Dr Peter Brukner
Peter Brukner is a specialist sports and exercise physician and the founding partner at the Olympic Park Sports Medicine Centre in Melbourne. Peter is a world renowned sports medicine clinician and researcher. He has recently been Head of Sports Medicine and Sports Science at Liverpool Football Club and is currently Team Doctor for the Australian cricket team. Peter is Professor of Sports Medicine at Latrobe University and has published widely internationally with a number of books, book chapters and over 90 original research articles. He is the co-author of several bestselling books. Peter has been team physician for Melbourne and Collingwood AFL clubs, as well as national athletics, swimming, soccer and men's hockey teams. He was an Australian Team Physician at the Atlanta Olympic Games, Team Manager of the Australian athletics team at the Sydney Olympics and a National Selector for Athletics Australia. Read more?
He was the Socceroo's Team Doctor for the 2010 World Cup campaign. In 2008 Peter was elected to the Board of Hockey Australia. His contribution to sports medicine has been recognised by the award of the inaugural Citation for Distinguished Service by the Australian College of Sports Physicians and the Citation Award of the American College of Sports Medicine. In 2006 Peter was awarded the Medal of the Order of Australia (OAM) for services to sports medicine.
LOW CARB AND HIGH PERFORMANCE
Professor Peter Brukner OAM, MBBS, FACSP
Specialist Sports and Exercise Physician
Professor of Sports Medicine, Latrobe University
Team Doctor, Australian cricket team
In recent years there has been increased interest in low carbohydrate high fat (LCHF). Diets. There is some evidence that LCHF diets may be preferable to the traditional low fat diet in relation to weight loss and lipid profile.
There has also been some interest in the use of LCHF in athletes. Prominent sports scientist and author of the runners' bible "The Lore of Running", Professor Tim Noakes from Cape Town has been a strong advocate highlighting his personal conversion from the high carbohydrate advocacy practiced by virtually all sports medicine professionals in the last thirty years.
A number of prominent athletes including tennis player Novak Djokovic, NBA players Ray Allen, Kobe Bryant, Carmelo Anthony and LeBron James, numerous endurance and ultra-endurance athletes , and closer to home, Australian cricketers Shane Watson, Mitchell Johnson and Dave Warner as well as AFL superstar Gary Ablett have proclaimed the benefits of LCHF or Paleo dieting.
For many years, nutrition professionals have been strong advocates of a diet high in complex carbohydrates as the ideal diet for the athlete with endurance athletes encouraged to have very high carbohydrate intakes. Marathon runners have traditionally carb loaded in the days prior to the event to ensure maximal glycogen stores.
The benefits of an LCHF diet in endurance and ultra-endurance sport is fairly convincing. Fat is a more efficient fuel than carbohydrate at low intensity of exercise and one's fat stores last considerably longer than carbohydrate stores. As a result there is not the need to constantly top up one's glycogen during endurance exercise. A recent example was ironman Sami Inkinnen's row across the Pacific using only fat as fuel. He smashed the previous record.
However the benefits of LCHF in higher intensity intermittent sports such as basketball and the various football codes is not as clear. It is argued that for bursts of high intensity activity, carbohydrates are a better fuel. This has led to the train low compete high philosophy when a footballer, for example, will train on a low carb diet with the aim of mobilizing his fat stores, but have an intake prior to and during matches to give him sufficient energy for those bursts of high intensity activity.
For the past two years a number of the Australian cricket team have been following a LCHF diet. They have been happy with their weight loss, energy levels and reduced appetite. I will present some of their case studies.
While the majority of young people metabolise carbohydrates well and do well on a high carbohydrate diet, there is a group who may be better suited to an LCHF approach.
Professor Arjuna De Silva
Sri Lanka Anti Doping Agency SLADA
Professor Arjuna De Silva MBBS,MD,MSc(Oxon),FRCP(Lond),FCCP is currently Chairman Sri Lanka Anti Doping Agency SLADA. He has been involved in anti doping activities for more than ten years. He was instrumental in establishing SLADA and introducing new legislation to criminalize trafficking in band substances. Sri Lanka is one of the only countries in Asia to have legislation to this effect. He is also involved in sports medicine and was Director General of Institute of sports medicine from 2011-2013. During this time he was the key medical provider for the 20/20 world cup hosted by Sri Lanka in 2012. He currently advisor to the Sri Lanka Cricket Board. Prof De Silva was the official physican to the Sri Lankan Olympic team at the London Olympics. Read more?
He is also Head of Department of Medicine Faculty of Medicine University of Kelaniya. Consultant Physician at Colombo North Teaching Hospital. Trainer in Gastroenterology and Chairman board of study in Gastroenterology. Member Board of study in Sports medicine and member board of study in medicine. Associate Editor World Journal of Gastroenterology. He has authored of One book (The role of TNF polymorphisms in IBD), two chapters (preparation for endoscopy), colonoscopy. By international publishers, published 38 papers and 100 published abstracts in international journals. One of his papers on Molicular classification of IBD has been cited 520 times.He has won many research awards including Presidential research awards 2006, 2008, 2010. Prof De Silva has delivered four orations and many lectures at national and international meetings.
Professor Mandeep S Dhillon
Post Graduate Institute of Medical Education and Research
Professor Mandeep S Dhillon is currently working as Professor Dept of Orthopaedics, Post Graduate Institute of Medical Education & Research (PGIMER). After passing his MBBS as the BEST GRADUATE OF THE UNIVERSITY, and MS (Ortho) from Medical College, Patiala, India, he moved to PGIMER, where he obtained the MNAMS and was working as Additional Professor, prior to moving to APOLLO HOSPITALS Colombo in January 2003. In Colombo, Dr Dhillon was associated with the SriLanka Cricket team for 2.5 years as a Sports Injury consultant. He is also a Visiting Professor, McMaster University, Canadal and a Visiting Professor University of Malaysia & Singapore University. Read more?
Professor Dhillon's contributions to sport science is widely recognized, appointed as honorary consultant to the Board of Control of Cricket in India, Sports Authority of India, Indian Hockey Federation, Gymnastic Federation of India, Punjab Cricket Association, and Chandigarh Lawn Tennis Association. He is also the Chairman of the Liaison Committee of the Indian Association of Sports Medicine, Member of the Scientific Committee on Sports medicine for ISAKOS, and member of the Medical Commission of the Indian Olympic Association. Professor Dhillon has a special interest in Arthroscopy, Joint replacement and Foot and Ankle problems, as well as sports related problems Since 1992, he has performed more than 2500 arthroscopic procedures, 100s of Joint replacements. More than 120 Postgraduates have been trained by him. He has more than 280 major publications, with some of his original scientific work also included in many textbooks – for example in Mercer's Textbook of Orthopaedics, and in Rockwood & Green's book on Fractures. He has also presented more than 250 papers at various conferences, and he has been awarded the best paper prize 5 times.
Emeritus Professor Bruce C. Elliott PhD, FACHPER, FISBS, FAAKPE
The University of Western Australia
Professor Elliott is a Senior Research fellow in biomechanics within the School of Sport Science, Exercise and Health at the University of Western Australia. Generally considered a world's leader in research into sport biomechanics, particularly cricket and tennis, he has co-authored 'Send the Stumps Flying: The Science of Fast Bowling' and has published over 230 refereed articles in journals, more than 30 involved cricket. He was a keynote or invited speaker at the 1st (England, 1999), 2nd (South Africa, 2003) and 4th (India, 2011) World Congresses of Science and Medicine in Cricket. Read more?
Bruce was awarded the inaugural Australian Sport Commission, National Sport Medicine Research Award in 1992 for work into back injuries and the cricket fast bowler. He organised the applied research Projects at the Sydney 2000 Olympics, and is a past president (2003-2005) of the International Society of Biomechanics in Sports. In 1999 he was honoured with the Award of Merit by the Western Australian Sports Federation and in 2003 the Australian Governemt awarded him their Centenary Medal for 'service to sport policy and research development for sport'.
THE BACK BREAKS BEFORE THE WICKET: THE HISTORY OF LUMBAR MECHANICS AND BACK INJURY - THE UWA JOURNEY
Bruce Elliott1, Jacqueline Alderson1 & Helen Bayne2
1The School of Sport Science, Exercise and Health, The University of Western Australia, Perth, Australia
2The High Performance Centre, University of Pretoria, South Africa
It all started with Dennis Lillee and his breakdown with multiple lumbar fractures in the 1970s. As part of the team that rehabilitated his back, thus enabling his successful return to test cricket, my appetite for lumbar injury research was 'wetted'. However, the real desire to 'make a difference' and discover the aetiology of the debilitating lumbar injury was created by the spate of lumbar fractures to talented adolescent fast bowlers in the 1980s.
LUMBAR INJURIES AND THE CRICKET FAST BOWLER
The journey was to be oh so simple! Injuries were logically linked to differences in side-on (SO) and front-on (FO) bowling, with the FO bowlers suffering a higher incidence of injury. The analysis of four Australian fast bowlers showed differences in kinematics and similarities in the ground reaction force at front foot impact (FFI), however, no link to lumbar injuries was evident (Elliott & Foster, 1984). The journey had begun! A prospective study was then completed that tracked 82 adolescent fast bowlers over a season (Foster et al., 1989). Thirty-eight percent of bowlers sustained a lumbar injury; 11% a lumbar stress fracture (bony injury) and 27% a soft tissue injury. The three bowling characteristics listed below were linked to those who sustained a bony injury:
- Counter rotation of the shoulder alignment (SCR) (40° bony injury vs 16° non injured)
- A greater ball release height
- Excessive bowling
A series of studies then followed that investigated the association between these variables and lumbar disc degeneration, as monitored using magnetic resonance imaging (Elliott et al., 1992, 1993). Again SCR was associated with high levels of disc degeneration. Burnett et al. (1996) further showed that if this SCR and a new bowling category - the mixed action were not remediated, then the incidence of lumbar disc degeneration would increase.
- 21% at ~14 years of age increased to 58% at ~17 years with no intervention.
The progression of disc degeneration was significantly related to those bowlers displaying levels of SCR ≥30° at both testing sessions. Elliott and Khangure (2002) showed that you were able to both reduce SCR in a three year intervention study and this change was paralleled by a significant reduction in the progression of lumbar disc degeneration.
This research never directly associated SCR with increased lumbar load leading to an increase in bony or disc abnormalities. SCR was simply identified as an observable movement characteristic 'correlated' with degeneration that could be addressed with technique modification.
Was part of the answer then 'fatigue' with bowlers modifying their SO or FO techniques and increasing their SCR as a spell progressed (Burnett et al., 1995)? No, results were similar for 12 overs. There was some evidence that FO bowlers increased the level of SCR - they became more' mixed' in their action. Pitch length was also shown to have minimal effect on SCR, as bowlers from a variety of age classifications bowled with a similar shoulder rotation over pitch lengths of (16 m, 18 m and 20.1 m)(Elliott et al., 2005).
Reviews were written (Bartlett et., 1996; Elliott, 2000) and a book (Elliott et al., 1989) produced to disseminate knowledge, so that coaches and other sport scientists were conversant with the current scientific literature. A number of technical papers followed that in some way 'backtracked' to validate previous procedures and compare bowling techniques. The comparison of shoulder alignment in 2D from an overhead video camera and a 3D calculation (6 camera retro-reflective Vicon) both projected onto the transverse plane showed a strong association at back foot impact (BFI) and FFI, but not at ball release (BR)(Elliott et al., 2002). Lumbar spinal movement for different bowling classifications were analysed using a 3D electromagnetic Fastrack device (Burnett et al., 1998). Typically the mixed compared with FO and SO techniques showed:
- Greater lateral flexion and a more extended spine at FFI
- A greater range of motion and angular velocity of the trunk about the lateral flexion and flexion/extension axes
Ranson et al. (2008), while showing SCR was high, was not able to confirm the above results in a study examining 50 professional bowlers. The authors did however; highlight the extreme range of lumbar lateral flexion experienced during fast bowling. In an effort to reduce SCR a harness was used during practice, however, no benefit was observed once the harness was removed (Wallis et al., 2002).
By the end of the first decade of the 21st Century, lumbar injuries and concerns over bowling technique remained. Ferdinands et al. (2010) and Portus et al. (2014 - for adolescents) showed that SCR was still an issue and it was found that lumbar radiological abnormalities were still extremely high amongst adolescent bowlers (Crewe et al., 2012a).
Since the start of biomechanical research on fast bowlers, approaches to discover the aetiology of lumbar injuries has become more sophisticated. Portus et al. (2004) used a rig to better analyse lumbar mechanics, while Ferdinands et al. (2009) in analysing lumbar segment kinetics reported that loads were greatest immediately after FFI and that there was significant chance of injury when the spine was positioned near its end range of motion. Further progress was made when Crewe et al. (2013b, see figure) was able to develop a lumbar model and test its sensitivity to inertial body segment parameter variations. This model was then used to test lumbo-pelvic loading during fast bowling (Crewe at al., 2012b) and augment the earlier work of Engstrom et al. (2007) on quadratus lumborum muscle imbalance. Bowlers with ≥10% difference in quadratus lumborum asymmetry (26 of 39 bowlers) experienced larger lumbo-pelvic lateral flexion (peak angle, moment and power) compared with bowlers with ≤10% difference (Crewe et al., 2013a). In a prospective study that examined musculoskeletal factors, bowling technique and lumbar load the following variables were identified as being key to the aetiology of lumbar injury (Bayne et al., 2014).
- Greater flexion and lateral flexion lumbar moments • Increased lateral flexion at FFI and BR
- Pelvic alignment beyond FO at BR
- Front hip flexion at FFI
- Reduced trunk extensor muscle endurance
- Core' control, based on a lumbar-pelvic stability test and single leg squat
Halley et al. (2014) attempted to affect change in these technique factors via a coaching intervention and were successful in those bowlers who initially displayed dangerously high levels in these measures.
The level of radiological abnormalities and injuries in general to the lumbar spine is still a major concern to bowlers, coaches and administrators. The message has not yet fully reached coaches, particularly those dealing with adolescents. While SCR still must be addressed it is imperative for coaches to:
- Reduce the level of trunk lateral flexion from FFI to BR
- Increase pelvic and 'core' strength and control,
- Manage workload - although not a focus of this paper, the research of Rebecca Dennis should be read
Remember to consider the whole body when making technical changes because of the mechanical interaction between segments (Ferdinands et al., 2009).
Bartlett, R., Stockill, N., Elliott, B. & Burnett, A. The biomechanics of fast bowling in men's cricket: A review. J of Sports Sciences, 14: 403-424, 1996.
Bayne, H., Elliott, B., Campbell, A. & Alderson. J. Lumbar load in adolescent fast bowlers: a prospective study. 2014 – In review.
Burnett, A., Elliott, B. & R. Marshall. The effect of a 12-over spell on fast bowling technique in cricket. J of Sports Sciences, 13(4): 329-341, 1995.
Burnett, A., Khangure, M., Elliott, B., Foster, D., Marshall, R. & Hardcastle, P. Thoracolumbar disc degeneration in young fast bowlers in cricket: a follow-up study. Clinical Biomechanics, 11(6): 305-310, 1996.
Burnett, A., Barrett, C., Marshall, R., Elliott, B. & Day, R. Three-dimensional measurement of lumbar spine kinematics for fast bowlers in cricket. Clinical Biomechanics, 13(8), 574-583, 1998.
Crewe, H., Elliott, B., Couanis, G., Campbell, A. & Alderson, J. The lumbar spine of the young fast bowler: An MRI study. J of Science and Medicine in Sport, 15(3): 190-194, 2012a.
Crewe, H., Campbell, A., Elliott, B. & Alderson. J. Lumbo-pelvic loading during fast bowling in adolescent cricketers: The influence of bowling speed and technique, . J of Sports Sciences, 31(10): 1082-1090, 2012b.
Crewe, H., Campbell, A., Elliott, B. & Alderson, J. Lumbo-pelvic biomechanics and quadratus lumborum asymmetry in cricket fast bowlers. Medicine and Science in Sport and Exercise, 45(4): 778-783,2013a.
Crewe, H., Campbell, A., Elliott, B. & Alderson. J. Kinetic sensitivity of a new lumbo-pelvic model to variation in segment parameter input. J of Applied Biomechanics, 29(3): 354-359, 2013B.
Elliott, B. & Foster, D. A biomechanical analysis of the front on and side on fast bowling techniques. J of Human Movement Studies, 10 (2): 83 94, 1984.
Elliott, B., Foster, D. & Blanksby, B. (Eds). Send The Stumps Flying, University of WA Press, 1989.
Elliott, B., Hardcastle, P., Burnett, A. & Foster, D. The influence of fast bowling and physical factors on radiological features in high performance young fast bowlers. Sports Training Medicine and Rehabilitation. 3: 113-130, 1992.
Elliott, B., Davis, J., Khangure, M., Hardcastle, P. & Foster, D. Disc degeneration and the young fast bowler in cricket. Clinical Biomechanics, 8(5): 227-234, 1993.
Elliott, B.C., Back injuries and the fast bowler in cricket. J of Sports Sciences, 18 (12), 983-991, 2000.
Elliott, B. & Khangure, M. Disc degeneration and the cricket fast bowler: an intervention study. Medicine and Science in Sport and Exercise, 34(11): 1714-1718, 2002.
Elliott, B., Wallis, R., Sakurai, S., Lloyd, D. & Besier, T. The measurement of shoulder alignment in cricket fast bowling. J of Sports Sciences, 20: 507-510, 2002.
Elliott, B., Plunkett, D. & Alderson, J. The effect of altered pitch length on performance and technique in junior fast bowlers. J of Sports Sciences, 23(7): 661-667, 2005.
Foster, D., John, D., Elliott, B., Ackland, T. & Fitch, K. Back injuries to fast bowlers in cricket: A prospective study, British J of Sports Medicine, 23(3): 150 - 154, 1989.
Halley, J., Cottam, D., Foster, D. & Alderson, J. Technique modification via coaching intervention: the key to reducing lumbar injury risk in adolescent cricket fast bowlers? Honours thesis, The University of Western Australia, 2015.
Portus, M., Mason. B., Elliott, B., Pfitzer, M. & Done, R. Technique factors related to ball release speed and trunk injuries in high performance cricket fast bowlers. Sports Biomechanics, 3 (2): 263-284, 2004.
Portus, M., Farhart, P., Elliott, B., Galloway, H., Orchard, J., Lloyd, D. & Heazlewood, I. Fast bowling biomechanics and lumbar spine injuries: a dual cohort prospective study. In preparation, 2014.
Wallis, R., Elliott, B. & Koh, M. The effect of a fast bowling harness in cricket: an intervention study. J of Sports Sciences, 20: 495-506, 2002.
REFERENCES - Other seminal papers
Engstrom, C., Walker, D., Kippers, V. & Mehnert, A. Quadratus lumborum asymmetry and L4 pars injury in fast bowlers: a prospective study. Medicine and Science in Sports and Exercise, 39(6): 910-917, 2007.
Ferdinands, R., Kersting, U. & Marshall, R. Three-dimensional lumbar segment kinetics of fast bowling in cricket. J of Biomechanics, 42(11), 1616-1621, 2009.
Ferdinands, R., Kersting, U., Marshall, R. & Stuelcken, M. Distribution of modern cricket bowling actions in New Zealand. European J of Sports Science, 10(3), 179-190, 2010.
Ranson, C., Burnett, C., King, M., Patel, N.& O'Sullivan, P. The relationship between bowling action classification and three-dimensional lower trunk motion in fast bowlers in cricket. J of Sports Sciences, 26(3): 267-276, 2008.
Dr Edouard René Ferdinands - Convenor
The University of Sydney
Dr. René Ferdinands heads the cricket biomechanics research program at the University of Sydney, where he is currently analyzing the techniques of fast bowling, spin bowling and batting using motion analysis technology, and human mechanics models based kinematics and analytic dynamics. He has published numerous research articles on cricket science in peer reviewed journals, as well holding various editorial positions. Dr. Ferdinands was the Chief Editor of Cricket Coaching Service for CoachesInfo.Com from 2004 - 2013, an online resource that was designed to deliver the latest information and education to sports practitioners throughout the world. He is currently editing a Special Cricket Technology edition for Sports Technology, a peer-reviewed scientific journal that advances the latest innovations in sports technology. Read more?
His research focuses on all aspects of cricket biomechanics, with some notable publications on lumbar mechanics in fast bowlers, bowling classification taxonomy, bowling segmental sequencing and bowling legality. He has also investigated the mechanics of footwork in batting against fast bowlers. In addition, Dr. Ferdinands' research was an important factor in the development of the current ICC bowling legality measures. Furthermore, Dr. Ferdinands is a professional cricket coach, operating as an international consultant, assisting elite cricketers throughout the world improve their performances. A former first-class cricketer with over 20 years of coaching experience, Dr. Ferdinands has worked with various cricket organisations, including the Indian National Cricket Academy (N.C.A., Bangalore), New Zealand Cricket, Sri Lanka Cricket, and The Victorian Cricket School (VCS). He also works as a professional coach within Sydney, formerly working as the technical bowling coach at the Western Suburbs District Cricket Club (Sydney Grade Level).
John Orchard is a sports and exercise physician and researcher based in Sydney. He is the Chief Medical Officer for the Cricket World Cup 2015 and currently team doctor for Cricket NSW (a position held since 2008). He has been team doctor for the Australian cricket team on 3 overseas tours to India (2007) the West Indies (2010) and England (2012). He also has many years of experience with football teams including Sydney Roosters (NRL), Sydney Swans (AFL) and the NSW State of Origin team. He has a PhD in sports injury epidemiology from the UNSW (1999), an MD by thesis from the University of Melbourne (2006), and has published over 100 scientific papers. His clinic practice is at the University of Sydney where he also holds an Adjunct Associate Professor position with the School of Public Health. He is an editorial board member for the British Journal of Sports Medicine and the American Journal of Sports Medicine.