Activity specific areal bone mineral density is reduced in athletes with stress fracture and requires profound recovery time: A study of lumbar stress fracture in elite cricket fast bowlers

Alway, Peter; Peirce, Nicholas; Johnson, William; King, Mark A.; Kerslake, Robert; Brooke‐Wavell, Katherine

doi:10.1016/j.jsams.2022.08.006

Cited by 5 publications

(6 citation statements)

References 31 publications

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“…Furthermore, players injured before ‘The Hundred’ with an expected return date close to the end of the tournament are likely to withdraw from the competition, whereas, in domestic cricket, these players will remain with the club influencing the prevalence rates. This is especially relevant for lumbar spine stress fractures, which typically require four to six months recovery 13 14. The full prevalence would not be captured in ‘The Hundred’ injury surveillance but would be in year-round injury surveillance.…”

Section: Discussionmentioning

confidence: 99%

“…This is especially relevant for lumbar spine stress fractures, which typically require four to six months recovery. 13 14 The full prevalence would not be captured in ‘The Hundred’ injury surveillance but would be in year-round injury surveillance. Bowlers’ workload is also limited to 20 deliveries per game (3.2 overs) in ‘The Hundred’ which is less than all other formats.…”

Section: Discussionmentioning

confidence: 99%

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A similar injury profile observed in franchise men’s and women’s cricket in England and Wales: injury surveillance analysis from the first three ‘The Hundred’ competitions

Williams,

Peirce,

Griffin

et al. 2024

BMJ Open Sport Exerc Med

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ObjectivesTo describe the injury profile of a novel format cricket competition (‘The Hundred’) and compare injury incidence and prevalence between the men’s and women’s competitions.MethodsMedical staff prospectively collected injury data from the eight men’s and women’s teams during the 2021–2023 competitions. Injury definitions and incidence calculations followed the international consensus statement.ResultsIn the men’s competition, 164 injuries were recorded, compared with 127 in the women’s competition. Tournament injury incidence was 36.6 (95% CI 31.4 to 42.7) and 32.5 (95% CI 27.3 to 38.7)/100 players/tournament in the men’s and women’s competition, respectively. Non-time-loss incidence (men’s 26.6 (95% CI 22.2 to 31.8), women’s 24.6 (95% CI 20.1 to 30.0)/100 players/tournament) was higher than time-loss incidence (men’s 10.0 (95% CI 7.5 to 13.5), women’s 7.9 (95% CI 5.6 to 11.3)/100 players/tournament). Injury prevalence was 2.9% and 3.6% in the men’s and women’s competitions, respectively. Match fielding was the most common activity at injury in both competitions. The thigh and hand were the most common body location time-loss injury in the men’s and women’s competitions, respectively.ConclusionA similar injury profile was observed between the men’s and women’s competition. Preventative strategies targeting thigh injuries in the men’s competition and hand injuries in the women’s competition would be beneficial. Compared with published injury rates, ‘The Hundred’ men’s presents a greater risk of injury than Twenty20 (T20), but similar to one-day cricket, with ‘The Hundred’ women’s presenting a similar injury risk to T20 and one-day cricket. Additional years of data are required to confirm these findings.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A similar injury profile observed in franchise men’s and women’s cricket in England and Wales: injury surveillance analysis from the first three ‘The Hundred’ competitions

Williams,

Peirce,

Griffin

et al. 2024

BMJ Open Sport Exerc Med

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“…Thus, athletes whose training was curtailed during this period may have less skeletal resilience and increased injury risk. Our previous research has demonstrated that young fast bowlers have increased injury risk, particularly as they start competing at senior level, 30 and that injury risk is associated with lower skeletal robustness 31 and high bowling volume, 12 in conjunction with inadequate rest periods. 32 It is thus important to progressively increase loading magnitude to achieve skeletal resilience in adolescence while controlling bowling volume and incorporating adequate rest to reduce injury risk.…”

Section: Discussionmentioning

confidence: 99%

Lumbar spine bone mineral adaptation: cricket fast bowlers versus controls

Keylock

Alway

Johnson

et al. 2023

BMJ Open Sport Exerc Med

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Elite adult male fast bowlers have high lumbar spine bone mineral, particularly on the contralateral side to their bowling arm. It is thought that bone possesses its greatest ability to adapt to loading during adolescence, but it is unknown at what age the greatest changes in lumbar bone mineral and asymmetry develops in fast bowlers.ObjectivesThis study aims to evaluate the adaptation of the lumbar vertebrae in fast bowlers compared to controls and how this is associated with age.Methods91 male fast bowlers and 84 male controls aged 14–24 years had between one and three annual anterior-posterior lumbar spine dual-energy-X-ray absorptiometry scans. Total (L1-L4) and regional ipsilateral and contralateral L3 and L4 (respective to bowling arm) bone mineral density and content (BMD/C) were derived. Multilevel models examined the differences in lumbar bone mineral trajectories between fast bowlers and controls.ResultsAt L1-L4 BMC and BMD, and contralateral BMD sites, fast bowlers demonstrated a greater negative quadratic pattern to their accrual trajectories than controls. Fast bowlers had greater increases in BMC in L1-L4 between 14 and 24 years of 55% compared with controls (41%). Within vertebra, asymmetry was evident in all fast bowlers and increased by up to 13% in favour of the contralateral side.ConclusionsLumbar vertebral adaptation to fast bowling substantially increased with age, particularly on the contralateral side. The greatest accrual was during late adolescence and early adulthood, which may correspond with the increasing physiological demands of adult professional sport.

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“…Irrespective of study design, the residual effects of previous injury potentially distort reported associations between investigated variables and reported outcomes of LBP and lumbar spine injury. An index LBSI in a fast bowler may be associated with recurrence at the same site, contralaterally, or at a different lumbar level [ 13 , 105 ]; however, the nature of any association is undetermined, as the effects of injury on the cellular and mechanical aspects of lumbar bone are unknown. Future studies should clearly define the nature and site of previous injuries and employ statistical designs to account for their influence on investigated variables and injury incidence.…”

Section: Discussionmentioning

confidence: 99%

“…Injury causality cannot be established in cross-sectional research that reported trends for less marked asymmetry of lumbar BMC/BMD being associated with LSF history [ 63 ]. These trends are supported by lumbar vertebral BMC/BMD being reduced at 21 to 24 weeks post LSF in fast bowlers in comparison to baseline [ 105 ]; and a post-injury delay in BMC/BMD recovery may be associated with LBSI recurrences [ 105 ]. The contrasting trend for bowlers with greater contralateral side BMD who developed LBSI [ 41 ] suggests that LBSI risk may be somewhat independent of BMD.…”

Section: Discussionmentioning

confidence: 99%

Intrinsic variables associated with low back pain and lumbar spine injury in fast bowlers in cricket: a systematic review

Farhart,

Beakley,

Diwan

et al. 2023

BMC Sports Sci Med Rehabil

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Background Lumbar spine injuries in fast bowlers account for the greatest missed playing time in cricket. A range of extrinsic and intrinsic variables are hypothesised to be associated with low back pain and lumbar spine injury in fast bowlers, and an improved understanding of intrinsic variables is necessary as these may alter load tolerance and injury risk associated with fast bowling. This review critically evaluated studies reporting intrinsic variables associated with low back pain and lumbar spine injury in fast bowlers and identified areas for future investigation. Methods OVID Medline, EMBASE, SPORTDiscus, CINAHL, Web of Science and SCOPUS databases were last searched on 3 June 2022 to identify studies investigating intrinsic variables associated with low back pain and lumbar spine injury in cricket fast bowlers. Terms relevant to cricket fast bowling, and intrinsic variables associated with lumbar spine injury and low back pain in fast bowlers were searched. 1,503 abstracts were screened, and 118 full‐text articles were appraised to determine whether they met inclusion criteria. Two authors independently screened search results and assessed risk of bias using a modified version of the Quality in Prognostic Studies tool. Results Twenty-five studies met the inclusion criteria. Overall, no included studies demonstrated a low risk of bias, two studies were identified as moderate risk, and twenty-three studies were identified as high risk. Conflicting results were reported amongst studies investigating associations of fast bowling kinematics and kinetics, trunk and lumbar anatomical features, anthropometric traits, age, and neuromuscular characteristics with low back pain and lumbar spine injury. Conclusion Inconsistencies in results may be related to differences in study design, injury definitions, participant characteristics, measurement parameters, and statistical analyses. Low back pain and lumbar spine injury occurrence in fast bowlers remain high, and this may be due to an absence of low bias studies that have informed recommendations for their prevention. Future research should employ clearly defined injury outcomes, analyse continuous datasets, utilise models that better represent lumbar kinematics and kinetics during fast bowling, and better quantify previous injury, lumbar anatomical features and lumbar maturation. Trial registration Open Science Framework https://doi.org/10.17605/OSF.IO/ERKZ2.

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Activity specific areal bone mineral density is reduced in athletes with stress fracture and requires profound recovery time: A study of lumbar stress fracture in elite cricket fast bowlers

Cited by 5 publications

References 31 publications

A similar injury profile observed in franchise men’s and women’s cricket in England and Wales: injury surveillance analysis from the first three ‘The Hundred’ competitions

A similar injury profile observed in franchise men’s and women’s cricket in England and Wales: injury surveillance analysis from the first three ‘The Hundred’ competitions

Lumbar spine bone mineral adaptation: cricket fast bowlers versus controls

Intrinsic variables associated with low back pain and lumbar spine injury in fast bowlers in cricket: a systematic review

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