From Injury to the Playing Field (Part 2)

The back, shoulders and knees are the areas that are most vulnerable to injury when playing cricket. Thus, any conditioning program for cricketers must address this. Back injuries were discussed in part one.

In this installment, I'll discuss shoulder and knee injury reconditioning.

Firstly, we will discuss basic functional anatomy of the shoulder complex and how that complex integrates with the rest of kinetic chain (human body). The shoulder complex is made up of four joints, the glenohumeral joint (GH joint), acromioclavicular joint (A/C joint), sternoclavicular joint (SC joint) and scapulothoracic joint.

The first three joints mentioned are anatomic joints (bone attachments), however the scapulothoracic joint is a physiologic joint that is muscular attachments. The shoulder complex consists of twenty muscles that which the synergy and balance are critical to healthy functional shoulder complex. According to Paul Chek, the scapulothoracic joint is the "master joint" of the shoulder complex. Chek further states, "from clinical experience if there are biomechanical faults in this joint complex, for any reason be it local or afar, there will be comparable problems in the shoulder".

The shoulder complex communicates and functions with the other parts of the kinetic chain through four slings that afford human movement. The first sling is the Deep Longitudinal System which consists of the peroneals, bicep femoris, sacrotuberous ligament, thoracolumbar fascia and this system is active in the propulsion phase of gait (walking, jogging and running) and if there is a dysfunction in this system the shoulder complex would be compromised in that the shoulder complex would carry a greater load in the propulsion phase of gait.

The next sling is the posterior oblique system which consists of gluteus maximus, thoracolumbar fascia and latissmus dorsi. This sling is action with the shoulder complex in the initial swing phase of gait. The next sling is the anterior oblique system which consists of internal and external obliques, contralateral adductor complex and contralateral hip external rotator complex.

This sling is in action with the shoulder complex if one is nailing a pile-on with a sledge hammer or a fast bowler delivering the ball. The final sling is the lateral system which consists of the gluteus medius, ipsilateral adductor complex, contralateral quadratus lumborum. This system is in action with the shoulder complex when walking up steps with a bag in the opposite hand or simply walking with a bag in the opposite hand. This is the basic biomechanics of how the shoulder complex works with the rest of the body.

The cervical spine plays a significant role in shoulder pathologies and must be cleared when the shoulder is assessed.

Prior to designing any reconditioning program for the shoulder complex a comprehensive assessment of the complex, cervical spine, core function, hips and lower legs must be done. The assessment complexity is beyond the scope of this article.

Following the assessment if the dysfunction is not beyond the scope of practice a corrective exercise program is designed. Such a program should consist of exercise, stretching, soft tissue work and nutrition and lifestyle modifications. A similar program periodization protocol as described in part one is followed.

The knee joint dysfunction has plagued cricketers on a regular basis especially fast bowlers. In terms of fast bowlers, according to research from University of Western Australia, when a fast bowler lands in delivery stride he generates up to 5 times his bodyweight in force that must dissipated from the knee joint. Now if there is poor biomechanics on delivery stride or kinetic chain dysfunction the knee joint can pay the price (injury).

The knee joint is what can described as a slave joint and the controlling arm of the joint is the hip joint and the transverse abdominus (TVA) the deepest abdominal muscle. For example if there tightness of iliopsoas muscle in the frontal plane will cause the knee joint to pick up the lost range of motion at the hip which would place the knee joint in an unstable position, thus at higher risk to injury.

The assessment of the knee should be of the following areas:

1. Core function
2. Hip musculature function and length and tension.
3. Quad and hamstring function and length and tension.
4. Knee stability and patella integrity.
5. Tibia function.
6. Foot pronation and supination and rear foot alignment.

Based on the findings of the evaluation a corrective exercise program is designed. Such a program would consist of exercise, stretching, soft tissue work and nutritional and lifestyle factors. The periodization protocol as described in part one is again followed. The sign that a cricketer is ready to return from a knee injury is his/her ability to do a single leg squat on an unstable surface.

In part three, I will discuss cricket specific conditioning which would include off-season and in-season protocols. References will be provided at the end of part three.

* See From Injury to the Playing Field (Part 1).

* Also by Basil Butcher Jr: Injuries, Conditioning and West Indies Cricket.