Injuries Associated With Tenpin Bowling

Tenpin bowling is an indoor sport in which a player scores points by striking down as many pins as possible with a bowling ball rolled along a wooden or polyurethane lane. According to an estimate, more individuals play bowling than any other sports; with the notable exception of football. Also, bowling is considered to have more registered players than any other competitive sport. The governing body for bowling, FIQ (Fédération Internationale des Quilleurs) has been pushing for Olympic recognition for the game.

Many theories abound regarding the origin of bowling. According to some, the beginning of bowling dates back millennia. In 1930, the British anthropologist, Sir Flinders Petrie, while excavating a grave in Egypt, found objects similar to bowling balls and bowling pins.

Others are of the opinion that bowling originated in Germany about 1700 years ago. Kegal, as it was then called in Germany, was played using 9 pins as opposed to 10 pins used in the modern game. The first textual reference to bowling comes from Britain. King Edward III, in 1366, supposedly banned his soldiers from participating in the game since it proved to be a major source of distraction for their duties.

Bowling in America was introduced by the Germans, the Dutch, and the English. The Germans were, however, mainly responsible for the rise in popularity of the sports in and around the American Civil War.

The immediate post-Second World War era is considered to be the ‘golden age’ of bowling. Immense rise in popularity was witnessed during these years. For the first time, the game came to be seen as one to be played and enjoyed by the masses. Introduction of technology in the form of semi and fully automatic pinspotters during this time was also a contributing factor. Introduction of television lead to increased popularity of all sports; bowling was no exception. In the 1980s, computerised systems made scoring simpler and the game more enjoyable. More recently, recognising the importance of family entertainment centres, bowling alleys are being constructed as parts of leisure centres and shopping malls. Electronic versions of the game including PlayStation, Jamdat, and Brunswick Circuit Pro, to name a few, are further adding to the popularity of the sport.

Types of Injuries and the associated mechanisms

Although, bowling is not a contact sport, it has its shares of injury risks. Injuries due to chronic repetitive stress as well as faulty techniques can cause injuries in bowling. Use of a ball which is too heavy can also, over time, cause injuries. Repetitive lateral flexion, twisting, extensions as well as tremendous ground reaction forces acting on the lower back and knee, in particular are causes of concern. Since, overuse injuries are more common in bowling, the number of times an individual bowls per week assumes significance. Keeping track of the work load can help competitive athletes peak at the right moments for an important tournament.

Acute injuries like back, leg or arm injury due to a fall during approach, hand or parts of the body getting caught in the ball retriever, as well as wrist and finger dislocation or sprains due to fingers getting caught in the holes of the ball are quite common place.

Anatomical Sites of Injury

More often than not, injuries in bowling involve the upper extremity, chiefly fingers, wrists, elbow and shoulder. However, knee and lower back injuries are a common occurrence as well. Occasionally, injuries due to fall can occur, especially in novice players and involve a variety of anatomical sites.

Upper Extremity

Finger sprain

These are caused due to damage to the ligaments due to movements in excess of that allowed at a particular joint. Symptoms involve swelling, pain during movement, restriction of movement and in severe cases, instability of the joint.

Thumb sprain

Similar to finger sprains, symptoms include pain and swelling over the base of the joint, pain on movement and in the webbing between the thumb and the forefinger. Severe cases are characterised by instability of joint. Treatment involves usual application of the RICE principle. Early mobilisation during rehab is usually warranted. Injuries with instability either occurring acutely or as a residual component require surgical intervention.

Carpal tunnel syndrome

Repetitive activity as well as trauma or fractures which reduce the space in the carpal tunnel formed by the wrist bones on beneath and a band of fibrous tissue over it can cause Carpal tunnel syndrome. Impingement of the median nerve is immediate cause of the syndrome. It is characterised by tingling numbness with weakness or pain over the hand or fingers. Some authorities suggest worsening of symptoms nocturnally. Diagnosis is usually clinical but an EMG study can confirm the diagnosis.

Biceps tendinopathy

‘Biceps tendinopathy’ is a general term used to describe a variety of injuries involving the tendon of origin of the biceps. As the names suggest, tendinitis and peritendinitis involves inflammation of the tendon or tendinous sheath. Chronic micro trauma due to repetitive nature of activity with minimal rest is mainly responsible. Degenerative change in the tendon is referred to as tendinosis whereas degenerative changed over a bony prominence due to repetitive movement of a tendon is called tenosynovistis.

Pain over the bicipetal groove (front of the shoulder) radiating down to the elbow, which increases in intensity on shoulder flexion, elbow flexion or forearm supination (actions of biceps) is the hallmark of diagnosis of bicipetal tendinopathy. Seldom seen as a single entity, it usually accompanies injuries of the shoulder such as a rotator cuff tear.

Modality of treatment specific to this type of injury involves scapular stabilisation. Strengthening of trapezius, serratus anterior muscle and latissimus dorsi is usually advocated. Correction of posture with conscious efforts of ‘pinching’ the shoulder blades together as well as use of posture braces forms an important part of treatment.

De Quervain’s tenosynovistis

Pain over the thumb side of the wrist, with or without swelling, and presence of crepitus is diagnostic of the condition.

Inflammation due to repetitive movement of tendons of two small muscles of the thumb, Abductor Pollicis Longus (APL) and Extensor Pollicis Brevis (EPB), over the lower part of radius bone leads to this condition. Holding the heavy ball, wringing as well as pinching, over a period of time, is thought to be the cause de Quervain’s tenosynovistis. Previous injury with subsequent scar tissue at the site as well as a generalised disease like arthritis also contributes to the aetiology of the condition.

Along with routine treatment, use of a thumb spica splint is considered important in rehabilitation.

Lower extremity

Ankle sprains

Sudden change of direction, twisting, improper landing and falls; with the ankle joint bearing most of the brunt causes ankle sprains. Pain, bruising swelling, bleeding into the joint and varying grades of rupture of the supporting ligaments can occur. In severe cases, bones may be involved.

Most commonly, the lateral ligament (on the outer aspect of the joint) is injured. Inversion sprains are considered to be responsible. However, deltoid ligament sprains (on the inner side of the joint) can also occur.

An important aspect of rehabilitation of ankle injury is the use of wobble boards or trampoline to improve balance and proprioception.

Knee joint ligaments injuries

Similar to the ankle joint, sudden change in direction, twisting and improper landing can lead to injuries to the knee joint. Most commonly involved structures are the ligaments of the knee joint, namely, the cruciates, the menisci or the collaterals.

Pain, bruising, swelling and instability of the joint are the usual features. Depending on the grade of injury, healing may require between four to twelve weeks. Use of knee braces forms an important part of rehab of knee ligament injuries. Sever grades of injury may require surgical reconstruction of structures.

Patello-femoral Syndrome

During ball release, the body balances on the front leg with flexed knee. In addition, there is twisting of the trunk to the same side. At this moment tremendous ground reaction forces act on the front knee. Such stress over time can cause patello-femoral syndrome. Chronic bearing of body weight on a semi-flexed knee with resultant grinding of the patella over the femoral bone and subsequent inflammation is considered to cause the condition. Symptoms include gradually increasing pain in the front of the knee, typically felt while climbing a flight of stairs. Over period of time, simple activities like sitting in a chair, kneeling and jogging causes pain.

Faulty foot structure as well as mal-alignment of the leg can also cause the syndrome.

Important aspects of rehabilitation include VMO and glutes strengthening, use of braces to strengthen surrounding structures and orthotics to correct structural abnormalities, if any.

Shoulder injuries

The shoulder goes through various movements during different stages of bowling. In the cocking phase, before delivery of the ball, abduction, posterior flexion and external rotation occurs. During release, there is forceful adduction with forward flexion and internal rotation which is followed by sweeping of the arm across the chest during follow through. This multitude of actions can cause shoulder ligaments tears, impingement syndromes (involving tendons of the rotator cuff or biceps), etc.

Lower back

Injuries affecting the lower back in bowling can be due to muscle fatigue, undue and sudden stretching of stiffened muscles, improper techniques of bowling and repetitive trauma with minimal strengthening program and rest.

In addition, muscle strains or spasms involving the quadriceps, hamstrings or the adductor group of muscles can also occur.

Preventive Measure for Injuries in Bowling

A general plan for staying free from injuries in bowling should involve:

Use of proper technique: inputs from your coach to improve technique and reduce injury risks

Designing and implementation of a fitness regimen: Strengthening of musculature and supporting structures forms the first line in the prevention of injuries. Particular emphasis on finger and wrist strength as well as muscles specific to bowling like quadriceps, hamstrings, and adductors is called for. Flexibility training for the back, legs, arms and wrists is as important, if not more, as resistance training. Additionally, cardiovascular fitness training is recommended for a minimum of 3 days a week

Warm up: for up to 20 minutes, include cardio work or calisthenics (exercises using body weight). This gets the blood flowing, making the muscles warm and flexible

Stretching: with specific emphasis on muscle used in bowling like quadriceps, hamstrings, shoulders, and lower back.