A RARE INJURY

Dale Steyn and the pain barrier

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'It was a rarity among a rare injury' © Cricbuzz

When Dale Steyn returned to South Africa with his right shoulder in a sling last November, he carried an injury so rare that doctors could only speculate as to how it had happened. Now, almost three months down the line, he is on the road to recovery. But the nature of Steyn's injury points to a story of pathos, of a champion fast bowler coming to terms with the physical demands of his trade.

Steyn's future rests on an obscure bone in the shoulder which looks similar to a raven's beak. The hook-like bone - called the coracoid process - is part of the scapular, better-known as the shoulder blade, and the scapular links the upper arm to the collar bone, both vital cogs for a functioning fast-bowler.

In Steyn's case the coracoid - which helps articulate the tip of the upper arm (called the humerus) and the collar bone - broke off entirely from his right shoulder - an extremely painful and almost unheard-of injury. "I felt this pop, like a thud, in my shoulder - I was in a lot of pain," he told Channel Nine in the aftermath of the injury.

While stress fractures of the coracoid are not uncommon - Steyn suffered one during the Boxing Day Test against England in 2015 - examples of a complete detachment are extremely rare. The operation to re-attach the coracoid was conducted by Dr Steve Roche, a highly-respected orthopaedic surgeon in Cape Town at the end of last year and Steyn's career is now contingent on how well his re-attached coracoid heals and strengthens.

After some early frustrations, early indications are that his rehabilitation is progressing well, with running, gym and resistance work in the swimming pool. "From what we're seeing he's making tremendous progress," Dr Shuaib Manjra, head of CSA's medical committee, told Cricbuzz.

Although it has now been re-attached, the injury's rarity has amazed specialists and doctors. When asked if it was an injury you expect to see in fast bowlers, Dr Manjra, replied: "You actually don't. It's an extremely, extremely rare injury. If you look at the world literature, there are probably two or three cases where such an injury has been recorded. There are other cases where fast bowlers have injured the coracoid, but none in the way that Dale has injured his. It was a rarity among a rare injury."

Not only is the Steyn injury an unusual one but the medical community have been befuddled by what exactly caused it. Some informed speculation revolves around Steyn's declining powers (he will turn 34 in June, when he hopes to return to action) and argues that where he might have previously generated speed from his thighs and lower back, he is now straining other muscles in an effort to keep up his pace.

His shoulder muscles might already be showing signs of wear and tear after a long career but this, stress specialists, is only informed guesswork. There might also be a neuro-muscular component to the injury, the way in which the brain is controlling those particular muscles, but Manjra was careful to indicate that thinking along these lines was also speculative.

"We're not completely sure [how the injury came about]," said Manjra. "We're kind of speculating as to how that injury occurred because it's an extremely rare injury and the mechanism of it is not particularly clear. We're speculating that after he sustained his original injury [in the Boxing Day Test against England in 2015], he had some degree of muscle weakness that didn't allow for proper control of his shoulder. As a result the ball of his shoulder - what we call the head of the humerus - was in a sense pushing forward, and it was pushing forward against his coracoid bone. That's what we presume caused a fracture."

Steyn's recent injury woes stretch beyond the 2015 Boxing Day Test. He started the first Test away to India in Mohali in early November of that year but sustained a groin injury in the first innings that ultimately ended his tour. He returned for the first Test against England, only to fracture his coracoid early in the second innings. "If you look at your fast cars, Ferraris, they always tell you drive it to 1000 kays (kms) before you hit 200-plus. I obviously didn't put in 1000 kays, I was just trying to hit 200 and then I bust the shoulder," he later said.

While he was initially cautious against New Zealand last August, saying he would leave it to Kagiso Rabada to hit 150kph in the two Tests, he was soon back to his terrifying best, taking five for 33 in the second innings at Centurion to help give the Proteas the match and the series. "Dale was still coming back and bowling a helluva fast ball," said Manjra. "Even in Australia, if I'm not mistaken, he was bowling over 140kph. So he was still bowling at that pace, but as you can imagine, without the control of the muscles bowling at that pace, the forces that were probably being exerted against the coracoid process were significant."

Despite the upbeat prognosis, it is telling that Steyn has been beset by injuries of one kind or another since November 2015, a period of 15 months. Like Allan Donald and Shaun Pollock, two great South African bowlers who faced niggles but remained injury-free for impressively long periods of their careers, Steyn has gone for a long time without serious injury. His imperishability has been the subject of much informed discussion in South Africa over the last two or three seasons, particularly as he hones in on Pollock's South African record of 421 Test wickets in 108 Tests. Steyn, by contrast, has taken 417 wickets in 85 Tests, and currently sits in tenth spot on the all-time Test wickets list between Pollock (ninth) and Harbhajan Singh (11th).

Despite Steyn's notoriously strong will, we might be witnessing the sad, slow demise of a South African cricketing institution. The wickets to come are unlikely to roll in at quite the rate they did when Steyn was the world games leading young tearaway. The next 15 months with Test series against England, India and Australia are likely to be clarifying for one of the world's great fast bowlers and a little hook-like bone in his shoulder.

© Cricbuzz

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