Case Study: Lumbar Bone Stress Injury

Background 

A 13-year-old right-handed, pace bowler developed a gradual onset of left sided low back pain during an indoor cricket net. He rested for a week and when he returned to bowling the pain was worse and he was unable to continue.

Immediate Care 

The player presented for physiotherapy assessment with Angie Jackson and after a detailed history was taken the patient was advised to get an MRI scan done for a suspected stress fracture. This type of injury cannot be seen in the early phases on a plain x-ray and it is therefore important that a specific type of MRI sequences are performed under the guidance of an experienced radiologist. The player was advised to rest from all sporting activity until the results were received. 

Diagnosis 

The MRI revealed an incomplete stress fracture at L5 on the left side. These injuries occur along a spectrum from bone swelling (Grade 1) to complete fractures (Grade 3) and this was a grade 2 injury which are common amongst junior cricketers and have an excellent potential for healing if caught early. 

Treatment Plan 

Following the diagnosis, a comprehensive treatment plan was discussed and a highly structured exercise regime was implemented to enable a safe return to play.  

Treatment included not just exercises to get stronger, but a comprehensive evaluation of their energy levels including nutritional intake, sleep quality and education around the importance of recovery. 

Recovery Timeline 

The average time for this grade of bone stress injury to heal is around 10-12 weeks with a progressive return to play often taking up to 8 weeks following healing. The player was dedicated in their approach to rehab, improved their energy intake and met all the timelines set and was able to get back to bowling at 16 weeks and competition by 20 weeks with no setbacks during the following season. 

Conclusion 

Critical to these injuries is early diagnosis. The involvement of a multidisciplinary team with experience in adolescent sports injuries enabled access to timely imaging, interpretation and getting the player on the correct pathway to ensure a good outcome and safe return to sport. It is important that players are not just treated until they are pain free, but are taken through a progressive rehabilitation and strength and conditioning programme so they are adequately prepared for the demands of cricket when they return to play.