Spondylolysis, or lumbar stress fracture, is a condition in the lower back where there is a defect or fracture in the part of the vertebra known as the pars interarticularis. The majority of pars defects occur in the lumbar vertebrae, with 90-95% occurring at the L5 level and at a ratio of 2:1, males to females. In an athletic population, the prevalence is between 8 and 15%, and has been reported at up to 67% in cricketers, particularly fast bowlers.

The action of fast bowling places significant stress on the lumbar spine in a highly repetitive nature. The movements exerted onto the lumbar spine include hyperextension, side bending and rotation. During the delivery of the bowl, forces between 4 to 6.5x bodyweight are transmitted through the lumbar spine. These forces in combination with the excessive spinal movements significantly increases the risk of development of spondylolysis.

What are the symptoms of spondylolysis?

  • Gradual onset of back pain, usually associated with a rapid increase in workload
  • One sided back pain – Initially sharp.
  • Aggravated by arching or standing, especially with increased training.
  • Pain may radiate to buttock or thigh
  • Pain eased by rest and flexed postures
  • Usually well localised over site of injury

Activities and sports that have been identified with a high incidence of spondylolysis include:

  • Cricket bowlers
  • Gymnastics
  • Swimming
  • Ballet dancing
  • Ice skating
  • Golf

Initial management of lumbar stress fractures targets identification and modification of bowling action, as well as activity monitoring and management. It is widely expressed through scientific research that those bowlers demonstrating a mixed bowling action have a significantly increased chance of sustaining a pars injury.

The research shows a high success rate that 81% of pars stress fractures recover with conservative physiotherapy management. However, If left untreated, this condition has the potential to progress and impair the stability of the lumbar vertebra.

Physiotherapy management may involve:

  • Advice and education
  • Activity modification and load management
  • Core stability training using real time ultrasound feedback
  • Manual therapy to address musculoskeletal imbalances
  • Lumbo-pelvic and hip stability exercises

If you are a cricketer, at any level or just the general population experiencing these symptoms, be sure to see a health professional to get an opinion on your symptoms.


  • Ranawat VS, Dowell JK, Heywood-Weddington. Stress fractures of the lumbar pars interarticularis in athletes: a review based on long-term results of 18 professional cricketers. Department of orthopaedics. 2003;34(12): 915-19
  • Ranson et al. The relationship between bowling action classification and three-dimensional lower trunk motion in fast bowlers in cricket. Journal of sport sciences. 2008;26(3): 267-276
  • Bell PA. Spondylolysis in fast bowlers: principles of prevention and a survey of awareness among cricket coaches. Journal of British Sports Med. 1992;26: 273-5
  • Johnson M, Ferreira M, Hush J. Lumbar vertebral stress injuries in fast bowlers: A review of prevalence and risk factors. Physical therapy in sport. 2012;13(1): 45-52



Westmead Physio Team Complete Hand Hygiene Education

As part of our continuing professional development and dedication to high patient care standards, the physiotherapy team at Westmead Private Hospital participated in an online learning package delivered by Hand Hygiene Australia. This package highlighted the importance of adhering to hand hygiene standards and infection control procedures to reduce the risk of healthcare-associated infections.

As part of an ICU-driven initiative, physiotherapists who completed the online package went into a draw to enjoy a coffee and baked product from the “Mons on Darcy” cafe. Congratulations to Samantha and Gabrielle for successfully completing the package and winning a coffee break.

Paula Heads to Rio for the Paralympics

Paula Peralta (Principal Physiotherapist) from our Penrith rooms arrived in Rio on the 31st August after a medical handover with the Australian team and a mini-break to Argentina in between.   Below is a recount of her time in Rio:  I arrived with the first athletes into the Paralympic Village. We are in a different building than the Olympic team was and it has been reasonably smooth sailing since we arrived. Over the past 6 days it has been a huge privilege to meet so many different athletes in our team that have worked so hard to get to Rio. It has also been rewarding to see the athletes I have worked with over the past few years in boccia, shooting and track and field achieve their dream of being here and strive for that gold medal.

Whilst there has been many amazing performances so far I will single out a few:
· Katie Kelly winning gold in paratriathlon which has made its debut in these Games. Katie’s guide was Michellie Jones who is infamous in the world of triathlon and won silver in Sydney in triathlon’s debut in the Olympic Games.
· Taylor Doyle won silver in long jump yesterday and her infectious personality and enthusiasm saw a number of victory dances in the village on return.
· The cool, calm Sam von Einem won silver yesterday in table tennis in a very close, hard fought match against his World number 1 ranked opponent.

It is difficult to single out a few performances as many athletes have achieved a PB- whether that has resulted in a medal and you cannot ask for any more than that.We look forward to sailing, canoeing and wheelchair rugby starting tomorrow and will hopefully send an update through soon!

Paula @ Aussie HQ

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The Netball Finals Are Here

The ANZ Championships final series is in full swing with the top 4 teams fighting off this weekend for a spot in the grand final. The Queensland Firebirds will play the Southern Steel in Brisbane on Sunday night and  the NSW Swifts will play the WBOP Magic in the semi-final in Hamilton on Monday night.

Team Physiotherapists for the NSW Swifts Paula Peralta and Daniel Vukovic (pictured) have been busy getting the girls game ready.   We wish them all the best for a good win on the weekend.

(Photo courtesy of Narelle Spangher Photography).