Vijai Ranawat explains cricket injuries
England and Australia meet for a final time in this year’s men’s Ashes series, with both sides affected by injuries to their bowlers. Why is it that cricket bowlers seem to be particularly vulnerable to certain injuries, and how are they treated?
Written by PR & Communications Manager, Mr. Jack Cutforth
Published: Thursday 3 August 2023
Injuries are an occupational hazard in all sports, but fast bowlers in cricket seem to be especially vulnerable - particularly to back injuries. Vijai Ranawat, an orthopaedic surgeon in Mebelle’s network, happens to have written an influential academic paper on exactly this subject. We sat down with Vijai to ask him about cricketing injuries and how a hip and knee surgeon came to be known as an expert in this area.
You’re an experienced hip and knee surgeon, but you also have expertise in spinal injuries in cricketers - how did that happen?
When I was newly qualified, I worked with a spinal specialist surgeon in Essex, where I had played a lot of cricket previously. I noticed that my boss had operated on quite a few Essex County cricketers, some of whom I knew well when I was playing seriously for the Essex junior teams so that piqued my interest.
At the time, there had hardly been any big case series compiled about spinal injuries in cricketers, so I thought it would be a good subject for a paper. So I compiled the data and outcomes for these cases, we wrote it up, and it was subsequently published.
What were the findings of your paper?
All of the injuries were spinal stress fractures, and out of the 19 players who were treated, 13 of them were either fast or medium-paced bowlers. What we found was that the injuries were mostly in the lower spine, but not always, and usually in the side of the spine opposite to the bowling arm. This mostly affected younger bowlers, with an average age of 20.
Is it surprising that injuries were happening so young? You might think that older players would be more susceptible.
Our paper backed up findings from other studies about the effect of bowling load - how many times a player is bowling without rest - on the spine. These studies found that the spine is particularly susceptible when it is still developing, so youth players between 11 and 15 can be particularly vulnerable to these stress fractures if they are not properly rested. That was certainly backed up by our findings.
And how effective was the treatment in these cases?
Surgery wasn’t required in every case, but of those that did undergo surgery, all went back to playing professionally in the years following their injury. A few even went on to play internationally. It shows the effectiveness of surgical intervention - but only after more conservative interventions like physiotherapy have already been tried.
Spinal injuries
Of course, it's not only cricketers who are susceptible to spinal injuries. Medbelle's network of surgeons includes spinal specialists who can help to diagnose issues and recommend treatment.
What was the reception to your paper?
It generated a lot of interest, and I had a lot of queries afterwards. The New Zealand and Indian cricket boards both got in touch to ask for advice. I think they were probably expecting a grey-haired old professor rather than a young newly-qualified surgeon!
What did the cricket boards ask you?
They were looking for advice about injured bowlers. In particular, they were wondering if it was really worthwhile to wait up to a year to see if conservative interventions had any effect when our research showed that the majority of fast bowlers would end up needing surgery anyway. From their perspective, they were going to be losing out on one of their best bowlers for a year, and surgery could potentially speed that up. I explained that while our research showed, surgery could be very effective, it should always be a last resort, with less invasive measures tried first.
Latterly, I was able to help out a young fast bowler who played for India. He had been given a lot of conflicting advice and so when he contacted me, I was able to give him an evidence base on which he could make an informed decision. He underwent surgery with us, and he went on to bowl internationally and play for several years in the IPL (Indian Premier League). It was rewarding to help him out because he was at the start of his career, and there aren’t always many fall-back career options for a young fast bowler who is injured.
What are these more conservative measures?
With any injury it’s important to exhaust other treatment options before resorting to surgery. Things like physiotherapy, muscle strengthening, and analysing the bowler’s action to see if they can still bowl effectively while putting less strain on the spine. But that last one is a lot harder in a bowler who has been bowling effectively professionally for years.
England have struggled with injuries to their fast bowlers recently. Is the problem getting worse?
Our research was carried out almost twenty years ago, so I can’t say if injuries are becoming more commonplace, but teams now are definitely more aware of the injury and more conscious of the impact of continuous bowling, and measures are in place to rest fast bowlers, especially when they are younger. In this series, England has been rotating their bowlers, so there’s definitely more awareness about the risk of these kinds of injuries now.
At the same time, the game is now year-round in a way it wasn’t twenty years ago. There are winter tours and domestic tournaments like the IPL which means some players will not have much of a break.
When you break it down, fast bowling is just hard on the body. It’s a lot of repetitive actions, lots of impacts. Good bowling is all about getting into a rhythm, but doing the same thing over and over again is always going to put you at risk of stress fractures and other injuries. So it’s good to see more of a focus on resting bowlers.
How did you go from spinal surgery to your current role as an orthopaedic surgeon interested in hip and knee conditions? And what attracted you to surgery in the first place?
I come from an orthopaedic background, and I’m lucky enough to have some incredibly good role models. Both my dad and uncle are orthopaedic surgeons; in fact, my uncle is one of the original designers and pioneers of total knee replacement based in New York.
I did keep an open mind throughout my training, but deep down, I knew orthopaedics was what I really wanted to do. I started out with an interest in the spine, and of course, with that research paper, I became quite well known, but ultimately what I really love to do is joint replacements. And it’s fantastic to be able to discuss things with my dad and ask him what he’d have done in this or that case.
But it was nice to also be able to do this research in a subject that I’ve always had an interest in, and exciting for my two passions - surgery and cricket - to overlap. Not many people can have work and play overlap to that degree.
Moving away from cricket, what inspired you to join the Medbelle network?
Once I learned about Medbelle’s vision and their mission to make the whole patient experience more seamless, I wanted to find out more.
I realised Medbelle could work with me to make the overall healthcare experience better for my patients - it makes a big difference that they have one adviser who will deal with everything for them, will take care of logistics and listen to any concerns.
It’s allowed me to focus even more on the clinical aspects of care rather than the admin or finances, and ultimately that’s better for my patients.
Finally, who will win the last test match?
England, of course! My wife is Australian, and I worked there for about ten years, so I have loads of Aussie mates. So it’s even more important for me that England do well!
