measures to prevent cricket injuries

Measures to Prevent Cricket InjuriesAn Overview

Caroline F. Finch,1 Bruce C. Elliott2 and Alicia C. McGrath3

1 School of Human Health Sciences, Deakin University, Melbourne, Victoria, Australia2 Department of Human Movement and Exercise Science, The University of Western Australia,

Perth, Western Australia, Australia3 Monash University Accident Research Centre, Melbourne, Victoria, Australia

ContentsAbstract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2631. Overview of General Cricket Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2642. Overuse Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 266

2.1 Overuse Injuries in Fast Bowlers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2662.2 Overuse Injuries in Other Players . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 267

3. Impact Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2684. Measures to Prevent Cricket Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2695. Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 270

Abstract Cricket is a major international sport, generally played in British Common-wealth nations. Although strictly a non-contact sport, injuries in cricket can resultin a number of ways. In high level cricket, overuse injuries are common andrelated to the physical demands of the sport, particularly in the delivery of theball. The bowling action involves repetitive twisting, extension and rotation ofthe trunk at the same time as absorption of large ground reaction forces over ashort period of time. Thesemovements, if performed incorrectly or too frequently,can lead to overuse injuries of the back, particularly in elite and high level cricketers.Cross-sectional studies have demonstrated that spinal overuse injuries occurmorefrequently to cricketers adopting amixed bowling action than to thosewho favoura front- or side-on bowling technique. Strategies to ensure that cricketers do notadopt the mixed action or bowl too fast for extended periods can prevent theseback injuries. Injuries resulting from impacts, generally from the cricket ball, canalso occur and are more common during low level competition or informal par-ticipation. Because of the potential severity of these impacts, a range of protectiveequipment ranging from body padding to gloves and face protectors are nowcommon features of standard cricket equipment. Although a number of measuresto prevent cricket injuries have been widely suggested in the literature, there havebeen very few studies that have formally assessed their effectiveness in prevent-ing injury. Further research is needed to gain a greater understanding of thebiomechanics of cricket actions, the mechanisms of resultant injuries and the roleof various risk factors in injury causation.

REVIEW ARTICLE Sports Med 1999 Oct; 28 (4): 263-2720112-1642/99/0010-0263/$05.00/0

© Adis International Limited. All rights reserved.

Cricket injuries have been documented as farback as 1751, when the Prince of Wales was killedby a cricket ball striking him in the head.[1] Thepace of the game, hazards of play and expectationsof the players have all increased over time. Althoughstrictly a non-contact sport, cricket injuries can re-sult in a number of ways. Impact injuries can resultfrom a direct blow by a ball or bat, or as a result ofa collision between players or with the game sur-rounds. Protective equipment and game rules havelargely developed to prevent these injuries. At themore competitive level, overuse injuries are com-mon and attention to technique and pre-participationscreening are important countermeasures. Othercountermeasures, such as warm-up, footwear andadequate treatment and rehabilitation for injurieshave more general relevance.As a sport generally played in British Common-

wealth nations, the amount of literature publishedon the epidemiology, mechanisms and preventionof cricket injuries is limited, particularly at the non-elite levels of play. Much of the available literaturefocuses on back injuries in high level cricket, withvery little describing cricket injuries in general.Such injuries, whether overuse or impact in nature,are generally the result of an accumulation of a setof circumstances and pre-existing conditions thatmay best be understood as a chain of events: pre-event, event and post-event.[2] Injury countermea-sures are measures that can ‘counter’, that is pre-vent or reduce, the risk of injury. Countermeasuresshould be targeted at the different links in the chainof events leading to injury, and there is a range ofcountermeasures available to prevent these inju-ries. Table I lists countermeasures for preventingcricket injuries and illustrates how these relate tothe various stages of prevention.Countermeasures for cricket may either be spe-

cific to the sport (e.g. improved skills and tech-niques to prevent overuse injuries and protectiveequipment to prevent impact injuries) or more ge-neric (e.g. physical preparation, environmental con-ditions, modified rules, education, coaching, firstaid and appropriate rehabilitation to reduce recur-rence of an injury).

Unlike other literature describing cricket inju-ries,[3-8] this review does not specifically focus onthe epidemiology of cricket injuries, nor does itprovide a detailed description of their aetiology.Instead, a critical review of the range of counter-measures promoted to prevent such injuries is de-scribed. These are presented in terms of how theyrelate to overuse injuries, impact injuries and othergeneral injury occurrences during cricket. This pa-per also provides an evaluation of the extent to whichthese countermeasures have been demonstrated tobe effective. A brief overview of the epidemiologyof cricket injuries, however, is given to set the scenefor the subsequent discussion.The sources of information used to compile this

review were: a Medline and Sport discus CD-ROMsearch for published literature (over the past 15years), injury conference proceedings, and discus-sions with key Australian cricket injury researchersand Australian cricket organisations.

1. Overview of General Cricket Injuries

Despite the historical recognition of injury andpossible death resulting from cricket, very few stud-ies have documented the incidence and nature ofgeneral cricket injuries to populations of non-eliteplayers. Table II summarises the published studiesdescribing cricket injuries to broad-based samplesof players and presents details of the body regionsmost commonly injured.The incidence of cricket injuries has been re-

ported to be 2.6 injuries per 10 000 hours played ina British Sports Council survey.[11] The average riskof a fatality whilst participating in cricket has beenestimated at 2 for every 100 million adult partici-pants in the UK.[12] Cricket also ranked fifth high-est in terms of non-fatal accident rates, with 40injuries occurring for every 100 000 hours of par-ticipation.[12]South African studies have reported seasonal in-

cidence injury rates of 49% for both NationalCricket Club players and schoolboy cricketers.[9]Bowlers were reported to have more injuries thanother players. In particular, these players sustaineda higher proportion of lower limb (22%) and back

264 Finch et al.

© Adis International Limited. All rights reserved. Sports Med 1999 Oct; 28 (4)

injuries (17%) than other players. Research by El-liott et al.[13] highlighted the severity of the bonyand tissue injuries to the lumbar vertebrae of fastbowlers. Stretch[9] attributed this to the forces ap-parent in the delivery stride and bowling actionsused by the bowlers.According to Stretch,[9] upper limb injuries are

most frequent in fielders (26%), with a possibleexplanation being the forces involved about thejoints of the upper limb in excessive throwing overa large distance. Temple[14] found that upper limbinjuries accounted for 25% of both schoolboy andclub cricket injuries. Furthermore, Stretch[7,9]identified that 32 to 34% of provincial and clubcricketers sustained some form of upper limb in-jury. Amongst schoolboy cricketers, the seasonalinjury incidence rate in bowlers (47%) was greaterthan that in batsmen (30%) and fielders (23%).[9]When batting, injuries caused by impact consistedprimarily of fractures, dislocations and contusionsof the fingers.[7,9,15,16] Corrigan[17] identified thatinjuries sustainedwhile batting also occurred to theforearm/hand and other soft tissue structures (par-ticularly the upper leg), as well as resulting in frac-tures to the ribs.Amongst adults (> 15 years) who presented to

emergency departments in Australia for treatmentof a sports injury, cricket accounted for 7.3% of allcases, ranking it as the fifth highest source of sports-

related emergency department presentations.[10] Theinjuries were predominantly sprains/strains (26%),fractures (21%) and bruising (20%). However,Ball[12] found that cricket ranked third for sportsinjury presentations to an accident and emergencydepartment, with 130 attendances for every 100000 adults participating in cricket. In a study ofsports injuries presenting to an emergency depart-ment in Scotland, 100% of cricket injury presenta-tions were associated with a bony injury.[18] X-rayswere required in 75% of these cases.Among children, cricket injuries contributed

4% of all sports-related injuries, ranking it as theeighth largest cause of sports-related injuries lead-ing to child emergency department presentationsin Australia.[10] The fact that impact injuries rankso highly in emergency department data collectionsin Australia is related to the fact that these injuriesare often acute and severe (e.g. fractures). How-ever, it is important to note that whilst emergencydepartment data collections represent the more se-vere injuries requiring hospital treatment, the ma-jority of cricket injuries are not severe enough towarrant hospital attendance.Other studies have also found a relatively high

incidence of facial injuries as a result of cricket, incomparison to other sports,[19] with the rising de-livery being the cause of the majority of these in-juries.

Table I. Countermeasures for preventing cricket injuries

Primary (pre-event) Secondary (event) Tertiary (Post-event)Adequate water intake Environment Availability of first aid equipmentAttention to biomechanics Footwear Prompt first aidCoach education Protective equipment RehabilitationFootwear Helmets Rest, ice, compression, elevation, referralModified rules PaddingNutrition GlovesOrthotics BoxesPlaying environment VisorsPre-participation screening MouthguardsPre-season conditioning SurfaceTechniqueTrainingUV protectionWarm-up

Preventing Cricket Injuries 265


2. Overuse Injuries

Like many athletes today, cricketers are expectedto train harder and longer, and at an earlier age, ifthey are to succeed at the elite level. Therefore, it isnot surprising that the hours of repetitious practiceproduce a gradual deterioration in the functionalcapacity of the body.[20-22] This deterioration infunction is often matched by a form of overuse in-jury where repeated sub-threshold forces, each lowerthan the acute injury threshold for tissue, producea combined fatigue effect in musculoskeletal tissueover a period of time. Cricketers can experience arange of overuse injuries associated with all aspectsof the game including running (e.g. lower limb),throwing (e.g. shoulder and elbow) and bowling(e.g. lower back). Probably the most common over-use injury, particularly within the organised settingat the elite level, is abnormal radiological featuresof the lumber spine in fast bowlers.[23] Indeed, fastbowling has been described as one of the highestnon-contact injury risk activities in cricket.[24]A summary of the risk factors associated with

overuse cricket injuries is presented in table III.

2.1 Overuse Injuries in Fast Bowlers

Bowling involves repetitive twisting, extensionand rotation of the trunk in a short period, whilebody tissues and footwear must absorb the largeground reaction forces (GRF). It is the speed of thedelivery, and thus the force of the action, thatmakes the fast bowler prone to a higher incidence

of injury.[13] The bowling action itself can be di-vided into 3 stages: the run-up to back foot impact(BFI), the delivery stride and the release and followthrough. The run up to the BFI is the movement ofthe bowler from stance (i.e. a standing position) tothe landing of the back foot. The delivery stride isthe period between the BFI and ball release. Therelease phase occurs when the ball actually leavesthe hand and has been delivered to the receivingbatter.These stages of the bowling action determine a

bowler’s technique, and there is evidence to sug-gest that particular bowling techniques can put abowler at an increased risk of injury (unpublisheddata).[4,5,22,26,27] The fast bowler uses one of 2bowling techniques (side- or front-on) or a combina-tion of these, known as the mixed bowling tech-nique.[22] The side- and front-on bowling tech-niques are associated with the lowest incidence ofinjury as they reduce the degree of extension andlateral flexion of the lower back (unpublisheddata).[4,5,22,26,27] The mixed action results in exces-sive twisting of the spine that leads to the adoptionof a hyperextended and laterally flexed position ofthe spine during the delivery stride (unpublisheddata).[4,5,22,26] This places considerable stress on thelumbar spine, making it prone to injury.Regardless of how physically fit a cricketer is,

if the bowling technique used involves hyperexten-sion and/or excessive twisting of the spine (i.e. themechanical characteristics of the mixed bowlingtechnique) then there is a significant risk of devel-

Table II. Reported frequency of general cricket injuries according to body region injured

Study Data source Number (population) Injured area (%)head upper

extremitieslowerextremities

trunk other

Stretch[8] Self-report questionnaire,schoolboy cricketers,South Africa

116 (teenagers) 19.3(head/neck/face)

24.6 22.8 33.3

Stretch[9] Self-report questionnaire,club and provincialplayers, South Africa

183 (adults) 9.1(head/neck/face)

34.1 37.5 19.3

Finch et al.[10] Australian emergencydepartment presentations

3846 injuries, 3408players (adults)

16.6 32.6 22.8 4.2 4.1

Australian emergencydepartment presentations

2345 injuries, 1945players (children)

44.2 33.9 15.5 3.2 3.2

266 Finch et al.


oping a back injury (unpublished data).[13] Suchinjuries can include the development of abnormalradiological features in the lumbar spine, whichresult from a combination of factors such as geneticdisposition, incorrect bowling technique, poor prep-aration and/or overuse.While abnormal radiological features of the spine

of fast bowlers have not been significantly associ-ated with impact forces involved in the bowlingstride, there is little doubt that the large GRF, inconjunction with the mixed action, will lead to in-jury.[13] The bowler experiences a series of impactswith the grass in the run-up, followed by 2 largeimpacts resulting from landing on the back and thenfront foot, on very hard turf or concrete. Duringdelivery, these forces are transmitted through thebones, cartilage, tendons, ligaments and musclesof the foot, leg, thigh and pelvis to the discs in thespine and the facet joints of the vertebrae.[13] Peakvertical GRFs of 4.1 to 9 times the bowler’s body-weight have been recorded when the front foot isplanted on the ground.[3,28]The fast bowler has been reported to experience

a range of abnormal radiological features such asbony abnormalities (e.g. spondylolytic incidences,spondylolisthesis, spondylolysis, pedicle sclerosisand pars defect), disk degeneration, muscle and othertissue tears, and pain (unpublished data).[4,5,22,25-27,29]Engstrom et al.[30] also showed that there were sig-nificant differences in the size of the muscles oneach side of the lumbar spine (particularly in thequadratus lumborum). However, the effect of mus-cle asymmetries on forces and torques about thelumbar spine remains unclear.The Australian Cricket Board (ACB) states that

bowlers concentrating on bowling too fast for ex-tended periods during practice and match play willbe predisposed to lower back injury.[28] As a result,the ACB limits bowlers of medium pace and aboveto a maximum of 8 consecutive overs in 1 spell,and to a maximum of 20 overs in any 1 day.[31]

2.2 Overuse Injuries in Other Players

Other overuse injuries to cricketers are relatedto the actions of throwing, catching or running.

There is a paucity of literature specifically focusingon overuse injuries associated with these aspectsof cricket. Repetitious throwing can result in over-use shoulder problems, degenerative changes in therotator cuff, tendinitis in the biceps or a tear of thesupraspinatus tendon.[17] Given that bowlers andbatters are expected to run long distances during agame, overuse injuries of the legs (i.e. stress frac-tures, shin pain, patellar tendinitis and muscle tears)can occur.[17] For example, in a study of injuriespresenting to a podiatric sports medicine clinic, 7%of patients presenting with patellofemoral jointpain were participants in cricket.[32]All bowlers are at risk of splitting or wearing of

the finger skin as it is dragged across the seam ofthe ball to impart spin.[17] Protective strapping can-not be used, and the skin may only partially heal

Table III. Risk factors for overuse injuries in cricket

Overuse type injuries ReferenceHereditary factors 4, 22, unpublished

dataIncorrect bowling technique 4, 5, 24Poor preparation 4, 5Bowling too many overs in a single spell, orbowling for too many spells

5

Excessive bowling throughout the growthperiod (for young players)

Unpublished data

Increased stiffness of the lumbar vertebrae inthe off-season

25

Tightness in the muscle groups around thepelvis which can lead to forward rotation,thereby increasing the forward curvature ofthe lumbar spine

25

Decreased flexibility in the lower back 5Too much reliance on upper body strength,in attempting to bowl too fast

5

Poor hamstring or lower back flexibility,predisposing bowlers to an intervertebraldisk abnormality

4

A body which is not physically prepared forthe rigours of fast bowling

4, 5, 25

Excessive body fat 4, 5Adverse posture 4Height of the longitudinal arch of the foot 5Excessive shoulder rotation to attain aside-on bowling action

4, 5, 24

Higher release position of the ball 4, 5, 24Mixed action bowling technique 4, 5, 22, 26,

unpublished data



between matches. The end or middle finger jointsare often traumatised repeatedly by the bowling ac-tion, and sometimes the consequent osteoarthriticchanges are severe enough to prevent participationin the sport.[17] A wicket keeper may also experi-ence osteoarthritic changes in the knees (becauseof the unnatural action of repeated squatting), andin the joints of the hand from the repeated actionof catching the ball.[17]Cricketers are also at risk of reoccurring injury.

Smith[33] found that 20% of injuries sustainedwhile touring were the re-aggravation of a previousinjury. Furthermore, approximately 24% of inju-ries to club and provincial cricketers were recur-rent, while around 23% of all new injuries werere-aggravated again during the same season.[9] Aneven more alarming statistic reported by Stretch[9]was that 30% of injuries to schoolboy cricketerswere a recurrence of an old injury, while 37% ofnew injuries recurred again during the same season.This possibly indicates a lack of adequate rehabil-itation, leading to re-injury and potential problemsfor young players in the future.

3. Impact Injuries

Impact or collision injuries can occur in a num-ber of ways on the cricket field. They can be theresult of direct contact with a ball, another player,the ground or the boundary. For example, bowlersand infielders can be exposed to balls of very highspeed andmisjudgment of the ball or anunanticipated

bounce may result in injury. Table IV summarisesthe risk factors for impact injuries in cricket.In cricket, a solid ball is propelled from a dis-

tance of about 20m, at speeds around 140 km/h,towards the batter.[17,41] Within a very short periodof time of the delivery, a number of decisions haveto be made by the batter, including determining theline and length of the ball, whether to move for-ward or back, whether or not to play a stroke andwhich stroke to play.[36] If a predictable delivery isbowled, then stroke production will naturally fol-low. However, laboratory measures of visual reac-tion time suggest that in some aspects of high speedball games, such as cricket batting, changes to strokeproduction appear to be impossible to monitor be-cause there is insufficient time for the player torespond to unpredictable movements of the ball.[37]This lack of time creates a visual inadequacy whichcauses the batsman to misjudge where the ball willland.[40] This misjudgment could cause the ball toricochet off the bat’s edge or lead to the batsmanmissing the ball completely, both possibly resultingin a collision of the cricket ball with the body.[38]Helmets are a relatively new protective device

for cricketers. Although injury data gathered be-fore and after the introduction of cricket helmetsand associated standards are nonexistent,[34] the useof helmets as a preventive measure has been welldocumented in other sports.[42] Likewise, the useof eye and facial visors attached to helmets has notbeen formally evaluated, although the benefits inother sports have been documented.[42] Australiaand New Zealand have developed a standard forhelmets, based on a discussion paper by McColough(unpublished data). This standard (AS/NZ 4499)specifies the requirements for helmet use in cricketto mitigate the effects of a blow to the head by acricket ball.Cricket as a cause of eye and facial injuries has

received very little attention. A survey over 18months at the Sussex Eye Hospital, England, re-vealed 5 minor cricket-related eye injuries, account-ing for 5.4% of all sporting eye injuries recorded.[15]In a study of sports injury presentations to theRoyal Victorian Eye and Ear Hospital inMelbourne,

Table IV. Risk factors for impact injuries in cricket

Collision type injuries ReferenceDirect contact with a ball or bat 16, 34, 35,

unpublished dataDirect contact with another player 35Direct contact with the ground or boundary 17Unanticipated bounce 36, 37Lack of protective equipment 17, 34, 37, 38,

unpublished dataLevel of skill or experience 39Age 12Poor visual/spatial awareness skills 37, 40

268 Finch et al.


Australia, cricket was associated with 14% of eyetrauma attendances over a 2-year period.[35] Stud-ies by MacEwan[43] and Jones[44] also highlightedcricket as a potential risk of eye trauma, accountingfor 2 and 4% of eye hospital presentations, respec-tively. Furthermore, Jones and Tullo[16] observedthat cricket represented 9.0% of sport-related eyeinjuries, including such severe injuries as a detachedretina, orbital fracture and rupture of the globe. Theprovision of a polycarbonate visor or face cage tocricket helmets could protect against severe eyeinjuries caused by an uneven ball bounce or a ric-ochet off the bat’s edge.[38] Balls coming from thisdirection have the potential to cause such seriouseye trauma as globe ruptures.[38]There is a large array of other protective equip-

ment available for batters and wicket keepers thathas become part of the game’s culture, includinghelmets with visors, leg guards, thigh pads, chestprotectors, forearm guards, gloves and groin boxes.They are worn to varying degrees, at all levels oforganised cricket, to reduce the injury rate and se-verity of injuries. A batter’s feet are vulnerable tobeing struck by a ball, and a light batting shoe topromote quick running speed may offer little pro-tection against impact from a cricket ball.[17,45]Wicket keepers can experience a great deal oftrauma, especially when on the receiving end of afast delivery.Wicket keepers’ gloves have paddingand webbing between the fingers and thumb andare often worn with protective inner gloves andtaping.Fielders, particularly those in the infield, can

also encounter direct blows from the ball. Anothercollision-type injury can occur when the fielder runsor slides into the boundary fence. For example,Corrigan[17] described 3 fielders who ruptured theirspleen when attempting to catch and landing heavilyon their side.In reviewing the literature regarding cricket

countermeasures, no formal evidence was identifiedfor the benefit of body padding in reducing injuryin a controlled trial. In a biomechanical, laboratory-based impact study, Hrysomallis[34] reported thatalthough leg guards were found to offer adequate

impact resistance around the shin and ankle, 6 ofthe 11 guards tested did not meet the requirementsfor repeated drops on the knee roll. Of the 11 battinggloves tested, 2 did not meet the required stand-ards, and many gloves had gaps in the padding.Furthermore, the study indicated that the price ofbody padding did not reflect the level of protectionit provided. As cricket is predominantly played insummer, it was also found that the higher temper-ature and humidity resulted in more protectiveequipment failing tomeet the British Standard, whileconstruction and pad thickness significantly influ-enced shock absorption ability.

4. Measures to Prevent Cricket Injuries

While there are various countermeasures in placeto prevent specific types of overuse and impact in-juries, there are also other, more general, strategieswhich can be used to prevent a wide range of inju-ries from occurring. Good stretching programmesbefore and after play, as well as comprehensiveconditioning and technique programmes before andduring the season, are important injury preventionmeasures.[46,47] Non-elite cricketers may believe thatpreparation for the cricket season is not importantand that skill alone will determine how well acricketer will perform.[6] Perhaps the lack of re-search into the role of fitness and cricket performanceis a major reason for this attitude. There have beenno specific evaluations of the role of warm-up andconditioning programmes for preventing cricketinjuries.Cricket is a summer sport, and with it comes an

increased risk of skin cancer, dehydration, heat ex-haustion and heat stroke. In general, cricketers arerequired to wear white shirts, trousers and, if de-sired, a hat, reflecting heat to a greater extent thancoloured clothes. By wearing these, the eyes andskin are given additional protection from the sun.It has also been suggested that when playing in hotor humid conditions the medium pace bowler shouldalternate 4 minutes of bowling and 4 minutes ofstanding still on the boundary.[6] Given a bowler’scontinual energetic and strenuous activity, and bat-ters who may control the strike for a number of



overs with many singles being scored, and thenstand at the non-striker end for an undue period oftime at high temperatures, dehydration has to beconsidered a serious possibility.[6] Regular intakeof fluids should be maintained to reduce the risk ofheat illness, and maintain physical and mental per-formance. It is recommended that 1 or 2 glasses ofwater be consumed 45 minutes prior to the event,continual opportunities to drink be provided duringplay, and that consumption after play greater thanthat dictated by thirst occurs in order to replacefluid loss.[48]Cricketers rely heavily on the quality of the

whole playing field, and not just specifically on thepitch. The New Zealand Turf Culture Institute hasresponded to requests from several national sportsbodies to establish a national performance testingsystem.[49] The performance testing system is aprecise and scientific means of monitoring the stand-ard of the construction and maintenance of thecricket field. Specific details are given for outfielddimensions, levelness and speed, pitch levelness andpace, surface and sub-surface hardness, and ballrebound resilience.Appropriate footwear is relevant to all cricket-

ers, especially bowlers, who will run 5 to 6km andwalk 10 to 15kmduring a day’s play,while absorbingGRF of 4 to 9 times their own bodyweight (unpub-lished data).[3,28] A batter’s feet are also vulnerableto injury from being struck by a ball, and a lightbatting shoe, which may promote quick runningspeed, may offer little protection against impactfrom a cricket ball.[17,34,45] However, no specificliterature describing the selection and benefits ofwell-designed cricket footwear was identified.Instruction clinics on proper cricketing techniques

currently occur in school-related organisations.Guidelines are produced by the ACB to aid in schooleducation programmes, particularly Kanga Cricketand the progression to the VicHit programme. How-ever, the large number of recreational players makesthis source of information impractical for community-based teams. As a result, those in a coaching posi-tion need to be fully educated about the correcttechniques needed in all aspects of the game.

Kanga cricket, a modified version of cricket, hasbeen developed for primary-aged children in Aus-tralia, to offer an introduction to the game and achance to develop skills before progressing tomorecompetitive levels.[50] Kanga cricket is played witha specially designed soft ball and smaller, light-weight moulded plastic bats and stumps, whicheliminates the need for protective equipment andreduces the likelihood of injury. Kanga cricket alsohas rules about short pitch deliveries.Injuries need to be properly managed to restrict

the possibility of further damage. Overall, the treat-ment goals are pain relief, promotion of healing,decreased inflammation and a return to functionaland sports activities as soon as possible. Returningto play too early after injury can make the playersusceptible to further injury.[48] The coach shouldensure that the risk of further injury is reduced. Arehabilitation programme cannot be regarded ashaving been completed until the athlete is free frompain, muscle strength has returned to approximatelythe pre-injury level, and articulatorymobility (jointunion movement) has recovered to a pre-injury level.

5. Conclusions

This paper has discussed the full range of injuryprevention activities for preventing cricket injuries.Many of the recommended or widely promotedcountermeasures have yet to be proven effective,and more controlled studies ‘in the field’ are needed.More effort directed towards basic scientific studiesto better understand the biomechanics of cricket,the mechanisms of injury, and the role of variousrisk factors in causation is also required. Indeed,the evidence for the effectiveness of certain counter-measures such as warming-up, shoe design, reducedbowling spells and body padding remains equivocal.Information regarding an association between

abnormal radiological features of the lumbar spineand fast bowling has largely been based on cross-sectional prevalence surveys, with only 1 prospec-tive study having been conducted to date.[5] Addi-tional prospective studies need to be undertaken tofully explore this relationship. Research is also re-quired to determine the maximum desired number

270 Finch et al.


of overs to be bowled in a single spell. This shoulddetermine whether it is the number of overs perday, the number of overs per spell, or a combina-tion of these 2 measures that is the crucial variable,and whether there is a critical number of overs perseason. Further research into the biomechanics offast bowling is required to determine the clusteringof factors that lead to overuse back injury.[23] Re-search is also required to determine the role of thearm in rotation on spine loading.Specific recommendations for future counter-

measure research and development include:• Longitudinal studies demonstrating correctbowling techniques (front- and side-on actions),leading to a reduction in the incidence of backinjuries.

• Studies that link spinal muscular asymmetry,specific bowling techniques and injury.

• Research into the mechanisms of overuse injuriesto the shoulder and legs.

• Developmental research into ways to preventfinger injuries in bowlers.

• Development and formal evaluation of pre-participation screening programmes and sub-sequent physical training of elite fast bowlers.

• Epidemiological research into the incidence ofeye, dental and facial injuries, and associatedfactors.

• Measurement and improvement of the protectiveperformance of padding.

• Additional research into the role, and optimalduration and frequency of warm-up, stretchingand cool-down as an injury prevention measure.

• Further development of appropriate footwear forboth fast bowlers and other players.

Acknowledgements

This study was funded by Sport and Recreation Victoriaand undertaken at theMonash University Accident ResearchCentre. The paper waswrittenwhilst Dr Finchwas employedat Deakin University. The work of Dr Finch was funded bya Public Health Research and Development Committee (ofthe National Health andMedical Research Council) Fellowship.DrewMitchell assisted in the preparation of this manuscript.

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