Incidence and prevalence of lumbar stress fracture in English County Cricket fast bowlers, association with bowling workload and seasonal variation

Alway, Peter; Brooke‐Wavell, Katherine; Langley, Ben; King, Mark A.; Peirce, Nicholas

doi:10.1136/bmjsem-2019-000529

Cited by 28 publications

(52 citation statements)

References 37 publications

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“…2 Efforts to reduce injury rates in this population have led to investigations of the influence of bowling volumes and bowling session frequency on injury risk. 3 Several authors have reported both high and low bowling loads to be associated with increased injury, 4,5 and recommendations for 'safe' fast bowling volumes/frequencies have been proposed. 6 Following on from these initial load-injury investigations in cricket, the ratio of acute (one-week) to chronic (four-week rolling average) loads have been modelled against injury risk, with this metric termed the 'acute-to-chronic workload ratio' (ACWR).…”

Section: Introductionmentioning

confidence: 99%

Bowling loads and injury risk in male first class county cricket: Is ‘differential load’ an alternative to the acute-to-chronic workload ratio?

Tysoe

Moore

Ranson

et al. 2020

Journal of Science and Medicine in Sport

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Bowling loads and injury risk in male first class county cricket: Is 'differential load' an alternative to the acute-to-chronic workload ratio? Abstract Objectives: Methodological concerns relating to acute-to-chronic workload ratios (ACWR) have been raised. This study aimed to assess the relationship between an alternative predictor variable named 'differential load', representing the smoothed week-to-week rate change in load, and injury risk in first class county cricket (FCCC) fast bowlers. Design: Prospective cohort study. Methods: Bowling loads and injuries were recorded for 49 professional male fast bowlers from six FCCC teams. A range of differential loads and ACWRs were calculated and subjected to a variable selection procedure. Results: Exponentially-weighted 7-day differential load, 9:21-day ACWR, 42-day chronic load, and 9day acute load were the best-fitting predictor variables in their respective categories. From these, a generalized linear mixed-effects model combining 7-day differential load, 42-day chronic load, and 9day acute load provided the best model fit. A two-standard deviation (2SD) increase in 7-day differential load (22 overs) was associated with a substantial increase in injury risk (risk ratio [RR] = 2.47, 90% CI: 1.27-4.80, most likely harmful), and a 2SD increase in 42-day chronic load (17.5 overs/week) was associated with a most likely harmful increase in injury risk (RR = 6.77, 90% CI: 2.15-21.33). For 9day acute load, very low values (≤1 over/week) were associated with a most likely higher risk of injury

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Section: Introductionmentioning

confidence: 99%

Bowling loads and injury risk in male first class county cricket: Is ‘differential load’ an alternative to the acute-to-chronic workload ratio?

Tysoe

Moore

Ranson

et al. 2020

Journal of Science and Medicine in Sport

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“…Incidence of lumbar stress fracture (LSF) is high in fast bowlers, with up to 67% having a history of LSF across their career (Johnson et al, 2012). LSF are most prevalent at the fourth and fifth lumbar vertebra (66% of all incidence), with 93% of all LSF occuring at the neural arch on the non-dominant side (contralateral to bowling arm, Alway et al, 2019). This unilateral injury may be a result of the increased stress placed on this area, with a finite element analysis estimating that stresses within the neural arch on the nondominant side of L4 are up to 10% greater than on the dominant side (De Visser et al, 2007).…”

Section: Introductionmentioning

confidence: 99%

Lumbar bone mineral asymmetry in elite cricket fast bowlers

Alway

Peirce

King

et al. 2019

Bone

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Bone responds to mechanical loading by increasing bone mineral density (BMD) and/or bone area to enhance bone strength at the site of the greatest strain. Such localised adaptation has not been demonstrated at the spine. The aim of this study is to determine if BMD and/or bone mineral content (BMC) differs between dominant (ipsilateral to bowling/throwing arm) and non-dominant sides of the vertebrae in cricket fast bowlers, and whether this asymmetry differs according to stress fracture or disc injury history. A further aim was to determine if regional BMD and BMC in the lumbar spine differ between fast bowlers, other cricketers, rugby players and non-active controls, to highlight the site-specific response of lumbar vertebra to unilateral activity Methods 23 fast bowlers, 14 other cricketers, 22 rugby players and 20 controls underwent an anteroposterior (AP) and lateral DXA scans of their lumbar spine to assess BMD, BMC and area. A custom analysis measured BMD and BMC of the dominant and non-dominant sides (lateral 33%) of the AP lumbar spine. BMD and BMC were compared between groups, injury status, vertebrae and sides using ANOVA. Results Analysis of medical records showed that 6 fast bowlers had a history of lumbar stress fracture. Significantly greater BMD and BMC was found in the L4 non-dominant vertebra compared with the dominant vertebra in fast bowlers. BMD and BMC differed significantly according to vertebra, side and group, with fast bowlers having significantly greater BMD and BMC at the L3 and L4 non-dominant vertebra compared with other groups (L3: 13.3%-45.3%, L4: 15.7%-44.0%) compared with other groups. Fast bowlers who never suffered lumbar stress fracture had 3.6% and 1.7% greater BMD in the dominant and non-dominant sides of lumbar vertebrae respectively compared with those who did suffer lumbar stress fracture, but evidence of this was weaker (P = 0.08). Conclusion The lumbar spine responds to a unique unilateral high loading activity through site-specific increased bone mass at the site of most strain. Fast bowlers had increased lumbar BMD, particularly on the non-dominant side of L4, although this adaptation was less marked in those with history of lumbar stress fracture. Site-specific low bone mineral density within the lumbar side may be implicated in the aetiology of lumbar stress fracture.

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“…Fast bowlers with stress fractures could be a subset of cricketers to focus on for any proposed intervention, given the relative availability of research in this area and well documented recovery phases. 1 46 47 …”

Section: Discussionmentioning

confidence: 99%

“…Injury epidemiology reporting within the cricket medical literature has emerged over the past 2 years with a focus on physical injuries. [1][2][3][4] Cricket researchers have been proactive in standardising the description of physical injuries in order to better define injury cohorts and structure appropriate preventive and responsive services. 5 6 In contrast, there is a lack of research evidence on the mental health of cricketers, despite this being an area of interest within the wider sporting medical literature.…”

Section: Introductionmentioning

confidence: 99%

Narrative review of mental illness in cricket with recommendations for mental health support

McCabe

Peirce

Gorczynski

et al. 2021

BMJ Open Sport Exerc Med

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IntroductionEpidemiology reporting within the cricketing medical literature has emerged over the past 2 years, with a focus on physical injuries. Despite mental health in elite sport gaining increasing recognition, few studies have addressed mental health symptoms and disorders within cricket. Recently, cricketers have been prominent in the mainstream media describing their lived experiences of mental illness. As a result, some have withdrawn from competition and suggested there is an unmet need for mental health services within the sport.Objectives(i) To appraise the existing evidence on mental health symptoms and disorders amongst cricketers. (ii) To provide guidance on shaping mental health research and services within cricket.DesignA narrative review of the literature from inception of available databases until 26 July 2019, with analysis and recommendations.ResultsFive studies were included in this narrative review. Studies covered a range of mental health symptoms and disorders, including distress, anxiety, depression, sleep disturbance, suicide, adverse alcohol use, illicit drug use, eating disorders and bipolar disorder. Results indicated that cricketers are at high risk for distress, anxiety, depression and adverse alcohol use. When compared with the general population, cricketers are more likely to experience anxiety and depressive symptoms. Rates of suicide were proposed to be high for test cricketers. Overall, studies to date have been of low quality, demonstrating non-rigorous research methods. Some studies have relied on non-validated questionnaires to collect self-reported data on mental health symptoms and disorders, while others have presented biographical data obtained through searches of the media.ConclusionsThe results of this narrative review highlight the lack of evidence underpinning mental health services for athletes within cricket. We suggest the following recommendations for future research and practice: (i) normalising mental health symptoms and disorders; (ii) working with and helping vulnerable demographic segments within the target population; (iii) designing and implementing early recognition systems of mental health symptoms and disorders; (iv) addressing the mental health needs of cricketers on a population basis.

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Incidence and prevalence of lumbar stress fracture in English County Cricket fast bowlers, association with bowling workload and seasonal variation

Cited by 28 publications

References 37 publications

Bowling loads and injury risk in male first class county cricket: Is ‘differential load’ an alternative to the acute-to-chronic workload ratio?

Bowling loads and injury risk in male first class county cricket: Is ‘differential load’ an alternative to the acute-to-chronic workload ratio?

Lumbar bone mineral asymmetry in elite cricket fast bowlers

Narrative review of mental illness in cricket with recommendations for mental health support

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