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A responsibility to shoulder
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Keep rotator cuff injuries at arm's length by timely attention and physiotherapy.
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ROTATOR CUFF injuries are notorious for putting bowlers out of action for months together, but they also affect the elderly who have never bowled a ball in all their lives. The rotator cuff is a `musculotendinous' band that links shoulder muscle tendons to the top of the humerus-the arm bone. Overuse as in the case of Anil Kumble, for whom sending down 40 overs - all in a day's work, is the chief cause of rotator cuff injuries in sportspersons.
The first warning signs are vague shoulder pains that are more noticeable at night, especially while lying on the affected shoulder. Medical attention at this stage prevents more serious, incapacitating tears, but few bowlers see a doctor at this stage.
In today's tough and competitive sporting culture, crying off from training or pulling out of a match because of a "shoulder niggle" can result in a player's commitment being called into question. But playing through the pain causes more long-term harm than short-term good.
Progressing down the scale, rotator cuff symptoms include locking of the shoulder while lifting the arm sideways and an inability to swing the arm high in a marching motion. Partial cuff tears weaken sideways shoulder actions, and complete tears prevent sideways arm lifting beyond 90 degrees. Shoulder joint overuse is common in sports and it is very difficult to prevent these injuries in athletes. What many bowlers consider to be a normal quota of overs in fact causes minute tears of the cuff every day. This is why rotator cuff injuries creep up on so many bowlers who believe they are not over-bowling.
The most important elements of treatment are rest and withdrawal from activities that caused the injury in the first place. Tendons heal very slowly, and they never really regain their pre-injury strength. Sportspersons must rethink their role on the field. The over-worked bowler will probably have to bowl less and focus more on batting if he is to have a really long career. A shoulder sling rests the joint properly in the early stages, and painkillers and warm compresses lessen discomfort. But prolonged rest can result in a "frozen" shoulder and is not advisable. Early physiotherapy under medical supervision helps maintain the shoulder's normal range of motion during convalescence. Steroid and local anaesthetic injects into the joint lessen inflammation and swelling, but chronic cases may require surgery.
Complete tears usually require surgery, but it can be avoided in the above-75s who can get by without full-range shoulder function. The road to recovery after a rotator cuff repair operation is a long and frustrating one, and relapses are common, but a rotator cuff tear need not mean the end of a sporting career. In that sense, Kumble's career is both a warning as well a beacon of hope.
RAJIV M.
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