John Shepherd speaks with David Bartlett, the physio for Middlesex CCC

You might not think it but there are similarities between cricket and athletics. I recently had the chance to talk to David Bartlett, the physio for Middlesex and Gloucestershire CCC. David is also an expert in musculoskeletal injuries.

In AW we have featured a number of articles on RED-S (relative energy deficiency in sport), most recently by Joasia Zakrzewski (AW January 31). The ultra-runner and GP describes how she suffered from stress fractures (a consequence of RED-S).

Okay, you may be asking, now what’s this got to do with stumps, a bat and a ball (and a lot more to you Wisden readers!)? Well, physio David has to deal with stress fractures amongst cricketers.

Here’s what he had to say on the subject in response to my questioning:

John: Stress fractures are sometimes difficult to identify – can you provide some signs that coaches and athletes should look out for?

David: Appropriate workload management is key to preventing stress fractures, and this doesn’t mean complete rest. Bone has to be loaded in order to withstand load … ‘load to withstand load’. We follow the 25% rule – don’t increase your load by more than 25% of the previous week – but also try and not go over more than 150% of your previous month’s rolling ”average” workload – called the ‘Acute:Chronic Workload’. Finally, appropriate de-load weeks need to be placed into the training schedule, because accumulative high loads will cause the bone to overload.

Ultimately, the best way to prevent a stress fracture is to catch the symptoms early. If we can diagnosis the early signs of bone bruising (stress reaction) then you can off-load the athletes for a short period and prevent it developing into a fracture. The players often describe the symptoms of a bruise type sensation and it’s nearly always situated directly over the bone. It worsens with the given activity, and settles with rest – with stiffness in the mornings.

(Very interestingly, Joasia describes similar symptoms that were in part ignored in her account of her stress fractures.)

John: I actually have an athlete in my training group who is prone to stress fractures of the shin.

David: As mentioned earlier, rest isn’t always the right thing for stress fractures, the bone needs to be loaded to withstand load. Without appropriate load, the bone won’t heal efficiently and be able to tolerate the forces the athlete then needs.

If diagnosed with a stress fracture, whilst the initial period will be to off-load and rest, a good physiotherapist should then devise you a rehab programme to graduate your return to activity. I would be meticulous with the numbers of what the athlete does from a week by week basis and follow the workload rules as above.

Biomechanically it may be useful to look at running styles both above and below the injury site – is the footwear correct? Does the athlete need to see a podiatrist for custom orthotics? Do they have good lumbo-pelvic stability? Or is there a weakness in the glutes, for example, which is causing a biomechanic stress through the tibia and then overloading the bone?

John: How important is diet for general injury avoidance?

David: Having a good diet is vital in terms of performance but also injury prevention. For bone injuries, we always look at our athlete’s vitamin D levels. All of our athletes are routinely supplemented with vitamin D throughout the winter months when the daylight hours are so much shorter and monitored in the summer (despite being an outdoor sport, they wear floppy hats, trousers and layer on the factor 50!).

For more on combatting stress fractures and what athletics can learn from cricket in terms of injury prevention, see the February 7 edition of AW.

Info provided for guidance only. RED-S has other symptoms i.e. cessation of periods for females, and expert advice should be sought if any symptoms are experienced.

» David Bartlett also works out of Harley Street Sports and Human Performance Clinic, The Centre for Health & Human Performance (CHHP),

» Read more from John Shepherd’s performance blog here

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