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   Cricket

Cricket Injuries

Cricket is a major international sport played in more than 60 countries. The laws of cricket were drawn up by the London Club in 1744, formalising a game that had been played for a hundred years before. While its popularity spread throughout the countries of the British Empire and western Europe, it was not until the mid-19th century that cricket gained its international status and regular international matches were played between touring teams.

The first recorded international took place in 1844, at St George’s Park, New York, between the United States and Canada. Canada won. The inaugural test match was played between Australia and England at the Melbourne Cricket Ground in1877   Professionalisation and more recently, media coverage have led to a huge expansion and popularisation of the game as we know it today. Ten nations are full members of the International Cricket Conference, and 45 more are associated or affiliated members.

Although strictly a non-contact sport, injuries in cricket are common, and have been documented as far back as 1751, when Frederick, Prince of Wales (son of George II), expired suddenly from an abscess in his head as a consequence of a blow he’d received from a cricket ball. For one of the widely popular team sports, there have been relatively few publications in the medical literature on cricket injuries. This article reviews the injuries occurring commonly in cricket and describes measures to prevent or minimise them.

Types and causes of injuries

There are three broad categories:
Direct impact,
Indirect, and
Overuse.

1.Direct blow injuries occur when a player is struck by the ball, collides with another player, or crashes into the boundary fence. For example, bowlers and fielders can be exposed to balls of very high speed and are at risk from a misjudgment of the ball or unanticipated bounce. A cricket ball is a leather-covered solid cork sphere weighing 160g and measuring 22.4cm to 22.9cm in circumference. As the ball is propelled down the pitch at speeds of up to 150km/h, the batsman must make a series of very quick decisions, including determining the line and length of the ball, whether to move forwards or backwards, whether to play a stroke and which stroke to play. Any misjudgement creates a visual inadequacy which could cause the ball to ricochet off the bat’s edge or the batsman to miss the ball completely, either of which might end up with the cricket ball colliding with a body . The batsman’s feet are vulnerable to being struck by a ball and lightweight batting shoes offer little protection against such impact.

Wicket-keepers can experience great trauma, especially on the receiving end of a fast delivery. Fielders are susceptible both to direct blows from the ball and running and sliding into the boundary fence.

Despite batsmen and close-in fielders wearing protective equipment, reports of head and eye injuries are common. Other frequently reported impact injuries are fractures of the arm, hands and toes, and soft-tissue injuries to the upper arm and thigh, thorax, abdomen and testicles. Splenic rupture has been reported both because of a blow from a cricket ball and collision with the boundary fence, and at the extreme, there was a report of fatal cardiac arrest after a player was hit in the chest by a cricket ball.

2.Indirect injuries are muscle, ligament and tendon damage sustained while attempting to perform a specific activity. These injuries are most prevalent at the start of a season and in players who pay less attention to warming up and their general level of fitness.

3.Overuse can produce a range of injuries secondary to running (eg lower limb), throwing (eg shoulder and elbow) and bowling (eg lower back). But the most common overuse injury is associated with fast bowling. Bowling involves repetitive twisting, extension and rotation of the trunk in a short period, while body tissues and footwear must absorb large ground reaction forces of 4.1 to 9 times the bowler’s body weight. It is the speed of the delivery, and thus the force of the action, that makes the fast bowler more injury prone, particularly to bony abnormalities (eg spondylolytic incidences, spondylolisthesis, spondylolysis, pedicle sclerosis and pars defect), disc degeneration, stress fracture at various sites, primarily in the metatarsal bones, fibula and tibia, muscle and other tissue tears, and pain . The other overuse injury is splitting or wearing of the finger skin as spin bowlers repeatedly drag their skin across the seam of the ball to impart spin. The laws of the game prohibit the use of protective strapping, and the skin may only partially heal between matches. The end or middle finger joints are often traumatised repeatedly by the bowling action, and sometimes the consequent osteoarthritic changes can be severe enough to end a bowler’s playing career.

A wicket-keeper may also experience osteoarthritic changes in the knees (because of the action of repeated squatting), and in the joints of the hand, from repeatedly catching the ball.

Other overuse injuries are related to throwing, catching or running. Repetitious throwing can result in instability, impingement syndrome, degenerative changes in the rotator cuff, and tendinitis in the biceps or a tear of the supraspinatus tendon. Running long distances during matches predisposes the player to stress fractures, shin pain, patellar tendinitis and muscle tears.

Hamstring injury
Hamstring tears are a widespread sporting hazard, reported in sports as diverse as athletics, football, Australian rules football, cricket, rugby, hurling, dancing, water skiing and judo. They are often serious, causing long rehabilitation times and a increased susceptibility to re-injury. Persistent symptoms and slow healing make hamstring tears a frustrating injury.

  •     The prevalence of hamstring tears (defined as ‘preventing player participation in a match’) has been measured at between 11% and 16% in studies of football, Australian rules and cricket  . About six players per squad will pick up a hamstring injury each season in professional soccer and Australian Rules football.

  •     An acute strain to the hamstring muscles may result in a spectrum of injuries ranging from delayed onset muscle soreness and partial strain to complete muscle rupture. Avulsion of the ischial  tuberosity (where the bone is pulled off while the muscle attachment remains intact) occurs occasionally in young athletes. Complete rupture of the top end of the hamstring complex.

  •     Injury can cause a player to miss, on average, three matches or three weeks of play.

 Anatomy and function

The word ‘hamstring’ comes from ham (back of the knee) and string (tendon); the hamstring group is comprised of the three muscles that together span the posterior compartment of the thigh: semitendinosus, semimembranosus and biceps femoris. At their top end, the muscles attach to the ischial tuberosity of the pelvic bone and the femur (thigh bone). At their far point, they attach to the outer side of tibia and fibula (the leg bones).

  •     The hamstring muscles, with their two-joint attachments, serve the unique function of flexing the leg upon the thigh; and contribute to the hip extensor function of the gluteus maximus muscle.

 Risk factors

o  Hamstring injuries in sport usually happen as a result of rapid acceleration or deceleration while running or jumping. The main modifiable risk factors include:

·         inadequate warm-up/muscle fatigue

·         muscle tightness

·         imbalance of muscular strength with low hamstring to quadriceps ratio

·         previous injury. 

Symptoms and signs

  •     The most common symptom of upper hamstring tear is pain in the back of the thigh or buttock. Other symptoms include swelling and bruising (ecchymosis) of the rear thigh, local tenderness, asymmetry and a slipping or bunching of the avulsed muscle belly down the thigh. Weakness and visible defects with active and resisted knee flexion may confirm a complete hamstring tear at the upper attachment.

  •    After a hamstring injury, diagnosis is often delayed. Therapists should be prepared to seek early ultrasound imaging to verify suspected tears. MRI can also identify which muscle has been injured and the amount of tendon retraction that has occurred. Sciatic nerve symptoms, such as numbness or muscle weakness should also be investigated. These are often related to inflammation and scarring around the nerve, because of its close proximity to the injured muscle groups. Note that pain referred from the lumbar spine, sciatic nerve or gluteal and piriformis muscles may mimic hamstring strains .

  Management

  •     The initial management of hamstring injuries involves rest, analgesia and ice packs. But where you suspect a complete upperattachment tear, a conservative approach is not advised. In these cases, non-operative management is associated with a delay in return to sports and long-term functional impairment. It is currently thought far better to seek an early diagnosis and acute surgical repair to reattach the torn tendons.

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