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Cricket Fast Bowlers Without Low Back Pain Have Larger Quadratus Lumborum Asymmetry Than Injured Bowlers

Kountouris, Alex Post Graduate Diploma (Sports Physiotherapy)*; Portus, Marc PhD; Cook, Jill PhD

Clinical Journal of Sport Medicine: July 2013 - Volume 23 - Issue 4 - p 300–304
doi: 10.1097/JSM.0b013e318280ac88
Original Research

Objective: The objective of the study was to determine the magnitude and side of quadratus lumborum (QL) asymmetries in elite, adult, cricket fast bowlers and the relationship with lumbar spine injury.

Design: Cohort study.

Setting: Cricket fast bowers had magnetic resonance (MR) scans at the start of a cricket season and their injury characteristics over the next cricket season were compared with the amount of QL asymmetry.

Participants: Twenty-three elite, asymptomatic, adult, cricket fast bowlers.

Assessment of Risk Factors: The cross-sectional area (CSA) of QL was measured using MR imaging. The association between side-to-side differences in CSA (asymmetry) was evaluated as a possible risk factor for development of lumbar spine injury.

Main Outcome Measures: The main outcome measurements were QL CSA and asymmetry in relation to lumbar spine injury in cricket fast bowlers.

Results: There were a greater proportion of dominant- (bowling arm) side asymmetries (65%). Asymmetry magnitudes that favored the dominant side were not significantly larger than those on the nondominant side. Four participants who had bone oedema on MR imaging preseason went on to develop symptomatic lumbar stress fractures. Participants with no lumbar spine injury had significantly larger QL asymmetries than those who sustained lumbar spine injury.

Conclusions: Cricket fast bowlers demonstrated asymmetrical QL development, which may be related to the trunk positions adopted in the fast bowling technique. Uninjured bowlers had larger asymmetries than those who developed lumbar spine injury, which is contrary to some previous research.

*Cricket Australia, Melbourne, Victoria, Australia

Praxis Sport Science, Brisbane, Queensland, Australia

Department of Physiotherapy, School of Primary Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston, Victoria, Australia.

Corresponding Author: Alex Kountouris, 60 Jolimont St, Jolimont, Victoria 3002, Australia (

Supported by Cricket Australia's Sport Science and Sports Medicine unit.

Professor Cook was supported by the Australian Centre for Research into Injury in Sport and its Prevention, which is one of the International Research Centers for Prevention of Injury and Protection of Athlete Health supported by the International Olympic Committee (IOC). Other authors report no conflicts of interest.

Received May 31, 2012

Accepted November 29, 2012

© 2013 by Lippincott Williams & Wilkins