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Audit of Injuries in Scottish Cricket

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Study of Injuries in a pool of international Scottish cricketers; conducted in association with the University of Glasgow

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									An Audit of Injuries in Cricket in Scotland in the
                  2008 Season

A research project submitted in partial fulfillment of MSc degree in
                    Sports & Exercise Medicine.




                                               Dr Deepak Sitaram Hiwale

                                             Matriculation no. 0809366H,
                                    Faculty of Sports & Exercise Medicine,
                                                University of Glasgow, UK.
                                                             August 2009.
Matriculation No. 0809366H




                             2
                                                   Matriculation No. 0809366H



                               Table of Contents

                                                                    Page No.

ACKNOWLEDGEMENT                                                             5

LIST OF FIGURES AND TABLES                                                 6

ABBREVIATIONS                                                              7

ABSTRACT                                                                   8

1.0   INTRODUCTION                                                        11
2.0   METHODOLOGY                                                         17
      2.1   Aim of the study                                              17
      2.2   Study Design                                                  17
      2.3   Ethical Approval                                              18
      2.4   Subjects                                                      18
      2.5   Data Analysis                                                 18


3.0   RESULTS                                                             19


4.0   DISCUSSION                                                           26
5.0   METHODOLOGICAL LIMITATIONS                                           27
      5.1.1 Subjects                                                      27
      5.1.2 Procedural                                                    28
      5.1.3 Analytical                                                    28


6.0   TAKE HOME MESSAGE                                                    28
7.0   REFERENCES                                                           29


      PARTICIPANT QUESTIONNAIRE




                                                                                3
Matriculation No. 0809366H




                             4
                                                         Matriculation No. 0809366H



                              Acknowledgements




I would like to express my solemn gratitude to the following for their invaluable

support during the undertaking and conduction of this study.


Dr John A Maclean, Hon. Senior Clinical lecturer in Sport & Exercise Medicine,

University of Glasgow, for his immense support, expertise and reviewing of the work

from time to time, Dr Paul Macintyre, course director for MSc Sport and Exercise

Medicine, University of Glasgow for his financial support and advice, Mr. Andrew

Tennant, Head of Performance at Cricket Scotland & National Cricket Academy,

Edinburgh, for his logistic support and feedback and Ms Zeenat Khan, Director (HR),

Royal Promoters and Builders, Pune, India, for her invaluable advice on statistical

matters.


And last but not the least, my family and friends, for their constant support and

encouragement, without which, none of this would have been possible.




Dr Deepak S Hiwale,

University of Glasgow

September, 2009




                                                                                      5
                                                             Matriculation No. 0809366H



                             List of figures and tables
                                                                              Page No.

Figure I    Injury % according to activity                                        22

Figure II   Distribution of injuries according to anatomical site                  22

Figure III Injury % according to occurrence                                       23

Figure IV Matches missed due to injury                                             23

Figure V Time lost through injury (weeks to attain practice                       24

            or match fitness after injury)

Figure VI Availability of Sports Injury advice to players                         24

Table 1     Type of injuries in the 2008 season                                   25




                                                                                          6
                            Matriculation No. 0809366H



        Abbreviations


ACC           Accident Compensation Corporation

ICC           International Cricket Council

SNCL          Scottish National Cricket League

SSMAG         Sports Science Medicine Advisory Group




                                                         7
                                                                 Matriculation No. 0809366H



                                       Abstract



Cricket is a popular sport played and followed by millions around the globe. It is a

relatively non contact sport with a low to moderate risk of injury. However, in the last

decade, the incidence of injury has been shown to be on the rise. This is possibly due

to increase in the workload for modern cricketers.


Aim of the study

The aim of the study was to audit the prevalence and patterns of injuries in cricket in

Scotland over a complete season. A study of this nature has never been undertaken in

Scotland. This study will act as pilot study for a long term injury surveillance program in

Scottish cricket. Cricket researchers have long been in favour of a ‘world cricket injury

surveillance report’. This study, we reckon, will contribute to such a report when

undertaken.


Methods


A questionnaire was sent to Cricket Scotland who in turn engaged 150 professional

cricket players from the Scottish international team, SNCL Premier League, SNCL

division I and division II. Involvement of the team coaches through the initiative of

Cricket Scotland was sought to increase the compliance for return of the questionnaire.


Results


We received feedback from 26 of the 150 players that we approached. The numbers of

injuries reported throughout the season were 18. An increased prevalence of injuries

was apparent at the start of the season with 27% of all injuries occurring in April, 2008.

Of all the players, 42% suffered injuries at some point of time during the season. Most

                                                                                          8
                                                                  Matriculation No. 0809366H



of the injuries (66%) occurred in match situations. Acute injuries accounted for 60% of

all injuries. As expected, bowling was responsible for 36.84% of injuries while fielding

caused 52.36% of injuries.


Upper limb injuries contributed to 57.89% of the injuries. Finger injuries in the form of

fractures or contusions had a prevalence rate of 15.29%. Lower limb injuries accounted

for 31.58% of all injuries with knee and shin stress fracture being common and

hamstring injuries having prevalence rate 16.67%. Midsection injuries accounted for

10.53 % of injuries with a 5.26% prevalence rate for side or abdominal muscle strain.

During the entire season, there was not a single case of head, neck or face injury.


35.29% of injuries took more than 6 weeks to heal, while almost half of the injured

players took more than 4 weeks to recover from injury.


An interesting statistic was that only 8.33% of international cricketers had access to a

medical support in the form of a sports doctor or a physiotherapist. At the domestic

level, provision of medical support as well as sports injury advice was lacking for 100%

of players. Likewise, none of the clubs we came across had implemented injury data

collection or monitoring program.


Discussion


The injury patterns and prevalence rates identified showed similarities to previous

studies, especially for lower limb and fingers injuries. Fielding was recognised as the

most injury prone mechanism while bowling was a major contributor for injury. Also,

time lost due to injury was seen to be a major concern. Thus, in our view, improved

techniques for fielding, catching and throwing and biomechanical analysis for correction

of technical flaws in bowlers’ actions and will go a long way in reducing injuries.


                                                                                           9
                                                                Matriculation No. 0809366H



Also, we identified a need for the provision of medical support to players to make them

realise their full potential.


A national database for cricket injuries within the confines of the Scottish government

similar to the Accident Compensation Corporation (ACC), in New Zealand or the Sports

Science Medicine Advisory Group (SMAGG) in Australia should be implemented. The

ICC should look to help full as well as associate members in setting up injury prevention

programs. It should allocate funds and provide expertise in the form of trained

individuals for the same. Appointment of injury statisticians for recording of injury data

for every first class, one day or twenty 20 match should be looked at. At the end of

every match an injury report should be sent to the team management, and the SNCL

which in turn will pass it on to the ICC. This collection of data should be anonymised as

much as possible to help safeguard players’ interests.


In summary, we recommend designing and implementation of a long term injury

survelliance program, improved medical support to players and further research into

methods to reduce injuries.




                                                                                        10
                                                                Matriculation No. 0809366H



                                   1. Introduction



Cricket is a popular sport played and followed by millions around the globe. It is a

relatively non contact sport with a low to moderate risk of injury as compared to sports

like hockey or football.1;2 However, in the last decade, the incidence of injury has been

shown to be on the rise.3 This is possibly due to increase in the workload for modern

cricketers. Intense competition, higher levels of fitness and skills required and increase

in the number of matches played throughout the season has resulted in this trend.

Furthermore, pressures of international travel and acclimitisation to foreign playing

conditions in a matter of days have added to the stress.


Although the popularity of cricket is on the rise, worldwide research into injuries has

been dismal, to say the least. The International Cricket Council (ICC), which governs

the game, boasts a membership of 104 countries including 10 full, 34 associate and 60

affiliate members. However, most of the statistical data on incidence and prevalence of

injuries comes from just four countries, namely, Australia, South Africa, England and

the West Indies.


Australia was the first country to introduce long term injury surveillance in professional

cricket in the summer of 1998-99.2 The Sports Science Medicine Advisory Group

(SSMAG) set up by Cricket Australia is responsible for the collection and maintenance

of a long term injury database.3 Recently, the English and the South African Boards

have set up their own injury surveillance programs. In New Zealand, the Accident

Compensation Corporation is responsible for recording all sporting injuries. The rest of

the test playing nations, however, along with the associate members of the ICC do not

have programs implemented to record cricketing injuries. Although cricket has a vast


                                                                                        11
                                                                   Matriculation No. 0809366H



following in the subcontinent, availability of statistical data regarding injuries is lacking.

Similarly, a study of the nature and prevalence of injuries in cricket has never been

undertaken in Scotland.

In the backdrop of researchers pushing for a ‘world cricket injury report’, all test playing

and associate member countries should set up injury surveillance programs to identify

patterns along with prevalence and incidence of injuries. This would enable

comparisons of data across varying sets of playing conditions prevailing in different

countries.




                                   Injuries in Cricket




Although cricket is a non contact sport, injuries are quite common, especially in fast

bowlers.4-7 Some instances of death due to cricket have also been documented in

literature.8


Importance of Injury Surveillance


Long term injury surveillance in sport is the basis for prevention of injuries. Identification

of causes with subsequent designing and implementation of interventions forms the

‘sequence of prevention’ of injuries.9


Surveillance of injuries across nations has however proved to be more difficult than

previously thought. Over the years, different studies have sought to define injury in

cricket and devise methods for injury surveillance.10-14 However, disparity in the

definitions used by different researchers has been a problem in comparing injury rates


                                                                                           12
                                                                    Matriculation No. 0809366H



                         3;12;15
from across the world.             Orchard et al. defined injury in cricket as “any injury or

medical condition that either (a) prevents a player from being fully available for

selection for a major match or (b) during a major match, causes a player to be unable to

bat, bowl or keep wickets when required by either the rules or the team’s captain”
3;12
   .whereas,Leary et al. defined injury in cricket as an event which caused a player to

seek medical attention.10


Overall Incidence of Injuries


Different studies report injury incidence in cricket varying from 2.6 to 333/ 10,000 player

hours.1;2;16;17 Of all the Accident and Emergency department presentations in Australia,

8% cases were cricket related injuries, making cricket the 5th most injury prone sport in

Australia.2 In South Africa, Stretch found that there was an injury incidence per player

of 1.6 to 1.91 per season; also that 49% of all players get injured sometime throughout

a season.13 Leary et. al. in their 10 year study of professional English county cricketers

found the acute injury incidence to be 57.4 per 1000 days of cricket. 10 In a South

African study, of all the injuries in cricket, acute injuries accounted for 64.8% of all

injuries while 16.6% were chronic. Majority of the injuries were first time injuries (64.5%)

with recurrent injuries from the previous season account for 22.8% of injuries. 13


Injuries by anatomical site


Lower limb injuries are the most common with an incidence of 45% to 49.8% where as

trunk (20-32.6%) and upper limb (18.9 to 29 %) were the other sites commonly

involved.7;10;13 The tissues mostly involved are muscles and other soft tissues (41.0%),

joints (22.2%), tendons (13.2%), and ligaments (6.2%).7 Muscle strains were found to

be most common. Of the lower limb injuries, hamstring injuries were reported to be

most common by Orchard et al (11% of all injuries).2 Most of these were in the form of

                                                                                            13
                                                                   Matriculation No. 0809366H



muscle strains and tears especially in bowlers and fielders.18 Knee injuries, usually

comprise of joint sprains (27.6%), tendonitis (26.5%) and contusions (16.3%).10 Orchard

et al reported that knee ligament injuries were uncommon in cricket. An interesting

observation was that cricketers were more likely to suffer from knee ligament injuries

during the game of football that cricketers play as a form of pre-match warming up or

cross training.2 Groin injuries in bowlers (8% of all injuries in bowlers) and batsmen (9%

of injuries in batsmen) had an overall incidence of 7%.2 Stress fractures of the tibia,

fibula and foot, and ankle sprains occurred mostly in fast bowlers and had a combined

incidence of 6% in the study conducted by Orchard et al.2


Upper limb injuries make up 19.8% to 34.1% of all injuries in cricket. 2;17;18 Most of these

are finger injuries due to ball impact occurring during fielding or batting. 1;7;18;19

Contusions    account    for   a   major    share    of   finger   injuries   (40%)    while

fractures/dislocations (28.9%) and joint sprains (23%) are the other finger injuries

commonly encountered.10 Although, most of the finger injuries in cricket have a

satisfactory treatment outcome, cricketers often report a residual component of l pain or

minor swelling and / or deformity.19 Most of the wicket keepers have been known to

carry finger injuries but rarely report them for the fear of missing matches. Shoulder

injuries usually occur in fielders and bowlers while batsmen and wicket keepers are

characteristically spared.10;18 Shoulder tendon injuries were reported to comprise of 6%

of all injuries by Orchard et al. 2, Supraspinatus tendon was seen to be mostly affected.

Incidence of shoulder dislocation or subluxation was shown to be low 1%. Upper limb

lacerations or fractures were reported to have a low incidence and occurred mostly in

batsmen.2


Side strain occurring on the non dominant arm in bowlers is quite notorious to heal.2

Incidence of side or abdominal muscle strain is 9% of all injuries; 1% of all cricket

                                                                                           14
                                                                 Matriculation No. 0809366H



injuries are side strains due to a stress or traumatic fracture of the rib.2 The overall

incidence of back and trunk injuries accounted was 18% to 33% of all injuries.7;16-18

Fast bowlers were found to be at particular risk of developing lower back injury.4;20-24

So much so that Foster et al. and Bell have likened the injuries in fast bowlers to en

epidemic.4;25


The incidence for head, neck and face injuries vary from 5% to 25 % usually resulting

from impact of the cricket ball causing lacerations or contusions and rarely

concussions.1;2;13;16-18 Weightman and Brown reported a quarter of cricket injuries to be

concussions due to a ball impact on the head.1 This was probably due to the fact that

use of helmets in cricket was not in fashion in the 70s when the study was conducted.

Of the cervical spine injuries, 63.6% were in the form of sprains or strains resulting from

batting for long periods of time.7


Jones and Tullo reported an incidence of 9% for eye injuries in sports in the UK. 26

Although, eye injuries in cricket are rare, some studies have reported a few cases

associated with cricket.27;28 These are usually more severe.


Seasonal Variation of injuries


Injuries in cricket are more common at the start of the season.7;10 The highest incidence

number of injuries mostly muscle, tendon and ligament injuries occur at the start of the

season (April–27.3%).10 Whereas fractures or dislocations occur with the same

frequency throughout the season. Stretch reported a similar incidence of higher injuries

at the start of the season (32.3%) compared to than mid-season (21.7%) or towards the

end (12.5%) or offseason (12.5%).18




                                                                                         15
                                                                Matriculation No. 0809366H



Role performed in the team


Stretch reported an injury incidence according to activity as follows: bowling (41.3%),

fielding and wicket keeping (28.6%), and batting (17.1%).18 A study by Orchard et al,

reports that wicketkeepers had the lowest injury incidence (2%) probably because of

minimal sprinting, throwing or bowling.2 Bowlers usually sustained lower limb or back

injuries while fielders and wicket keepers usually suffered upper limb (42.9%) or lower

limb injuries (40.6%). Batsman on the other hand suffered mainly lower limb injuries

(54.4%).


Delivery and follow through of the fast bowler (25.6%), overuse (18.3%), and fielding

(21.4%) were the main mechanisms of injury.18


Age Incidence


Young fast bowlers tend to get injured more often.7;13;14;18      Also the incidence of

overuse injuries in cricketers in the age group of 19-24 years tends to be higher than

their older counterparts.7 An important observation by Stretch is that of 14 stress

fractures encountered during the study, all occurred in in young cricketers with 13 of

them due to bowling.7


Time lost due to injury


Stretch states in his longitudinal study of South African cricketers that after an injury,

47.8% of injured players were able to return to play within a week. However, 23.8% of

the players were not able to train or participate in a match for more than 3 weeks after

the incidence.7




                                                                                        16
                                                                Matriculation No. 0809366H



                                   2.0 Methodolgy



2.1 Aim of the Study


The aim of the study was to audit the prevalence and patterns of injuries occurring in

cricket in Scotland over a complete season. A study of this nature has never been

undertaken in Scotland. This study will act as pilot study for a long term injury

surveillance program in Scottish cricket. Cricket researchers have long been in favour

of a ‘world cricket injury surveillance report’. This study, we reckon, will contribute to

such a report, if and when it is undertaken.


2.2 Study design


The study was a retrospective, questionnaire based study carried out online with the

support of Cricket Scotland. The involvement of Cricket Scotland, the national

governing body for the sport in Scotland, we hoped, would increase the response rate

for the questionnaires and thus the reliability of the audit. We feared that compliance

would be an issue. However, we were hopeful that involvement of the club coaches via

the governing body for cricket in Scotland would maximise the return rate.


Scotland were granted associate membership of the International Cricket Council in

1994 after having severed their cricketing ties with the England cricket board two years

earlier. This allowed them to qualify for the Cricket World Cup in 1999. The highest

point in their short international has been the winning of the Inaugural ICC

intercontinental Cup in 2004. The Scottish cricket team also plays in the English one

day tournament, the Friends Provident Trophy as the Scottish Saltires. The first class

structure for cricket in Scotland, Scottish National Cricket League (SNCL) is divided into



                                                                                        17
                                                                Matriculation No. 0809366H



three levels, the SNCL Premiere League, the SNCL division I and the SNCL division II.

Each of these levels consists of 10 teams, playing each other home and away. In

addition, there is an under 19s Scottish cricket team. Each of the first class teams plays

an extra game with the under 19s, making a total of 19 matches over the season for

each team.

Cricket Scotland distributed the questionnaire to 150 elite cricketers from the

international team as well as those in the three divisions of the SNCL. The audit

assessed areas such as nature of injury, body part affected, mechanism of injury,

recovery time, etc as well as the provision of medical support at the club – (see

attached questionnaire). Data was recorded from the feedback received from the

questionnaire. Data analysis was done on a prevalence percentage basis and

comparisons made with the limited existing studies.


2.3 Ethical Approval


Ethical approval for undertaking this study was sought from and granted by the Faculty

of Medicine Ethics Committee for Non Clinical Research involving Human Subjects,

University of Glasgow, Scotland.


2.4 Subjects


The subjects involved in the study were 150 elite cricket players from the Scottish

national team and clubs in the top 3 divisions of the Scottish National Cricket league

(SNCL).


2.5 Data Analysis


Minitab 15.1 was used to carry out statistical analysis whereas Microsoft Excel 2007

was used to provide graphical analysis of the data. Also, for comparison with the

                                                                                        18
                                                                 Matriculation No. 0809366H



existing data, literature searches were carried out using Reference Manager

Professional Network Edition 12.0. The databases used were Pubmed and ISI Web of

Knowledge for the period of 1970 to 2009 with key words for search being cricket,

injury, surveillance, patterns, incidence, and prevalence. The review considered all

papers up to May 2009 relevant to definition, incidence, prevalence, causes and

prevention of injuries in cricket.




                                      3.0 Results



During the study, Cricket Scotland distributed the questionnaires to 150 cricket players

from the international team and the three divisions of the SNCL. To improve the

response rate, the coaches were instructed get the players to fill in the questionnaires.


We received feedback from 26 of the 150 players that we approached. Of these, almost

77% were of current international status with 85% having represented Scotland at some

point in their careers. In the SNCL, 73.08% of all players represented the premier

division in 2008 season, 19.23%, division I while only one player each featured in

division II and domestic matches outside the SNCL. 73% of the players that responded

were in the age group of 19-25 while 15.38% were in the under 19 age group of and

12% in the over 24 age group. Batsmen comprised of 35% of players while bowlers and

all-rounders formed a major share of 64%. Only one wicketkeeper featured in the study.

The percentage of players who appeared in more than 30 matches over the season

was 46% while 23% played between 11-30 matches.




                                                                                         19
                                                                  Matriculation No. 0809366H



The numbers of injuries reported throughout the season were 18. An increased

prevalence of injuries was apparent at the start of the season with 27% of all injuries

occurring in April, 2008. Of all the players, 42% suffered injuries at some point of time

during the season. Most of the injuries (66%) occurred in match situations. Acute

injuries accounted for 60% of all injuries while acute or gradual recurrence of a previous

injury was responsible for 35% of the cases. Fielding (along with catching and throwing)

caused 52.36% of injuries, with throwing alone being responsible for 10% of all injuries.

Bowling was found to be responsible for 36.84% of the injuries.


Regional Distribution of injuries (See fig. II and table I)


Upper limb injuries contributed to 57.89% of the injuries, with shoulder tendon injury

accounting for 27.27% of all upper limb and 15.79% of all injuries. Injuries to the fingers

in the form of fractures or contusions had a prevalence rate of 15.29% for all injuries

and 27.27% of all upper limb injuries. Lower limb injuries accounted for 31.58% of all

injuries with knee and shin stress fracture being more common. Hamstring injuries

having prevalence rate 16.67%. During the entire season, there was not a single case

of head, neck or face injury. Midsection injuries accounted for 10.53 % of injuries with

5.26% prevalence rate for side or abdominal muscle strain.


35.29% of injuries took more than 6 weeks to heal enough for the player to participate

in a match again, while almost half of the injured players took more than 4 weeks to

recover from injury.


Injury Advice and Surveillance


In our analysis we found that only 8.33% of international cricketers had any access to a

medical support team in the form of a sports doctor or a physiotherapist while 75% of


                                                                                          20
                                                                Matriculation No. 0809366H



players at did not have injury advice at all. At the domestic level, provision of medical

support as well as sports injury advice was lacking for 100% of players. Likewise, none

of the clubs we came had implemented injury data collection or monitoring program for

the 2008 season.




                                                                                        21
                                                                           Matriculation No. 0809366H




Figure I. Injury % according to activity




               Other                  5.2
                                                                                          of all
      Wicketkeeping                   5.2                                                 injuries
             Throwig                                        15.78

            Catching                                                     21.05

             Fielding                                                    21.05

             Bowling                                                     21.05

 Running bet. wickets                 5.2

              Batting                 5.2

                        0         5               10   15           20           25




Figure II. Distribution of injuries according to anatomical site




                              11%
                                            32%


                                                                            Lower Limbs
                                                                            Upper Limb
                                                                            Trunk & back
                                                                            Head, Neck or Face
                            58%




                                                                           *no head, neck, face
                                                                           injuries reported




                                                                                                     22
                                                                                        Matriculation No. 0809366H



Figure III. Injury % according to occurrence




                                                                        Sudden

                                                                        Gradual

                                                                        Sudden recurrence of previous injury
                                          10%
                                                                        Gradual recurrence of previous injury

                            25%

                                                               60%
                                  5%




                                  Injuries according to occurrence




Figure IV. Matches missed due to injury




                       40
                                                 35.71                              35.71               None
                       35

                       30

                       25
                                  21.43
% of injured players




                       20

                       15

                       10                                      7.14
                        5

                        0
                                  None           1 to 3        4 to 6                >6




                                                                                                                23
                                                                                                      Matriculation No. 0809366H



Figure V. Time lost through injury (weeks to attain practice or match fitness after
injury)




                       40
                                                                                                      35.29        Practice
                       35
                                                                                                                   Match
                                      29.41         29.42                                     29.41
                       30
                              25.53
% of injured players




                       25                                   23.53

                       20                                                 17.65

                       15                                                         11.76
                       10

                        5

                        0
                                < 1 week               1-3 week            4-6 week            > 6 week




Figure VI. Availability of medical support to players




       100%                                        0                0                 0
                                16.6                                                                               Not Sure
               90%
               80%                                                                                                 No

               70%                                                                                                 Yes
               60%
% of players




               50%                                100               100              100              100
                                 75
               40%
               30%
               20%
               10%
                                8.33
                       0%                          0             0               0                  0
                            International     SNCL Premier SNCL Division I SNCL Division II       Other
                                                League




                                                                                                                              24
                                                              Matriculation No. 0809366H



Table I. Type of injuries in the 2008 season



Type of Injury              International   SNCL (domestic)


Head / Face
Fractures                         0                  0
Eyes                              0                  0
Other                             0                  0

Neck
Sprains                           0                  0
Other                             0                  0

Shoulder
Tendon / muscle                   3                  1
Dislocation / subluxation         0                  0

Arm / Elbow / Forearm
Fracture                          2                  0
Other                             1                  0

Wrist / Palm
Dislocation/Fracture                                 1
Split webbing                     0                  0
Other                             0                  0
                                  0
Fingers
Fractures                         3                  0
Other                             1                  0

Trunk
Abd/Side strain                   1                  0
Other                             1                  0

Back
Lumbar stress fracture            0                  0
Other                             0                  0

Groin/Hip                                            1
Ham / Quad                                           1
Knee
Ligament                          0                  0
Other                             1                  0

Shin /Ankle / Foot
Stress fracture                   0                  1
Sprains                           0                  0
Other                             0                  0

Total                           13               5




                                                                                      25
                                                                  Matriculation No. 0809366H



                                      4.0 Discussion



The prevalence rate of injuries in Scottish cricket players both international and

domestic over a season was ascertained in this study. Players in Scotland do not

feature in as many matches over a season as players from places like Australia or

India. As such, injury rates have not reached alarming proportions but the injury

patterns and prevalence rates do show some similarities. The distribution of injuries

according to anatomical site is similar to other studies, especially prevalence rate for

lower limb fingers injuries.7;   19
                                      Fielding and bowling were recognised as major

contributors for injury. Seasonal variations were also similar to a previous English

study.10 Most of the injuries were seen to occur at the start of the season.


The time lost due to injury is a major concern. Number of weeks taken to get back to

match fitness was similar to previous studies.7 Thus, in our view, improved techniques

for fielding, catching and throwing and biomechanical analysis for correction of

technical flaws in bowlers’ actions and will go a long way in reducing injuries.


It is interesting to note that none of the domestic players had access to medical back up

in the form of a doctor or a physiotherapist. Even at the international level only one

player had a sports doctor to attend to his injuries. Also, we identified a need for the

provision of medical support to players to make them realise their full potential. An

injury free player is more likely to perform to the best of his ability ensuring good

performance of the team. A successful team in turn can attract sponsors thereby further

enhancing the injury aspect of the game.




                                                                                          26
                                                                Matriculation No. 0809366H



A national database for cricket injuries within the confines of the Scottish government

similar to the ACC or the SMAGG should be implemented. The ICC should look to help

full as well as associate members in setting up injury prevention programs. The ICC

should allocate funds and provide expertise in the form trained personnel for the same.

Appointment of injury statisticians for recording of injury data in every first class, one

day or twenty 20 match should be looked at. At the end of every match an injury report

should be sent to the team management, the SNCL which in turn will pass it on to the

ICC. This collection of data should be anonymised as much as possible to help

safeguard players’ interests.


In summary, we recommend designing and implementation of a long term injury

survelliance program, improved medical support to players and further research into

methods to reduce injuries.




                          5.0 Methodological Limitations



5.1 Subjects


The response we got for the questionnaire was not as good as expected. Unforeseen

logistics and strategic problems due to prior commitment of the Scottish international

team with World twenty 20 Cup, 2009 in England and the domestic teams being busy

in the final stages of the season hampered collection of feedback from the players.

The selection of players from the elite level did serve the purpose of determining injury

prevalence at the highest level. However, patterns of injury at the school and junior

level need to be identified as well.



                                                                                        27
                                                                Matriculation No. 0809366H



5.2 Procedural


Since it was a retrospective study, the authenticity of injuries reported form memory by

the players can be questioned. Injuries should ideally have been diagnosed and

recorded by professional medical personnel like a physiotherapist or a sports doctor.

Furthermore, this study looked into injuries over just one season.


Having said so, this study can prove to be a pilot project on which future research can

be based.


5.3 Analytical


We calculated prevalence of the different types of injuries. However, the study did not

look into the incidence rates of different injuries. The incidence rates along with

prevalence rates as done by some previous studies would have been a better reflection

of injuries affecting professional cricketers in Scotland.




                              6.0 Take Home Message



Design and implementation of a long term injury survelliance program


Improved medical support to players


Further research into methods to reduce bowling and fielding injuries




                                                                                          28
                                                                Matriculation No. 0809366H



                                  7.0 References



 (1) Weightman D, Browne RC. Injuries in Eleven Selected Sports. Br J Sports Med
     1975; 9(3):136-141.

 (2) Orchard J, James T, Alcott E, Carter S, Farhart P. Injuries in Australian cricket at
     first class level 1995/1996 to 2000/2001. Br J Sports Med 2002; 36(4):270-274.

 (3) Orchard JW, James T, Portus MR. Injuries to elite male cricketers in Australia
     over a 10-year period. J Sci Med Sport 2006; 9(6):459-467.

 (4) Foster D, John D, Elliott B, Ackland T, Fitch K. Back injuries to fast bowlers in
     cricket: a prospective study. Br J Sports Med 1989; 23(3):150-154.

 (5) Hardcastle P, Annear P, Foster DH, Chakera TM, McCormick C, Khangure M et
     al. Spinal abnormalities in young fast bowlers. J Bone Joint Surg Br 1992;
     74(3):421-425.

 (6) Hardcastle PH. Repair of spondylolysis in young fast bowlers. J Bone Joint Surg
     Br 1993; 75(3):398-402.

 (7) Stretch RA. Cricket injuries: a longitudinal study of the nature of injuries to South
     African cricketers. Br J Sports Med 2003; 37(3):250-253.

 (8) Brasch R. How did sports begin? Sydney: Camberwell: Longman; 1971.

 (9) Van MW, Hlobil H, Kemper HCG. Incidence Severity Aetiology and Prevention of
     Sports Injuries A Review of Concepts. Sports Medicine 1992; 14(2):82-99.

(10) Leary T, White JA. Acute injury incidence in professional county club cricket
     players (1985-1995). Br J Sports Med 2000; 34(2):145-147.

(11) Mitchell R, Hayen A. Defining a cricket injury. J Sci Med Sport 2005; 8(3):357-
     358.

(12) Orchard J, Newman D, Stretch R, Frost W, Mansingh A, Leipus A. Methods for
     injury surveillance in international cricket. J Sci Med Sport 2005; 8(1):1-14.


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                                                               Matriculation No. 0809366H



(13) Stretch RA. The incidence and nature of injuries in first-league and provincial
     cricketers. S Afr Med J 1993; 83(5):339-342.

(14) Stretch RA. The seasonal incidence and nature of injuries in schoolboy
     cricketers. S Afr Med J 1995; 85(11):1182-1184.

(15) Finch CF, Elliott BC, McGrath AC. Measures to prevent cricket injuries: an
     overview. Sports Med 1999; 28(4):263-272.

(16) Corrigan AB. Cricket injuries. Aust Fam Physician 1984; 13(8):558-9, 562.

(17) Crisp T. Cricket: fast bowler's back and thrower's shoulder. Practitioner 1989;
     233(1469):790-792.

(18) Stretch RA. Incidence and nature of epidemiological injuries to elite South
     African cricket players. S Afr Med J 2001; 91(4):336-339.

(19) Belliappa PP, Barton NJ. Hand injuries in cricketers. J Hand Surg Br 1991;
     16(2):212-214.

(20) Bartlett RM, Stockill NP, Elliott BC, Burnett AF. The biomechanics of fast bowling
     in men's cricket: a review. J Sports Sci 1996; 14(5):403-424.

(21) Bell PA. Spondylolysis in fast bowlers: principles of prevention and a survey of
     awareness among cricket coaches. Br J Sports Med 1992; 26(4):273-275.

(22) Dennis R, Farhart P, Goumas C, Orchard J. Bowling workload and the risk of
     injury in elite cricket fast bowlers. J Sci Med Sport 2003; 6(3):359-367.

(23) Dennis R, Farhart P, Clements M, Ledwidge H. The relationship between fast
     bowling workload and injury in first-class cricketers: a pilot study. J Sci Med
     Sport 2004; 7(2):232-236.

(24) Engstrom CM, Walker DG. Pars interarticularis stress lesions in the lumbar spine
     of cricket fast bowlers. Med Sci Sports Exerc 2007; 39(1):28-33.

(25) Bell P. Cricket: injury in long trousers. Br J Sports Med 1999; 33(3):151-152.




                                                                                       30
                                                             Matriculation No. 0809366H



(26) Jones NP, Tullo AB. Severe eye injuries in cricket. Br J Sports Med 1986;
     20(4):178-179.

(27) Abedin A, Chen HC. An uncommonly serious case of an uncommon sport injury.
     Br J Sports Med 2005; 39(8):e33.

(28) Aburn N. Eye injuries in indoor cricket at Wellington Hospital: a survey January
     1987 to June 1989. N Z Med J 1990; 103(898):454-456.




                                                                                     31
                                                                      Matriculation No. 0809366H



                            Cover Letter for the Questionnaire




               An Audit of Injuries in Cricket in Scotland in the 2008 Season.


    With increased participation in cricket in Scotland, sports doctors and physiotherapists have
become aware of a corresponding increase in cricket related injuries. Also, researchers
worldwide have felt the need for a global injury incidence report to identify risk factors for
subsequent designing and implementation of interventions for prevention of injuries. Some data
regarding injuries in cricket is available from Australia, South Africa, England and the West
Indies. However, epidemiological collection of data of injuries from the rest of the world is
dismal, to say the least.
     In Scotland as well, there has never been any audit of injuries in cricket, time lost due to
injuries, implementation of injury prevention program and provision of medical support to
players.
    This audit aims to look at the type and prevalence of injuries that occurred over the 2008
season in cricket in Scotland, allowing an insight into the mechanisms of injury in cricket. We
hope that this will assist the development of medical support and injury prevention programmes.
This study would also contribute to a ‘World Injury Incidence Report’ to be undertaken in the
near future.
    This audit is being conducted by the Department of Sport & Exercise Medicine, University of
Glasgow with the support of Cricket Scotland.

    We are grateful for your valuable time spent in answering the questionnaire. If you have any
questions regarding the study or the questionnaire please do not hesitate to contact either:




Dr Deepak S Hiwale               or          Dr John A Maclean
0809366H@student.gla.ac.uk                   john.maclean@sportsmedicinecentre.org
07919493421                                  0141-616-6166




                                                                                               32
                                                                        Matriculation No. 0809366H




                                        Questionnaire
Do you play international cricket?

Yes, Currently
Previously
No

Please indicate the level of domestic cricket that you play in.

SNCL Premier                                         SNCL Div 2
SNCL Div 1                                           Other

Does your club provide access to sports injury advice and treatment?

 Yes
 No
not sure

If yes, who provides this support?

Doctor                                               Sports Therapist
Physiotherapist                                      Other

Are you aware of an injury prevention program being followed at your club?

Yes
No
not sure

How old are you?

12-18 y                                              25-29 y
19-24 y                                              >29 y


What role do you perform in the team?

Batsman                                              All Rounder
Bowler                                               WKeeper


Please specify the number of matches you played in the 2008 season.

International
Club
Other

                                                                                                33
                                                                     Matriculation No. 0809366H




Please specify the number of matches played by your club throughout the 2008 season.
       (Please put in an appropriate number in the box)



Please specify the total number of players in your club squad at the start of the 2008 season.
       (Please put in an appropriate number in the box)




Did you suffer any injuries during the 2008 season?

Yes
No

If the answer to the above question is ‘No’, that is the end of the questionnaire.
Thank you for your help.

If however, the answer is ‘Yes’, please go to the next question


Please specify the total number of injuries that you suffered in 2008.
   (For the purpose of this questionnaire we define an injury as the presence of pain or
   discomfort which prevented you from training or playing in the next match.)




The rest of the questionnaire is related to the injuries you sustained during the 2008
season. Please fill in questions 1-9 for EACH of the injuries you reported in the
question above. We have copied questions 1-9 five times to allow you to report up to 5
injuries. If you have had more than 5 injuries, please add the details at the end of the
questionnaire.




                                                                                                 34
                                                                       Matriculation No. 0809366H


                                           INJURY 1

1. Please tick the most appropriate box to describe this injury.

       Head, neck or face                                   Fingers
       Fractured facial bones                               Fracture
       Eye injury                                           Other
       Cut
       Other                                                Trunk
                                                            Abdominal /side strain
       Neck Injury                                          Other
       Muscle injury
       Other                                                Back
                                                            Lumbar spine stress fracture
       Shoulder                                             Other
       Muscle/tendon injury
       Dislocation / subluxation                            Groin, hip or buttock injury
       Other                                                Muscle injury
                                                            Other
       Elbow/arm
       Fracture                                             Thigh muscle injury
       Muscle injury
       Other                                                Hamstring muscle injury

                                                            Calf muscle strain
       Wrist & palm
       Dislocation / fracture                               Knee
       Split webbing                                        Bony injury
       Other                                                Cartilage injury
                                                            Other
       Thumb Injury
       Dislocation / fracture                               Shin and foot
       Other                                                Stress fracture
                                                            Other




       Other injury not noted above (please specify injury site)




                                                                                               35
                                                                   Matriculation No. 0809366H


2. Have you injured this body part before?

       Yes
       No

3. What best describes the onset of this injury.

       Contact/sudden onset of new injury
       Gradual onset of new injury
       Sudden reoccurrence of previous injury
       Gradual reoccurrence of pervious injury

4. How did this injury occur?

       Batting
       Running between wickets
       Bowling
       Fielding
       Catching
       Throwing
       Wicket keeping


5. Where did this injury occur?

       Match
       Nets
       Warm up & stretches
       General training (cross)

    If other, please specify
        (E.G. Sports other than cricket, not related to sports, work related etc)




6. What month of the season did this injury occur in?

       Apr-2008                                           Aug-2008
       May-2008                                           Sep-2008
       Jun-2008                                           Out of season
       Jul-2008


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                                                                        Matriculation No. 0809366H


7. How many matches did you miss as a result of this injury?

       None
       1–3
       4–6
       >6

8. How long did it take before you were able to return to training after this training?

       <1 Week
       1-3 Weeks
       4-6 Weeks
       >6 Weeks


9. How long did it take before you were able to return to playing after this injury?

       <1 Week
       1-3 Weeks
       4-6 Weeks
       >6 Weeks




                                                                                                37
                                                                       Matriculation No. 0809366H


                                           INJURY 2

1. Please tick the most appropriate box to describe this injury.

       Head, neck or face                                   Fingers
       Fractured facial bones                               Fracture
       Eye injury                                           Other
       Cut
       Other                                                Trunk
                                                            Abdominal /side strain
       Neck Injury                                          Other
       Muscle injury
       Other                                                Back
                                                            Lumbar spine stress fracture
       Shoulder                                             Other
       Muscle/tendon injury
       Dislocation / subluxation                            Groin, hip or buttock injury
       Other                                                Muscle injury
                                                            Other
       Elbow/arm
       Fracture                                             Thigh muscle injury
       Muscle injury
       Other                                                Hamstring muscle injury

                                                            Calf muscle strain
       Wrist & palm
       Dislocation / fracture                               Knee
       Split webbing                                        Bony injury
       Other                                                Cartilage injury
                                                            Other
       Thumb Injury
       Dislocation / fracture                               Shin and foot
       Other                                                Stress fracture
                                                            Other




       Other injury not noted above (please specify injury site)




                                                                                               38
                                                                   Matriculation No. 0809366H


2. Have you injured this body part before?

       Yes
       No

3. What best describes the onset of this injury.

       Contact/sudden onset of new injury
       Gradual onset of new injury
       Sudden reoccurrence of previous injury
       Gradual reoccurrence of pervious injury

4. How did this injury occur?

       Batting
       Running between wickets
       Bowling
       Fielding
       Catching
       Throwing
       Wicket keeping


5. Where did this injury occur?

       Match
       Nets
       Warm up & stretches
       General training (cross)

    If other, please specify
        (E.G. Sports other than cricket, not related to sports, work related etc)




6. What month of the season did this injury occur in?

       Apr-2008                                           Aug-2008
       May-2008                                           Sep-2008
       Jun-2008                                           Out of season
       Jul-2008


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                                                                        Matriculation No. 0809366H



7. How many matches did you miss as a result of this injury?

       None
       1–3
       4–6
       >6

8. How long did it take before you were able to return to training after this training?

       <1 Week
       1-3 Weeks
       4-6 Weeks
       >6 Weeks


9. How long did it take before you were able to return to playing after this injury?

       <1 Week
       1-3 Weeks
       4-6 Weeks
       >6 Weeks




                                                                                                40
                                                                       Matriculation No. 0809366H


                                           INJURY 3

1. Please tick the most appropriate box to describe this injury.

       Head, neck or face                                   Fingers
       Fractured facial bones                               Fracture
       Eye injury                                           Other
       Cut
       Other                                                Trunk
                                                            Abdominal /side strain
       Neck Injury                                          Other
       Muscle injury
       Other                                                Back
                                                            Lumbar spine stress fracture
       Shoulder                                             Other
       Muscle/tendon injury
       Dislocation / subluxation                            Groin, hip or buttock injury
       Other                                                Muscle injury
                                                            Other
       Elbow/arm
       Fracture                                             Thigh muscle injury
       Muscle injury
       Other                                                Hamstring muscle injury

                                                            Calf muscle strain
       Wrist & palm
       Dislocation / fracture                               Knee
       Split webbing                                        Bony injury
       Other                                                Cartilage injury
                                                            Other
       Thumb Injury
       Dislocation / fracture                               Shin and foot
       Other                                                Stress fracture
                                                            Other




       Other injury not noted above (please specify injury site)




                                                                                               41
                                                                   Matriculation No. 0809366H


2. Have you injured this body part before?

       Yes
       No

3. What best describes the onset of this injury.

       Contact/sudden onset of new injury
       Gradual onset of new injury
       Sudden reoccurrence of previous injury
       Gradual reoccurrence of pervious injury

4. How did this injury occur?

       Batting
       Running between wickets
       Bowling
       Fielding
       Catching
       Throwing
       Wicket keeping


5. Where did this injury occur?

       Match
       Nets
       Warm up & stretches
       General training (cross)

    If other, please specify
        (E.G. Sports other than cricket, not related to sports, work related etc)




6. What month of the season did this injury occur in?

       Apr-2008                                           Aug-2008
       May-2008                                           Sep-2008
       Jun-2008                                           Out of season
       Jul-2008


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                                                                        Matriculation No. 0809366H



7. How many matches did you miss as a result of this injury?

       None
       1–3
       4–6
       >6

8. How long did it take before you were able to return to training after this training?

       <1 Week
       1-3 Weeks
       4-6 Weeks
       >6 Weeks


9. How long did it take before you were able to return to playing after this injury?

       <1 Week
       1-3 Weeks
       4-6 Weeks
       >6 Weeks




                                                                                                43
                                                                       Matriculation No. 0809366H


                                           INJURY 4

1. Please tick the most appropriate box to describe this injury.

       Head, neck or face                                   Fingers
       Fractured facial bones                               Fracture
       Eye injury                                           Other
       Cut
       Other                                                Trunk
                                                            Abdominal /side strain
       Neck Injury                                          Other
       Muscle injury
       Other                                                Back
                                                            Lumbar spine stress fracture
       Shoulder                                             Other
       Muscle/tendon injury
       Dislocation / subluxation                            Groin, hip or buttock injury
       Other                                                Muscle injury
                                                            Other
       Elbow/arm
       Fracture                                             Thigh muscle injury
       Muscle injury
       Other                                                Hamstring muscle injury

                                                            Calf muscle strain
       Wrist & palm
       Dislocation / fracture                               Knee
       Split webbing                                        Bony injury
       Other                                                Cartilage injury
                                                            Other
       Thumb Injury
       Dislocation / fracture                               Shin and foot
       Other                                                Stress fracture
                                                            Other




       Other injury not noted above (please specify injury site)




                                                                                               44
                                                                   Matriculation No. 0809366H


2. Have you injured this body part before?

       Yes
       No

3. What best describes the onset of this injury.

       Contact/sudden onset of new injury
       Gradual onset of new injury
       Sudden reoccurrence of previous injury
       Gradual reoccurrence of pervious injury

4. How did this injury occur?

       Batting
       Running between wickets
       Bowling
       Fielding
       Catching
       Throwing
       Wicket keeping


5. Where did this injury occur?

       Match
       Nets
       Warm up & stretches
       General training (cross)

    If other, please specify
        (E.G. Sports other than cricket, not related to sports, work related etc)




6. What month of the season did this injury occur in?

       Apr-2008                                           Aug-2008
       May-2008                                           Sep-2008
       Jun-2008                                           Out of season
       Jul-2008


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                                                                        Matriculation No. 0809366H



7. How many matches did you miss as a result of this injury?

       None
       1–3
       4–6
       >6

8. How long did it take before you were able to return to training after this training?

       <1 Week
       1-3 Weeks
       4-6 Weeks
       >6 Weeks


9. How long did it take before you were able to return to playing after this injury?

       <1 Week
       1-3 Weeks
       4-6 Weeks
       >6 Weeks




                                                                                                46
                                                                     Matriculation No. 0809366H


                                         INJURY 5

1. What was the diagnosis of this injury? Please tick the most appropriate box to describe this
   injury.

       Head, neck or face                                 Fingers
       Fractured facial bones                             Fracture
       Eye injury                                         Other
       Cut
       Other                                              Trunk
                                                          Abdominal /side strain
       Neck Injury                                        Other
       Muscle injury
       Other                                              Back
                                                          Lumbar spine stress fracture
       Shoulder                                           Other
       Muscle/tendon injury
       Dislocation / subluxation                          Groin, hip or buttock injury
       Other                                              Muscle injury
                                                          Other
       Elbow/arm
       Fracture                                           Thigh muscle injury
       Muscle injury
       Other                                              Hamstring muscle injury

                                                          Calf muscle strain
       Wrist & palm
       Dislocation / fracture                             Knee
       Split webbing                                      Bony injury
       Other                                              Cartilage injury
                                                          Other
       Thumb Injury
       Dislocation / fracture                             Shin and foot
       Other                                              Stress fracture
                                                          Other




       Other injury not noted above (please specify injury site)




                                                                                             47
                                                                   Matriculation No. 0809366H



2. Have you injured this body part before?

       Yes
       No

3. What best describes the onset of this injury.

       Contact/sudden onset of new injury
       Gradual onset of new injury
       Sudden reoccurrence of previous injury
       Gradual reoccurrence of pervious injury

4. How did this injury occur?

       Batting
       Running between wickets
       Bowling
       Fielding
       Catching
       Throwing
       Wicket keeping


5. Where did this injury occur?

       Match
       Nets
       Warm up & stretches
       General training (cross)

    If other, please specify
        (E.G. Sports other than cricket, not related to sports, work related etc)




6. What month of the season did this injury occur in?

       Apr-2008                                           Aug-2008
       May-2008                                           Sep-2008
       Jun-2008                                           Out of season
       Jul-2008

                                                                                           48
                                                                        Matriculation No.
0809366H




7. How many matches did you miss as a result of this injury?

       None
       1–3
       4–6
       >6

8. How long did it take before you were able to return to training after this training?

       <1 Week
       1-3 Weeks
       4-6 Weeks
       >6 Weeks


9. How long did it take before you were able to return to playing after this injury?

       <1 Week
       1-3 Weeks
       4-6 Weeks
       >6 Weeks
                                                                 Matriculation No.
0809366H


                              For more than 5 injuries

If you have had more than 5 injuries during the season, please add details (of injures
not already mentioned)




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