Enhancing Lumbar Stability in Fast Bowlers through Advanced Physiotherapy Intervention Focused on the Multifidus Muscle: A Case Report

Abstract

Introduction: Fast bowlers are highly susceptible to overuse injuries, with lumbar spine problems being the most common. While 8% of cricket players experience low back pain, the incidence rises to 14% in fast bowlers, with lumbar instability affecting up to 57% of individuals with chronic low back pain (CLBP). This case report aimed to evaluate the combined effect of lumbar Sustained Natural Apophyseal Glides (SNAGs) and core stabilization exercises on lumbar stability, pain, and multifidus muscle thickness. Case Description: A 27-year-old male fast bowler with over eight years of bowling experience and a two-time state-level cricket player. The athlete regularly attended daily training sessions at a cricket academy, including intensive bowling practice, and reported persistent low back pain following training and matches, along with frequent episodes of a sudden jerking sensation in the lumbar region during the bowling action. Intervention: A six-week program combining conventional core stabilization exercises with lumbar SNAGs was administered after informed consent. Outcomes: Post-intervention assessments using the Oswestry Disability Index (ODI), Prone Lumbar Extension Test (PLET), and rehabilitative ultrasound imaging showed marked improvements. The ODI score reduced from 35.5% to 11.1% (68.7% improvement). Multifidus resting thickness increased from 6.2 mm to 8.3 mm, and contraction thickness rose from 7.2 mm to 9.2 mm, though percentage change during contraction declined (16.13% to 10.84%). PLET changed from positive to negative. Conclusion: In conclusion, the integration of SNAG manual therapy and targeted core stabilization exercises in this preventive intervention program showed simple and effective in improving lumbar stability, reducing disability, and enhancing multifidus muscle function.