Statistics from Altmetric.com
This issue of the BJSM contains three cricket injury surveillance studies, including the first published multicountry surveillance project. Cricket1 narrowly preceded football2 and rugby union3 to the publication of the sport's first consensus statement of injury definitions in 2005. A major distinction between the statements was that the authors of the cricket statement chose to focus on match time-loss injuries only4 rather than ‘all reported’ injuries5 ,6 (which was the perspective chosen by football and rugby union). One of the reasons for cricket statement focusing on the match time-loss injuries was that owing to limited resources being devoted to injury surveillance in cricket, compliance would presumably be easier if there were fewer reporting requirements. Despite this, it has taken 8 years for the first multicountry study7 (and ironically both time-loss and non-time-loss injuries have been reported). During these years, T20 cricket has become far more prominent than it was and consequently many players have multiple contracts with different teams in a given year, so the original definitions probably need updating.8
Good surveillance requires funding
International injury surveillance in football and rugby union has fared only marginally better over the past 8 years and there are lessons for all sports about the slow progress of ongoing international sports injury surveillance systems. The clearest lesson is that good injury surveillance requires ongoing funding. In less-enlightened days of sports medicine, professional teams thought that medical staff should work for honorariums rather than professional salaries. It was envisaged by teams that they could obtain medical staff who wanted to work just for the privilege or to promote their own profile (they were correct) and that this would be a prudent saving (on which point they were mostly incorrect). Now most (but not all) professional teams around the world understand that if you want a high service level from well-qualified medical staff you need to pay for it. The same logic is not yet as widespread with respect to injury surveillance, but needs to be if high-quality international surveillance is desired. Funding has already been cited as a key factor in the success (or otherwise) of national joint replacement registries.9
Player consent for surveillance
The current study also highlights key issues with obtaining consent.10 ,11 It is disappointing that in the Cricket World Cup of 2011 there were other teams where independent data was being collected by the respective countries but the players had only consented to their national system (not the international one) and hence the data could not be included. I believe that consent for de-identified data probably should change from an ‘opt-in’ to ‘opt-out’ default (which of interest is the case with many successful medical registries) with the consent written into the standard playing contract. There is a miniscule effect on privacy for injury information to be included in a de-identified database but a massive effect on study power if signed written consent cannot be obtained from every individual.
Tournament versus year-round injury epidemiology
The most important lesson for cricket itself is that an isolated limited-overs tournament appears to lead to low-injury prevalence, even in fast bowlers. While it is a great start to have a profile of injuries during a particular tournament, the ICC cannot feel satisfied that they have a clear picture of injuries in their sport until most countries report year-round results. If all cricket was of the limited-overs variety, fast bowlers may not be more likely than other positions (or players in other sports) to suffer long-term injuries. This tends to confirm previous reports that high workloads for fast bowlers12 ,13 (and perhaps also the rapid transition from low-workload tournaments to high-workload ones) are the main culprit with respect to high injury prevalence in fast bowlers. Consideration which would potentially limit or reduce workloads (eg, allowing substitutes in first-class cricket14 ,15) would therefore be likely to prevent injuries in fast bowlers.
Head and eye injuries in cricket
The paper on eye injuries in wicketkeepers makes a very good case that eye protection should be compulsory when keeping up at the stumps, because eye injuries, while uncommon, can be catastrophic and/or career-ending.16 While there can be a debate between a regulatory versus an educational approach, medical professionals should probably be in the former camp and support compulsory eye protection. Mouthguard use in rugby union in New Zealand has been made compulsory with proven results17 and there should be more use of rules forcing players to protect themselves where the value of equipment is proven.
The final paper is an excellent example of injury surveillance being carried further along the line to prevention, so it is easy to see why it was a prizewinning study.18 There appears to have been no resistance to reform among helmet manufacturers in the UK and it is likely that future UK standards will be safer. The regulatory debate may arise in poorer countries if it is found that safer helmets are more expensive to manufacture, although again medical professionals should probably lobby for greater safety, given that the direct and indirect costs concerning facial injuries are likely to be greater than the savings from the use of cheaper helmets.
Competing interests JO provides paid injury surveillance consultancy services to Cricket Australia.
Provenance and peer review Commissioned; internally peer reviewed.
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.