Injury in elite New Zealand cricketers 2002–2008: descriptive epidemiology

Lumbar Bone Stress Injuries and Nonunited Defects in Elite Australian Cricket Players

OBJECTIVE

To describe the presentation and management of lumbar bone stress injuries (LBSI), recurrent LBSI, and lumbar nonunited defects in elite Australian male and female cricket players.

DESIGN

Retrospective case series.

SETTING

Professional domestic and international cricket teams over 13 seasons.

PARTICIPANTS

Elite Australian cricket players.

INDEPENDENT VARIABLES

Symptomatic LBSI requiring time off cricket and lumbar nonunited defects, both confirmed by imaging.

MAIN OUTCOME MEASURES

Incidence, presentation, history, healing, and management.

RESULTS

211 LBSI were identified at an average incidence of 5.4 per 100 players per season. LBSI were most common in male pace bowlers younger than 20 years of age (58.1 per 100 players per season), however, were also observed in older players, females, and non-pace bowlers. Recurrent LBSI accounted for 33% (27%-40%) of all LBSI. Median days to return to match availability was 182 (128-251) days for all LBSI, with a shorter time frame observed for new and less severe injuries, and male spin bowlers. Healing was demonstrated in 87% (81%-91%) of all LBSI cases. 29 nonunited defects were identified and predisposed subsequent pain, LBSI, and spondylolisthesis.

CONCLUSIONS

LBSI are experienced by approximately 5.4 in every 100 elite Australian cricket players per season, with a high time cost of approximately 4 to 8 months. Nonunited defects also have a high time cost with associated subsequent lumbar spine issues. The findings of this study reinforce the importance of early detection and conservative management of LBSI, particularly for younger male pace bowlers and players with recurrent LBSI, which may be supported by MRI.

Is MRI screening for bone marrow oedema useful in predicting lumbar bone stress injuries in adult male professional cricketers? A New Zealand pilot study

OBJECTIVES

The aims were to (1) prospectively observe the incidence of bone marrow oedema in asymptomatic adult male domestic professional cricketers during a season and evaluate its relationship to the development of lumbar bone stress injury and (2) further understand the practicalities of implementing a Magnetic Resonance Imaging-based screening program to prevent lumbar bone stress injury in New Zealand cricket.

DESIGN

Prospective observational cohort.

METHODS

Adult male pace bowlers received 6-weekly pre-planned Magnetic Resonance Imaging scans over a single season to determine the presence and intensity of bone marrow oedema in the posterior vertebral arches of the lumbar spine. The participants bowling volume and back pain levels were monitored prospectively.

RESULTS

22 participants (mean age 25.3 years (range 20-32 years)) completed all 4 scans. Ten participants had a prior history of lumbar bone stress injury. Ten participants (45 %, 95 % confidence interval 24-68 %) had bone marrow oedema evident on at least one scan, with 9 (41 %) participants recording a bone marrow oedema intensity ≥ 2 and 5 (23 %) participants demonstrated an intensity ≥ 3. During the study one participant was diagnosed with a lumbar bone stress reaction. No participants developed a lumbar bone stress fracture.

CONCLUSIONS

Due to the lower incidence of lumbar bone stress injuries in adult bowlers coupled with uncertainty over appropriate threshold values for bone marrow oedema intensity, implementation of a resource intense screening program aimed at identifying adult domestic cricketers at risk of developing a lumbar bone stress injury is not currently supported.

Cricket injury in New Zealand: a study of injury insurance claims from 2008 to 2018

OBJECTIVES

This study aimed to quantify injury claims in organised community cricket in New Zealand over a 10-year period, 1 July, 2008 to June 30, 2018.

DESIGN

Retrospective analysis of administrative insurance claims data from the Accident Compensation Corporation (ACC), New Zealand.

METHODS

Injury claims relating to cricket in males and females in New Zealand were identified from coded data and relevant text searches of routinely collected claims data. Summary statistics for key variables (age, body part, injury type, and injury factors) are presented together with annual injury claim incidence rates (ICR) calculated using population-based denominators.

RESULTS

There were 62,776 claims for cricket injury occurring at a place of recreation/sports. Most claims were in males (91.4%) and those aged 15-19 year old age group. There was an increase in the total number of injury claims over the 10-year period (1.5%, p = 0.04), but the ICR was consistent (males: varying between 258.8-304.8, and females: 22.6-28.3 claims annually per 100,000 population). Soft tissue injury claims were the most common injury type. Lumbosacral claims were most common for bowlers (78%). Lower limb injury claims were the predominant claim from batting (36%) and fielding (42%), with knee injury claims (34%) being the most common lower-limb injury location.

CONCLUSIONS

Lumbosacral, shoulder and knee injuries were common amongst all playing positions and worthy of preventative attention. Strategies targeting prevention of these injuries may reduce the ICR within the ACC.

Comparison of injury profiles between elite Australian male and female cricket players

OBJECTIVES

This study presents seven seasons of injury surveillance data for both elite Australian male and female cricket players, revealing injury statistics and allowing for comparison between sexes.

DESIGN

Retrospective cohort.

METHODS

Participants were elite Australian male and female cricket players who were contracted to play for a national and/or state/territory team and/or T20 franchise between 2015-16 and 2021-22 (7 seasons). Injury data was recorded in Cricket Australia's Athlete Management System database and combined with match data. The STROBE-SIIS statement was used as the relevant guideline for this study.

RESULTS

Data for 1345 male player seasons and 959 female player seasons revealed sex-related differences in the injury incidence rates and prevalence. Males had higher incidence (average 136 vs 101 injuries per 1000 match days) and prevalence of match time-loss injuries (average 10.4% vs 6.5% players unavailable). However, the overall incidence of all medical attention injuries were similar between sexes (Incidence Rate Ratio (IRR) 0.9, 95%CI 0.8-1.0). The most frequent match time-loss injuries for males were hamstring strains (7.4 new injuries per 100 players per season), side and abdominal strains (5.5), concussion (5.0), lumbar stress fractures (4.3), and wrist and hand fractures (3.9). The most frequent match time-loss injuries for females over the 7 seasons were hamstring strains (3.1), concussion (2.3), quadriceps strains (2.4) and shin/foot/ankle stress fractures (2.0). The IRR of medical attention injuries for males compared to females was higher for lumbosacral stress fractures (IRR 2.3), elbow and forearm injuries (1.5), and concussion (1.4), and lower for lower leg, foot, and ankle stress fractures (0.6), shoulder and upper arm injuries (0.7), and quadriceps strains (0.6).

CONCLUSIONS

Robust long-term injury surveillance enabled the injury profiles of elite Australian male and female cricket players to be understood and compared. Males had a higher incidence and prevalence of match time-loss injuries, likely reflecting a higher match exposure.

New Zealand cricket injury analysis based on 12 years of Accident Compensation Corporation data

Objectives

To provide epidemiological data for cricket injuries in New Zealand.

Methods

A retrospective analytical review using epidemiological cricket data obtained from the national Accident Compensation Corporation (ACC) for 2005–2016. Injury incidence was calculated per 1000 participants.

Results

There were 86 562 injuries (77 212 males and 9350 females) during the 12 years with higher injury incidence for males (64.1) than females (36.1). While cricket-related injury claims increased by 42.6%, the injury incidence decreased from 59.0 in 2006 to 42.8 in 2016. The pooled injury rate per 1000 participants was highest for hand/fingers (9.2) and lumbar (8.1) body regions, and for contact (44.7) activities. Players aged 10–20 years were more likely to experience injury.

Conclusions

Analysis of 12 years of ACC cricket-related injury claims showed only minimal reductions in injury incidence over the years. Therefore, cricket-related contact injuries to the hand/fingers and head need to be the focus of injury prevention programmes (eg, via promoting use of protective gear and correct technique), particularly in players aged 10–20 years.

Injury surveillance in community cricket: A new inning for South Africa

Published injury rates amongst elite and club-level youth cricketers highlight the need to implement injury risk-reducing strategies amongst the youth cricketing population. Data from sports injury surveillance systems are a prerequisite for the development and evaluation of strategies to reduce injury risk. Therefore, collecting injury surveillance data is a positive move towards reducing injuries in cricket. In South Africa, a systematic, standardised, evidence-informed injury surveillance system currently does not exist for community levels of play, namely, in cricket-playing high schools and cricket clubs. Although injury surveillance systems exist at elite levels, the obvious differences in elite versus community cricket settings mean that these systems cannot be implemented in their current form at community-level cricket. An innovative model is required to implement an injury surveillance system in community cricket.

Clinical implications

This article proposes and describes a new research-practice partnership model to implement a systematic, standardised, evidence-informed injury surveillance system at cricket-playing high schools or cricket clubs within South Africa. Once this model has been employed, database systems will need to be established to allow long-term data management and sharing.

Injury incidence within male elite New Zealand cricket from the early T20 era: 2009-2015

Objectives

This study aimed to describe the injury epidemiology of domestic and international level male New Zealand cricketers from seasons 2009–2010 to 2014–2015 across all match formats given the increasing popularity of T20 cricket.

Methods

Match exposure and injury surveillance data collected prospectively by New Zealand Cricket was analysed using international consensus recommendations for injury surveillance and reporting in cricket. Relationships between playing level, role and injury were statistically analysed.

Results

A total of 268 elite male New Zealand cricketers from seasons 2009–2010 to 2014–2015 were analysed from the New Zealand Cricket injury surveillance system. Total new match injury incidence rates were 37.0 and 58.0 injuries per 10 000 player hours in domestic and international cricket, respectively. Total new and recurrent match injury incidence in international cricket was approximately 1.7 times higher than domestic cricket (277.6 vs 162.8 injuries per 1000 player days). Injury prevalence rates were 7.6% and 10.0% in domestic and international cricket. The hamstring (8.2%) in domestic cricket and the groin (13.5%) in international cricket were the most injured body sites. Most match days lost in domestic cricket were to the lumbar spine (417 days), and groin in international cricket (152 days). There were statistically significant differences in injury between domestic and international level cricketers (χ²=4.39, p=0.036), and playing role (χ²=42.29, p<0.0001).

Conclusions

Total injury incidence rates in elite New Zealand cricket increased in 2009–2015 compared with previous data. International-level players and pace bowlers were the most injured individuals.

External workload intensity in cricket fast bowlers across maximal and submaximal intensities: Modifying PlayerLoad and IMU location

Workload is a commonly accepted risk factor for injury among fast bowlers, however many methods exist to characterise workload. Recently, automated intensity-sensitive measures like PlayerLoad have been used to improve the estimation of workload in fast bowlers. The purpose of this study was to determine whether similar variables could be extracted from a single inertial measurement unit (IMU) that highly correlate with intensity, according to release speed. Eight elite and pre-elite bowlers participated in the study, with each bowler bowling one over each at 60%, 80% and 100% intensity and repeating this across two sessions (36 balls per participant). IMUs were placed on the upper-back and non-bowling wrist and maximum PlayerLoad from each delivery (PL_max) was compared to the accumulated value across each delivery (PL_acc). The strongest correlation with release speed was with PL_acc from the non-bowling wrist (R = 0.74), followed by PL_acc from the upper-back (R = 0.65) and PL_max from the upper back (R = 0.60). Consequently, an improved estimation of the intensity at which bowlers are working at could be gained by examining accumulated PlayerLoad values from an IMU on the non-bowling wrist.

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.

The impact of COVID-19 related disruption on injury rates in elite men's domestic cricket

This study aimed to investigate the impact of COVID-19 enforced prolonged training disruption and shortened competitive season, on in-season injury and illness rates. Injury incidence and percent proportion was calculated for the 2020 elite senior men's domestic cricket season and compared to a historical average from five previous regular seasons (2015 to 2019 inclusive). The injury profile for the shortened 2020 season was generally equivalent to what would be expected in a regular season, except for a significant increase in medical illness as a proportion of time loss (17% compared to historic average of 6%) and in-season days lost (9% compared to historic average of 3%) due to COVID-19 related instances (most notably precautionary isolation due to contact with a confirmed or suspected COVID-19 case). There was a significant increase in the proportion of in-season days lost to thigh injuries (24% compared to 9%) and a significant decrease in the proportion of days lost to hand (4% compared to 12%) and lumbar spine (7% compared to 21%) injuries. These findings enhance understanding of the impact prolonged period of training disruption and shortened season can have on cricket injuries and the challenges faced by practitioners under such circumstances.

Presence of bone marrow oedema in asymptomatic elite fast bowlers: Implications for management

OBJECTIVES

1) Quantify the intensity of bone marrow oedema (BMO) present in the lumbar vertebrae of asymptomatic elite adult fast bowlers; 2) relate the intensity of BMO to bowling workload and lumbar bone stress injury (LBSI), and; 3) evaluate the utility of MRI screening to reduce the risk of LBSI.

METHODS

Thirty-eight elite Australian fast bowlers (21.6 ± 3.7 years) completed 48 screening MRI over 3 years. BMO intensity was quantified on MRI retrospectively. Standard practices for bowling workload monitoring and injury diagnosis were followed.

RESULTS

Clinically significant BMO (signal intensity ratio ≥ 2.0) was observed in 22 (46%, 95% CI 31-61) screening MRI. These bowlers had a total of 77 (IQR 45-115) days off between seasons, compared to 66 (IQR 41-94) days off for bowlers with a BMO intensity less than 2.0 (p = 0.510). Fifteen bowlers received follow up MRI as part of individualised management based on their screening MRI, of which less than five went on to develop LBSI in the subsequent season. There was no difference in days or balls bowled in the 12 months following screening MRI between those who sustained LBSI and those who did not.

CONCLUSIONS

BMO is common in asymptomatic bowlers. Identification of high-risk bowlers using screening MRI informs individualised management and may prevent progression to LBSI.

A decade of head, neck and facial cricket injury hospitalisations in Victoria, Australia: From 2007/08 to 2016/17

OBJECTIVES

To present an epidemiological profile of hospital-treated head, neck and facial cricket injuries from 2007/08 to 2016/17 in Victoria, Australia.

DESIGN

Retrospective analysis of emergency department and hospital admission data.

METHODS

An analysis of Victorian hospital-treated head, neck and facial cricket injuries of all cricket participants over 5 years old between July 2007 and June 2017.

RESULTS

Over the decade, 3907 head, neck, facial (HNF) cricket injuries were treated in Victorian hospitals. The number of HNF cricket injuries substantially increased in the 2014/15 season from 367 to 435 injuries and remained over 400 in the subsequent years. More injuries were reported for male compared to female participants, 3583 compared to 324 injuries. When adjusted for participation in competitive cricket, the injury incidence rate was 1.3 per 1000 participants for males and 0.4 per 1000 participants for females. The 10-14year age group most frequently required hospital treatment. Open wounds were the most common type of injury (1166, 29.8%) and the main mechanism for HNF cricket injury for this decade was hit/struck/crush (3361, 86.0%).

CONCLUSIONS

This study provides a novel and current insight of the incidence and details of HNF injuries among cricket participants in Victoria over a decade. It is evident that males and younger participants, regardless of gender, have a higher risk of sustaining a HNF injury. This study provides a solid evidence base for stakeholders in developing strategies to minimise head, neck and facial injuries to make cricket a safe sport for all.

Injury and Player Availability in Women's International Pathway Cricket from 2015 to 2019

This prospective cohort study aimed to describe injury and illness epidemiology within women's international pathway cricket, understanding what influences player availability in this unique context where players are contracted part-time. Approximately 8.4% of players were impacted by injury or illness during the year, with an average 2.3% of players completely unavailable on any given day. Most medical complaints occurred during training (111.2 injuries/100 players per year). Of all complaints, medical illness had the highest overall incidence (45.0 complaints/100 players), followed by hand injuries (24.7 injuries/100 players). Gradual onset injuries were most common. Overall average match time-loss complaint prevalence rate was 4.1% and average match time-loss injury incidence rate was 7.0 injuries/1000 days of play. Fielding (56.4 injuries/100 players per year) was the activity resulting in the highest average overall and time-loss injury incidence rates, though 'other' activities (e. g. those occurring outside of cricket participation) collectively accounted for 78.3 injuries/100 players per year. The high incidence of medical illness relative to other complaints may be a distinct feature of the women's cricket international pathway compared to other cricket samples. The high occurrence of injuries arising from 'other' activities, likely due to part-time participation, presents an opportunity for targeted injury prevention strategies.• The first study on an international women's cricket pathway, contributes to the empirical base for specific injury risks associated with the women's cricket game, which is an emerging research area for a developing sport.• Some of the findings may be a distinct feature of the women's cricket international pathway, highlighting potential opportunities for targeted prevention strategies.• With the upcoming development of an elite domestic structure these preliminary findings will provide a good starting point for physiotherapy and medical staff working in these contexts.

Prospective reporting of injury in community-level cricket: A systematic review to identify research priorities

OBJECTIVES

Cricket is a popular sport enjoyed worldwide. Injuries in cricket are not well understood at community level but are important to understand for prevention to ensure the game continues to be enjoyed safely. This systematic review was designed to assess the quality of data collection and reporting, and to summarise the injury data, in studies of community cricket players.

DESIGN

Systematic review.

METHODS

Nine databases were searched to November 2018 using the terms "cricket*" and "injur*". A nine-item critical appraisal and three-item likelihood-of-bias evaluation was conducted on included studies. Data completeness was evaluated against recommendations in the international cricket consensus statement for recording/reporting injury and the Australian Sports Injury Data Dictionary (ASIDD). Descriptive injury data (n,%) are presented in tabular format for different subgroups (activity, position, population).

RESULTS

Thirteen studies were included, of which eight were rated as unclear, one as high and three having a low likelihood-of-bias. The mean score for completeness of data against the consensus statement was 3.5/10 (95%C.I. 2.8-4.2). The mean score for completeness of data against the ASIDD was 4.4/6 (95%C.I. 3.9-5.0). Bruising and inflammation was the most common injury in junior cricket. Stress fractures were most common in studies of bowlers. Where studies included all activities, batting accounted for most injuries (7-49%).

CONCLUSIONS

The included studies inconsistently addressed recommended items for injury surveillance in community sport and cricket. Most studies focused on junior levels or adolescent bowlers, with bruising/inflammation and stress fractures being most common, respectively.

Injuries in England and Wales elite men's domestic cricket: A nine season review from 2010 to 2018

OBJECTIVES

This study primarily aimed to explore injury incidence rates in the three main domestic competition formats in England and Wales (First-Class, One-Day and Twenty20 [T20]). For the first time, the study also describes the epidemiology of elite men's domestic cricket injuries across nine seasons (2010-2018 inclusive).

DESIGN

Prospective cohort analysis.

METHODS

Injury incidence and prevalence from all injuries calculated according to the updated international consensus statement on injury surveillance in cricket, with statistical process control charts (SPC) used to detect trends in the data.

RESULTS

The average match injury incidence was 102 injuries/1000 days of play, with highest incidence in One-Day (254 injuries/1000 days of play), followed by T20 (136 injuries/1000 days of play) and First-Class Cricket (68 injuries/1000 days of play). Most match injuries were sustained during bowling (41.6 injuries/1000 days of play), followed by fielding (26.8 injuries/1000 days of play) and batting (22.3 injuries/1000 days of play). The thigh was the body area most commonly injured (7.4 injuries/100 players per season), with lumbar spine injuries the most prevalent (1.3% of players unavailable on any given day during the season). On average, 7.5% of players were unavailable on any given day during the domestic season when all injuries were considered (match and training). The SPC charts showed relatively consistent match injury incidence for all competitions, reproduced across all nine seasons.

CONCLUSION

These findings provide a robust empirical base for the extent of the injury problem in domestic cricket played in England and Wales, with similar injury profiles across the three formats.

Incidence and prevalence of lumbar stress fracture in English County Cricket fast bowlers, association with bowling workload and seasonal variation

OBJECTIVES

Since much of the previous epidemiological research into lumbar stress fracture was conducted, there has been a marked increase in the amount of cricket being played. The aims were to determine the incidence and prevalence of lumbar stress fracture in English County Cricket fast bowlers between 2010 and 2016, determine the association with match bowling workload and observe seasonal variation in workload and injury.

METHODS

Lumbar stress fracture incidence and prevalence rates were calculated using new international methods for epidemiology in 368 professional English fast bowlers from 2010 to 2016. Workload variables were compared between lumbar stress fracture case and non-injured control groups, before entry in a logistic regression.

RESULTS

Fifty-seven lumbar stress fractures (mean age 22.81) were reported. Injury was most common in July and September. Match incidence was 0.16 lumbar stress fractures per 10 000 deliveries, annual incidence was 2.46 lumbar stress fractures per 100 fast bowlers and annual prevalence of lumbar stress fractures was 1.67% of squad days. Significant workload variables were observed between cases and controls. A peak 7-day workload of greater than 234 deliveries significantly increased the odds of sustaining a lumbar stress fracture 11-fold compared with bowling fewer than 197 deliveries.

CONCLUSION

Lumbar stress fractures are common in young fast bowlers possibly due to immaturity of the lumbar spine. The condensed early and late-season schedule may be causing periods of overuse, resulting in an increase in incidence of lumbar stress fracture. Reduction of workload in young fast bowlers is needed to reduce incidence.

Injury profiles in elite women's T20 cricket

OBJECTIVES

To Describe the injury incidence and prevalence during two years of a professional women's T20 cricket tournament.

DESIGN

Prospective cohort study.

METHODS

Injuries were recorded prospectively for 68 matches during a professional women's T20 tournament in 2016 and 2017. There were six teams of 15 players. Participants were female, aged between 16-38 years (mean 23.4±4.8). Time-loss and non time-loss incidence and prevalence were calculated for match days, region, skill group, mode and activity at time of injury.

RESULTS

The greatest incidence occurred in the shoulder (1.8 injuries per 100 match days), lower back (1.7 injuries per 100 match days) and knee (1.7 injuries per 100 match days). The highest time-loss prevalence occurred in hand (1.7%), head/face (0.8%) and thigh (0.6%). All head injuries were concussion. Catching related injuries caused the most time-loss (2.5% prevalence) and throwing related shoulder injury had the highest incidence (2.3 injuries per 100 match days). Gradual onset injuries had the highest overall incidence (7.9 injuries per 100 match days).

CONCLUSIONS

In elite female T20 cricket, time-loss injuries, particularly impact/traumatic injuries are most likely to occur during fielding, suggesting pitch side support and trauma training is a priority. The high incidence of gradual onset injuries, particularly throwing related shoulder pain, indicates that managing workload and ensuring physical preparedness is vital.

Match injuries in Sri Lankan junior cricket: A prospective, longitudinal study

OBJECTIVES

Understanding the nature of injuries in cricket is key to mitigate injury risks and prioritise preventive measures. This study aimed to identify the incidence and nature of match injuries among Sri Lankan junior cricketers.

DESIGN

Longitudinal follow-up study with prospective in-season data collection.

METHODS

A national survey of schoolboy, division-1 cricket teams in under-15 and under-17 age groups. Using a paper-based questionnaire, distributed to school-teams at the start of the 2016 cricket season, respondents recorded any injuries, including the site, type and mechanism. Match injury incidence rates (match-IIR) (injuries/100 match-player-days) were calculated overall, by position and for match time loss (MTL) and non-MTL injuries.

RESULTS

From 59 school-teams, 573 players responded, with 404 players reporting 744 injuries in 648 matches. The match-IIR was 28.0 injuries/100 match-player-days (95% CI=26.0-30.2). The highest match-IIR was reported among fielders (46.0% of all injuries sustained; match-IIR=12.9) compared with batters (25.4%; match-IIR=7.1) and bowlers (20.3%; match-IIR=5.7). Abrasions and bruises to the knee or elbow were the most common injuries among fielders, with the majority being non-MTL injuries.

CONCLUSIONS

Almost half (46.0%) of all injuries were to fielders, and more research into their severity and mechanisms is needed to identify the need for, and design of, preventive measures. Batters sustained a relatively large number of facial-organ injuries from being struck by the ball, presenting a need to evaluate the use and appropriateness of helmets by Sri Lankan junior cricketers. Similar to other junior cricket studies, the most common injuries among bowlers were strains and sprains, mainly affecting the lower limbs and lower back.

Effect of acute augmented feedback on between limb asymmetries and eccentric knee flexor strength during the Nordic hamstring exercise

Background

Hamstring strain injuries (HSI) are one of the most prevalent and serious injuries affecting athletes, particularly those in team ball sports or track and field. Recent evidence demonstrates that eccentric knee flexor weakness and between limb asymmetries are possible risk factors for HSIs. While eccentric hamstring resistance training, e.g. the Nordic hamstring exercise (NHE) significantly increases eccentric hamstring strength and reduces HSI risk, little research has examined whether between limb asymmetries can be reduced with training. As augmented feedback (AF) can produce significant acute and chronic increases in muscular strength and reduce injury risk, one way to address the limitation in the eccentric hamstring training literature may be to provide athletes real-time visual AF of their NHE force outputs with the goal to minimise the between limb asymmetry.

Methods

Using a cross over study design, 44 injury free, male cricket players from two skill levels performed two NHE sessions on a testing device. The two NHE sessions were identical with the exception of AF, with the two groups randomised to perform the sessions with and without visual feedback of each limb's force production in real-time. When performing the NHE with visual AF, the participants were provided with the following instructions to 'reduce limb asymmetries as much as possible using the real-time visual force outputs displayed in front them'. Between limb asymmetries and mean peak force outputs were compared between the two feedback conditions (FB1 and FB2) using independent t-tests to ensure there was no carryover effect, and to determine any period and treatment effects. The magnitude of the differences in the force outputs were also examined using Cohen d effect size.

Results

There was a significant increase in mean peak force production when feedback was provided (mean difference, 21.7 N; 95% CI [0.2-42.3 N]; P = 0.048; d = 0.61) and no significant difference in between limb asymmetry for feedback or no feedback (mean difference, 5.7%; 95% CI [-2.8% to 14.3%]; P = 0.184; d = 0.41). Increases in force production under feedback were a result of increased weak limb (mean difference, 15.0 N; 95% CI [1.6-28.5 N]; P = 0.029; d = 0.22) force contribution compared to the strong limb.

Discussion

The results of this study further support the potential utility of AF in improving force production and reducing risk in athletic populations. While there are currently some financial limitations to the application of this training approach, even in high-performance sport, such an approach may improve outcomes for HSI prevention programs. Further research with more homogenous populations over greater periods of time that assess the chronic effect of such training practices on injury risk factors and injury rates are also recommended.

The effect of Nordic hamstring exercise training volume on biceps femoris long head architectural adaptation

The aim of this study was to determine the time course of architectural adaptations in the biceps femoris long head (BF_LH ) following high or low volume eccentric training. Twenty recreationally active males completed a two week standardized period of eccentric Nordic hamstring exercise (NHE) training, followed by four weeks of high (n = 10) or low volume (n = 10) training. Eccentric strength was assessed pre- and post intervention and following detraining. Architecture was assessed weekly during training and after two and four weeks of detraining. After six weeks of training, BF_LH fascicles increased significantly in the high (23% ± 7%, P < .001, d = 2.87) and low volume (24% ± 4%, P < .001, d = 3.46) groups, but reversed following two weeks of detraining (high volume: -17% ± 5%, P < .001, d = -2.04; low volume: -15% ± 3%, P < .001, d = -2.56) after completing the intervention. Both groups increased eccentric strength after six weeks of training (high volume: 28% ± 20%, P = .009, d = 1.55; low volume: 34% ± 14%, P < .001, d = 2.09) and saw no change in strength following a four week period of detraining (high volume: -7% ± 7%, P = .97, d = -0.31; low volume: -2% ± 5%, P = .99, d = -0.20). Both low and high volume NHE training stimulate increases in BF_LH fascicle length and eccentric knee flexor strength. Architectural adaptations reverted to baseline levels within two weeks after ceasing training, but eccentric strength was maintained for at least four weeks. These observations provide novel insight into the effects of training volume and detraining on BF_LH architecture and may provide guidance for the implementation of NHE programs.

Physical activity in former elite cricketers and strategies for promoting physical activity after retirement from cricket: a qualitative study

OBJECTIVES

The health benefits of professional sport dissipate after retirement unless an active lifestyle is adopted, yet reasons for adopting an active or inactive lifestyle after retirement from sport are poorly understood. Elite cricket is all-encompassing, requiring a high volume of activity and unique physical demands. We aimed to identify influences on physical activity behaviours in active and insufficiently active former elite cricketers and provide practical strategies for promoting physical activity after cricket retirement.

DESIGN

18 audio-recorded semistructured telephone interviews were performed. An inductive thematic approach was used and coding was iterative and data-driven facilitated by NVivo software. Themes were compared between sufficiently active and insufficiently active participants.

SETTING

All participants formerly played professional cricket in the UK.

PARTICIPANTS

Participants were male, mean age 57±11 (range 34-77) years, participated in professional cricket for 12±7 seasons and retired on average 23±9 years previously. Ten participants (56%) were classified as sufficiently active according to the UK Physical Activity Guidelines (moderate-intensity activity ≥150 min per week or vigorous-intensity activity ≥75 min per week). Eight participants did not meet these guidelines and were classified as insufficiently active.

RESULTS

Key physical activity influences were time constraints, habit formation, intrinsic and extrinsic motivation, physical activity preferences, pain/physical impairment and cricket coaching. Recommendations for optimising physical activity across the lifespan after cricket retirement included; prioritise physical activity, establish a physical activity plan prior to cricket retirement and don't take a break from physical activity, evaluate sources of physical activity motivation and incorporate into a physical activity plan, find multiple forms of satisfying physical activity that can be adapted to accommodate fluctuations in physical capabilities across the lifespan and coach cricket.

CONCLUSIONS

Physically active and less active retired cricketers shared contrasting attributes that informed recommendations for promoting a sustainable, physically active lifestyle after retirement from professional cricket.

Cluster randomised control trial for cricket injury prevention programme (CIPP): a protocol paper

Background

Injury prevention programmes (IPPs) are effective in reducing injuries among adolescent team sports. However, there is no validated cricket-specific IPP despite the high incidence of musculoskeletal injuries among amateur cricketers.

Objectives

To evaluate whether a cricket injury prevention programme (CIPP) as a pretraining warm-up or post-training cool-down can reduce injury rates in amateur cricket players.

Methods

CIPP is a cluster randomised controlled trial which includes 36 male amateur club teams having cricket players aged 14–40 years to be randomly assigned to three study arms: warm-up, cool-down and control (n=12 teams, 136 players in each arm). The intervention groups will perform 15 min CIPP either as a pretraining warm-up or a post-training cool-down.

Outcome measures

The primary outcome measure will be injury incidence per 1000 player hours and the secondary outcome measures will be whether IPP as a warm-up is better than IPP as a cool-down, and the adherence to the intervention.

Trial registration number

ACTRN 1261700047039.

Latissimus Dorsi and Teres Major Tendon Avulsions in Cricketers: A Case Series and Literature Review

INTRODUCTION

Acute latissimus dorsi tendon injuries are uncommon, having not previously been described in cricketers. The leg spinner's stock ball bowling technique and the fast bowler's back-of-the-hand slow ball, which is used much more widely in T20 cricket, produce a significant eccentric contraction load on the latissimus dorsi muscle.

METHODOLOGY

A retrospective review of a case series of acute latissimus dorsi tendon injuries in 3 elite cricketers (2 fast bowlers and a leg-spin bowler). We compare the outcomes using patient-rated scales and objective strength testing. Two patients underwent operative repair and had excellent outcomes. One of the nonoperatively managed patients had mild ongoing symptoms at 7 months.

DISCUSSION

An associated injury to teres major did not affect the outcome of this injury. Operative repair is a viable alternative and may produce better outcomes in cricketers.

CONCLUSION

The short T20 form of cricket has lead to an increase in the number of back-of-the-hand slow balls, a risk factor for Latissimus injury, whereas leg-spin bowling is another risk.

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.

Incidence and prevalence of elite male cricket injuries using updated consensus definitions

BACKGROUND

T20 (Twenty20 or 20 over) cricket has emerged in the last decade as the most popular form of cricket (in terms of spectator attendances). International consensus cricket definitions, first published in 2005, were updated in 2016 to better reflect the rise to prominence of T20 cricket.

METHODS

Injury incidence and prevalence rates were calculated using the new international methods and units for elite senior male Australian cricketers over the past decade (season 2006-2007 to season 2015-2016 inclusive).

RESULTS

Over the past 10 seasons, average match injury incidence, for match time-loss injuries, was 155 injuries/1,000 days of play, with the highest daily rates in 50-over cricket, followed by 20-over cricket and First-Class matches. Annual injury incidence was 64 injuries/100 players per season, and average annual injury prevalence was 12.5% (although fast bowlers averaged 20.6%, much higher than other positions). The most common injury was the hamstring strain (seasonal incidence 8.7 injuries/100 players per season). The most prevalent injury was lumbar stress fractures (1.9% of players unavailable at all times owing to these injuries, which represents 15% of all missed playing time).

DISCUSSION

The hamstring strain has emerged from being one of the many common injuries in elite cricket a decade ago to being clearly the most common injury in the sport at the elite level. This is presumably in association with increased T20 cricket. Lumbar stress fractures in fast bowlers are still the most prevalent injury in the sport of cricket at the elite level, although these injuries are more associated with high workloads arising from the longer forms of the game. Domestic and international matches have very similar match injury incidence rates across the formats, but injury prevalence is higher in international players as they play for most of the year without a substantial off-season.

International consensus statement on injury surveillance in cricket: a 2016 update

Cricket was the first sport to publish recommended methods for injury surveillance in 2005. Since then, there have been changes to the nature of both cricket and injury surveillance. Researchers representing the major cricket playing nations met to propose changes to the previous recommendations, with an agreed voting block of 14. It was decided that 10 of 14 votes (70%) were required to add a new definition element and 11 of 14 (80%) were required to amend a previous definition. In addition to the previously agreed 'Match time-loss' injury, definitions of 'General time-loss', 'Medical presentation', 'Player-reported' and 'Imaging-abnormality' injuries are now provided. Further, new injury incidence units of match injuries per 1000 player days, and annual injuries per 100 players per year are recommended. There was a shift towards recommending a greater number of possible definitions, due to differing contexts and foci of cricket research (eg, professional vs amateur; injury surveillance systems vs specific injury category studies). It is recommended that researchers use and report as many of the definitions as possible to assist both comparisons between studies within cricket and with those from other sports.

Comparisons of eccentric knee flexor strength and asymmetries across elite, sub-elite and school level cricket players

Background. There has been a continual increase in injury rates in cricket, with hamstring strain injuries (HSIs) being the most prominent. Eccentric knee flexor weakness and bilateral asymmetries are major modifiable risk factors for future HSIs. However, there is a lack of data relating to eccentric hamstring strength in cricket at any skill level. The objective of this study was to compare eccentric knee flexor strength and bilateral asymmetries in elite, sub-elite and school level cricket players; and to determine if playing position and limb role influenced these eccentric knee flexor strength indices. Methods. Seventy four male cricket players of three distinct skill levels performed three repetitions of the Nordic hamstring exercise on the experimental device. Strength was assessed as the absolute and relative mean peak force output for both limbs, with bilateral asymmetries. Differences in mean peak force outputs between skill level and playing positions were measured. Results. There were no significant differences between elite, sub-elite and school level athletes for mean peak force and bilateral asymmetries of the knee flexors. There were no significant differences observed between bowler's and batter's mean peak force and bilateral asymmetries. There were no significant differences between front and back limb mean peak force outputs. Discussion. Skill level, playing position and limb role appeared to have no significant effect on eccentric knee flexor strength and bilateral asymmetries. Future research should seek to determine whether eccentric knee flexor strength thresholds are predictive of HSIs in cricket and if specific eccentric knee flexor strengthening can reduce these injuries.

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.

Nature and pattern of cricket injuries: the Asian Cricket Council Under-19, Elite Cup, 2013

Cricket has over the years gained much popularity in Asia, thus the number of cricket players has also grown in tandem. However, cricket players are not as fortunate as other athletes as they do not always have a standard cricket infrastructure to practice; therefore, the injury prevalence is expected to be high. Unfortunately, very few studies have been conducted to investigate the nature and pattern of cricket injuries prevalent to cricketers in this region. Therefore, a prospective cohort injury surveillance study was conducted during the Asian Cricket Council (ACC) Under-19 Elite Cup held in June 2013 in order to gather more data on the type of injuries sustained by cricket players. Overall, 31 injuries occurred to 28 players throughout the tournament, of which 7 injuries happened during practice sessions. The overall injury incidence rate (IIR) was 292.0 per 10,000 player hours (95% CI 176.9-407.1) and 10.4 per 10,000 balls faced and 2.6 per 1000 overs bowled delivered during batting and bowling, respectively. Injuries to the lower limb (IIR: 146; 95% CI 1.8-98.2) were the most frequent, followed by injuries to the upper limb (97.3;95% CI 30.2-164.5) and to the trunk and back (IIR: 36.5;95% CI 0.0-77.7). Sprain/strains (IIR 109.5;95% CI 38.4-180.7) to muscle/tendon and joint/ligament were the most commonly reported nature of injury. This is the first study investigating injury incidence among the players of the ACC. It provides an overview of injuries sustained by elite players' under-19 years of age from 10 Asian countries. The overall IIR is similar to earlier studies conducted in well-established cricket playing nations.

Immediate Effects of Neurodynamic Sliding versus Muscle Stretching on Hamstring Flexibility in Subjects with Short Hamstring Syndrome

Background. Hamstring injuries continue to affect active individuals and although inadequate muscle extensibility remains a commonly accepted factor, little is known about the most effective method to improve flexibility. Purpose. To determine if an isolated neurodynamic sciatic sliding technique would improve hamstring flexibility to a greater degree than stretching or a placebo intervention in asymptomatic subjects with short hamstring syndrome (SHS). Study Design. Randomized double-blinded controlled trial. Methods. One hundred and twenty subjects with SHS were randomized to 1 of 3 groups: neurodynamic sliding, hamstring stretching, and placebo control. Each subject's dominant leg was measured for straight leg raise (SLR) range of motion (ROM) before and after interventions. Data were analyzed with a 3 × 2 mixed model ANOVA followed by simple main effects analyses. Results. At the end of the study, more ROM was observed in the Neurodynamic and Stretching groups compared to the Control group and more ROM in the Neurodynamic group compared to Stretching group. Conclusion. Findings suggest that a neurodynamic sliding technique will increase hamstring flexibility to a greater degree than static hamstring stretching in healthy subjects with SHS. Clinical Relevance. The use of neurodynamic sliding techniques to improve hamstring flexibility in sports may lead to a decreased incidence in injuries; however, this needs to be formally tested.