Figure 3 - available via license: Creative Commons Attribution-NonCommercial 4.0 International
Content may be subject to copyright.
Axial MRI of lumbo-sacral junction, where it can be appreciated that L5 nerve may possibly be entrapped at the neural foramen by a protruding disc or bony hypertrophy. Abbreviation: MRI, magnetic resonance imaging.
Source publication
To assess whether a history of lumbar stress fracture in pace bowlers in cricket is a risk factor for lower limb muscle strains.
This was a prospective cohort risk factor study, conducted using injury data from contracted first class pace bowlers in Australia during seasons 1998-1999 to 2008-2009 inclusive. There were 205 pace bowlers, 33 of whom s...
Citations
... There is also a suggestion that a previous lumbar spine fracture may be a risk factor for a subsequent hamstring injury [27]. This has been shown in First-Class Australian cricketers whereby those with a previous lumbar spine stress fracture were 1.5 times more likely to sustain a subsequent hamstring injury, compared to those who have not sustained a lumbar spine stress fracture [28]. The associated hypertrophy from lumbar spine healing has been proposed to potentially lead to subsequent lumbar nerve root impingement which may increase the risk of subsequent lower limb muscle strains including hamstring injuries [27]. ...
Objectives: The aim of this study was to describe the epidemiology of injuries; time-loss and non-time loss, in elite male academy cricket.
Design: Prospective cohort analysis.
Methods: Annual injury incidence and prevalence from all cricket related injuries were calculated for 348 male academy players (under-13 to under-18) from the 18 First-Class County Cricket clubs in England and Wales across four years (2017/18, 2018/19, 2020/21 and 2021/22), in accordance with the updated consensus statement for injury surveillance methods in cricket.
Results: The average annual injury incidence was 115.0 injuries/100 players/year, with similar rates between time-loss (59.7 injuries/100 players/year) and non-time loss injury incidence (55.3 injuries/100 players/year). On average, 8.5 % of players were unavailable on any given day of the year due to injury. Match injury incidence (48.8 injuries/100 players/year) was higher than cricket-based training (25.2 injuries/100 players/year), gym- based training, illness, and ‘other’ injury incidences. Match bowling was the activity associated with the high- est total (17.7 injuries/100 players/year), time-loss (10.3 injuries/100 players/year) and non-time loss (7.4 in- juries/100 players/year) injury incidence. The lumbar spine was the body location most frequently injured (15.3 injuries/100 players/year) and was the most prevalent body location injured (2.9 % of players).
Conclusions: The findings from this study provide, robust evidence of the extent of the injury problem in elite male academy cricketers. Bowling poses the greatest risk to players and the lumbar spine is the most common and prevalent injury location.
... These factors were considered in exercise selection, staging progress and RTP clearance. While the length of the surveillance window post-RTP appears to vary due to the impact of intrinsic (age; previous CMSI; other injury history) [8,31,85] and extrinsic (stage of the season; playing position) [86,87] factors, as well as the pathology (muscle involved; index versus recurrent injury [7]), monitoring exposure for ≥ 2 months is likely critical to the ongoing success of managing CMSI [52,53]. ...
Background
Despite calf muscle strain injuries (CMSI) being problematic in many sports, there is a dearth of research to guide clinicians dealing with these injuries. The aim of this study was to evaluate the current practices and perspectives of a select group of international experts regarding the assessment, management and prevention of CMSI using in-depth semi-structured interviews.
Results
Twenty expert clinicians working in elite sport and/or clinician-researchers specialising in the field completed interviews. A number of key points emerged from the interviews. Characteristics of CMSI were considered unique compared to other muscle strains. Rigor in the clinical approach clarifies the diagnosis, whereas ongoing monitoring of calf capacity and responses to loading exposure provides the most accurate estimate of prognosis. Athlete intrinsic characteristics, injury factors and sport demands shaped rehabilitation across six management phases, which were guided by key principles to optimise performance at return to play (RTP) while avoiding subsequent injury or recurrence. To prevent CMSI, periodic monitoring is common, but practices vary and data are collected to inform load-management and exercise selection rather than predict future CMSI. A universal injury prevention program for CMSI may not exist. Instead, individualised strategies should reflect athlete intrinsic characteristics and sport demands.
Conclusions
Information provided by experts enabled a recommended approach to clinically evaluate CMSI to be outlined, highlighting the injury characteristics considered most important for diagnosis and prognosis. Principles for optimal management after CMSI were also identified, which involved a systematic approach to rehabilitation and the RTP decision. Although CMSI were reportedly difficult to prevent, on- and off-field strategies were implemented by experts to mitigate risk, particularly in susceptible athletes.
... We assessed the full text of 91 studies and included 16 studies for review (FIG-URE 1). 5,8,[19][20][21]26,30,31,39,41,42,[51][52][53][54]71 Reasons for exclusion are included in SUPPLEMENTAL APPENDIX 3. ...
... A total of 2408 quadriceps injuries from a pool of over 11 719 athletes were captured, all from prospective cohort studies (TABLE 1). The majority of studies represented athletic populations from male cohorts across football (soccer) 5,8,20,21,26,30,31,39,41,42,71 and Australian football, 51,53,54 with single studies with participants from cricket, 52 and National Collegiate Athletic Association programs. 19 ...
Objective:
To identify risk factors for quadriceps muscle strain injury in sport.
Design:
Risk factor systematic review.
Literature search:
A systematic search was conducted in the MEDLINECINAHL, Embase, AMED, AUSPORT, SPORTDiscus, PEDro, and Cochrane Library databases (from inception to September 2021).
Study selection criteria:
Studies reporting prospective data to evaluate risk factors related to index and/or recurrent quadriceps muscle strain injury.
Data synthesis:
A risk-of-bias assessment (using a modified Quality in Prognosis Studies tool) was performed, and we used best-evidence synthesis to qualitatively synthesize the data to quantify relationships between risk factors and quadriceps muscle injury.
Results:
Sixteen studies were included, capturing 2408 quadriceps injuries in 11 719 athletes. Meta-analyses were not performed due to clinical heterogeneity. The dominant kicking leg (over 3154 individuals, 1055 injuries), a previous history of quadriceps muscle injury (6208 individuals, 975 injuries), and a recent history of hamstring strain (4087 individuals, 581 injuries) were intrinsic factors associated with quadriceps injury. Extrinsic factors relating to the preseason period and competitive match play increased quadriceps injury risk; participating at higher levels of competition decreased quadriceps injury risk. Age, weight, and flexibility (intrinsic factors) had no association with quadriceps injury.
Conclusion:
Previous quadriceps injury, recent hamstring injury, the dominant kicking leg, and competitive match play were the strongest risk factors for future quadriceps muscle injury in sport. J Orthop Sports Phys Ther 2022;52(6):389-400. doi:10.2519/jospt.2022.10870.
... These factors were considered in exercise selection, staging progress and RTP clearance. While the length of the surveillance window post-RTP appears to vary due to the impact of intrinsic (age; previous CMSI; other injury history) [8,31,85] and extrinsic (stage of the season; playing position) [86,87] factors, as well as the pathology (muscle involved; index versus recurrent injury [7]), monitoring exposure for ≥ 2 months is likely critical to the ongoing success of managing CMSI [52,53]. ...
Background
Despite being a common cause of time loss, information regarding best practice for calf muscle strain injuries (CMSI) in sport is scarce.
Objective
To establish best practice for the assessment and management of CMSI.
Design
Qualitative.
Setting
In-depth interviews.
Patients (or Participants)
20 expert medical professionals working in elite sport and/or researchers specialising in the field; representing seven countries and seven sports.
Interventions (or Assessment of Risk Factors)
Semi-structured interviews using a schedule of questions canvassing pre-identified topics. Thematic coding to analyse findings.
Main Outcome Measurements
Data were evaluated in three key areas: (i) injury characteristics, (ii) injury management, and (iii) injury prevention.
Results
CMSI have unique injury characteristics compared to other common muscle strain injuries (e.g. hamstring), but a criteria-based approach can assist forming the most accurate impression of prognosis. Similarly, a structured approach should be followed to ensure the athlete returns to a high level of performance and the risk of re-injury is minimized, focusing on: re-strengthening, plyometric and ballistic exercises, as well as running-based reconditioning specific to the sport. For the best chance to prevent index CMSI, strategies should span multiple domains of athlete management: screening and monitoring, field-based exposure (e.g. workload data), and off-field interventions (e.g. strengthening). Injury prevention strategies should be tailored to the individual, considering extrinsic (the sport, position played, club culture/coach expectations) and intrinsic (previous injury history, age, training history) factors that may increase susceptibility to CMSI.
Conclusions
Knowledge about the unique injury characteristics of CSMI can clarify the likely prognosis and best approach to rehabilitation. Practitioners attempting to prevent CMSI should use a multi-faceted approach given that the aetiology of CMSI is complex and often unique to the individual.
... Recurrent strains of the thigh and leg muscles in athletes may relate to damage to the lumbosacral nerve roots. 336,337 Nerve injury may cause motor deficits that make these muscles more susceptible to injury. One study found that cricket pace bowlers with a history of lumbar stress fractures had increased odds of calf, quadriceps, and hamstring strains. ...
... One study found that cricket pace bowlers with a history of lumbar stress fractures had increased odds of calf, quadriceps, and hamstring strains. 336 Other conditions such as greater trochanteric pain syndrome (GTPS) are associated with gluteal muscle weakness 338 and by the same logic could also relate to lumbosacral radiculopathy. ...
• Low back disorders are the most common cause of sciatica
• Gluteal region disorders are the second most common cause of sciatica
• Systemic illness such as autoimmune or vascular disease may contribute to sciatica
• Patients may have more than one source of pain
... Our analysis showed that the most frequent themes identified in the included studies for mechanisms or risk factors injury were related to bowling biomechanics [18,34,44,45,51], workload [18,29,31,45,47,50,[52][53][54], lack of warm-up and conditioning [28,34,44], muscle strength and stability [36,46,51,54], ground hardness [35,36,52], age [37,52], fielding technique [26,34,35,37,44] and previous injury [28,55,56]. We divided these risk factors in three categories: (1) ...
... However, research around this covariate in the cricket injury epidemiology literature is limited. Orchard et al. [56] showed that the relative risk (RR) of injury, which is the ratio of injury incidence in the exposed group compared to the non-exposed group, increases if there is a lumbar stress fracture. For example, lumbar stress fractures predispose fast bowlers to a higher risk of muscular strains in the calf (RR 4.1; 95% CI 2.4-7.1), ...
Background:
At the turn of the century, a new format of cricket [Twenty20 (T20)] was introduced that has led to more matches being played. Since then, it has been debated whether T20 cricket has increased the risk of overuse injuries.
Objectives:
The primary aim of this study was to meta-analyse the cricket injury rates in the twenty-first century. The secondary aims were to explore the risk factors and mechanisms of injury by analysing correlates such as age, format, era of play, country, player type, etc., and to conduct a qualitative analysis of the published studies.
Methods:
Several databases were searched using keywords "cricket" and "injur*" and 24 papers reporting cricket injuries fitted the inclusion criteria. Fifteen papers included data on exposure time and were used to calculate injury rates to perform sub-group analysis.
Results:
Pooled data on 12,511 players revealed 7627 injuries, and the 1.12 million hours of cricket play from 15 studies reporting exposure time showed an injury rate of 53.16 (95% confidence interval 51.84-54.52) per 10,000 h of play. There were no statistically significant differences in injury rates based on age, format, era of play, country, player type and injury definitions. Bowling biomechanics and workload were identified as the major risk factors for bowling injuries.
Conclusions:
This review shows that injury rates in junior and amateur cricket are higher than the injury rates of comparable cohorts playing other popular non-contact or quasi-contact team sports. There is not enough evidence to conclude that T20 cricket has increased injury rates.
... A further five papers were identified for inclusion during backward citation tracking, forward citation tracking and PubMed 'similar articles' search. [47][48][49][50][51] At the end of this process, 12 studies were eligible for the review (figure 1). 29-33 47-53 characteristics of the included studies Ten of the 12 included studies had a cohort design, 29-32 47 49-53 while two used case-control designs (table 1). ...
... 30 Cricket fast bowlers with a previous history of lumbar stress fracture were also found to have a fourfold increased risk of sustaining a calf injury and a twofold risk of sustaining a subsequent quadriceps injury. 51 The same study did not find any significant association between lumbar stress fractures and groin or ankle sprains and joint injuries. ...
Background
Previous injury is a strong risk factor for recurrent lower limb injury in athletic populations, yet the association between previous injury and a subsequent injury different in nature or location is rarely considered.
Objective
To systematically review data on the risk of sustaining a subsequent lower limb injury different in nature or location following a previous injury.
Methods
Eight medical databases were searched. Studies were eligible if they reported lower limb injury occurrence following any injury of a different anatomical site and/or of a different nature, assessed injury risk, contained athletic human participants and were written in English. Two reviewers independently applied the eligibility criteria and performed the risk of bias assessment. Meta-analysis was conducted using a random effects model.
Results
Twelve studies satisfied the eligibility criteria. Previous history of an ACL injury was associated with an increased risk of subsequent hamstring injury (three studies, RR=2.25, 95% CI 1.34 to 3.76), but a history of chronic groin injury was not associated with subsequent hamstring injury (three studies, RR=1.14, 95% CI 0.29 to 4.51). Previous lower limb muscular injury was associated with an increased risk of sustaining a lower limb muscular injury at a different site. A history of concussion and a variety of joint injuries were associated with an increased subsequent lower limb injury risk.
Conclusions
The fact that previous injury of any type may increase the risk for a range of lower limb subsequent injuries must be considered in the development of future tertiary prevention programmes.
Systematic review registration number
CRD42016039904 (PROSPERO).
... 15,23,27,32,42,43,46 While the incidence of injuries is more or less the same, the prevalence of injuries has been steadily increasing because of the increasing number of matches played and the decreasing amount of rest periods between matches. 30 The most common cricket injury reported is hamstring strain, and most severe is lumbar stress fracture in young fast bowlers, which is usually season ending. 30,34 Bowling (41.3%), fielding, and wicket keeping (28.6%) account for most injuries. ...
... 30 The most common cricket injury reported is hamstring strain, and most severe is lumbar stress fracture in young fast bowlers, which is usually season ending. 30,34 Bowling (41.3%), fielding, and wicket keeping (28.6%) account for most injuries. 43 Acute injuries are most common (64%-76%), with the rest being acute-on-chronic (16%-22.8%) ...
... Most hamstring and abdominal strains occur on the nonbowling side, and most quadriceps and calf strains occur on the bowling side. 30 Appendix 2 (available online) provides further details on hamstring injuries. ...
Context
Cricket is a popular global sport that requires a combination of physical fitness, skill, and strategy. Although a noncontact sport, overuse and impact injuries are common since players engage in a wide range of physical activities, including running, throwing, batting, bowling, catching, and diving. Significant or match time-loss injuries are defined as those that either prevent a player from being fully available for selection in a major match, or during a major match, cause a player to be unable to bat, bowl, or keep wicket when required by either the rules or the team’s captain. This review describes the various region-wise injuries sustained in cricket along with their epidemiology, biomechanics, treatment, and prevention.
Evidence Acquisition
Data were collected from peer-reviewed articles (obtained via PubMed search) published through November 2016 that involved the medical, biomechanical, and epidemiological aspects of cricket injuries.
Study Design
Clinical review.
Level of Evidence
Level 4.
Results
Cricket was one of the first sports to publish recommended methods for injury surveillance in 2005 from England, South Africa, Australia, the West Indies, and India. While the incidence of injuries is about the same, the prevalence of injuries has increased due to game format changes, increasing number of matches played, and decreased rest between matches. Bowling (41.3%), fielding, and wicket keeping (28.6%) account for most injuries. Acute injuries are most common (64%-76%), followed by acute-on-chronic (16%-22.8%) and chronic ones (8%-22%). The most common modern-day cricket injury is hamstring strain, and the most severe is lumbar stress fracture in young fast bowlers.
Conclusion
With improved understanding of the scientific and medical aspects of cricket, along with advances in surgical and nonsurgical treatment techniques, the time to return to play has shortened considerably. While the prevalence of cricket injuries has increased, their severity has decreased over the past decades.
... Although all were elite, 10 % were described as elite junior or emerging fast bowlers. While all studies recruited bowlers, key dependent variables differed markedly and included injuries (n = 7 articles) [4][5][6][13][14][15][16], activity profiles involving global positioning systems (GPS) and microtechnology devices (n = 6) [2,[17][18][19][20][21], strength and fitness measures (n = 3) [22][23][24], markers of fatigue (n = 3) [2,17,24], and anthropometry (n = 2) [22,23]. Only three articles reported measures of fast bowlers' performance as key dependent variables (Table 1). ...
... From the six studies on fast bowling using injury as an outcome [4,6,[13][14][15][16], four counted the balls bowled as a measure of workload [4,6,14,16]. In each of these studies, bowling workload was linked to injury likelihood. ...
... Bone injury likelihood was increased with high medium-term and low career workload, while joint injury likelihood was associated with high previous season and career workloads [16]. The remaining studies using injury as an outcome either identified a need to change the injury definition for cricket [5], observed injury rate across a single competition period [15], or observed injury likelihood in fast bowlers with a history of spinal bone stress injury [13]. ...
Background:
Cricket is distinctly positioned in the world of elite sports because three different formats now exist, each with characteristically different workload requirements. Fast bowlers have greater match-play workload requirements and are at greater injury risk than other positions. An update on the current cricket literature regarding fast bowling match-play physiology, workload, and injury is required to demonstrate the extent to which workload is related to performance and injury in elite fast bowlers since the introduction of 20-over cricket in 2005.
Methods:
The current review examined articles published in English with data collected from 2005 onwards pertaining to in situ cricket fast bowling physiology, match play, injury, and workload. Four databases were searched using the combinations of the following keywords: 'cricket' and 'bowl', inclusive of 'pace', 'fast', 'medium', or 'seam' bowling. Articles from 2005 onwards with male participants, high-performing or elite, and fast bowlers in the game of cricket were considered for inclusion. Only workload assessments captured in a field setting were included.
Results:
A total of 751 articles were identified. Exclusions included 527 duplicates, papers pre-2005, review articles, and abstracts. A further 185 articles were excluded after review of titles and abstracts that were deemed to be outside the scope of research or population. The full texts of 39 articles were reviewed, with only 17 included in this systematic review. In five articles reviewed, fast bowlers had a greater workload than other player types. Bowling workload history was reviewed in seven articles and appeared to have a complex interaction with likelihood of injury and injury type.
Conclusion:
Fast bowling workload has a well recognised relationship with injury and performance. Although monitoring acute and chronic workloads of fast bowlers remains the most ideal method for identifying preparedness and injury likelihood in fast bowlers, complexities exist that make the systematic prescription of bowling workloads difficult. Advances in technology to monitor workloads may provide further insight into the intensity and workloads of fast bowlers. PROSPERO registration number: CRD42015032466.
... Although one of the inclusion criteria for this systematic review was bowlers aged 18 years and above, not all studies specified the age range of their participants. Studies where the mean age of bowlers was 18 years and older were included even though the age range was not specified [10,[24][25][26][27]. In the study by Aginsky and colleagues [28], the age range was 17-36 years but the mean age was 22.4 years, which was well above the inclusion criteria of 18 years. ...
... All six studies which investigated bowling workload were conducted in Australia [7,22,27,30,31,35]. Four of the studies investigating intrinsic factors were conducted in South Africa [28,[32][33][34], four in Australia [10,24,26,36], and two in England [25,29]. ...
... Ten studies evaluated intrinsic neuromusculoskeletal factors, namely shoulder isokinetic strength and flexibility [28], quadratus lumborum (QL) muscle asymmetry [24,36], static and dynamic balance, lumbo-pelvic movement control [34], lumbar spine reposition sense [33], history of lumbar stress fracture [26], previous injury [22], and bony and disc appearance on magnetic resonance imaging (MRI) [25,29]. Technique-related intrinsic factors were investigated by three studies [10,25,32]. ...
Background
The high prevalence of injury amongst cricket fast bowlers exposes a great need for research into the risk factors associated with injury. Both extrinsic (environment-related) and intrinsic (person-related) risk factors are likely to be implicated within the high prevalence of non-contact injury amongst fast bowlers in cricket. Identifying and defining the relative importance of these risk factors is necessary in order to optimize injury prevention efforts.
Objective
The objective of this review was to assess and summarize the scientific literature related to the extrinsic and intrinsic factors associated with non-contact injury inherent to adult cricket fast bowlers.
Method
A systematic review was performed in compliance with the PRISMA guidelines. This review considered both experimental and epidemiological study designs. Studies that included male cricket fast bowlers aged 18 years or above, from all levels of play, evaluating the association between extrinsic/intrinsic factors and injury in fast bowlers were considered for inclusion. The three-step search strategy aimed at finding both published and unpublished studies from all languages. The searched databases included MEDLINE via PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Cochrane Controlled Trials Register in the Cochrane Library, Physiotherapy Evidence Database (PEDro), ProQuest 5000 International, ProQuest Health and Medical Complete, EBSCO MegaFile Premier, Science Direct, SPORTDiscus with Full Text and SCOPUS (prior to 28 April 2015). Initial keywords used were ‘cricket’, ‘pace’, ‘fast’, ‘bowler’, and ‘injury’. Papers which fitted the inclusion criteria were assessed by two independent reviewers for methodological validity prior to inclusion in the review using standardized critical appraisal instruments from the Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI).
Results
A total of 16 studies were determined to be suitable for inclusion in this systematic review. The mean critical appraisal score of the papers included in this study was 6.88 (SD 1.15) out of a maximum of 9. The following factors were found to be associated with injury: bowling shoulder internal rotation strength deficit, compromised dynamic balance and lumbar proprioception (joint position sense), the appearance of lumbar posterior element bone stress, degeneration of the lumbar disc on magnetic resonance imaging (MRI), and previous injury. Conflicting results were found for the association of quadratus lumborum (QL) muscle asymmetry with injury. Technique-related factors associated with injury included shoulder–pelvis flexion–extension angle, shoulder counter-rotation, knee angle, and the proportion of side-flexion during bowling. Bowling workload was the only extrinsic factor associated with injury in adult cricket fast bowlers. A high bowling workload (particularly if it represented a sudden upgrade from a lower workload) increased the subsequent risk to sustaining an injury 1, 3 or 4 weeks later.
Conclusion
Identifying the factors associated with injury is a crucial step which should precede the development of, and research into, the effectiveness of injury prevention programs. Once identified, risk factors may be included in pre-participation screening tools and injury prevention programs, and may also be incorporated in future research projects. Overall, the current review highlights the clear lack of research on factors associated with non-contact injury, specifically in adult cricket fast bowlers.
Systematic review registration number Johanna Briggs Institute Database of Systematic Reviews and Implementation Reports 1387 (Olivier et al., JBI Database Syst Rev Implement Rep 13(1):3–13. doi:10. 11124/ jbisrir-2015-1387, 2015).
