Spine
On my way to the hospital I drive past Trent Bridge which for non-cricket aficionados is one of the principle grounds for Test matches. During a trip home and seeing the ground I was reminded that it was a great autumn for the English team. Fans were delighted with the 2-1 Test series win in India, the first since 1984. Thankfully Alastair Cook’s back problem did not surface during the tour.
All this is of particular interest to a spine surgeon as cricket is a sport with one of the highest prevalence of lumbar stress fractures. Located near my hospital is an English Institute of Sport High Performance Centre based in Loughborough University. We regularly receive elite athletes with injuries to their spines in need of further investigation and management.
A paper from our hospital that has not in my view received enough prominence quantifies the risk of developing stress fractures.1
This longitudinal cohort study recruited 28 elite fast bowlers (mean age 19 years) that were playing competitively at the start of the study. All had base line MRI studies and a further scan one year later.
Fifteen (54%) of the group had evidence of acute bone stress in either scan. In this same group 11 went on to develop a partial or complete stress fracture at a mean interval of ten weeks. All six bowlers with evidence of a stress fracture on initial scanning became symptomatic within four weeks. ...
Another study demonstrates that the pattern of lumbar stress fractures in footballers is different from cricketers. Fractures in footballers tended to be more symmetrical or bilateral in location.2
What are the implications of these studies? Regular MRI scans of asymptomatic elite athletes may anticipate impending fracture, and thus alter training intensity or methods with reduced long term disability. This approach has significant financial and resource implications.
There are also messages for non-elite athletes. My anecdotal impression is that incidence of spondylolysis is rising in youth players. I wonder if modern high intensity training and competition in this skeletally immature group is creating early damage. In an increasingly litigious society I wonder how long it will be before a parent sues a club or coach for not recommending a pre-season MRI scan?
Another local distinction is that Nottingham University is the academic ‘home’ of Sir Peter Mansfield, the father of MRI technology. Call me biased but shares in MRI scanning companies have never looked more attractive!
Mr Michael Grevitt, Centre for Spinal Studies and Surgery, Queens Medical Centre campus, Nottingham University Hospitals NHS Trust, Nottingham, UK
May 2013
References:
1. Ranson CA, Burnett AF, Kerslake RW. Injuries to the lower back in elite fast bowlers. Acute stress changes on MRI predict stress fracture. J Bone Joint Surg [Br] 2010;92-B:1664-8.
2. Gregory Pl, Batt ME, Kerslake RW. Comparing spondylolysis in cricketers and soccer players. Br J Sports Med 2004:38:737-42.
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