Background Injury surveillance is the cornerstone of effective injury management. However, to date no studies using recommended methods and involving multiple nations have been conducted within International Cricket.
Aim To conduct injury surveillance across multiple teams during the ICC Cricket World Cup 2011.
Methods An electronic system, based on the guidelines for injury surveillance in international cricket, was used to record all new injury episodes was used for data collection.
Results Twenty-three time-loss and 97 non-time-loss injuries were recorded. The injury incidence was 3.7/100 player-days (0.7 time-loss and 3.0 non-time-loss) with time-loss incidence being; for match injury 20.1/1000 player-days, bowling injury 3.3/100 bowling days and batting injuries 2.2/10 000 balls faced. Thigh muscle strain and medical illness were the diagnoses with the highest incidence. Fast bowlers, slow bowlers and batters all had a similar injury prevalence of approximately 5%. The bowling delivery stride was the activity that resulted in the greatest lost time.
Conclusions This is the first study to use recommended injury surveillance guidelines to reporting injury rates across multiple teams at a major cricket tournament. Non-time-loss injury incidence appears relatively high and further study of the effect on performance and progression to subsequent time-loss is required. Fast bowler injury prevalence rates are lower than reported elsewhere, however this may be due to the nature of the tournament and match format, which is likely to impose a lower relative workload. In future, data from all competing teams over all formats of the game (Twenty20, ODI and Tests) needs to be analysed to effectively inform injury prevention research and practice.
- Injury Prevention
- Sporting injuries
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Injury and illness surveillance (IS) is considered a vital first step in the management and prevention of athlete health problems.1 ,2 Effective collection, analysis and reporting of injury and illness types, rates, severity and causes allows sporting organisations to identify those that have the biggest impact on athlete availability and performance. Focused efforts can then be made towards optimising player preparation, and the training and competition environment to manage injury and illness risk.
Several international sporting organisations now undertake some form of IS during major competitions. These include the International Olympic Committee (IOC),3 the International Association of Athletics Federations (IAAF),4 the Fédération Internationale de Football Association (FIFA)5 and the International Rugby Board (IRB).6
There is only one study, from the 2003 Cricket World Cup, reporting injury data from multiple teams at an International Cricket Council (ICC) competition.7 This work preceded the recommended methods for IS in international cricket published in 2005,8 which has since provided the basis for IS programmes individually undertaken by the West Indies Cricket Board,9 New Zealand Cricket,10 South Africa11 and Cricket Australia.12 ,13
The limited numbers of available studies have identified that although cricket has generally been considered as a low-to-moderate injury risk game, injury rates seem to be rising with annual average prevalence (percentage of players unavailable due to injury) within Australian domestic and international teams recently exceeding 10%.13 One particular player type, fast bowlers, have injury prevalence rates consistently exceeding 15%,9 ,12 ,13 an injury prevalence comparable with contact sports such as Australian football14 and Rugby Union.15 Historically, lumbar stress fractures in fast bowlers have accounted for the most lost playing time, whereas hamstring and thigh muscle strains have had the highest incidence (number of injuries within a given period).13
It is not currently possible to generalise individual nations’ IS results due to the markedly different playing conditions and ethnic populations found across the major cricketing nations. Therefore, a coordinated international cricket IS programme aimed at informing injury prevention and management optimisation is essential and rightfully considered as long overdue.13 The ICC Cricket World Cup 2011 (CWC) provided the first opportunity for several competing teams to submit standardised IS data. The purpose of this study is to present an analysis of the injury and illness profile of multiple teams who participated in the ICC CWC 2011 jointly hosted by India, Sri Lanka and Bangladesh between February and April 2011.
Prior to the tournament, players from 5 of the 14 competing teams (76 players, from one associate and four test playing nations) provided written informed consent for injury data collection by their teams’ medical staff. The teams were Zimbabwe, Sri Lanka, South Africa, Bangladesh and Pakistan. Of the nine teams not included in the study, one team opted not to participate, three failed to provide data even though consent had been obtained, and the ICC was unable to obtain consent to use the injury surveillance data of the remaining five test playing nations who all collected injury surveillance data during the tournament using their own systems.
Injury and illness data collection was standardised via the use of a custom built electronic system that was provided to the teams by the ICC. Medical staff of each of the teams received face-to-face training from ICC staff in the lead up to the tournament.
The recommended definition8 of a significant cricket injury is any injury or other medical condition that either
Prevents a player from being fully available for selection in a major match; or
During a major match, causes a player to be unable to bat, bowl or keep wicket when required by either the rules or the team's captain.
This recommended international definition of a significant cricket injury only includes match time-loss injuries and illnesses (hereafter collectively termed ‘injuries’). However, it was felt that in a short tournament such as a Cricket World Cup that an accurate and reliable profile of all injuries, time-loss and non-time loss, could be achieved. Therefore medical staffs were requested to record all injury incidences that required medical assessment or intervention. This included any injuries that players carried into the tournament. ICC staff contacted team medical staff at regular intervals in the 3 months following the tournament reminding them to complete the records of injuries that had not resolved by the end of their tournament participation.
Data collected for each injury consisted of
Date of first symptoms. This was the date that the player first became aware of the injury.
Whether the injury resulted in the player being considered unavailable for selection, regardless of whether there was a match or training scheduled on that date.
If the answer to (2) above was yes, then it was considered a ‘time-loss injury’ and the following data was required
The date they were first considered unavailable for selection.
The expected number of days before they would become available for selection.
The actual date they became available for selection, regardless of whether there was a match scheduled on that date.
The date the injury was fully resolved, that is, all signs and symptoms had resolved and no further medical intervention was required.
For ‘non-time-loss injuries’ only the date of first symptoms and the ‘resolved’ date were required. These were player injuries presenting to the team medical staff that required assessment and potentially treatment, but did not at any time during the tournament period render them unavailable for selection.
The injury side, location, diagnosis and OSICS 10 code.
The mechanism of injury and the activity thought to be the most significant contributor to injury (table 1).
For an year round cricket injury surveillance, Orchard et al8 defines a ‘squad’ as 25 players and a ‘season’ as 60 days of scheduled match play. However, in this study exact squad sizes, consisting of all consenting players who were at some stage available for selection for their respective nation during the tournament, were divided by the number of teams to give an average ‘squad’ size.
The total amount of ‘tournament’ exposure was defined as the sum total of days each team participated in the tournament, with day one for all teams being 12 February 2011 (the date by which all teams were at their pre-tournament training bases) and the last being the date of each team's final match, multiplied by the number of players in each squad. This gave the total ‘tournament player days’.
The scorecards for each match were used to calculate the number of tournament match batting balls faced and overs bowled for each team. The average number of bowling days (match or training) per team, per week, was estimated as four, based on the likely training, match and travel schedules for each team.
The number of match days of exposure was calculated as the number of players per squad multiplied by the total number of games played by the five teams. In accordance with the recommended international formula, hours of player exposure in matches are calculated by multiplying the number of team days of exposure by 6.5 for the average number of players on the field and then multiplying by the number of designated hours in a day's play. For 50 over 1-day matches such as those of the ICC CWC 2011 this is 6.7 h/day, or, 43 h/team/day.
The major injury rate indices calculated were injury incidence and injury prevalence.
Injury incidence analyses the number of injuries occurring over a given time period. For the purposes of this study it included all new, gradual onset, recurrent, non-cricket related, training and match injuries recorded during the 50-day period of the tournament in the one measurement. The following formulae were used to calculate injury incidence subtypes:
Time-loss injury incidence per 100 player-days
Non-time-loss injury incidence per 100 player-days
Match injury incidence was calculated per 10 000 match hours and included only those injuries that occurred during official 2011 ICC CWC matches
As recommended by Orchard et al,13 match injury incidence was also calculated per 1000 player-days
Time-loss and non-time-loss bowling match incidence rates were calculated as the number of match bowling injuries per 1000 overs bowled in the tournament
Time-loss and non-time-loss batting match incidence rates were calculated as the number of match batting injuries 10 000 balls faced during the period of the tournamentTime-loss and non-time-loss tournament bowling incidence rates were calculated as bowling injuries per 1000 days of bowling (match and training) exposure.
‘Injury prevalence’ was the average percentage of players missing through injury for each day of the tournament. It was calculated using the numerator of ‘missed days due to time-loss injury’, with a denominator of number of tournament days multiplied by the average number of squad members per team, that is:
Tournament injury prevalence
‘Match injury prevalence’ is the average percentage of players missing through injury for each match of the tournament. It is calculated using the numerator of ‘missed player matches due to time-loss injury’, with a denominator of total number of matches played by the five teams, multiplied by the average number of squad members.
Match injury prevalence
A total of 143 injuries were recorded, however, 23 non-time-loss injuries were sustained prior to, but had not resolved before the tournament began, that is, they were carried into the tournament. Descriptive statistical analysis was undertaken only on the 120 new injuries sustained during the tournament period (table 2).
Table 3 shows the total and average number of matches, tournament days, players, match balls faced and bowled and estimated number of bowling days for the five teams over the period of the tournament.
Table 4 shows the number of tournament and match player-days, and the match player-hours of exposure for the five teams.
The overall injury incidence rates are shown in table 5.
Injury incidence rates per player position, body area and injury mechanism are displayed in tables 6 and7, tables 8 and 9, and tables 10 and 11, respectively. Fast bowlers had the highest time-loss (0.3) and batters (1.0) the highest non-time-loss injury incidence.
Time-loss injury incidence was highest for the thigh (0.2) and medical illness (0.2) body areas (table 8). The body areas with the highest non-time-loss injury incidence were lumbar (0.5), thigh (0.4) and knee (0.3) (table 9). The time-loss thigh injuries consisted of three quadricep, one adductor and one hamstring muscle strain. Four of these five occurred during matches and all but one (bowling delivery stride) were associated with running activities. Of the five medical problems, three were gastrointestinal illness.
Of the 16 non-time-loss lumbar injuries, seven were recorded as facet joint problems and seven were denoted as being muscle stiffness or ‘trigger point’ problems. Nine of the 14 non-time-loss thigh injuries were coded as hamstring muscle ‘minor strains’ or ‘trigger points’.
‘Acute sprain or strain’ was the most common injury mechanism for time-loss injuries with an incidence of 0.3, followed by ‘blow/contact’ with an incidence of 0.2/100 player-days (table 10). Cumulative microtrauma (overuse or unaccustomed use) was the mechanism with the highest non-time-loss injury incidence (1.0) (table 11).
When analysed by age, younger (25 years and under) and older (over 25 years) players had very similar time-loss injury incidence at 0.4 and 0.3, respectively. However, older players had much higher non-time-loss injury incidence (2.0 vs 1.1 for younger players).
The tournament injury prevalence was calculated as 5.1% of players being unavailable on any given tournament day. The match injury prevalence was 4.8% (table 12).
The tournament and match injury prevalence was calculated for each player position separately* and the results are indicated in table 13. The rates within batters, slow bowlers and fast bowlers were very similar at around 5%.
The tournament injury prevalence by body area is indicated in table 14 with ankle and hand having the highest injury prevalence at 1.2% and 1.1%, respectively. Others with relatively high injury prevalence were the abdomen, lumbar and thigh body areas.
The activity that resulted in the greatest tournament time-loss injury prevalence and match injury prevalence was delivery stride or follow-through of bowling, followed by running in the field, diving in the field and playing a shot during batting (table 15).
Acute sprain or strain was the injury mechanism with the highest prevalence (table 16) followed by a blow or contact, cumulative microtrauma and illness.
The aim of this study was to analyse the rates of injury and illness among multiple teams competing at the CWC 2011. The reasons were twofold, the first being to gain insight into the most important injury problems occurring during tournaments, and secondly, to pilot the logistics of conducting such a programme so that comprehensive injury surveillance of all teams may be instituted during all fixtures of the ICC Future Tours calendar and ICC Events.
That the medical staff of the five participating teams recorded 120 new injuries suggests that compliance with the request to record all problems presenting for medical attention was high. Similarly, the completeness of the data attests to the efficacy of using a networked electronic data collection system as opposed to most other similar programmes in other sports that have relied upon paper based data collection,3–6 ,12 ,15 which although effective, are likely to require significantly more collection and processing human resource. As only one of the participating teams, South Africa,11 has previously published any injury data, this study is perhaps an important first step in broadening and deepening the general knowledge of injury rates and risk factors previously only report by a few individual nations.9 ,13 ,16
Although an average of 1.6 new injuries per player across five teams seems a relatively high number for a tournament of this duration, it is worth noting that only 23 (19%) were ‘time-loss’, that is, they resulted in players being considered unavailable for selection. This study is the first to record ‘non-time-loss’ injuries in cricket and their seemingly high incidence indicates that cricketers, particularly fast bowlers, continue to play and train despite requiring medical attention, sometimes for multiple injuries. Future research should investigate the potential effects of these somewhat ‘occult’ injuries on performance, and any progression to more serious injury, particularly of lower back and knee problems that also rank highly within time-loss injuries.
Time-loss injury incidence was even across batters and bowlers (pace and slow), with wicket-keepers having a very low injury incidence and prevalence, as shown in other work.17 The bowling match injury incidence in this study was slightly higher than reported for Australian domestic one-day cricket (2.7 vs 2.2/1000 overs) and while it is not possible to draw firm inferences from one tournament, a higher intensity of cricket and players aggravating injuries carried into games may be contributing factors.
It appears that as previously recognised thigh (hamstring, quadricep and adductor) muscle strain injuries13 seem to commonly occur in the limited overs format of the game. However, in this study relatively low prevalence figures for this body area indicate ‘time-loss’ for these types of injuries was relatively short. It is known that recurrence rates for thigh strain injuries are high18 ,19 and therefore recognised risk factors such as muscle strength imbalance20 should be thoroughly addressed during rehabilitation and prevention programmes.
Not unexpectedly for a tournament conducted in the subcontinent, medical illness, particularly gastrointestinal problems, was common. Reassuringly, the prevalence rates indicate bouts were mostly short lived and this is probably testament to the aggressive treatment practices now undertaken by most travelling sports teams who are acutely aware of this problem.21 Nevertheless, the high incidence suggests that precautions such as hand washing, eating only piping hot well prepared food, drinking bottled water and isolating sick team members remain indicated.
Unsurprising is that along with acute strains and sprains (particularly thigh and ankle respectively), injuries due to being hit by the ball made up the bulk of ‘time-loss’ incidences while the ‘non-time-loss’ problems were predominantly attributed to cumulative micro-trauma. While the ICC recognises that helmet and glove design should be improved in the attempt to reduce the incidence and severity of impact injury to batters, there is an increasing concern that fielders are at risk from balls being hit ever harder in their direction.
Orchard and et al12 expressed concern that injury prevalence for their cohort of Australian domestic cricketers had increased to over 10% during the last few years. The tournament and match injury prevalence rates for the CWC were approximately half of that at around 5%. The lower prevalence rate seen during the CWC may be due to a number of factors and it is tentatively speculated that these could include; players and teams risking playing on despite injury due to the importance of the tournament, greater preparation and recovery time between matches due to the relatively spread out nature of the fixtures, and the limited bowling workload of a maximum of 10 overs per bowler per match for this format of cricket. Considerably higher over rates and consecutive days of bowling are undertaken during 4-day or 5-day cricket matches.
The time-loss match injury incidence of 71/10 000 player-hours is comparable to the long-term average for Australian domestic and international 1-day cricket reported by Orchard et al12 of approximately 50/10 000 player-hours. In this study a further 244 non-time-loss injuries per 10 000 player-hours were found to have been sustained during matches. As the incidence of non-time-loss injury data has never previously been collected it is difficult to comment on whether this is a high number or not. However, as many players, particularly older players, are clearly playing through injuries sustained during matches further study into the influence of these type of injuries on player performance and rates of progression to time-loss injury are warranted.
Injury suffered during the delivery stride or follow through of bowling was the activity that accounted for by far the greatest lost playing time, re-enforcing that this cricketing activity has the highest risk of severe injury.17 There are very few fast bowling injury prevention intervention studies and they have focused on technique modification in small groups of young fast bowlers.22 Recent work has identified that due to complex and highly trained movement patterns associated with the mature fast bowling action, modifying what are thought to be the most injurious technique characteristics is likely to be extremely difficult.23 There are also a limited number of studies identifying a link between injury-risk and bowling workload24 ,25 and although this information has been incorporated into workload directives and guidelines in Australia and the UK, the effectiveness has not been assessed. While it is accepted that bowling, in particular fast-bowling, has inherent injury risk, data from this study highlights the need for further research, coach and player education and management of potentially modifiable risk factors. In order for bowlers to have the best chance of minimising their unavailability for training and matches factors such as workload, footwear, training surfaces, bowler conditioning, nutrition, hydration and recovery practices need to be addressed.
A limitation of the study is that only ‘Tournament’ incidence and prevalence figures could be calculated, as injuries that prevented players being available for tournament selection could not be considered. Had they been, overall injury rates for the participating teams are likely to have been higher. Further, as the data is from only 5 of the 14 teams over one tournament it was not possible to measure aspects such as recurrence of injury and for these reasons generalisability of this preliminary study is limited. However, only one of these five teams11 has previously reported injury data and the number of injuries reported indicates that the medical staffs were diligent in their recording. The analysis also applies to only one type of cricket, 50-over 1-day Internationals, and other formats of the game also need to be tracked, ideally over the complete ICC Future Tours Programme.
With the rising prominence of formats such as T20 and because non-time-loss injuries are not included, it is recommended that the 2005 guidelines for injury surveillance in international cricket be revised. Suggested amendments to the injury rate units that might better reflect the modern cricket calendar include expressing match injury incidence per 1000 days of play, rather than per 10 000 h of play as they are now.13 Also, in line with the terminology used in international rugby injury surveillance26 the cricket injury definitions should be expanded to separately include ‘non-time-loss’ and ‘time-loss’ injuries, not simply the current ‘match time-loss injuries’. Suggested definitions are:
Non-time-loss injury: Any injury or illness that requires medical assessment or treatment but would not cause the player to be considered unavailable for major match selection, regardless of whether a major match is scheduled within the duration of the injury.
Time-loss injury: Any injury or illness whereby a player would be considered unavailable for major match selection for at least a 24 h period, regardless of whether there is a match scheduled within that period or not.
Within the injury definition, medical staff would need to assume that a major match is scheduled on every day of the year and based on that, make a judgement on whether the player would be considered unavailable on any given day. The number of days of time-loss is calculated from the date they would first be considered unavailable for major match selection, to the date they would be first considered available for major match selection. For all injuries, the duration of the injury would be calculated from the date of first symptoms, to the date where no further medical intervention is considered to be required, that is, the date of injury resolution. These updated definitions would help identify injuries that limit cricket participation without reliance on cricket match scheduling. Match schedules would of course still need to be considered when determining ‘match injury incidence and prevalence’.
This study is the first to report injury and illness rates across a number of teams at a major international cricket tournament. It is also the first to present data on both time-loss and non-time-loss injuries. Bowling continues to be the cricket activity resulting in the highest injury rates (incidence and prevalence) and along with acute muscle strains, particularly thigh and hamstring injury, should be the priorities for injury prevention programmes. While this information will make a valuable contribution to informing injury prevention practices and research priorities, in order to have maximal impact, data from all competing teams over the ICC Future Tours Programme (which includes all three formats of the game), and ICC events needs to be collected and analysed. To facilitate accurate and relevant injury reporting the guidelines for injury surveillance in international cricket should be updated to include units of injury rate measurement, and injury definitions (time-loss and non-time loss) more relevant to the modern game.
What are the new findings?
This study is the first to report injury and illness rates across a number of teams (only one which has previously reported injury statistics) at a major international cricket tournament.
It is also the first to present data on both time-loss and non-time-loss injuries.
Indications are that injury prevalence may be lower during ICC tournament conditions, possibly due to lower and more controlled workload as compared to the entire ICC Future Tours Programme.
How might it impact on clinical practice in the near future?
International cricket injury surveillance will identify priority injury problems that can be targeted by focused injury prevention and management programmes.
Sports medicine practitioners will be able to better inform cricket coaches and selectors as to player availability and injury risk so that team selection and preparation can be optimised.
Cricket's governors and administrators will be better informed of the costs and risks of injury within the game so that cricket development strategies can be honed.
The authors would like to acknowledge the ICC and ICC Medical Committee for their support of the project and the medical staff of the participating teams for their diligence in recording the injury data.
Contributors CR led the conception and design of the study, the analysis and interpretation of data, drafting and finalising of the paper's intellectual content. RH played a key role in conceiving the methodology, data collection and analysis and assisted with drafting and revising the manuscript. LR played a significant part in designing the study, led data acquisition, revised the paper and provided final approval of the submitted version. AM assisted with the study design, data interpretation and contributed to the drafting and revision of the intellectual content. JC roles were in conception and development of the methodology, data collection and analysis and he revised manuscript drafts. All authors approved the final submitted manuscript.
Competing interests None.
Ethics approval International Cricket Council Legal Department and the Federation of International Cricketers Associations.
Provenance and peer review Not commissioned; externally peer reviewed.