The national cricket team of India has been besieged by an epidemic of injuries which is causing a drop out of its key players. This is not only affecting the performance of the team, but has dealt a blow to the ranking of India in international cricket. There is much speculation regarding this sudden spurt of injuries and dismal performance of the team. The human body has the capacity to adapt to the imposed demands and thus become fitter and faster. However, tissues have a limit for adaptation. An optimal training programme loads the tissues in a systematic manner and allows for maximising performance in a minimum period of time. Inadequate rest, recovery and psychological stress can all upset this fine balance and impede adaptation leading to the accumulation of the cumulative effect of trauma because of the repeated high intensity demands. With Indian cricket now becoming a money spinner for both the BCCI and the players where the stakes are very high with the turnover running into millions, Indian cricket has now evolved into a round the year high intensity sport, now associated with fatigue and overuse injuries.
Thus the two main factors associated with the overuse injuries in the Indian cricket team are excessive playing throughout the year as well as inadequate time for a single trauma to heal and the rehab programmes to take effect. In the human body the different parts are linked and can be viewed as functioning in interconnected segments. Thus the movement of one part would affect others as a part of this chain. What must be highlighted here is that even a relatively uncomplicated injury alters the load bearing capacity of the entire kinematic chain and very often tissues which are not load bearing start taking the load and impact of sporting activity because of the alteration in the functioning of this kinematic chain. Thus these tissues are now subject to injury.
A combination of both the intrinsic and extrinsic risk factors are implicated in the generation of overuse injuries. The intrinsic risk factor (athlete/individual related) which seems to have largely played a role in the development of injuries in the team is — age. We now see an ageing Indian team with a large proportion of players beyond their prime. Reduced ranges of motion because of both ageing and inadequate rehabilitation of the player are also individual factors which may have played a role. The time between the series is often too short for a proper and adequate rehabilitation. Improper rehabilitation also leads to minor changes in symmetry and strength, the effects of which are magnified due to the high impact nature of sports.
Extrinsic risk factors are risk factors related to training, equipment, biomechanics, playing surfaces etc. Intrinsic risk factors would predispose the athlete to injuries and the effect of extrinsic risk factors is increased. The extrinsic risk factors that may have played a role in the sudden increase of injuries are a sudden spurt in the competition activity, inadequate time for proper warm up and cooling down, excessive intensity of activity and added to it are change in playing conditions. Although the Indian cricket team is well-staffed with adequate scientific back up with the team, the above enumerated factors are beyond their control and may have played a role in the current pattern of injuries. Strategies used by sports scientists to prevent this are correct biomechanics, proper progression of training and playing schedule, adequate recovery and psychological and nutritional support.
Coming to the specific injuries plaguing the cricket team — Virender Sehwag has the rotator cuff injury which is quite disabling especially to bowlers and batsmen. The rotator cuff is a major stabiliser of the shoulder and it may take anywhere between 2-12 weeks of healing time for full recovery depending on the severity of injury. Return to play will be when he is able to perform all skills and requirements of the sport without pain. A too early introduction of sports can lead to a permanent damage and the return depends on how soon the cuff repairs rather than the duration of injury. At this stage it seems that the pressure to play for India dictates the return to play and here lies the cause of recurrent injuries.
The hamstring pull, which Zaheer Khan has, is a very common injury and the probable causes could be muscle fatigue leading to dyssynergia of muscle contraction. Return to activity before complete healing can lead to a recurrence of the injury. Physical therapy is indicated as treatment and prevention of reinjury is dependent upon successful completion of the rehabilitation programme and warm-up, stretching as well as correction of muscle strength imbalances.
Yuvraj Singh and Rohit Sharma have fractures of the fingers which may take a few months to heal but the return to sports depends on the degree of displacement and the risk of redisplacing the fracture. Athletes can practise with the cast or with functional braces which allows the fracture to heal while the player practices.
Ishant Sharma and Praveen Kumar have ankle sprains which is another very common sporting injury and an incidence of approximately 25,000 ankle sprains per day has been reported. The goal of rehab is to return the players to the preinjury level of range of motion and strength. Abnormal proprioception and kinesthesia leads to delayed reaction times of key muscles, in addition to changes of centre of pressure and sway leading to recurrent ankle sprains and repeated injuries. They will need to fine tune rehabilitation protocols with the needs of the game.
Concussion is a relatively serious injury with a chance of second impact injury if the recovery is not complete. Adequate time for recovery should be given to prevent the damaging consequences of reinjury.
In the quest for perfection the bodies of the athletes are subjected to great stresses which lead to mechanical fatigue in the soft tissues. This stimulates the adaptive response if adequate time is given to heal. Otherwise if the adaptations fail it would lead to overuse injuries.A good way would be to keep the financial prospects at bay and look after one’s body. The body should adapt itself before it is stressed further.
Jaspal S Sandhu is secretary general of Asian Federation of Sports Medicine. E-mail: jssandhu2000@yahoo.com