Cricket is a worldwide sport performed in a variety of countries that were former British colonies and it is played and appreciated by athletes. Bowlers and fielders who must often toss the ball during practices are particular to overexposure pains. Cricket is a popular sport that requires a lot of physical fitness and strategy^.[1]

Cricket is generally considered to be a low injury-risk sport compared with other sports. In cricket, the fast bowler , strives towards adopting a bowling technique that will allow for a fast and accurate delivery to the opposing batsman , however of all the various roles of the cricketer the fast bowler has the highest risk of injury and is specifically at risk of lower back and lower limb (low quarter) injury due to the high load, biomechanical nature of the fast bowling action.^[1]

Cricket is played on a rectangular field centered on an oval field with 11 players on a team.

Each includes Batsmen, Bowlers, fielders, and a wicket keeper. Hit the stumps 22

Yards/20.12m in length and 10ft or 3.05m in width it is bounded at either end by the bowling creases and on either side by imaginery lines one each side of the imaginery lines joining the centres of the two stumps (20 away from the ground using a round-arm extended elbow. With the ball usually bouncing before being hit by the batsmen a special wooden bat, the batsmen hit the ball and score runs, Fielders, including the wicket keeper behind the stumps, runs from being scored and to get the batsmen out^.[1]

Four action categories are commonly used to classify fast bowling actions: side-on, front-foot on, semi-open, and mixed. Despite the increased risk of injury among young fast bowlers, particularly to the low back, as a result, over use and impact injuries are more prevalent. The fast-bowling action commence after the ball handout, front foot contact follow. Fast bowling movement can be broadly separate into one of four action type, shoulder counter rotation is defined as the change in the shoulder alignment tilt in a relatively front –on alignment at back foot contact to the frequent shoulder alignment during the delivery stride^.[1]

Despite cricket being a noncontact sport, overuse and impact injuries are common, players of physical activities, including running, throwing, batting, catching, jumping and diving. Significant or match time-loss cricket injury is one that either prevents a player from being fully available for selection. While fielding, ankle sprain during bowling run-up, rectus tear during sudden evasive action during batting), impact/traumatic injury^.[2]

The bowler is more vulnerable to injury due to a mix of internal and external causes. Extrinsic variables are known to increase the Bowlers risk of injury, particular when intrinsic factors are present. Muscle strength, flexibility, balance and bio-mechanics are examples of intrinsic or person-related, characteristics. The fast bowlers within the game attempt to deliver the ball as fast as possible towards a batter to reduce their time and to interpret the delivery and play appropriate delivery stroke. The bowling movement consists of a run-up where linear momentum is developed which is then converted to angular momentum and transferred through the trunk and upper extremity to the ball during the bowling action^.[3].

Ankle instability refers to a condition characterized by repeated episodes of the ankle giving way or feeling unstable, often resulting from a previous ankle sprain or injury, Ankle instability can make individuals vulnerable to low back pain. To overcome ankle instability, leg and hip muscles are being stretched out at place. Which may result in overload support leading to lower back pain. The most common cause of ankle instability is a previous ankle sprain, particularly a lateral ankle sprain, which damages the ligaments that support the ankle joint. Individuals with ankle instability may experience symptoms such as an impaired sensation (burning , tingling sensations) of the ankle^[4].

Although spine and ankle seem like a distant region of the body, they are functionally connected by lower extremity kinematic chain which indeed acts as a transformer that will transfer the amount of load. Due to excessive hip lateral rotation and excessive pronation of the foot on the same side of the unilateral low back pain suggested a possible connection between low back symptoms, hip and lower extremity dysfunction. Ankle instability can make individuals vulnerable to low back pain. To overcome ankle instability, leg and hip muscles are being stretched out at place. Which may result in overload support leading to lower back pain^.[4,5].

Bowling in cricket involves a run-up and the circumduction of a straight arm about the glenohumeral joint to propel a leather ball of 155.9–163.0 g at a batter, who stands some distance away (approximately 17–18 m or 22 yards) . Biomechanics of fast bowling can be divided into 2 distinct phases: the run-up and delivery stride that includes predelivery stride^.[6]

In the legal delivery of a fast ball, large ground reaction forces are produced first by the back foot contact with the ground and second by the front foot contact with the ground^.[6]

 It suggested that a large initial peak ground reaction force during front foot contact, together with lateral flexion, hyperextension, and rotation of the lower back, could be a major cause of lower back injuries^.[6]

The momentum can be transferred through the delivery stride and body to the ball, it does not put the bowler at undue risk of injury because of excessively higher impact forces caused by an increased run-up velocity.  

Although there should be a focus on core conditioning for all fast bowlers as their trunk must flex, extend, laterally flex, and rotate, it would seem logical to have a major concentration on strengthening and therefore supporting the lower back region of the bowlers who use the mixed action. It is understood that the mixed action bowling group is more prone to injury and specifically lower back injury. A large percentage of bowling injuries involved the back (26.3%) or the lower limbs (14%).^[6]

To aid in the evaluation of fast bowling technique three dimensional-kinematics and ground reaction force characteristics were estimated. With the effect of combination of various aspects of fast bowling technique on ball release speed and ground reaction force in particular. A three dimensional full-body inverse dynamics be allowing for the estimation of forces in the lower back and their correlation between bowling techniques^.[6]

In the front foot contact phase of the bowling activity, each bowler stimulates six the velocity deliveries, striking the force plate with their front foot contact. In each bowler, the three fastest deliveries-with the minimal marker loss were checked. In fast bowler a particular techniques parameter has been found that the optimal movement pattern for maximizing ball release speed these include faster run-up speeds, a longer front leg, increased trunk flexion and a longer duration circumduction arm measurement^.[6]

The analysis was customised for each bowler using subject specific segmental properties.

Parameters were drawn that describe elements of fast bowling technique as well as the ground reaction forces. Using linear regression, the effect of these three parameters in ball release velocity peak ground reaction force and peak forces in the lower back were checked. The fastest bowlers had a quicker run-up and maintained a straighter front knee throughout the front foot contact phase of the bowling^.[6]

The fastest bowlers also display experience in thoracic flexion, between front foot contact and ball release, and to delay the onset of upper arm circumduction.74% of the ball release equal variations were explained by the four aspects of technique. On addition to lower peak loading rate fast ball release speeds were associated with a great braking impulse between front foot contact and ball actions. This shows that the peak ground reaction forces and peak forces in the lower back are determined by an initial direction of the front leg at the circumduction of the foot and high ground reaction forces are associated with the delivery phase of the bowling action^.[6] .

The professional cricket fast bowlers are highly prone to low back pain(LBP) due to the repetitive high impact forces and extreme spinal movements involved in the bowling action, this could be due to fast bowlers often extend and rotate their lumbar spine aggressively during the delivery stride. During the front foot contact phase of bowling, ground reaction forces can exceed 8-10 times body weight by placing significant strain on the lumbar spine. The bowlers with a mixed bowling action (combining front -on and side-on techniques) are at higher risk due to excessive lateral flexion and rotation, leading to structural overload. The fast bowler action involves a run-up and straight-arm movement, leading to extreme lumbar motions and torques in the presence of ground reaction forces^[9].

Ankle instability can lead to proprioceptive deficits (awareness of joint position) which can affect balance and coordination during the bowler’s approach and delivery, this can result in reduced accuracy, inconsistent pace and increased injury risk. Fast bowlers often face recurrent ankle sprains due to the high stresses placed on their ankles. Chronic instability can lead to functional impairments and increased injury susceptibility particularly in the ankle and lower back^[10].

The Cricket fast bowlers during the delivery stride, fast bowlers experience significant ground reaction forces upon front-foot landing. This repetitive high impact can lead to ligamentous injuries and chances of leading, the bowling action often requires forced plantar flexion, which can cause compression at the back of the ankle joint. This may result in posterior ankle impingement syndrome characterized by pain and reduced range of motion, contributing to ankle instability, the dynamic movements and sudden directional changes inherent in fast bowling increase the risk of ankle sprains. Recurrent sprains can weaken the supporting structures of the ankle, leading to chronic ankle instability^[12].

The dynamic stability test (Star Excursion Balance Test) was used to assess ankle instability, this test was divided further into posterolateral, posteromedial and anterior parts and bowlers were asked to reach as far as can in all aforementioned directions and touch a specific point without shift of wait to other leg. After a maximum reach in that specific direction, bowler was to reach back to double stance without altering the base of support. The termination of test upon failed returning to starting position, reaching limb touched down, moved or lifted stance foot or unilateral stance. True length was measured from lateral malleolus distal end to anterior superior iliac spine. The scoring of each score was done by entering reach value in centimetres. Combined reach score was average of reach scores in all directions^[12].

Low back pain is a prevalent condition especially among athletes engaged in high -impact sports like cricket. LBP typically arises due to the repetitive strain placed on the lumbar spine, leading to muscle fatigue and ligamentous stress and potential injury. Fast bowlers experience intense biomechanical stress during each delivery, with their low back often subjected to forces that can lead to acute injuries or chronic pain over a period of time, the bowling action including significant torque, flexion and extension of the lumbar spine makes the lower back vulnerable, which develops over time due to the effect of repetitive stress on the spine^[13].

The lumbar region is especially vulnerable to injury because of the combined torque and axial load generated during the delivery phase. The high velocity and intensity of the bowling action require exceptional core strength, balance and stability if any of these factors are deficient such as due to weak core muscles or ankle instability, there leads to low back pain. Combining the postural action of ipsilateral spinal rotation, contralateral flexion and lumbar extension contributes to lower back injury during the delivery strike^[13].

The Oswestry Disability Index (ODI) was the scales being used to assess the low back pain. It consists of 10 items representing different aspects (eg, pain intensity, physical functioning, sleep functioning, social functioning). Each item was assessed on a six level ordinal scale with ‘0’ describing no limitation and 5 describing extreme limitation or an inability to function a score of 0% represents the highest possible level of functioning and independence, where a score of 100% represents the lowest possible level of functioning with dependence. The total score of ODI is calculated by adding all scores of applicable items, dividing the obtained score by the total maximal total score, and by multiplying the result by hundred to obtain a percentage score^[14]