and played). Rugby, however, is becoming much more popular here with most of the high schools here in Sacramento having a boys rugby teams. Now rugby is a sport I would have loved playing in my younger days.

    Also, the orthopedic surgeon that I worked with for 16 years, Fred Khasigian, has coached and managed one of the local high school rugby teams to 4 national high school rugby champtionships. Here is nice article about the development of rugby here in California high schools over the past 15 years for those that are interested how rugby is doing in the USA.

    http://www.erugbynews.com/article.php?sec=365&a=569
     
  18. markjohconley

    markjohconley Well-Known Member

    Brought up on rugby I'm now a big fan of NFL, enjoy watching the uncondensed version where they go through each play, mark
     
  19. RobinP

    RobinP Well-Known Member

    If it is always the longest metatarsal being fractured, would it not be possible to create a localised metatarsal head relief (as would be done for a plantar plate tear) to reduce the bending moment at the metatarsal in addition to increasing the length of the shank of the shoe(and perhaps also the stiffness) to the proximal end of the metatarsal head. This woudl reduce the bending moment at the metatarsal.

    Only other thing would be to ensure that the spike of the shoe was nowhere near the longest metatarsal head.
     
  20. Fast Bowlers are a different breed with all sorts of tricks to keep the feet healthy. Any and all of the biomechanical interventions mentioned above are often employed as well as cutting the toes out of boots, hikers wool, special socks.......the "technical" term we use for a heavy front foot strikers is the "slapper", this term may not catch on...

    As a podiatrist, i do a lot of work with Queensland (that’s National League for all you Base Ball Lovers) Bulls Fast Bowlers and local first grade cricket teams. In addition to the problem of Metatarsal stress fractures there are other conditions to be considered, commonly fat pad syndrome, shin splints and stress reactions in the Tibia/Fibula and lateral ankle pathologies. It is a fine line when altering the forces on the foot and leg at the front crease, merely deflecting the forces can result in disaster (blisters and subungal haems are show stoppers!).

    It is important to redistribute the loads in a case by case basis working to the particular biomechanics of the individual bowlers (I made the Australian U17 team many moons ago and broke down with Tibial Stress fractures).

    I have found using a combination of high speed video gait analysis synchronised with Parotec Dynamic in shoe pressure measurement to be the most effective for diagnosis and evaluation of the forces being transmitted through the front foot. This also allows me to objectively assess changes made to the orthotic prescription. The overlay of the pressure measurement can also be integrated into the modelling software to allow Paromed CAD CAM orthotic production with the peak pressures highlighted. It is amazing to see the difference that semi compressed felt or, as Kevin suggested a 2-3 mm wedge, can make. Being able to quantify and make changes on the spot and re-evaluate allows the practitioner to get excellent results.

    The Parotec Dynamic Inshoe Pressure measurement is a wide ranging diagnostic tool. Traditionally many podiatrist see its application for high risk feet, such as the Diabetic Foot, but more recently I have been involved with Podiatrists working with elite athletes, not only cricket. The most interesting case in the past 2 weeks is the power lifter (weights) and performance gain achieved by understanding pressure distribution (and the alteration of with orthotics and wedging) during his lift.
    Craig, I am more than happy to share some data with you with my cricketers, send me an email.
    Andrew Barlow
    Clinical Director Paromed Australia
     
  21. Johnny G

    Johnny G Welcome New Poster

    I have played cricket myself for a long time now and still do. The action which is queried earlier can be changed and often it changes with every delivery type. The foot position and strike will vary greatly between each delivery type ie outswinger or inswinger so it can be difficult to make changes to incorporate this situation. The other factor is whether or not the bowler bowls "front on" or "open". We see less of the open actions as they believed earlier that this could cause greater back issues than front on bowling. I am not sure about that. Having said that I have seen plenty of rearfoot strikers at delivery but the degree of plantarflexion is brutal. I have seen this particularly with bowlers that have a high jump at point of delivery. Interesting stuff. One thing is for sure my body is nearly stuffed bowling little mediums for 30 years.
     
  22. W J Liggins

    W J Liggins Well-Known Member


    Hi Andrew

    Have you found that the 2nd met is most commonly affected and do you ascribe this purely to the sagittal forces or do you feel that the supination and abductory twist are involved. I've never seen this (I don't work in sports) but I suppose that the site and nature of the # may offer a clue?

    All the best

    Bill
     
  23. Bmuellerpod

    Bmuellerpod Welcome New Poster

    Hi All,
    My first post for a long time...
    I know a shotputter who had metatarsal stress fracture problems in his foot that he plants last before releasing the shotput.
    He ended up using a full length metal insole (for want of a better description), as suggested above, and had great results.
    Similar kind of action in both sports I suppose.
    Thanks for the thread and the great forum- I look forward to my weekly updates!
    Cheers,
    Beth
     
  24. Hi,

    Great questions.

    Johnny G, I certainly identify an increased incidence rate for lower limb and back injuries with a "mixed action" where one half of the body is "open" (or front on) in technique and the other half is side on (ie torso is front on, legs are side on). This leads to torsion forces, particularly in the lower back and abdbuctory twisting of the back foot. The front foot placement is indeed very important not only due to the type of delivery but the forces that are transmitted. I have found that an abducted front foot tends to create large lateral forces and sometimes lateral ankle pathologies. I measure this with Parotec in shoe pressure measurement. Interestingly, podiatric intervention of the front foot changes the bowlers line (aim) and ability to swing (move the ball -like a curve ball) the ball largely.

    Bmueller Pod- the changes made by creating a metal shank through the whole shoe creates a "Post Op' shoe like pressure measurement, it does not allow the pathological motion! A great example of using biomechanics to relieve symptoms (with metal!) however not practical with the rapid deceleration that occurs in a bowling action front foot strike!

    Bill, the players pre-existing biomechanical alignment will generally determine which overuse injury occurs first, for example a congenital short first metatarsal on a fast bowler is likely to create the sagittal plane pivot point over the second metatarsal head and to some extent create excessive loads on the joint distal to the first MPJ- the IPJ of the hallux. This shows up very clearly on the in shoe pressure measurement and I am usually able to immediately reduce symptoms by designing the orthotic around the pressure measurement with respect to the high speed footage of the bowling action.

    The fast bowling action is a high impact activity that must be repeated 100’s of times per day; overuse injuries are all too common. I have found that there is no “right” prescription as such, the results of the orthotic should be evaluated and changes made to increase the effectiveness. With technology like Parotec in shoe pressure measurement/CAD-CAM you can objectively diagnose, evaluate and adjust, creating the best result from the device. You are also able to measure the effects of different variables such as material densities, footwear and playing/training surfaces.
     
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