EFFECTIVENESS OF CORE STRENGTHENING EXERCISES TO REDUCE

INCIDENCE OF SIDE STRAIN INJURY IN MEDIUM PACE BOWLERS

Omkar P.Padhye*, Subin Solomen**, Pravin Aaroon***

ABSTRACT
BACKGROUND: Sports injuries are injuries that happen when playing sports or exercising. Some are from
accidents. A side strain refers to a tear of the internal oblique the external oblique, or the Transversalis fascia
at the point where they attach to the four bottom rib. In cricket prevalence of side strain injury in bowlers is
21% in bowlers 5% and overall 9% of total injury in cricket. Management of side strain takes lengthy
procedure so players may lose game so prevention is better than cure. Study done by Tymothy et al. stated
that muscle strengthening program can reduce incidence of injury Hence in this study we have discussed
about preseason core muscle strengthening can reduce the chances of incidence of side strain injury in
medium pace bowlers. OBJECTIVES: 1) To calculate the pre-season risk of side strain injury in medium
pace bowlers.2) To measure the effectiveness of core strengthening muscles to reduce incidence of side strain
injury.3) To calculate changes in plank score measurement in medium pace bowlers before and after
intervention.4) To assess severity of side strain injury using electrotherapeutic measurements. METHODS:
Longitudinal study.30 male medium pace bowlers from Goregaon sports club, Prabodhan sports club,
Payyade sports club selected for study. Pre and post plank score taken. Follow up done by phone call.
INTERVENTION: Core muscle strengthening exercise will be given to players for 6 weeks. On first visit
core strengthening exercise will be taught to all players, they will be observed for 6 weeks and follow up
taken. RESULTS: In the study group descriptive statistical analysis is used, statistically it was found that
there were significant increase in Prone hold test score(Plank test score) (pre intervention plank score
2.00±0.00) , ( post intervention plank score 2.93±0.64), P value(< .0001). Mean incidence were calculated by
new injury per 1000 hrs. of participation time there were 3% of wrist injuries,10% ankle, 3% groin,14%

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hamstring 7% low back,3% shin splint, 13% shoulder,10% side strain and 37% no injuries.
INTERPRETATION & CONCLUSION: As compare to other common sports injuries like incidence of
Shoulder injury (33.33/1000hrs), incidence of Hamstring injury (33.33/1000hrs) incidence of side strain
injury (25.00/1000hrs) is less, so it proves that core muscle strengthening exercise is effective to reduce
incidence of side strain injury. Thus, Core muscle strengthening exercises can be given to medium pace
bowlers to reduce incidence of side strain injury.

KEYWORDS: Side strain, Prevalence of side strain injury, prone hold test, Sports injuries, Severity of side
strain.

INTRODUCTION
second highest seasonal incidence and fourth
Almost half of all injuries to adult cricketers
highest prevalence of all body areas5.
occur during formal play. One third of cricket
injuries to children occur during school hours A side strain refers to a tear of the
reflecting the popularity of cricket as a school internal oblique the external oblique,
sport, almost 20% of injuries occur during or the Transversalis fascia at the point
training or practice.1, 2 where they attach to the four bottom
rib6. All side strain injuries to bowlers
To prevent injuries in cricket, the Australian
described within the literature affect
cricket board SPOT program advocates the
the side opposite to the bowling arm,
screening of young bowlers for risk factors,
with all but one injury affecting
including postural stature, physical
internal oblique (IO) or external
preparation, avoidance of over bowling, and
oblique (EO)7. In cricket the bowlers
2
use of correct bowling techniques. There are
suffer the Side Strain7,8, on the non-
various different physical demands involved
bowling arm side as a result of a
in different types of cricket, which has meant
forcible contraction of the muscle on
the injury profile is slightly different between
that side while they are fully stretched
five day test matches, 3 day matches, one day
as the bowling arm is cocked for
matches, and twenty-20 matches. There are 5
bowling. It has been postulated that the
common cricket injuries hamstring strain, low
probable point of internal oblique
back pain, side strain, shoulder pain, and
rupture in side strain injuries in cricket
sprained ankle3. Side strain is fairly common
bowlers is the sudden vigorous motion
in cricket, where it typically occurs in
from assumed maximum eccentric
bowlers.4 Cricket injury surveillance research
contraction when the non-bowling arm
in Australian first class cricket has reported
is fully flexed and then suddenly
that side and abdominal strains account for the
extends or pulls through, allowing the

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bowling shoulder to flex to bowl the more active rehabilitation can be

ball. started under the supervision of
physiotherapist, once the immediate
The fast bowling technique is
pain resolves. So if the strength of the
classified into four distinct styles:
muscle is less then muscle is more
(son)side-on, (sop)semi-open,
prone for strain injury10. Hence
(fo)front-on or mixed, according to
strengthening exercises can be
their relationship between the planes of
incorporated to prevent sports injuries
the hips and shoulders, and shoulder
like side strain injury. Core
counter-rotation during the bowling
strengthening exercises can be done on
action8. Investigations of side strain in
an exercise mat using swiss ball and
cricket bowlers using MRI found that
resistance band which includes core
the injury consistently occurred on the
activation exercises, mat exercises,
non-bowling side and tended to affect
simple exercise and the Pilates10.
abdominal muscles internal oblique
Compare to other sports injuries side
muscle rather than the external oblique
strain injuries are not recurrent if
muscle, this could suggest that the
treated11.
asymmetrical muscular demands of the
repetitive bowling action creates Timothy et al did study to examine
hypertrophy in the torque producing whether players classified as “at risk”
muscles of trunk rotation and side participate in an intervention program
flexion.2 could reduce the incidence of adductor
muscle strain. The author concluded
Side strain injury is very common in
that a preseason strengthening exercise
cricket players and javelin throwers8,
to adductor muscle group appears to be
in cricket prevalence of side strain
an effective method for preventing
injury in bowlers is 21% in bowlers
adductor strain in professional Ice
5% and overall 9% of total injury in
Hockey players, similarly it is not
cricket8. All side strain injuries
known that whether a preseason core
required some kind of treatment which
strengthening exercises can reduce the
is aimed at pain relief and restore
risk of incidence of side strain injury in
mobility and strength9. Management of
medium pace bowlers who are at
side strain is ice application for twenty
risk12.
minutes every two hours, application
of cohesive compression bandage to Management of side strain takes
help to limit bleeding in the tissue, lengthy procedure so players may lose

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game so prevention is better than
cure.9Hence, if the strength of muscle
is increased, it can increase
performance of the individual.12So
greater the performance more the
chance of winning the game and
increase in ranking level.
METHODOLOGY
Study design: Descriptive longitudinal study
Setting and Participants: 30 male medium
pace bowlers from prabodhan sports club,
payyade sports club, cricket clubs.Medium
pace bowlers with core muscle strength
average (i.e. Grade 2) on plank score, Age
group of 18 to 24, with bowling action front
on were included.Previous history of lateral
trunk pain or low back pain or side trunk
injuries, previous history of chest pain due to
cardio, respiratory disorders were excluded.
Intervention Procedure:
The plank test was described as follows. The
player lied in prone position on mat or couch.
Watch was being positioned on the ground
where the player and therapist can easily see
it. Player assumed the basic press up position
(elbow on the ground) and holded that
position for 60 seconds. Player lifted his right
arm off the ground and holded that position
for 15 seconds and take it return to the ground
after 15 seconds. Player lifted his left arm off
the ground and holded that position for 15
seconds and take it return to the ground after
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15 seconds. Player lifted his right leg off the
ground and holded that position for 15
seconds and take it return to ground after 15
seconds. Player lifted his left leg off the
ground and holded that position for 15
seconds. Player lifted his left leg & right arm
off the ground and holded that position for 15
seconds and take it return to the ground after
15 seconds. Player lifted his right leg & left
arm off the ground and holded that position
for 15 seconds and take it return to basic up
position (elbows on the ground) and hold that
position for 30 second. Grading was done
according to scoring as mentioned in table
below.
Grades:
Time Grades Scores
Under 20 seconds Poor 1
21-45 seconds Average 2
46-70 seconds Good 3
71+seconds Excellent 4
Core muscle strengthening exercise22 was
given to players for 6 weeks. On first visit
core strengthening exercise was taught to all
players, they were observed for 6 weeks.
During exercise sessions, coaches or
physiotherapist were educated about side
strain injury, which includes concept of side
strain injury, its symptoms, diagnostic tests
and its management. After one season (20
 Scientific Research Journal of India ● Volume: 2, Issue: 4, Year: 2013

matches) matches, number of incidence of OUTCOME MEASURES

side strain injury was collected from coaches
• Number and percentage of incidence
or physiotherapist then severity of side strain
of side strain injury among medium
injury was assessed by Sonography or
pace bowlers after one season.
Magnetic resonance imaging and was
• Number and percentage of players who
confirmed by Orthopaedic. Data was collected
are at risk of side strain injury
in form of number and percentage of
• Plank scores in all players before and
incidence of side strain injury after one
after one season.
season.

DATA ANALYSIS

Data analysis was performed by SPSS

(version 17). Alpha value was set as 0.05.
Effectiveness of core strengthening exercise
was assessed by number and percentage of
incidence of side strain injury. Injury
incidence was calculated by new injury per
1000 hrs. of participation time. Wilcoxon
signed rank sum test was used to find out pre
post difference within the group for plank
score (ordinal scale) for assessing core muscle
strength.

RESULTS

Study Design: A study was undertaken to

measure effectiveness of core strengthening
muscle exercise to reduce incidence of side
strain injury.

Table 1: Descriptive statistics for demographic & outcome variables

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Variables Range Minimum Maximum Mean Std. Deviation

Age 6.00 18.0 24.00 20.73 2.04

Height 19.0 165.00 184.00 171.68 4.66

Weight 34.00 59.00 93.00 70.03 7.22

BMI 14.30 19.90 34.20 23.79 2.64

Pre Plank Score 3.00 1.00 4.00 2.70 0.74

In the study group the range of age is 6,

minimum 18.00yrs. and maximum 24.00yrs.
with mean 20.73yrs and std. deviation of 2.04.
In the study group the range of height is 19
with minimum height 165cm and maximum
height 184cm with the mean of 171.68cm and
std. deviation of 4.66. In the study group range
of weight is 34.00 with minimum weight of
59.00kg and maximum weight of 93.00kg
This graph explains about preseason risk
with mean of 70.03kg and std. deviation 7.22.
medium pace bowlers. In the study group 88%
In the study group the range of BMI is 14.30
of medium pace bowlers are considered as at
with minimum BMI 19.90 and maximum BMI
risk of injury before season and 12% were
34.20 with mean of 23.79 and std. deviation of
having no preseason risk of injury.
2.74 In the study group the range of Plank
score is 3 with minimum plank score as 1and Graph : Side strain injury in 30 medium
maximum as 4 with mean of 2.70 and std. pace bowlers
deviation 0.74.

Graph: Preseason risk of injury in

bowlers

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This graph explains about presence of side

strain injury in medium pace bowlers. In the
study group 90% of medium pace bowlers
have not shown side strain injury after one
season but 10% of medium pace bowlers have
shown side strain injury after one season(one
season = 20 matches).

Graph: Percentage of injuries in medium

pace bowlers

This graph explains about percentage of total

injuries in the study group it was 1( 3%) of
wrist injuries,3 (10%) ankle,1(3)%
groin,4(14%) hamstring,2( 7%) low
back,1(3%) shin splint, 4(13%)
shoulder,3(10%) side strain and11( 37%) no
injuries.

Table 2: Pre- post data within groups

Variable Pre post þ value

Plank score 2.00±0.00 2.93±0.64 < .0001

Data are mean ± SD in study Plank score is improved from pre mean score of 2.00with Sd. of 0.00
to post mean score 2.93 with Sd.of 0.64 and which was statistically significant.( p < 0.0001 ).

DISCUSSION strain injury. Third objective was to calculate

changes in plank score measurement in
Objective of the present study was to calculate
medium pace bowlers before and after
the pre-season risk of side strain injury in
intervention. & fourth objective was to assess
medium pace bowlers. Second objective was
the severity of side strain injury using
to measure the effectiveness of core muscle
electrotherapeutic measurements.
strengthening to reduce the incidence of side

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 ISSN: 2277-1700 ● Website: http://srji.drkrishna.co.in ● URL Forwarded to: http://sites.google.com/site/scientificrji
30 male medium pace bowlers were chosen
for present study. Demographic variables
included were age, weight, height, BMI. In the
present study players with age group 18-24
who were highly susceptible for side strain
injury was taken. This was in accordance with
study done by HaronObaid et al. Author did a
study on sonographic appearance of side strain
injury and author stated that there were nine
men, one woman who showed side strain
injury of mean age, 22 years; range, 16–30
years it concludes that this age group is highly
susceptible for side strain injury.
In the present study 21 right arm medium pace
bowlers and 9 Left arm medium pace bowlers
who fulfilled inclusion criteria and who were
having plank score Grade-2 (poor core muscle
strength) who were at risk of side strain injury
because of muscle weakness were chosen.
This was in accordance with study done by
HaronObaid et al. Author did a study on
sonographic appearance of side strain injury
and author stated that 8 bowlers have got
strain side injury out of which 7 were right
arm bowlers and one was left arm bowler, so it
concludes that incidence of side strain injury
was more to right arm bowlers than left arm.
In this study there were 88% out of 30
medium pace bowlers showed risk of injury.
This was in accordance with study done by R.
A. Stretch et al. Author stated that injuries
tend to occur during specific stages of the
season, with the many preseason matches and
the concentration of matches toward the end of
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the season tending to result in an increase in
injuries at those times Fast bowlers are at the
greatest risk of injury for a variety of reasons,
including the demands that fast bowling places
on the musculoskeletal system, incorrect
technique, poor preparation and training, and
overuse.
In this study there were 3 side strain injury
(10%) observed after one season( 20 matches)
out of which one was left arm medium pace
bowler 33% and two were right arm medium
pace bowlers 67%. Number of games missed
by injured bowlers is 7, 6 & 5 respectively.
This was in accordance with study done by
HaronObaid et al. Author stated in the study of
sonographic appearance of side strain injury
that 8 bowlers have got side strain injury out
of which 7 were right arm bowlers and one
was left arm bowler. So present study
concludes incidence of side strain injury were
more in right arm bowlers than left am
medium pace bowlers.
In the present study, 3 (10%) out of 30
medium pace bowlers have got side strain
injury after one season (20 matches), and 23
(90%) showed other injuries or no injury. As
bowlers perform high velocity combination of
sudden eccentric contraction when they bowl,
there are high chances of getting Side stain
injury. This was in accordance with study
done by Haronobaid et al. Author stated that
Side strain is thought to occur as a
consequence of a combination of sudden
eccentric contraction of the internal oblique
 Scientific Research Journal of India ● Volume: 2, Issue: 4, Year: 2013
muscle that results in muscle tear. Also side
strain injury can occur due to Side due to
(plank score Grade-2) poor muscle strength
which is one of the causative factor for injury.
This was in accordance with study done by
Timothy et al. Author stated in preseason risk
study that poor muscle strength may cause
stain of abductor muscles.
In the present study, there were 3% of wrist
injuries,10% ankle, 3% groin,14% hamstring,
7% low back,3% shin splint,
shoulder,10% side strain and 37% no injuries.
This was in accordance with study published
by National Institute of Arthritis
Musculoskeletal and Skin Diseases. NIAMS
updated that there are some most common
sports injuries are: Sprains and strains Knee
injuries swollen muscles Achilles tendon
injuries Pain along the shin bone Fractures
Dislocations.
In the present study, Plank test was used to
measure strength of core muscles. This was in
accordance with study done by Janine Gray
and Rene Naylor. Author have used plank test
for musculoskeletal assessment for to test
strength of core muscles. The test is used to
determine the relative strength of the global
stabilizers of the body namely the transverses
abdominus, internal and external obliques, and
scapula stabilizers. When compared with in
group it was found that there were significant
increase in plank score from a pre mean plank
score of 2.00 to post mean plank score 2.93
which was statistically significant.
Mean incidence was calculated by new injury
per 1000 hrs. of participation time.
Calculations were given by Foundation in
sports marketing. Out of 30 medium pace
bowlers there were 4 hamstring injury (33.33
mean incidence value) 1 wrist and forearm
injury (8.33 mean incidence), 3 side strain
injuries (25.00 incidence), 4 shoulder injuries
(33.33 mean incidence), 3 ankle injuries
(25.00 mean incidence), 1 groin injury (8.33
mean incidence), 2 low back injuries (16.66
13%
mean incidence), and 1 shin injury (8.33
mean incidence). 11 players did not show any
injury after one season (20 matches).
and
Total numbers of hours played by 30 medium
pace bowlers were 3276 hours. Total numbers
of hours were calculated by the product of
number of matches played by individual
player and number of hours played by
individual. (e.g. 17 matches * 6 hours = 102
hours) and sum of all hours were calculated.
Total numbers of games played by 30 players
were 546and total games missed by 30 players
were 54. In the present study it was considered
one season = 20 matches so total number of
games played were calculated by product of
total number games played by 30 players and
20 matches (one season) and total number of
games missed by player were calculated by
subtracting total number of games missed by
30 players from the total number of games
played which was considered for 20 matches
i.e. one season.
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In the present study, MRI technique is used to
measure severity of side strain injury. This
was in accordance with study done by
Kathleen shorter et al. Author stated that a
high percentage of type II or fast twitch fibers
may also be a predisposing factor to tearing.
MRI appears to be a sensitive test for
evaluating side strain injury, showing an
abnormality in all patients who had a clinical
suspicion of a muscular tear and also to assess
the severity of injury.
It is postulated that the mechanism of injury
for internal oblique muscle strain is sudden
eccentric contracture with rupture of muscle
fibers. Movements associated with medium
pace bowling, which is then subjected to
superimposed eccentric contraction, making it
vulnerable to rupture. Present study describes
an effective strategy for injury prevention, by
core muscle strengthening exercises program
before season in medium pace bowlers to
reduce incidence of side strain injury.
LIMITATIONS

Inability to monitor
compliance(daily
performance) with the home exercise
program which might have influenced
the study.

The study was done with small sample
size.

Long term effects of the treatment
were not assessed.

Involvement of side in terms of
dominance is not considered which
might have influenced the study.

Lack of control group.
RECOMMENDATIONS

Further studies can be done by
comparing core muscle strengthening
exercise with other pre-season
prevention protocols.

Study can be done to see how much
incidence of side train injury is
reduced when compared to a preseason
when there is no intervention given

Further studies can be done to find its
effectiveness in fast bowler, batsmen
& other sports like javelin throw
hockey, tennis, badminton etc.
CONCLUSION
Objective of present study was to calculate the
pre-season risk of side strain injury in medium
pace bowlers. Second objective was to
player’s measure the effectiveness of core
exercise strengthening muscles to reduce incidence of
side strain injury. Third objective was to
calculate changes in plank score measurement
in medium pace bowlers before and after
intervention. & fourth objective was to assess
severity of side strain injury using
electrotherapeutic measurements. As there was
a significant improvement in pre and post
plank score (prone hold test) with in group.
And significant improvement in core muscle
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 Scientific Research Journal of India ● Volume: 2, Issue: 4, Year: 2013

strength. Incidence of side strain injury as reducing the incidence of side stain injury in
compare to other common cricket injuries medium pace bowlers”. Thus, Core muscle
were less. Hence null hypothesis was rejected. strengthening exercises can be given to
The study concludes as “Core muscle medium pace bowlers to reduce incidence of
strengthening exercises are effective in side strain injury.

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CORRESPONDING AUTHOR:

• Email: padhye_omkar@rediffmail.com

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