Upper Lumbar Bone Stress Injuries in Elite Cricketers

Objective: Describe the proportion of upper lumbar bone stress injuries (LBSI; T12-L3) relative to all LBSI, and the clinical presentation and diagnosis of upper LBSI in elite cricketers. Design: Case series. Setting: Professional domestic and international cricket teams over a 9-year period. Participants: Elite Australian cricketers. Independent Variables: Symptomatic upper LBSI diagnosed based on clinical findings and medical imaging. Main Outcome Measures: Prevalence, injury history, and clinical management. Results: Twenty-four pace bowlers (22 male and 2 female) sustained 39 cases of upper LBSI (T12:2, L1:3, L2:20, L3:14). Upper lumbar vertebrae were involved in 41% (95% CI 31-51) of all LBSI in this cohort. Twenty-seven (69%, 54-81) cases had an injury that occurred only on the side contralateral to the bowling arm. Ipsilateral injuries tended to occur secondary to a contralateral nonunited defect. In all 7 cases with known radiology follow-up that had a contralateral then ipsilateral LBSI, the contralateral injury did not achieve bony union before the onset of the ipsilateral LBSI. For stress fractures with imaging follow-up, those who achieved bony union took longer to return to bowling training [median 152 days (IQR 117-188)], compared to those who achieved partial or no union [median 68 days (IQR 46-115)]. Conclusions: Upper LBSI in elite cricketers occurs in approximately 2 out of 5 cases of LBSI. Clinicians should allow sufficient time for upper LBSI to resolve and unite (if a fracture) because cases that returned to bowling training earlier were less likely to achieve bony union, and those that failed to unite commonly went on to have a recurrent LBSI.