Case Study on Low Back Pain in A Fast Bowler Treated with Core Strengthening

Abstract

Background: Low back pain is one of the most important musculoskeletal problems affecting cricket fast bowlers because the bowling action repeatedly exposes the lumbar spine and lumbopelvic region to high impact loading, side flexion, rotation, extension stress and rapid transfer of force from the lower limbs to the trunk and bowling arm. In fast bowling, the trunk does not function only as a passive link; it provides stability, energy transfer, postural control and deceleration during the delivery stride. When core muscle endurance, pelvic control and trunk coordination are reduced, the fast bowler may develop repeated lumbar strain, painful guarding, altered run-up rhythm, reduced front-foot control, shortened follow-through and loss of confidence during bowling. Core strengthening is therefore a clinically relevant rehabilitation approach because it targets deep and superficial trunk stabilizers, improves lumbopelvic control, supports safe movement during sport-specific tasks and helps the player return gradually to bowling activities.

Presentation of a Case: This case study presents a 22-year-old right-arm fast bowler with mechanical low back pain of gradual onset. The pain was aggravated during run-up, back-foot contact, front-foot landing, delivery stride, follow-through, prolonged practice sessions, forward bending after training and repeated bowling spells. The patient showed lumbar paraspinal tenderness, hamstring tightness, reduced lumbar mobility, poor abdominal bracing, weak gluteal control, reduced plank endurance and apprehension while extending and rotating the trunk during bowling simulation.

Intervention: A structured phase-wise physiotherapy program was implemented for 12 weeks. The program included pain relief measures, mobility correction, activation of transverse abdominis and multifidus, gluteal strengthening, progressive core endurance training, anti-rotation drills, postural correction, balance training, hip mobility work, graded bowling-specific drills, workload education and return-to-bowling progression.

Outcome Measure: Pain was measured using the Numerical Pain Rating Scale. Lumbar range of motion was measured by clinical movement assessment and inclinometer-based observation. Muscle strength and core endurance were assessed through Manual Muscle Testing, prone plank, side plank, bridge endurance and functional lumbopelvic control tests. Disability was assessed using the Modified Oswestry Disability Index, and sports function was evaluated by bowling tolerance, run-up comfort, follow-through control and return to practice participation.

Result: The patient showed progressive improvement after introduction of a structured core strengthening program. Improvement was observed in pain intensity, lumbar movement tolerance, abdominal activation, gluteal strength, trunk endurance, bowling confidence, running mechanics and functional return to cricket practice. The patient progressed from painful bowling avoidance to controlled bowling drills and later to short bowling spells without major symptom aggravation.

Conclusion: This case study supports the clinical value of patient-specific core strengthening in the rehabilitation of mechanical low back pain in a fast bowler. When combined with education, mobility correction, graded strengthening and sport-specific retraining, core strengthening may improve lumbar stability, reduce pain, restore confidence and support safe return to bowling.