Injury to recreational and professional cricket players: circumstances, type and potential for intervention

The relationship between cricket participation, health and wellbeing: A scoping review

Summarising and synthesising the evidence on cricket health and wellbeing can help inform cricket stakeholders and navigate future research directions. The purpose of this study was to investigate the relationship between cricket participation, health and wellbeing at all ages and playing standards, and identify research gaps in the existing literature. A scoping review was performed from inception to March, 2020. Studies were included if they assessed a construct related to health and/or wellbeing in cricketers, available in English. 219 articles were eligible. Injury incidence per 1,000 player exposures ranged from 1.8-5.7 injuries. 48% of former cricketers experienced persistent joint pain. However, former cricketers reported greater physical activity levels and mental-components of quality of life compared to the general population. Heat injury/illness and skin cancer are concerns and require further research. Cricket participation is associated with an inherent injury risk, which may have negative implications for musculoskeletal health in later life. However, cricket participation is associated with high quality of life which can persist after retirement. Gaps in the literature include prospective studies on health and wellbeing of cricketers, female cricketers, injury prevention strategies, and the impact of cricket participation on metabolic health and lifetime physical activity.

A systematic review of head, neck and-facial injuries in cricket

This systematic review was conducted to identify the incidence, nature and mechanisms of head, neck and facial (HNF) injuries in cricket and the reported use of helmets. Five databases were searched up to 30th November 2020. From peer-reviewed cricket injury studies published in English, studies reporting on HNF cricket injuries as per the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were selected. Twenty-nine studies were included. HNF injuries had a cumulative total of 794/5,886 injuries equating to 13% of all injuries. Non- specified HNF injuries (n=210, 26%) were the most prevalent type of injury followed by non-specified head injuries (n=130, 16%), other non-specified fractures (n=119, 15%) and concussions (n=60, 8%).The impact of the ball was reported as the most common mechanism for sustaining HNF injuries in cricket. The use of helmet was reported in only three studies (10%). From studies reporting on HNF cricket injuries, facial fractures, and concussions were the most common specified-types of injury. There is little evidence on reporting of HNF cricket injuries as per the international cricket consensus injury definitions, as well as the use of helmets at the time of injury.

Variations in cricket players' upper body dynamic balance across different levels of competition

BACKGROUND

Balance ability has been associated with performance and injury prevention in athletes. Previous studies have investigated the differences in lower body dynamic balance abilities among male high school, collegiate and professional soccer players.

OBJECTIVE

To investigate the differences on the Upper Quarter Y-Balance Test (UQYBT) in school, collegiate and employed cricket players.

SUBJECTS

Dynamic balance data were collected for school (SCH; n = 22), collegiate (COL; n = 19) and employed (EMP; n = 15) cricket players of Jamia Millia Islamia, New Delhi, India using the UQYBT standardized protocol.

METHODS

For the UQYBT, the participant reached with one hand in the medial, superolateral and inferolateral directions while maintaining three points of contact (other hand and both feet). The test was performed for both non-dominant and dominant hands.

RESULTS

The SCH group had the least medial reach distance than the other two groups (p = 0.010). Also, SCH players tended to exhibit a lower composite reach score than the other groups, but this difference was not significant (p > 0.05). No bilateral differences were observed among the three groups in any of the reach directions.

CONCLUSIONS

Upper body dynamic balance performance varied with the competition level. This may indicate that athletes' movement strategies may be different depending on the competition level and that normative values may need to be established for each competition level.

Medical-attention injuries in community cricket: a systematic review

Objectives

The aim was to identify and describe outcomes from original published studies that present the number, nature, mechanism and severity of medically treated injuries sustained in community-level cricket.

Design

Systematic review.

Methods

Nine databases were systematically searched to December 2019 using terms "cricket*" and "injur*". Original, peer-reviewed studies reporting injury for at least one injury descriptor (body region, nature of injury and/or mechanism of injury) in community-level cricketers of all ages were included. Qualitative synthesis, critical appraisal and descriptive summary results are reported within the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines.

Results

Six studies were included: five reported hospital-treated data and one reported insurance claims data. Two had a low risk of bias. In hospital-based studies, fractures were the most frequent injury type. Upper and lower limb injuries (age ≥15 years) and injuries to the head (age <15 years) were the most common body region injured. Being struck by the ball was the most common mechanism for injury presenting to hospitals. Children were also commonly struck by equipment. One study using insurance claims data reported soft tissue injuries as the main of injury type.

Conclusion

Hospital treatment data were most prominent, which emphasised injuries of a more serious nature or requiring acute care. These injuries were primarily fractures, dislocation/sprain and strains, bruising and open wounds with the majority resulting from players being struck by the ball. Research into whether properly fitted protective equipment, at an approved standard, is worn and is effective, is recommended.

Health-related quality of life and flourishing in current and former recreational and elite cricketers

BACKGROUND

Health related quality of life (HRQoL) and flourishing are constructs that encompasses a holistic representation of physical, psychological, and social health. The underlying psychological factors that can affect HRQoL and flourishing in sports participants is poorly understood. The purpose of this study was to i) evaluate HRQoL (physical and mental-components) and flourishing in recreational and elite and current and former cricketers; ii) determine the effect of resilience, playing-standard, and playing status on HRQoL and flourishing in cricketers.

METHODS

The Cricket Health and Wellbeing Study (n = 2598 current and former cricketers, aged ≥18 years) collected cross-sectional questionnaire data including the Flourishing Scale, Short Form-8 (physical (PCS) and mental (MCS) component scores), resilience (European Social Survey), highest standard-of-play, and playing status. Multivariable linear regressions with fractional polynomials were utilised, adjusted for age, gender, total cricket-seasons, comorbidity, ≥ 4-week time-loss injury, and orthopaedic surgery.

RESULTS

Two thousand two hundred eighty individuals (aged (mean (SD)) 51.7(14.7) years, 61% played recreationally, 37% former cricketers) were included in analyses. The median (IQR) PCS was 51.4(46.9-55.9), MCS was 54.3(50.0-58.6), and Flourishing Scale score was 48 [ (1-7)] .Greater resilience was associated with better PCS (effect (95% CI) 1.41(0.70-2.11)), MCS (4.78(4.09-5.48)), and flourishing (2.07(2.55-3.59)) compared to less resilience. Playing standard was not associated with HRQoL. Playing at an elite standard was associated with greater flourishing (1.21(0.68, 1.73)), compared with playing recreationally. Current cricket participation was associated with better PCS (3.61(2.92-4.30)) and flourishing scores (0.53(0.02-1.04)), compared to former cricket participation.

CONCLUSION

Cricketers reported high levels of mental-components of HRQoL and flourishing, and this was similar in recreational, elite, current and former cricketers. Current cricket participation and a higher standard-of-play was associated with greater flourishing. Current cricket participation was also associated with better PCS, however playing-status was not related to MCS. Further research is needed to understand if cricket participation may have psychological benefits that persist beyond cricket retirement.

Correlation Between Upper Body Balance, Muscle Strength, and Power in Cricketers Belonging to Different Age Groups

Objective

The purpose of this study was to assess correlation between variables of upper body balance, muscular strength, and power in cricketers belonging to different age groups.

Methods

Forty-eight healthy male cricketers (26 adolescents aged 14-17 years and 22 adults aged 18-25 years) were recruited from Jamia Millia Islamia, New Delhi, India. After a warm-up, the participants underwent Upper Quarter Y Balance Test, backward overhead medicine ball throw test, and back-strength testing in a random order.

Results

Values of the Pearson correlation coefficient for muscle strength and upper body power were found to be 0.397 and 0.499 for adolescent and adult cricketers, respectively. Correlation coefficient values for upper body balance and strength range from -0.008 to 0.05 and 0.325 to 0.414 and for upper body balance and power range from 0.059 to 0.062 and 0.133 to 0.153 for adolescent and adult cricketers, respectively.

Conclusion

Statistically significant, moderate-sized correlations were demonstrated between muscular strength and upper body power in adolescent and adult cricketers. However, no correlations existed between upper body balance and power and upper body balance and muscular strength in these athletes.

Evaluation of possible head injuries ensuing a cricket ball impact

BACKGROUND AND OBJECTIVE

The aim of this research is to study the behaviour of a human head during the event of an impact of a cricket ball. While many recent incidents were reported in relation to head injuries caused by the impact of cricket balls, there is no clear information available in the published literature about the possible threat levels and the protection level of the current protective equipment. This research investigates the effects of an impact of a cricket ball on a human head and the level of protection offered by the existing standard cricket helmet.

METHOD

An experimental program was carried out to measure the localised pressure caused by the impact of standard cricket balls. The balls were directed at a speed of 110 km/h on a 3D printed head model, with and without a standard cricket helmet. Numerical simulations were carried out using advanced finite element package LS-DYNA to validate the experimental results.

RESULTS

The experimental and numerical results showed approximately a 60% reduction in the pressure on the head model when the helmet was used. Both frontal and side impact resulted in head acceleration values in the range of 225-250 g at a ball speed of 110 km/h. There was a 36% reduction observed in the peak acceleration of the brain when wearing a helmet. Furthermore, numerical simulations showed a 67% reduction in the force on the skull and a 95% reduction in the skull internal energy when introducing the helmet.

CONCLUSIONS

(1) Upon impact, high localised pressure could cause concussion for a player without helmet. (2) When a helmet was used, the acceleration of the brain observed in the numerical results was at non-critical levels according to existing standards. (3) A significant increase in the threat levels was observed for a player without helmet, based on force, pressure, acceleration and energy criteria, which resulted in recommending the compulsory use of the cricket helmet. (4) Numerical results showed a good correlation with experimental results and hence, the numerical technique used in this study can be recommended for future applications.

Medical Attention Injuries in Cricket: A Systematic Review of Case Reports

BACKGROUND

Cricket, classified as noncontact game, has been shown to be associated with increased incidence of injury. Further the recent consensus update in cricket injury surveillance have updated the injury definitions which includes "Medical Attention" injuries. The purpose of this review was to systematically review the various case reports and studies reporting injuries in the game of cricket that fall under the gambit of medical attention injuries.

MATERIALS AND METHODS

A systematic review was conducted online using PubMed and Google Scholar, as per Preferred Reporting Items for Systematic reviews and Metaanalyses guidelines. Predefined eligibility criteria were applied, and the data thus compiled were analysed.

RESULTS

A total of 32 studies reporting 43 players including 42 males and 1 female were included in the review. Bowling injuries were the most commonly reported injury. Impact injury was the most common mode with acute presentation in batting and fielding injury, whereas it was gradual onset mode with chronic presentation in bowling injuries. Head and neck injuries were the most common in batting injuries while extremity injuries were common in fielding and bowling injuries. No injuries were reported in umpires.

CONCLUSION

The evidence provided, although not sufficient for any recommendation, it should alert the physicians and those concerned with the primary care of the cricketers to be vigilant of the eccentricity and severity of the injuries, their atypical presentation, mode, mechanism and trend, thereby being prepared for the unexpected presentations.

High-grade pronator teres tear in a cricket batsman

We present a case of a torn pronator teres muscle of the right forearm that occurred following prolonged batting during recreational cricket. Previous reports of cricket injuries to batsmen describe phalanx fractures due to direct ball impact. However, we could find no prior reports of pronator teres or other upper-extremity muscle injury. Our patient demonstrated a high-grade tear to the pronator teres muscle and no injury to the collateral ligaments. In this case, repetitive use of the pronator and flexor muscles with quick acceleratory movements stressed this muscle group and resulted in injury.

Novel presentation of a cricket ball-related intra-abdominal injury: genitofemoral nerve referred pain

Serious intra-abdominal injuries are very uncommon in cricket; traumatic cricket injuries are traditionally musculoskeletal, soft tissue or maxillofacial in origin. The cause of such cricket injuries can be broadly divided into collision type injuries (a result of direct contact with the ball or bat, another player, the ground or boundary) or overuse injuries (due to running, throwing, batting, bowling, repetitive movements and overexertion). This case report describes a rare cause of small bowel perforation and suspected genitofemoral nerve injury secondary to the direct impact of a cricket ball, and includes a brief review of blunt abdominal injuries resulting in isolated small bowel perforations.

Helmets, head injury and concussion in sport

Research on the mechanism of concussion in recent years has been focused on the mechanism of injury as well as strategies to minimize or reverse injury. Sports-related head injury research has led to the development of head protective gear that has evolved over the years. Headgears have been designed to protect athletes from skull fractures, subdural hemorrhages and concussions. Over the years, through experience of athletes and continued scientific research, improvements in helmet design have been made. Although these advances have decreased the number of catastrophic injuries throughout sports, the effects on concussions are promising, but largely unproven. In this review, we will discuss development of helmets and studies analyzing their level of protection for both concussion and head injury. This will help us understand what future developments are still needed to minimize the risk of concussion among athletes in various forms of sports.

Hand and wrist injuries in professional county cricket

AIM

This study aims to examine the mechanism and subsequent treatment modalities of hand and wrist injuries sustained in a professional cricket team.

METHODS

We performed a retrospective review of prospectively collected injury data at Gloucestershire County Cricket Club (GCCC) over six seasons (2008-2013). We investigated all injuries sustained, treated by the team lead physiotherapist and senior author.

RESULTS

There were a total of 64 injuries recorded, with 55 (86%) hand and 9 (14%) wrist injuries. The little and ring fingers were the most commonly injured, and the most commonly occurring specific injury was distal interphalangeal joint dislocations. The majority of injuries, 33 (52%), occurred during fielding activities. There were a total of 10 fractures (16%), predominantly phalangeal, and only 7 players (11%) had injuries that required operative intervention.

CONCLUSIONS

The majority of injuries sustained by professional cricketers occur in the little and ring fingers, whilst fielding during match situations. We recommend buddy strapping of little and ring fingers during fielding to prevent injury.

Increased delivery stride length places greater loads on the ankle joint in elite male cricket fast bowlers

The purpose of this study was to investigate the effect stride length has on ankle biomechanics of the leading leg with reference to the potential risk of injury in cricket fast bowlers. Ankle joint kinematic and kinetic data were collected from 51 male fast bowlers during the stance phase of the final delivery stride. The bowling cohort comprised national under-19, first class and international-level athletes. Bowlers were placed into either Short, Average or Long groups based on final stride length, allowing statistical differences to be measured. A multivariate analysis of variance with a Bonferroni post-hoc correction (α = 0.05) revealed significant differences between peak plantarflexion angles (Short-Long P = 0.005, Average and Long P = 0.04) and negative joint work (Average-Long P = 0.026). This study highlighted that during fast bowling the ankle joint of the leading leg experiences high forces under wide ranges of movement. As stride length increases, greater amounts of negative work and plantarflexion are experienced. These increases place greater loads on the ankle joint and move the foot into positions that make it more susceptible to injuries such as posterior impingement syndrome.

Injury risk associated with ground hardness in junior cricket

OBJECTIVES

To establish if there is an association between ground hardness and injury risk in junior cricket.

DESIGN

Nested case-series of players who played matches on specific grounds with objective ground hardness measures, within a prospective cohort study of junior community club cricket players.

METHODS

Monitoring of injuries and playing exposure occurred during 434 matches over the 2007/2008 playing season. Objective assessment of the hardness of 38 grounds was undertaken using a Clegg hammer at 13 sites on 19 different junior cricket grounds on the match eve across the season. Hardness readings were classified from unacceptably low (<30 g) to unacceptably high (>120 g) and two independent raters assessed the likelihood of each injury being related to ground hardness. Injuries sustained on tested grounds were related to the ground hardness measures.

RESULTS

Overall, 31 match injuries were reported; 6.5% were rated as likely to be related to ground hardness, 16.1% as possibly related and 74.2% as unlikely to be related and 3.2% unknown. The two injuries likely to be related to ground hardness were sustained whilst diving to catch a ball resulting, in a graze/laceration from contact with hard ground. Overall, 31/38 (82%) ground assessments were rated as having 'unacceptably high' hardness and all others as 'high/normal' hardness. Only one injury occurred on an objectively tested ground.

CONCLUSIONS

It remains unclear if ground hardness is a contributing factor to the most common injury mechanism of being struck by the ball, and needs to be confirmed in future larger-scale studies.