Association of Intrinsic Factors with Non-contact Low Back Pain Among Fast Bowlers Aged between 15 – 19 Years in Division 1 Boys’ Schools in Colombo

Association of Intrinsic Factors with Non-contact Low Back Pain Among Fast Bowlers Aged between 15 – 19 Years in Division 1 Boys’ Schools in Colombo | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research note Association of Intrinsic Factors with Non-contact Low Back Pain Among Fast Bowlers Aged between 15 – 19 Years in Division 1 Boys’ Schools in Colombo Udeesh Satheesha Jayasinghe, Imasha Swaris, Diluka Weerasooriya, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-65463/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective: Cricket fast bowlers are identified as the greatest injury risk players who are more prone to sustain with low back pain (LBP). The current study was aimed to investigate how intrinsic factors associate with LBP among fast bowlers aged between 15-19 years. A descriptive cross-sectional study was conducted with one hundred and two (102) fast bowlers in Colombo division 1 boys’ schools in Sri Lanka. Bowlers were prospectively monitored over the competition period of 2019 cricket season and the demographic data, severity of LBP, general characteristics and intrinsic factors related data were recorded. Results: Thirty-seven (43.5%) of the subjects were presented with LBP. Reduction of quadriceps strength of dominant side, hamstring strength of non-dominant side and increased ankle dorsiflexion of non-dominant side were found to be significantly associated with non-contact LBP (P<0.05). There were significant differences for the quadriceps strength of dominant side and hamstring strength and ankle dorsiflexion of non-dominant side between the fast bowlers with and without LBP. The results indicated that reduced quadriceps muscle strength of dominant side, reduced hamstring muscle strength and high ankle dorsiflexion of non-dominant side have an important role in predisposing a fast bowler to have an increase in non-contact LBP. Sports Medicine and Kinesiology Orthopedics Intrinsic factors Non-contact low back pain Fast bowlers Age 15-19 years Introduction Cricket fast bowlers are more prone to get injuries due to their heavy workload and repetitive stress acts through body alignments which results from ground reaction force (GRF) [1]. GRF will result stress force on lumbar spine through foot, ankle, knee and hip kinetic chain. Incorrect techniques, less physical preparation, high intensity and excessive workload will put fast bowlers at a high risk of having non-contact LBP [2,3]. The prevalence of injury among fast bowlers was 8% in the international cricket [4]. Australian, South African, English, West Indian and Indian bowlers experienced more injuries (41.3%) and among young fast bowler’s lumbar stress fractures is the most severe condition [5]. Lower limbs and lower back strains and sprains are at greatest injury incidence in Sri Lankan junior cricket bowlers with 20.3% and match injury incidence rate is 5.7 [6]. Non-contact LBP is the occurrence of pain without any collision mechanism with an external force; players or objects [7]. Intrinsic factors are considered as factors which are related to players themselves (techniques, structural alignment) for being injured. These factors are related with quadriceps strength, hamstring flexibility, hip internal rotation, ankle dorsiflexion, back muscles strength and trunk movements [8]. Thus, the aim of this study was to examine the association of intrinsic factors with non-contact LBP among fast bowlers aged between 15-19 years in division 1 boy’s schools in Colombo district. School fast bowlers those who are yet having time to mature physically are susceptible for injuries and they are the ones who are going to represent the national team in near future. This research will open up the pathways to evolving of many other research topics related to school level cricketers about what they are going to face in the future. Methods Subjects This descriptive cross-sectional study was conducted with 102 subjects in the competition period of 2019 cricket season among all the division 1 boys’ schools in Colombo. Among them, the subjects with a history of any neurological disorders, cardio-vascular diseases, experience of pain in any area that different from lower back region, complaint of pain more than 6 in the Numerical Pain Rating Scale (NPRS) of any joint which was used in the test procedures, intolerable pain during the measurement gaining procedures and the subjects with contact LBP were excluded. The data provided by the fast bowlers were collected and recorded following taking the written informed consent and explaining the procedure of the research. Selected subjects performed a 5 minutes warm up session and 5 minutes static stretching exercises to minimize the variability and the standard error of the measurements by reducing the impact of different muscle temperature on muscle flexibility. There was one specific examiner all the time to examine the specific task to avoid the inter-examiner error. 30 seconds rest was allowed during each trial and 2-3 minutes resting time was allowed during each station. Before administrating the questionnaire (Additional file 1) which was developed for this study as the data collection tool for the study participants, it was administered to randomly select 10 male fast bowler between 15-19 years old, who were outside the defined study area. Measurements and procedures Back extensor strength was measured by using Back-Leg-Chest dynamometer. Subject was asked to stand with both feet on base in lined with erect trunk and bent knees, as hands were able to grasp the chain of the dynamometer at a proper height. Adjust chain to accommodate a suitable height for the test. The body would be inclined forward about 60 degrees. Then subject was asked to straighten the knees, lift the chain, and apply a pulling force on the handle. Subject should lift in a gradual vertical motion. Quadriceps and hamstring muscle strength and muscle strength were measured by using a calibrated modified sphygmomanometer. When taking the measurement of quadriceps strength, athlete was sitting in 90 degrees flexed hip and 90 degrees flexed knee position. When assessing the hamstring strength, the athlete was in prone lying position with knees extended fully. During the test, athletes were asked to perform maximum isometric contractions. The modified-modified Schober was used to measure ROM of trunk flexion and extension [9]. Trunk lateral flexion was measured by using the fingertip-to-floor method [10]. Hip internal rotation and external rotation were measured by using goniometer modified with a spirit level while lunge test was used to assess the ROM of ankle dorsiflexion. Hamstring flexibility was measured by using sit and reach test. Athlete has to reach forward as much as possible along the measuring line and touch the extreme point. Intensity of pain was measured by NPRS in interviewer administered questionnaire. Statistical analysis All statistical analysis was conducted by the SPSS version 22. As the variable data did not express a normal distribution across the sample, nonparametric tests were used to analyze the data. Mann Whitney U test was used to assess the difference between the fast bowlers with and without LBP. Spearman correlation was used to assess the association between two variables. P < 0.05 was considered for significant level. Results Eighty-five (85) fast bowlers were recruited and 17 were excluded from a preliminary sample of 102. The mean age of study population was 16.6 ± 1.0 years. The Prevalence of LBP was 43.5% in the study population. The majority of the population is with right arm bowlers (91%) while the remaining of the population (9%) is with left arm. Distribution of the type of seeking health care professionals by fast bowlers with LBP is shown in Additional file 2: Figure S1. As the data did not show a normal distribution, non-parametric median values were used to assess the difference between two variables (Table 1). The age, bowling experience, training period, height, weight and BMI did not show any significant difference between the fast bowlers with and without LBP (p>0.05). Table 1 Distribution of general characteristics of the study population (n=85) Median Variable With LBP (n=37) Without LBP (n=48) p-value Age (years) 17.0 17.0 0.81 Bowling experience (years) 6.0 6.0 0.83 Training period (hours per week) 2.0 3.0 0.08 Height (meters) 1.7 1.7 0.58 Weight (kilograms) 56.3 61.7 0.17 Body Mass Index (kg/m -2 ) 20.0 21.1 0.26 p-value: significant level result from Mann Whitney U test; LBP: Low Back Pain; kg/ m -2 : kilograms per square meter Table 2 reflects the intrinsic factors of the study population with and without LBP. It showed a highly significant difference only for the quadriceps strength of dominant side, hamstring strength and ankle dorsiflexion of non-dominant side between the fast bowlers with and without LBP (p<0.05). However, no significant difference was identified for other intrinsic factors between the fast bowlers with and without LBP (p<0.05). Table 2 Distribution of intrinsic factors of the study population (n=85) Median Variable With LBP (n=37) Without LBP (n=48) p-value Quadriceps strength of non-dominant side (mmHg) 142.0 152.5 0.12 Quadriceps strength of dominant side (mmHg) 147.0 163.0 0.01* Hamstring strength of non-dominant side (mmHg) 101.0 117.0 0.04* Hamstring strength of dominant side (mmHg) 108.0 119.0 0.35 Back extensor muscles strength (kg) 72.0 85.0 0.11 ROM of trunk Flexion (cm) 6.5 6.5 0.86 ROM of trunk extension (cm) 3.2 3.5 0.67 ROM of non-dominant side trunk lateral flexion (cm) 21.2 21.5 0.33 ROM of dominant side trunk lateral flexion (cm) 21.0 21.0 0.44 ROM of non-dominant side trunk rotation (cm) 5.5 6.3 0.54 ROM of dominant side trunk rotation (cm) 6.5 7.1 0.20 Hip internal rotation of non-dominant side (degrees/°) 38.0 36.0 0.45 Hip internal rotation of dominant side (degrees/°) 36.0 35.5 0.21 Ankle dorsiflexion of non-dominant side (cm) 13.9 15.2 0.04* Ankle dorsiflexion of dominant side (cm) 14.9 15.1 0.33 Hamstring flexibility (cm) 32.2 32.3 0.31 p-value: significant level result from Mann Whitney U test; LBP: Low Back Pain; ROM: Range of Motion * p < .05: significant Association of general characteristics with LBP of the study population was evaluated in Additional file 3: Table S1. There were negative correlations for the age, body mass index and training period and a positive correlation for the bowling experience with LBP of the study population which was insignificant. Table 3 shows the association of intrinsic factors with the LBP of the study population. Quadriceps strength of dominant side, hamstring strength and ankle dorsiflexion of non- dominant side was significantly negatively correlated with the LBP (p0.05). Quadriceps strength of non-dominant side, hamstring strength of dominant side, ROM of trunk flexion, extension, rotations and non-dominant side lateral flexion were negatively correlated with the LBP, while ROM of dominant side lateral flexion was positively correlated with the LBP. However, none of the parameters were not significantly associated with the LBP (p>0.05). Table 3 Association of intrinsic factors with Low Back Pain of the study population Variable r sp p-value Quadriceps strength of non-dominant side (mmHg) -0.18 0.11 Quadriceps strength of dominant side (mmHg) -0.34* 0.01* Hamstring strength of non-dominant side (mmHg) -0.28* 0.01* Hamstring strength of dominant side (mmHg) -0.15 0.17 Back extensor muscles strength (kg) -0.20 0.06 ROM of trunk Flexion (cm) -0.01 0.91 ROM of trunk extension (cm) -0.09 0.42 ROM of non-dominant side trunk lateral flexion (cm) -0.05 0.64 ROM of dominant side trunk lateral flexion (cm) 0.09 0.41 ROM of non-dominant side trunk rotation (cm) -0.07 0.51 ROM of dominant side trunk rotation (cm) -0.18 0.11 Hip internal rotation of non-dominant side (degrees/°) 0.08 0.46 Hip internal rotation of dominant side (degrees/°) 0.14 0.21 Ankle dorsiflexion of non-dominant side (cm) 0.26* 0.02* Ankle dorsiflexion of dominant side (cm) 0.13 0.25 Hamstring flexibility (cm) 0.11 0.31 r sp : Spearman’s correlation coefficient; p-value: significant level result from Spearman’s correlation test; ROM: Range of Motion * p < .05: significant Discussion This study describes the associated intrinsic factors and how it relates to the prevalence of non-contact LBP in adolescent male fast bowlers playing for division 1 Colombo schools aged between 15-19 years. Previously some studies had been conducted, but focusing only one or two intrinsic factors related to this topic. This is the first research study presenting associated intrinsic factors to fast bowlers’ low back pain in Sri Lankan region. Similar to present study, Foster et al. [11] also explained that the age of adolescent the fast bowlers might be susceptible for high incidence of lower back injuries (LBI) due to incomplete ossification of neural arches of lumbar vertebrae. A study of three dimensional measurement of lumbar spine kinematics in fast bowlers emphasized that there was no significant relationship between lumbar injuries and all the lower lumbar movements [12]. With regards to that, excessive trunk lateral flexion has been identified by analyzing dynamic biomechanics, as a risk factor of low back injuries in adolescent cricket pace bowlers [7]. There was no significant difference in hip internal or external rotation between adolescent fast bowlers with or without LBP [13]. However, Dennis et al. [14] evaluated that reduction of hip internal rotation of dominant side had significant association with reduction of LBI risk in male adult fast bowlers. Higher peak vertical GRF which is considered as the main contributing factor to the lumbar stress fractures among fast bowlers is associated with a small plantar angle due to increased ankle dorsiflexion and reduced hip flexion [15]. At the delivery stride, a fast bowler has to absorb a maximum GRF of nine times of the body weight during the initial front foot landing [16]. Conversely, restriction in foot and ankle motion can be associated with prevalence of LBP [17]. Weakened quadriceps muscle strength can be lead to LBI [11]. Normally during run up phase, the generated GRF was absorbed by the knee joint and the lumbar spine and the reduction of quadriceps muscle strength resulted reduction of shock absorption on the knee joint and increased the force on the lumbar spine [18]. In contrast, a study interpreted that quadriceps muscle strength of non-dominant side was associated with LBP of young fast bowlers [11]. In fast bowlers, quadriceps and hamstrings muscles are repeatedly contracted eccentrically and concentrically through the run up phase and a peak vertical GRF and a horizontal GRF exert on the dominant side leg on delivery stride [19]. It was evident that reduced hamstring muscle strength cause LBP. When hamstrings weakened than quadriceps muscle, it resulted a downward pull of pelvis that cause hyperextension of lumbar spine. Due to the changed vertebral angle of the spine, the pressure placed on intervertebral discs was increased which would lead to LBI [20]. There were no significant differences existed between strength of back extensor muscles with and without LBP groups in fast bowlers (mean age = 17.9 years) [21]. Some postural deficits caused by genetic factors may predispose an individual to develop the injuries of the lumbar spine, especially when young and playing a high-risk sport like cricket fast bowling [22,23]. Children are more susceptible to overuse injuries than adults due to the effect on their immature growth cartilages and as children become more heavily involved in cricket [24]. LBP is not associated with impaired hamstring flexibility, stiffness [25] or hamstring muscle length [26]. MassoudArab et al. [27] further described that there is no significant difference in hamstring muscle length with and without sacroiliac joint dysfunction. Some controversial findings stated that lumbar disc abnormalities had an association with reduced hamstring flexibility [8]. Conclusion The findings of this study revealed that none of the general characteristics which are age, BMI, training period and bowling experience did not contribute to develop LBP symptoms among the adolescent fast bowlers aged between 15-19 years. The higher muscular strength of dominant side quadriceps muscle and non-dominant side hamstring muscle having less probability to develop LBP. Likely, the fast bowlers with higher non-dominant side ankle dorsiflexion are more prone to having LBP. Limitations To the best of our knowledge, this was the first study to investigate the associated intrinsic factors to adolescent male fast bowlers’ low back pain in Sri Lankan region., however there were a number of limitations. This study was limited to the male population though the game of cricket is now played more commonly by females in Sri Lanka. Further studies should be carried out to cover all areas in Sri Lanka including the Division 02 and Division 03 schools to enhance the sample size. Abbreviations BMI – Body Mass Index GRF – Ground Reaction Force LBP – Low Back Pain LBI – Lower Back Injuries NPRS – Numerical Pain Rating Scale Declarations Ethics approval and consent to participate A written informed consent was obtained from all the participants and their parents and the ethical clearance was obtained from the Ethics Review Committee, Faculty of Medicine, General Sir John Kotelawala Defence University. Consent for publication Not applicable. Availability of data and materials Since the privacy of research participants may be compromised, we cannot make the information publicly available. Competing interests The authors declare that they have no competing interests. Funding None Authors' contributions USJ and ADPP contributed to manuscript writing, developing study concept and design, data acquisition and data analysis; USJ, IS, DW, DM, SB and KD contributed to data acquisition. All authors read and approved the final manuscript. Acknowledgements The authors would like to express their sincere gratitude to the supervisor of this research Mrs. ADP Perera, Senior lecturer, Department of Physiotherapy, Faculty of Allied Health Sciences, General Sir John Kotelawala Defense University for the tremendous guidance and the support given in every step throughout the process of this study. References Elliott BC. Back injuries and the fast bowler in cricket. Journal of sports sciences. 2000 Jan 1;18(12):983-91. Mathew A, Rai S, Kumar D. Low back injuries in fast bowlers: A literature review. International Journal of Allied Medical Sciences and Clinical Research. 2016;4(2):184-195. Thiagarajan KA, Parikh T. Anees Sayed Cricket Biomechanics Analysis of Skilled and Ameteur Fast Bowling Technique. Journal of Postgraduate Medicine, Education and Research. 2015:173-81. Mount S, Moore I, Ranson C. Injury types and rates in an international cricket team: Application of subsequent injury categorisation. British journal of sports medicine. 2014 Apr 1;48(7):642-. Pardiwala D, Rao N, Varshney A. Injuries in Cricket. Sports Health: A Multidisciplinary Approach. 2017;10(3):217-222. Gamage PJ, Fortington LV, Kountouris A, Finch CF. Match injuries in Sri Lankan junior cricket: A prospective, longitudinal study. Journal of science and medicine in sport. 2019 Jun 1;22(6):647-52. Forrest MR, Hebert JJ, Scott BR, Brini S, Dempsey AR. Risk factors for non-contact injury in adolescent cricket pace bowlers: a systematic review. Sports medicine. 2017 Dec 1;47(12):2603-19. Olivier B, Stewart A, Taljaard T, Burger E, Brukner P, Orchard J, Gray J, Botha N, Mckinon W. Extrinsic and intrinsic factors associated with non-contact injury in adult pace bowlers: a systematic review protocol. JBI database of systematic reviews and implementation reports. 2015 Jan 1;13(1):3-13. Williams R, Binkley J, Bloch R, Goldsmith CH, Minuk T. Reliability of the modified-modified Schöber and double inclinometer methods for measuring lumbar flexion and extension. Physical therapy. 1993 Jan 1;73(1):26-37. Frost M, Stuckey S, Smalley LA, Dorman G. Reliability of measuring trunk motions in centimeters. Physical therapy. 1982 Oct 1;62(10):1431-7. Foster D, John D, Elliott B, Ackland T, Fitch K. Back injuries to fast bowlers in cricket: a prospective study. British journal of sports medicine. 1989 Sep 1;23(3):150-4. Burnett AF, Barrett CJ, Marshall RN, Elliott BC, Day RE. Three-dimensional measurement of lumbar spine kinematics for fast bowlers in cricket. Clinical Biomechanics. 1998 Dec 1;13(8):574-83. Bayne H, Elliott B, Campbell A, Alderson J. Lumbar load in adolescent fast bowlers: a prospective injury study. Journal of Science and Medicine in Sport. 2016 Feb 1;19(2):117-22. Dennis RJ, Finch CF, McIntosh AS, Elliott BC. Use of field-based tests to identify risk factors for injury to fast bowlers in cricket. British Journal of Sports Medicine. 2008 Jun 1;42(6):477-82. Worthington P, King M, Ranson C. The influence of cricket fast bowlers’ front leg technique on peak ground reaction forces. Journal of Sports Sciences. 2013 Feb 1;31(4):434-41. Krishna SA, Alwar TK, Sayed A, Gnanavel MB, Sivaraman A. Are Indian Cricket Fast Bowlers At Risk Of Injury?-A 3d Biomechanical Investigation: 1378 Board# 53 June 1 800 AM-930 AM. Medicine & Science in Sports & Exercise. 2017 May 1;49(5S):374-5. Brantingham JW, Gilbert JL, Shaik J, Globe G. Sagittal plane blockage of the foot, ankle and hallux and foot alignment-prevalence and association with low back pain. Journal of chiropractic medicine. 2006 Dec 1;5(4):123-7. Cai C, Kong PW. Low back and lower-limb muscle performance in male and female recreational runners with chronic low back pain. Journal of Orthopaedic & Sports Physical Therapy. 2015 Jun;45(6):436-43. Feros SA. The Determinants and Development of Fast Bowling Performance in Cricket. An Internasional Perspective on Topics in Sports Medicine and Sports Injury. 2015 Sep. de Sousa CS, de Jesus FL, Machado MB, Ferreira G, Ayres IG, de Aquino LM, Fukuda TY, Gomes-Neto M. Lower limb muscle strength in patients with low back pain: a systematic review and meta-analysis. Journal of musculoskeletal & neuronal interactions. 2019;19(1):69. Elliott BC, Hardcastle PH, Burnett AE, Foster DH. The influence of fast bowling and physical factors on radiologic features in high performance young fast bowlers. Research in Sports Medicine: An International Journal. 1992 Feb 1;3(2):113-30. Millson HB, Gray J, Stretch RA, Lambert MI. Dissociation between back pain and bone stress reaction as measured by CT scan in young cricket fast bowlers. British journal of sports medicine. 2004 Oct 1;38(5):586-91. Cyron BM, Hutton WC. The fatigue strength of the lumbar neural arch in spondylolysis. The Journal of Bone and Joint Surgery. British volume. 1978 May;60(2):234-8. Harris I. The prevalence of low back pain in cricketers–An undergraduate epidemiological study. South African Journal of Physiotherapy. 1993 Nov 30;49(4):65-6. Hori M, Hasegawa H, Takasaki H. Comparisons of hamstring flexibility between individuals with and without low back pain: systematic review with meta-analysis. Physiotherapy Theory and Practice. 2019 Jul 19:1-24. Nourbakhsh MR, Arab AM. Relationship between mechanical factors and incidence of low back pain. Journal of Orthopaedic & Sports Physical Therapy. 2002 Sep;32(9):447-60. MassoudArab A, RezaNourbakhsh M, Mohammadifar A. The relationship between hamstring length and gluteal muscle strength in individuals with sacroiliac joint dysfunction. Journal of Manual & Manipulative Therapy. 2011 Feb 1;19(1):5-10. Supplementary Files FigureS1.jpg TableS1.docx InterviewerAdministeredQuestionnaire.pdf Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-65463","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research note","associatedPublications":[],"authors":[{"id":2803487,"identity":"580d3d1c-4af0-4a2b-ac15-ad4d93798296","order_by":0,"name":"Udeesh Satheesha Jayasinghe","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA0ElEQVRIiWNgGAWjYFCCBAYGxgab+n4wu4B4LWmMMxtAbAPitRxm3HAAxCFGi8Hx5IMPf+5gZjY+vzrxwwMDBnl+sQMEtJx5lmzMe4aNzezG280SQIcZzpydQEDLjRwzacY2Hh6zG2c3gLQkGNwmqCX/+8+fbRISxjPObv5BpJYcNgbeNgMDA/7ebcTZInnmmbE0b1tCgsQN3m0WCQYShP3Cdzz54cefbf8T+PvPbr75o8JGnl+agBYEkACrlCBWOQjwHyBF9SgYBaNgFIwkAACKKUg+6r4rgAAAAABJRU5ErkJggg==","orcid":"","institution":"General Sir John Kotelawala Defence University","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Udeesh","middleName":"Satheesha","lastName":"Jayasinghe","suffix":""},{"id":2803488,"identity":"7e7b0586-dd48-4cfa-a371-328ac5f966a6","order_by":1,"name":"Imasha Swaris","email":"","orcid":"","institution":"General Sir John Kotelawala Defence University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Imasha","middleName":"","lastName":"Swaris","suffix":""},{"id":2803489,"identity":"c6b8de84-5ade-4fd2-a3ef-61ff8d45d5f1","order_by":2,"name":"Diluka Weerasooriya","email":"","orcid":"","institution":"General Sir John Kotelawala Defence University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Diluka","middleName":"","lastName":"Weerasooriya","suffix":""},{"id":2803490,"identity":"2c171771-da70-4077-81e3-b16dc7390d17","order_by":3,"name":"Dushan Mayura","email":"","orcid":"","institution":"General Sir John Kotelawala Defence University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Dushan","middleName":"","lastName":"Mayura","suffix":""},{"id":2803491,"identity":"e279ba25-ae96-4549-8432-9b7df4f8ceed","order_by":4,"name":"Sachinda Bandara","email":"","orcid":"","institution":"General Sir John Kotelawala Defence University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Sachinda","middleName":"","lastName":"Bandara","suffix":""},{"id":2803492,"identity":"fdefca31-dc0c-4808-a0e9-8500917e1a8f","order_by":5,"name":"Kavindi Disanayake","email":"","orcid":"","institution":"General Sir John Kotelawala Defence University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Kavindi","middleName":"","lastName":"Disanayake","suffix":""},{"id":2803493,"identity":"6c686736-c69b-4760-9b4d-3bc56ba48c97","order_by":6,"name":"Angage Dilani Priyashanthi Perera","email":"","orcid":"","institution":"General Sir John Kotelawala Defence University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Angage","middleName":"Dilani Priyashanthi","lastName":"Perera","suffix":""}],"badges":[],"createdAt":"2020-08-25 11:37:48","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-65463/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-65463/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":13597408,"identity":"b50aad90-27e5-4a24-aeda-b5c98bf5ccd8","added_by":"auto","created_at":"2021-09-17 05:32:19","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":310124,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-65463/v1/a875ea42-5c24-4b82-9bf9-a3f5883ba3d1.pdf"},{"id":2722634,"identity":"aa709b4e-d9c4-472a-ae10-f8aa3dc0bd75","added_by":"auto","created_at":"2020-10-01 14:29:15","extension":"jpg","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":42748,"visible":true,"origin":"","legend":"","description":"","filename":"FigureS1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-65463/v1/FigureS1.jpg"},{"id":2722635,"identity":"86aa43c0-c4a5-45e0-9e3c-00533e8d55a8","added_by":"auto","created_at":"2020-10-01 14:29:15","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":12772,"visible":true,"origin":"","legend":"","description":"","filename":"TableS1.docx","url":"https://assets-eu.researchsquare.com/files/rs-65463/v1/TableS1.docx"},{"id":2722636,"identity":"10a24439-a5d0-49ff-b949-351ca818209a","added_by":"auto","created_at":"2020-10-01 14:29:15","extension":"pdf","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":430198,"visible":true,"origin":"","legend":"","description":"","filename":"InterviewerAdministeredQuestionnaire.pdf","url":"https://assets-eu.researchsquare.com/files/rs-65463/v1/InterviewerAdministeredQuestionnaire.pdf"}],"financialInterests":"","formattedTitle":"\u003cp\u003eAssociation of Intrinsic Factors with Non-contact Low Back Pain Among Fast Bowlers Aged between 15 – 19 Years in Division 1 Boys’ Schools in Colombo\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eCricket fast bowlers are more prone to get injuries due to their heavy workload and repetitive stress acts through body alignments which results from ground reaction force (GRF) [1]. GRF will result stress force on lumbar spine through foot, ankle, knee and hip kinetic chain. Incorrect techniques, less physical preparation, high intensity and excessive workload will put fast bowlers at a high risk of having non-contact LBP [2,3]. The prevalence of injury among fast bowlers was 8% in the international cricket [4]. Australian, South African, English, West Indian and Indian bowlers experienced more injuries (41.3%) and among young fast bowler\u0026rsquo;s lumbar stress fractures is the most severe condition [5]. Lower limbs and lower back strains and sprains are at greatest injury incidence in Sri Lankan junior cricket bowlers with 20.3% and match injury incidence rate is 5.7 [6].\u003c/p\u003e\n\u003cp\u003eNon-contact LBP is the occurrence of pain without any collision mechanism with an external force; players or objects [7]. Intrinsic factors are considered as factors which are related to players themselves (techniques, structural alignment) for being injured. These factors are related with quadriceps strength, hamstring flexibility, hip internal rotation, ankle dorsiflexion, back muscles strength and trunk movements [8].\u003c/p\u003e\n\u003cp\u003eThus, the aim of this study was to examine the association of intrinsic factors with non-contact LBP among fast bowlers aged between 15-19 years in division 1 boy\u0026rsquo;s schools in Colombo district. School fast bowlers those who are yet having time to mature physically are susceptible for injuries and they are the ones who are going to represent the national team in near future. This research will open up the pathways to evolving of many other research topics related to school level cricketers about what they are going to face in the future.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"Methods","content":"\u003ch2\u003eSubjects\u003c/h2\u003e\n\u003cp\u003eThis descriptive cross-sectional study was conducted with 102 subjects in the competition period of 2019 cricket season among all the division 1 boys\u0026rsquo; schools in Colombo. Among them, the subjects with a history of any neurological disorders, cardio-vascular diseases, experience of pain in any area that different from lower back region, complaint of pain more than 6 in the Numerical Pain Rating Scale (NPRS) of any joint which was used in the test procedures, intolerable pain during the measurement gaining procedures and the subjects with contact LBP were excluded.\u003c/p\u003e\n\u003cp\u003eThe data provided by the fast bowlers were collected and recorded following taking the written informed consent and explaining the procedure of the research. Selected subjects performed a 5 minutes warm up session and 5 minutes static stretching exercises to minimize the variability and the standard error of the measurements by reducing the impact of different muscle temperature on muscle flexibility. There was one specific examiner all the time to examine the specific task to avoid the inter-examiner error. 30 seconds rest was allowed during each trial and 2-3 minutes resting time was allowed during each station.\u003c/p\u003e\n\u003cp\u003eBefore administrating the questionnaire (Additional file 1) which was developed for this study as the data collection tool for the study participants, it was administered to randomly select 10 male fast bowler between 15-19 years old, who were outside the defined study area.\u003c/p\u003e\n\u003ch2\u003eMeasurements and procedures\u003c/h2\u003e\n\u003cp\u003eBack extensor strength was measured by using Back-Leg-Chest dynamometer. Subject was asked to stand with both feet on base in lined with erect trunk and bent knees, as hands were able to grasp the chain of the dynamometer at a proper height. Adjust chain to accommodate a suitable height for the test. The body would be inclined forward about 60 degrees. Then subject was asked to straighten the knees, lift the chain, and apply a pulling force on the handle. Subject should lift in a gradual vertical motion.\u003c/p\u003e\n\u003cp\u003eQuadriceps and hamstring muscle strength and muscle strength were measured by using a calibrated modified sphygmomanometer. When taking the measurement of quadriceps strength, athlete was sitting in 90 degrees flexed hip and 90 degrees flexed knee position. When assessing the hamstring strength, the athlete was in prone lying position with knees extended fully. During the test, athletes were asked to perform maximum isometric contractions. The modified-modified Schober was used to measure ROM of trunk flexion and extension [9]. Trunk lateral flexion was measured by using the fingertip-to-floor method [10]. Hip internal rotation and external rotation were measured by using goniometer modified with a spirit level while lunge test was used to assess the ROM of ankle dorsiflexion.\u003c/p\u003e\n\u003cp\u003eHamstring flexibility was measured by using sit and reach test. Athlete has to reach forward as much as possible along the measuring line and touch the extreme point. Intensity of pain was measured by NPRS in interviewer administered questionnaire.\u003c/p\u003e\n\u003ch2\u003eStatistical analysis\u003c/h2\u003e\n\u003cp\u003eAll statistical analysis was conducted by the SPSS version 22. As the variable data did not express a normal distribution across the sample, nonparametric tests were used to analyze the data. Mann Whitney U test was used to assess the difference between the fast bowlers with and without LBP. Spearman correlation was used to assess the association between two variables. P \u0026lt; 0.05 was considered for significant level.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003ca href=\"#_ftnref1\" name=\"_ftn1\"\u003e\u003c/a\u003e\u003c/strong\u003e\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eEighty-five (85) fast bowlers were recruited and 17 were excluded from a preliminary sample of 102. The mean age of study population was 16.6 \u0026plusmn; 1.0 years. The Prevalence of LBP was 43.5% in the study population. The majority of the population is with right arm bowlers (91%) while the remaining of the population (9%) is with left arm. Distribution of the type of seeking health care professionals by fast bowlers with LBP is shown in Additional file 2: Figure S1.\u003c/p\u003e\n\u003cp\u003eAs the data did not show a normal distribution, non-parametric median values were used to assess the difference between two variables (Table 1). The age, bowling experience, training period, height, weight and BMI did not show any significant difference between the fast bowlers with and without LBP (p\u0026gt;0.05).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eDistribution of general characteristics of the study population (n=85)\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd width=\"223\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"258\"\u003e\n\u003cp\u003e\u003cstrong\u003eMedian\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"223\"\u003e\n\u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"126\"\u003e\n\u003cp\u003e\u003cstrong\u003eWith LBP (n=37)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003e\u003cstrong\u003eWithout LBP (n=48)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"223\"\u003e\n\u003cp\u003eAge (years)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"126\"\u003e\n\u003cp\u003e17.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003e17.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003e0.81\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"223\"\u003e\n\u003cp\u003eBowling experience (years)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"126\"\u003e\n\u003cp\u003e6.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003e6.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003e0.83\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"223\"\u003e\n\u003cp\u003eTraining period (hours per week)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"126\"\u003e\n\u003cp\u003e2.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003e3.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003e0.08\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"223\"\u003e\n\u003cp\u003eHeight (meters)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"126\"\u003e\n\u003cp\u003e1.7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003e1.7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003e0.58\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"223\"\u003e\n\u003cp\u003eWeight (kilograms)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"126\"\u003e\n\u003cp\u003e56.3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003e61.7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003e0.17\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"223\"\u003e\n\u003cp\u003eBody Mass Index (kg/m\u003csup\u003e-2\u003c/sup\u003e)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"126\"\u003e\n\u003cp\u003e20.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003e21.1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003e0.26\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"4\" width=\"223\"\u003ep-value: significant level result from Mann Whitney U test; LBP: Low Back Pain; kg/ m\u003csup\u003e-2\u003c/sup\u003e: kilograms per square meter\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 2 reflects the intrinsic factors of the study population with and without LBP. It showed a highly significant difference only for the quadriceps strength of dominant side, hamstring strength and ankle dorsiflexion of non-dominant side between the fast bowlers with and without LBP (p\u0026lt;0.05). However, no significant difference was identified for other intrinsic factors between the fast bowlers with and without LBP (p\u0026lt;0.05).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eDistribution of intrinsic factors of the study population (n=85)\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd width=\"295\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"258\"\u003e\n\u003cp\u003e\u003cstrong\u003eMedian\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"72\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"295\"\u003e\n\u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"120\"\u003e\n\u003cp\u003e\u003cstrong\u003eWith LBP (n=37)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"138\"\u003e\n\u003cp\u003e\u003cstrong\u003eWithout LBP (n=48)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"72\"\u003e\n\u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"295\"\u003e\n\u003cp\u003eQuadriceps strength of non-dominant side (mmHg)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"120\"\u003e\n\u003cp\u003e142.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"138\"\u003e\n\u003cp\u003e152.5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"72\"\u003e\n\u003cp\u003e0.12\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"295\"\u003e\n\u003cp\u003eQuadriceps strength of dominant side (mmHg)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"120\"\u003e\n\u003cp\u003e147.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"138\"\u003e\n\u003cp\u003e163.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"72\"\u003e\n\u003cp\u003e0.01*\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"295\"\u003e\n\u003cp\u003eHamstring strength of non-dominant side (mmHg)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"120\"\u003e\n\u003cp\u003e101.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"138\"\u003e\n\u003cp\u003e117.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"72\"\u003e\n\u003cp\u003e0.04*\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"295\"\u003e\n\u003cp\u003eHamstring strength of dominant side (mmHg)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"120\"\u003e\n\u003cp\u003e108.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"138\"\u003e\n\u003cp\u003e119.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"72\"\u003e\n\u003cp\u003e0.35\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"295\"\u003e\n\u003cp\u003eBack extensor muscles strength (kg)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"120\"\u003e\n\u003cp\u003e72.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"138\"\u003e\n\u003cp\u003e85.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"72\"\u003e\n\u003cp\u003e0.11\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"295\"\u003e\n\u003cp\u003eROM of trunk Flexion (cm)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"120\"\u003e\n\u003cp\u003e6.5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"138\"\u003e\n\u003cp\u003e6.5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"72\"\u003e\n\u003cp\u003e0.86\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"295\"\u003e\n\u003cp\u003eROM of trunk extension (cm)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"120\"\u003e\n\u003cp\u003e3.2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"138\"\u003e\n\u003cp\u003e3.5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"72\"\u003e\n\u003cp\u003e0.67\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"295\"\u003e\n\u003cp\u003eROM of non-dominant side trunk lateral flexion (cm)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"120\"\u003e\n\u003cp\u003e21.2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"138\"\u003e\n\u003cp\u003e21.5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"72\"\u003e\n\u003cp\u003e0.33\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"295\"\u003e\n\u003cp\u003eROM of dominant side trunk lateral flexion (cm)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"120\"\u003e\n\u003cp\u003e21.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"138\"\u003e\n\u003cp\u003e21.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"72\"\u003e\n\u003cp\u003e0.44\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"295\"\u003e\n\u003cp\u003eROM of non-dominant side trunk rotation (cm)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"120\"\u003e\n\u003cp\u003e5.5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"138\"\u003e\n\u003cp\u003e6.3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"72\"\u003e\n\u003cp\u003e0.54\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"295\"\u003e\n\u003cp\u003eROM of dominant side trunk rotation (cm)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"120\"\u003e\n\u003cp\u003e6.5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"138\"\u003e\n\u003cp\u003e7.1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"72\"\u003e\n\u003cp\u003e0.20\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"295\"\u003e\n\u003cp\u003eHip internal rotation of non-dominant side (degrees/\u0026deg;)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"120\"\u003e\n\u003cp\u003e38.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"138\"\u003e\n\u003cp\u003e36.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"72\"\u003e\n\u003cp\u003e0.45\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"295\"\u003e\n\u003cp\u003eHip internal rotation of dominant side (degrees/\u0026deg;)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"120\"\u003e\n\u003cp\u003e36.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"138\"\u003e\n\u003cp\u003e35.5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"72\"\u003e\n\u003cp\u003e0.21\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"295\"\u003e\n\u003cp\u003eAnkle dorsiflexion of non-dominant side (cm)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"120\"\u003e\n\u003cp\u003e13.9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"138\"\u003e\n\u003cp\u003e15.2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"72\"\u003e\n\u003cp\u003e0.04*\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"295\"\u003e\n\u003cp\u003eAnkle dorsiflexion of dominant side (cm)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"120\"\u003e\n\u003cp\u003e14.9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"138\"\u003e\n\u003cp\u003e15.1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"72\"\u003e\n\u003cp\u003e0.33\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"295\"\u003e\n\u003cp\u003eHamstring flexibility (cm)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"120\"\u003e\n\u003cp\u003e32.2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"138\"\u003e\n\u003cp\u003e32.3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"72\"\u003e\n\u003cp\u003e0.31\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"4\" width=\"295\"\u003e\n\u003cp\u003ep-value: significant level result from Mann Whitney U test; LBP: Low Back Pain; ROM: Range of Motion\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e* p \u0026lt; .05: significant\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAssociation of general characteristics with LBP of the study population was evaluated in Additional file 3: Table S1. There were negative correlations for the age, body mass index and training period and a positive correlation for the bowling experience with LBP of the study population which was insignificant.\u003c/p\u003e\n\u003cp\u003eTable 3 shows the association of intrinsic factors with the LBP of the study population. Quadriceps strength of dominant side, hamstring strength and ankle dorsiflexion of non- dominant side was significantly negatively correlated with the LBP (p\u0026lt;0.05). Hip internal rotation of dominant and non-dominant sides, ankle dorsiflexion of dominant side, hamstring flexibility were insignificant positively correlated with the LBP (p\u0026gt;0.05). Quadriceps strength of non-dominant side, hamstring strength of dominant side, ROM of trunk flexion, extension, rotations and non-dominant side lateral flexion were negatively correlated with the LBP, while ROM of dominant side lateral flexion was positively correlated with the LBP. However, none of the parameters were not significantly associated with the LBP (p\u0026gt;0.05).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eAssociation of intrinsic factors with Low Back Pain of the study population\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd width=\"360\"\u003e\n\u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"144\"\u003e\n\u003cp\u003e\u003cstrong\u003er\u003csub\u003esp\u003c/sub\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"96\"\u003e\n\u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"360\"\u003e\n\u003cp\u003eQuadriceps strength of non-dominant side (mmHg)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"144\"\u003e\n\u003cp\u003e-0.18\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"96\"\u003e\n\u003cp\u003e0.11\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"360\"\u003e\n\u003cp\u003eQuadriceps strength of dominant side (mmHg)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"144\"\u003e\n\u003cp\u003e-0.34*\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"96\"\u003e\n\u003cp\u003e0.01*\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"360\"\u003e\n\u003cp\u003eHamstring strength of non-dominant side (mmHg)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"144\"\u003e\n\u003cp\u003e-0.28*\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"96\"\u003e\n\u003cp\u003e0.01*\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"360\"\u003e\n\u003cp\u003eHamstring strength of dominant side (mmHg)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"144\"\u003e\n\u003cp\u003e-0.15\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"96\"\u003e\n\u003cp\u003e0.17\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"360\"\u003e\n\u003cp\u003eBack extensor muscles strength (kg)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"144\"\u003e\n\u003cp\u003e-0.20\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"96\"\u003e\n\u003cp\u003e0.06\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"360\"\u003e\n\u003cp\u003eROM of trunk Flexion (cm)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"144\"\u003e\n\u003cp\u003e-0.01\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"96\"\u003e\n\u003cp\u003e0.91\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"360\"\u003e\n\u003cp\u003eROM of trunk extension (cm)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"144\"\u003e\n\u003cp\u003e-0.09\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"96\"\u003e\n\u003cp\u003e0.42\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"360\"\u003e\n\u003cp\u003eROM of non-dominant side trunk lateral flexion (cm)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"144\"\u003e\n\u003cp\u003e-0.05\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"96\"\u003e\n\u003cp\u003e0.64\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"360\"\u003e\n\u003cp\u003eROM of dominant side trunk lateral flexion (cm)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"144\"\u003e\n\u003cp\u003e0.09\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"96\"\u003e\n\u003cp\u003e0.41\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"360\"\u003e\n\u003cp\u003eROM of non-dominant side trunk rotation (cm)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"144\"\u003e\n\u003cp\u003e-0.07\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"96\"\u003e\n\u003cp\u003e0.51\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"360\"\u003e\n\u003cp\u003eROM of dominant side trunk rotation (cm)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"144\"\u003e\n\u003cp\u003e-0.18\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"96\"\u003e\n\u003cp\u003e0.11\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"360\"\u003e\n\u003cp\u003eHip internal rotation of non-dominant side (degrees/\u0026deg;)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"144\"\u003e\n\u003cp\u003e0.08\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"96\"\u003e\n\u003cp\u003e0.46\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"360\"\u003e\n\u003cp\u003eHip internal rotation of dominant side (degrees/\u0026deg;)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"144\"\u003e\n\u003cp\u003e0.14\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"96\"\u003e\n\u003cp\u003e0.21\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"360\"\u003e\n\u003cp\u003eAnkle dorsiflexion of non-dominant side (cm)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"144\"\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp;0.26*\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"96\"\u003e\n\u003cp\u003e\u0026nbsp;0.02*\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"360\"\u003e\n\u003cp\u003eAnkle dorsiflexion of dominant side (cm)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"144\"\u003e\n\u003cp\u003e0.13\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"96\"\u003e\n\u003cp\u003e0.25\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"360\"\u003e\n\u003cp\u003eHamstring flexibility (cm)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"144\"\u003e\n\u003cp\u003e0.11\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"96\"\u003e\n\u003cp\u003e0.31\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"3\" width=\"360\"\u003e\n\u003cp\u003er\u003csub\u003esp\u003c/sub\u003e: Spearman\u0026rsquo;s correlation coefficient; p-value: significant level result from Spearman\u0026rsquo;s correlation test; ROM: Range of Motion\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; \u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e* p \u0026lt; .05: significant\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study describes the associated intrinsic factors and how it relates to the prevalence of non-contact LBP in adolescent male fast bowlers playing for division 1 Colombo schools aged between 15-19 years. Previously some studies had been conducted, but focusing only one or two intrinsic factors related to this topic. This is the first research study presenting associated intrinsic factors to fast bowlers\u0026rsquo; low back pain in Sri Lankan region.\u003c/p\u003e\n\u003cp\u003eSimilar to present study, Foster et al. [11] also explained that the age of adolescent the fast bowlers might be susceptible for high incidence of lower back injuries (LBI) due to incomplete ossification of neural arches of lumbar vertebrae. A study of three dimensional measurement of lumbar spine kinematics in fast bowlers emphasized that there was no significant relationship between lumbar injuries and all the lower lumbar movements [12]. With regards to that, excessive trunk lateral flexion has been identified by analyzing dynamic biomechanics, as a risk factor of low back injuries in adolescent cricket pace bowlers [7].\u003c/p\u003e\n\u003cp\u003eThere was no significant difference in hip internal or external rotation between adolescent fast bowlers with or without LBP [13]. However, Dennis et al. [14] evaluated that reduction of hip internal rotation of dominant side had significant association with reduction of LBI risk in male adult fast bowlers. Higher peak vertical GRF which is considered as the main contributing factor to the lumbar stress fractures among fast bowlers is associated with a small plantar angle due to increased ankle dorsiflexion and reduced hip flexion [15]. At the delivery stride, a fast bowler has to absorb a maximum GRF of nine times of the body\u0026nbsp;weight during the initial front foot landing [16]. Conversely, restriction in foot and ankle motion can be associated with prevalence of LBP [17].\u003c/p\u003e\n\u003cp\u003eWeakened quadriceps muscle strength can be lead to LBI [11]. Normally during run up phase, the generated GRF was absorbed by the knee joint and the lumbar spine and the reduction of quadriceps muscle strength resulted reduction of shock absorption on the knee joint and increased the force on the lumbar spine [18]. In contrast, a study interpreted that quadriceps muscle strength of non-dominant side was associated with LBP of young fast bowlers [11]. In fast bowlers, quadriceps and hamstrings muscles are repeatedly contracted eccentrically and concentrically through the run up phase and a peak vertical GRF and a horizontal GRF exert on the dominant side leg on delivery stride [19]. It was evident that reduced hamstring muscle strength cause LBP. When hamstrings weakened than quadriceps muscle, it resulted a downward pull of pelvis that cause hyperextension of lumbar spine. Due to the changed vertebral angle of the spine, the pressure placed on intervertebral discs was increased which would lead to LBI [20].\u003c/p\u003e\n\u003cp\u003eThere were no significant differences existed between strength of back extensor muscles with and without LBP groups in fast bowlers (mean age = 17.9 years) [21]. Some postural deficits caused by genetic factors may predispose an individual to develop the injuries of the lumbar spine, especially when young and playing a high-risk sport like cricket fast bowling [22,23].\u003c/p\u003e\n\u003cp\u003eChildren are more susceptible to overuse injuries than adults due to the effect on their immature growth cartilages and as children become more heavily involved in cricket [24].\u003c/p\u003e\n\u003cp\u003eLBP is not associated with impaired hamstring flexibility, stiffness [25] or hamstring muscle length [26]. MassoudArab et al. [27] further described that there is no significant difference in hamstring muscle length with and without sacroiliac joint dysfunction. Some controversial findings stated that lumbar disc abnormalities had an association with reduced hamstring flexibility [8].\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe findings of this study revealed that none of the general characteristics which are age, BMI, training period and bowling experience did not contribute to develop LBP symptoms among the adolescent fast bowlers aged between 15-19 years. The higher muscular strength of dominant side quadriceps muscle and non-dominant side hamstring muscle having less probability to develop LBP. Likely, the fast bowlers with higher non-dominant side ankle dorsiflexion are more prone to having LBP.\u003c/p\u003e"},{"header":"Limitations","content":"\u003cp\u003eTo the best of our knowledge, this was the first study to investigate the associated intrinsic factors to adolescent male fast bowlers\u0026rsquo; low back pain in Sri Lankan region., however there were a number of limitations. This study was limited to the male population though the game of cricket is now played more commonly by females in Sri Lanka. Further studies should be carried out to cover all areas in Sri Lanka including the Division 02 and Division 03 schools to enhance the sample size.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eBMI \u0026ndash; Body Mass Index\u003c/p\u003e\n\u003cp\u003eGRF \u0026ndash; Ground Reaction Force\u003c/p\u003e\n\u003cp\u003eLBP \u0026ndash; Low Back Pain\u003c/p\u003e\n\u003cp\u003eLBI \u0026ndash; Lower Back Injuries\u003c/p\u003e\n\u003cp\u003eNPRS \u0026ndash; Numerical Pain Rating Scale\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eEthics approval and consent to participate\u003c/h2\u003e\n\u003cp\u003eA written informed consent was obtained from all the participants and their parents and the ethical clearance was obtained from the Ethics Review Committee, Faculty of Medicine, General Sir John Kotelawala Defence University.\u003c/p\u003e\n\u003ch2\u003eConsent for publication\u003c/h2\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003ch2\u003eAvailability of data and materials\u003c/h2\u003e\n\u003cp\u003eSince the privacy of research participants may be compromised, we cannot make the information publicly available.\u003c/p\u003e\n\u003ch2\u003eCompeting interests\u003c/h2\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003ch2\u003eFunding\u003c/h2\u003e\n\u003cp\u003eNone\u003c/p\u003e\n\u003ch2\u003eAuthors' contributions\u003c/h2\u003e\n\u003cp\u003eUSJ and ADPP contributed to manuscript writing, developing study concept and design, data acquisition and data analysis; USJ, IS, DW, DM, SB and KD contributed to data acquisition. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003ch2\u003eAcknowledgements\u003c/h2\u003e\n\u003cp\u003eThe authors would like to express their sincere gratitude to the supervisor of this research Mrs. ADP Perera, Senior lecturer, Department of Physiotherapy, Faculty of Allied Health Sciences, General Sir John Kotelawala Defense University for the tremendous guidance and the support given in every step throughout the process of this study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eElliott BC. Back injuries and the fast bowler in cricket. Journal of sports sciences. 2000 Jan 1;18(12):983-91.\u003c/li\u003e\n\u003cli\u003eMathew A, Rai S, Kumar D. Low back injuries in fast bowlers: A literature review. International Journal of Allied Medical Sciences and Clinical Research. 2016;4(2):184-195.\u003c/li\u003e\n\u003cli\u003eThiagarajan KA, Parikh T. Anees Sayed Cricket Biomechanics Analysis of Skilled and Ameteur Fast Bowling Technique. Journal of Postgraduate Medicine, Education and Research. 2015:173-81.\u003c/li\u003e\n\u003cli\u003eMount S, Moore I, Ranson C. Injury types and rates in an international cricket team: Application of subsequent injury categorisation. British journal of sports medicine. 2014 Apr 1;48(7):642-.\u003c/li\u003e\n\u003cli\u003ePardiwala D, Rao N, Varshney A. Injuries in Cricket. Sports Health: A Multidisciplinary Approach. 2017;10(3):217-222.\u003c/li\u003e\n\u003cli\u003eGamage PJ, Fortington LV, Kountouris A, Finch CF. Match injuries in Sri Lankan junior cricket: A prospective, longitudinal study. Journal of science and medicine in sport. 2019 Jun 1;22(6):647-52.\u003c/li\u003e\n\u003cli\u003eForrest MR, Hebert JJ, Scott BR, Brini S, Dempsey AR. Risk factors for non-contact injury in adolescent cricket pace bowlers: a systematic review. Sports medicine. 2017 Dec 1;47(12):2603-19.\u003c/li\u003e\n\u003cli\u003eOlivier B, Stewart A, Taljaard T, Burger E, Brukner P, Orchard J, Gray J, Botha N, Mckinon W. Extrinsic and intrinsic factors associated with non-contact injury in adult pace bowlers: a systematic review protocol. JBI database of systematic reviews and implementation reports. 2015 Jan 1;13(1):3-13.\u003c/li\u003e\n\u003cli\u003eWilliams R, Binkley J, Bloch R, Goldsmith CH, Minuk T. Reliability of the modified-modified Sch\u0026ouml;ber and double inclinometer methods for measuring lumbar flexion and extension. Physical therapy. 1993 Jan 1;73(1):26-37.\u003c/li\u003e\n\u003cli\u003eFrost M, Stuckey S, Smalley LA, Dorman G. Reliability of measuring trunk motions in centimeters. Physical therapy. 1982 Oct 1;62(10):1431-7.\u003c/li\u003e\n\u003cli\u003eFoster D, John D, Elliott B, Ackland T, Fitch K. Back injuries to fast bowlers in cricket: a prospective study. British journal of sports medicine. 1989 Sep 1;23(3):150-4.\u003c/li\u003e\n\u003cli\u003eBurnett AF, Barrett CJ, Marshall RN, Elliott BC, Day RE. Three-dimensional measurement of lumbar spine kinematics for fast bowlers in cricket. Clinical Biomechanics. 1998 Dec 1;13(8):574-83.\u003c/li\u003e\n\u003cli\u003eBayne H, Elliott B, Campbell A, Alderson J. Lumbar load in adolescent fast bowlers: a prospective injury study. Journal of Science and Medicine in Sport. 2016 Feb 1;19(2):117-22.\u003c/li\u003e\n\u003cli\u003eDennis RJ, Finch CF, McIntosh AS, Elliott BC. Use of field-based tests to identify risk factors for injury to fast bowlers in cricket. British Journal of Sports Medicine. 2008 Jun 1;42(6):477-82.\u003c/li\u003e\n\u003cli\u003eWorthington P, King M, Ranson C. The influence of cricket fast bowlers\u0026rsquo; front leg technique on peak ground reaction forces. Journal of Sports Sciences. 2013 Feb 1;31(4):434-41.\u003c/li\u003e\n\u003cli\u003eKrishna SA, Alwar TK, Sayed A, Gnanavel MB, Sivaraman A. Are Indian Cricket Fast Bowlers At Risk Of Injury?-A 3d Biomechanical Investigation: 1378 Board# 53 June 1 800 AM-930 AM. Medicine \u0026amp; Science in Sports \u0026amp; Exercise. 2017 May 1;49(5S):374-5.\u003c/li\u003e\n\u003cli\u003eBrantingham JW, Gilbert JL, Shaik J, Globe G. Sagittal plane blockage of the foot, ankle and hallux and foot alignment-prevalence and association with low back pain. Journal of chiropractic medicine. 2006 Dec 1;5(4):123-7.\u003c/li\u003e\n\u003cli\u003eCai C, Kong PW. Low back and lower-limb muscle performance in male and female recreational runners with chronic low back pain. Journal of Orthopaedic \u0026amp; Sports Physical Therapy. 2015 Jun;45(6):436-43.\u003c/li\u003e\n\u003cli\u003eFeros SA. The Determinants and Development of Fast Bowling Performance in Cricket. An Internasional Perspective on Topics in Sports Medicine and Sports Injury. 2015 Sep.\u003c/li\u003e\n\u003cli\u003ede Sousa CS, de Jesus FL, Machado MB, Ferreira G, Ayres IG, de Aquino LM, Fukuda TY, Gomes-Neto M. Lower limb muscle strength in patients with low back pain: a systematic review and meta-analysis. Journal of musculoskeletal \u0026amp; neuronal interactions. 2019;19(1):69.\u003c/li\u003e\n\u003cli\u003eElliott BC, Hardcastle PH, Burnett AE, Foster DH. The influence of fast bowling and physical factors on radiologic features in high performance young fast bowlers. Research in Sports Medicine: An International Journal. 1992 Feb 1;3(2):113-30.\u003c/li\u003e\n\u003cli\u003eMillson HB, Gray J, Stretch RA, Lambert MI. Dissociation between back pain and bone stress reaction as measured by CT scan in young cricket fast bowlers. British journal of sports medicine. 2004 Oct 1;38(5):586-91.\u003c/li\u003e\n\u003cli\u003eCyron BM, Hutton WC. The fatigue strength of the lumbar neural arch in spondylolysis. The Journal of Bone and Joint Surgery. British volume. 1978 May;60(2):234-8.\u003c/li\u003e\n\u003cli\u003eHarris I. The prevalence of low back pain in cricketers\u0026ndash;An undergraduate epidemiological study. South African Journal of Physiotherapy. 1993 Nov 30;49(4):65-6.\u003c/li\u003e\n\u003cli\u003eHori M, Hasegawa H, Takasaki H. Comparisons of hamstring flexibility between individuals with and without low back pain: systematic review with meta-analysis. Physiotherapy Theory and Practice. 2019 Jul 19:1-24.\u003c/li\u003e\n\u003cli\u003eNourbakhsh MR, Arab AM. Relationship between mechanical factors and incidence of low back pain. Journal of Orthopaedic \u0026amp; Sports Physical Therapy. 2002 Sep;32(9):447-60.\u003c/li\u003e\n\u003cli\u003eMassoudArab A, RezaNourbakhsh M, Mohammadifar A. The relationship between hamstring length and gluteal muscle strength in individuals with sacroiliac joint dysfunction. Journal of Manual \u0026amp; Manipulative Therapy. 2011 Feb 1;19(1):5-10.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Intrinsic factors, Non-contact low back pain, Fast bowlers, Age 15-19 years","lastPublishedDoi":"10.21203/rs.3.rs-65463/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-65463/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective:\u003c/strong\u003e Cricket fast bowlers are identified as the greatest injury risk players who are more prone to sustain with low back pain (LBP). The current study was aimed to investigate how intrinsic factors associate with LBP among fast bowlers aged between 15-19 years. A descriptive cross-sectional study was conducted with one hundred and two (102) fast bowlers in Colombo division 1 boys’ schools in Sri Lanka. Bowlers were prospectively monitored over the competition period of 2019 cricket season and the demographic data, severity of LBP, general characteristics and intrinsic factors related data were recorded.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Thirty-seven (43.5%) of the subjects were presented with LBP. Reduction of quadriceps strength of dominant side, hamstring strength of non-dominant side and increased ankle dorsiflexion of non-dominant side were found to be significantly associated with non-contact LBP (P\u0026lt;0.05). There were significant differences for the quadriceps strength of dominant side and hamstring strength and ankle dorsiflexion of non-dominant side between the fast bowlers with and without LBP. The results indicated that reduced quadriceps muscle strength of dominant side, reduced hamstring muscle strength and high ankle dorsiflexion of non-dominant side have an important role in predisposing a fast bowler to have an increase in non-contact LBP.\u003c/p\u003e","manuscriptTitle":"Association of Intrinsic Factors with Non-contact Low Back Pain Among Fast Bowlers Aged between 15 – 19 Years in Division 1 Boys’ Schools in Colombo","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2020-10-01 14:29:13","doi":"10.21203/rs.3.rs-65463/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"767bd538-fc2b-4fb4-98ac-23760c055a8f","owner":[],"postedDate":"October 1st, 2020","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":661909,"name":"Sports Medicine and Kinesiology"},{"id":661910,"name":"Orthopedics"}],"tags":[],"updatedAt":"2020-11-02T19:17:58+00:00","versionOfRecord":[],"versionCreatedAt":"2020-10-01 14:29:13","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-65463","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-65463","identity":"rs-65463","version":["v1"]},"buildId":"ApUGefWb6u5IBVtyqm6d5","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}