# Risk Factors and Successful Interventions for Cricket-Related Low Back Pain: An Updated Systematic Review

## TL;DR

This paper reviews risk factors and interventions for low back pain in cricketers, highlighting workload, bone density, and screening for early signs like bone marrow oedema.

## Contribution

The study provides an updated systematic review of LBP risk factors and interventions in cricketers, incorporating recent trends like T20 cricket.

## Key findings

- Increased workload, decreased bone mineral density, and poor lumbo-pelvic control are significantly associated with LBP in cricketers.
- Bone marrow oedema detected via MRI is a reliable early indicator of potential stress fractures.
- High-quality studies on interventions for LBP in cricketers remain scarce, highlighting a need for further research.

## Abstract

Lower back pain (LBP) poses a significant challenge for cricketers of all standards, often leading to rehabilitation periods exceeding eight months and potential termination of the playing season. Despite the identification of modifiable risk factors and interventions in previous studies, a comprehensive review of the past decade is absent. With the introduction of shorter formats like Twenty20 (T20) and the rise of franchise cricket, an updated evaluation of risk factors and interventions for preventing and treating LBP in cricketers is needed. This study critically assesses and summarises current understanding in this area, incorporating previous recommendations and considering the evolving cricket landscape.

A systematic review was conducted using databases such as SportsDiscus, MEDLINE, CINAHL, ISI Web of Knowledge, and Cochrane Library. Key terms related to LBP in cricketers were utilised. The Down and Black quality assessment tool, in addition to van Tulder's criteria for levels of evidence, was applied. The quantitative analysis involved meta-analyses conducted using IBM SPSS Statistics for Windows, Version 29 (Released 2023; IBM Corp., Armonk, New York).

Sixteen studies, of which 15 were of high quality, investigated risk factors associated with LBP. One low-quality randomised controlled trial examined LBP treatment. The meta-analysis revealed significant associations between LBP and increased workload, decreased bone mineral density, and poor lumbo-pelvic control through increased side flexion during the bowling action. Strong evidence supported the association between the presence of bone marrow oedema (BMO) and LBP.

Bone marrow oedema on magnetic resonance imaging (MRI) provides an early indicator before the development of stress fractures, serving as a valid and reliable screening tool. Workload monitoring plays a crucial role in identifying high-risk bowlers. However, further research is needed to establish causal relationships among several other risk factors outlined. Additionally, addressing the scarcity of high-quality interventional studies is of utmost importance.