Stress, reactions, and bowling load. Where to now for Rabada?
So after a very successful albeit dramatic series vs Australia and an all round successful test summer for the Proteas they are hit wit some not so good news. Rabada is out inured for 3 months. After complaining of tightness and discomfort during the final test he was sent for scans which revealed he has sustained a “lower back stress reaction”1.
What is it?
Firstly lets look at what a “lower back stress reaction” is; this is when the bone starts becoming weaker but there is no fracture, also known to be a precursor to a stress fracture (basically when the part of the vertebrae that fractures in a stress fracture shows ‘degeneration’).
Is this diagnosis exactly what is causing him pain? There is a plethora of studies showing these abnormalities in pain free individuals from the back to the shoulder to the knee etc. etc. etc. (See a great Infographic here). We also know there is a high occurrence of abnormalities in the vertebrae of fast bowlers with no pain (See here2 and here3). So these findings COULD be (not are) just coincidental. Has he been bowling with this for a while? Is his pain a bit more complex than just ‘bone degeneration’? I believe yes and yes. We have to start looking deeper than just imaging findings and I’m sure they are.
Next question, why? Yes, Rabada is fast becoming our talisman and he is a fast bowler, fast bowlers need to bowl. However lets look at his load recently:
He has bowled 452.1 overs in test matches alone this season (July 2017-March 2018) he also bowled 70.3 overs in ODI’s this season. This excludes, training, warm up etc. The next highest load in the Proteas is Morkel with 387.1 overs (Philander with 323.2). He is only 22 years old. We HAVE to remember that. His load has to be managed, especially for a young fast bowler like Rabada.
Now lets look at the way they are managing it: he is to take a 1-month break from all physical activity. Now this is what I would like to focus on, why?! Wolff’s law- bones will grow and remodel in response to the forces/demands it is placed under. Taking all stress away from a so-called degenerating bone is not going to help it. In saying that I would like to stress what they have prescribed is current practice or close to for this type of injury.
There may be another way to look at this and that is, simply we are not getting all the information. They could, simply be guarding Rabada to decrease his workload. Then again is taking all cricket and load away from him a good idea?
Risk vs Reward.
So are we developing a culture of win at all costs disregarding risk vs reward for individual players health and longevity? I have seen that film before. I would like to end off saying I don’t think this is a CSA issue or any of the medical staff are at fault, however I believe it to be a bigger issue in the healthcare/rehabilitation community worldwide as these are the general, current guidelines. Is it good enough?
1) ESPNcricinfo staff. (2018, April 5). Kagiso Rabada sidelined for up three months. Retrieved from: http://espncricinfo.com
2) Millson HB, Gray J, Stretch RA, et al. (2004)
Dissociation between back pain and bone stress reaction as measured by CT scan in young cricket fast bowlers.
British Journal of Sports Medicine 2004;38:586-591.
3) Ranson C. A., Kerslake R. W., Burnett A. F., Batt M. E., and Abdi S. (2005) Magnetic resonance imaging of the lumbar spine in asymptomatic professional fast bowlers in cricket. The Journal of Bone and Joint Surgery. British volume 2005 87-B:8, 1111-1116