Lumbar Bone Stress Injuries and Nonunited Defects in Elite Australian Cricket Players.

OBJECTIVE: To describe the presentation and management of lumbar bone stress injuries (LBSI), recurrent LBSI, and lumbar nonunited defects in elite Australian male and female cricket players. DESIGN: Retrospective case series. SETTING: Professional domestic and international cricket teams over 13 seasons. PARTICIPANTS: Elite Australian cricket players. INDEPENDENT VARIABLES: Symptomatic LBSI requiring time off cricket and lumbar nonunited defects, both confirmed by imaging. MAIN OUTCOME MEASURES: Incidence, presentation, history, healing, and management. RESULTS: 211 LBSI were identified at an average incidence of 5.4 per 100 players per season. LBSI were most common in male pace bowlers younger than 20 years of age (58.1 per 100 players per season), however, were also observed in older players, females, and non-pace bowlers. Recurrent LBSI accounted for 33% (27%-40%) of all LBSI. Median days to return to match availability was 182 (128-251) days for all LBSI, with a shorter time frame observed for new and less severe injuries, and male spin bowlers. Healing was demonstrated in 87% (81%-91%) of all LBSI cases. 29 nonunited defects were identified and predisposed subsequent pain, LBSI, and spondylolisthesis. CONCLUSIONS: LBSI are experienced by approximately 5.4 in every 100 elite Australian cricket players per season, with a high time cost of approximately 4 to 8 months. Nonunited defects also have a high time cost with associated subsequent lumbar spine issues. The findings of this study reinforce the importance of early detection and conservative management of LBSI, particularly for younger male pace bowlers and players with recurrent LBSI, which may be supported by MRI.

Traumatic Head and Neck Injuries in Elite Australian Cricket Players: Retrospective Analysis from 12 Seasons.

Objectives: To describe traumatic head and neck injuries in elite Australian cricket players, for the purposes of understanding risk and the role of protective equipment and regulations. Design: Retrospective cohort study. Methods: This study reviewed twelve seasons of clinical data for elite male and female cricket players who sustained a traumatic head or neck injury (excluding isolated concussion) whilst participating in a cricket match or training. Results: 199 events of head and neck injuries were recorded over the 12 seasons, equating to an average incidence of 5.6 per 100 players per season. Since the introduction of helmet regulations in 2016, the average incidence was 7.3. Including concurrent injuries, 232 injuries revealed contusions were the most common type of injury (41%, 35-48%), and the face was the most common location (63%, 57-69%). Injuries resulted in the player being unavailable for cricket for one or more days in 15% (11-22%) of events. Since the introduction of cricket helmet regulations, the proportion of injuries sustained while batting decreased from 54% (43-65%) to 38% (30-47%) (p = 0.026), and the proportion of injuries sustained while wicket keeping decreased from 19% (11-29%) to 6% (3-11%) (p=0.004). Conclusion: Traumatic head and neck injuries occur at an incidence of approximately 7.3 per 100 players per season in elite Australian male and female cricket players. Whilst most injuries cause a low burden with respect to days unavailable, the risk of potentially serious or catastrophic consequences warrants further risk reduction strategies including tightening of the existing industry standard for helmets and governing body regulations.

Comparison of injury profiles between elite Australian male and female cricket players.

OBJECTIVES: This study presents seven seasons of injury surveillance data for both elite Australian male and female cricket players, revealing injury statistics and allowing for comparison between sexes. DESIGN: Retrospective cohort. METHODS: Participants were elite Australian male and female cricket players who were contracted to play for a national and/or state/territory team and/or T20 franchise between 2015-16 and 2021-22 (7 seasons). Injury data was recorded in Cricket Australia's Athlete Management System database and combined with match data. The STROBE-SIIS statement was used as the relevant guideline for this study. RESULTS: Data for 1345 male player seasons and 959 female player seasons revealed sex-related differences in the injury incidence rates and prevalence. Males had higher incidence (average 136 vs 101 injuries per 1000 match days) and prevalence of match time-loss injuries (average 10.4% vs 6.5% players unavailable). However, the overall incidence of all medical attention injuries were similar between sexes (Incidence Rate Ratio (IRR) 0.9, 95%CI 0.8-1.0). The most frequent match time-loss injuries for males were hamstring strains (7.4 new injuries per 100 players per season), side and abdominal strains (5.5), concussion (5.0), lumbar stress fractures (4.3), and wrist and hand fractures (3.9). The most frequent match time-loss injuries for females over the 7 seasons were hamstring strains (3.1), concussion (2.3), quadriceps strains (2.4) and shin/foot/ankle stress fractures (2.0). The IRR of medical attention injuries for males compared to females was higher for lumbosacral stress fractures (IRR 2.3), elbow and forearm injuries (1.5), and concussion (1.4), and lower for lower leg, foot, and ankle stress fractures (0.6), shoulder and upper arm injuries (0.7), and quadriceps strains (0.6). CONCLUSIONS: Robust long-term injury surveillance enabled the injury profiles of elite Australian male and female cricket players to be understood and compared. Males had a higher incidence and prevalence of match time-loss injuries, likely reflecting a higher match exposure.

Psychological safety in elite sport settings: a psychometric study of the Sport Psychological Safety Inventory.

Objectives: Effectively supporting the mental health of elite athletes and coaches requires validated tools that assess not only individual-level factors but organisational-level influences. The aim of this study was to develop a bespoke scale assessing perceived psychological safety within high-performance environments. Methods: 337 elite athletes (M=24.12 years) and 238 elite-level coaches and high-performance support staff (HPSS; M=41.9 years) identified via the Australian Institute of Sport provided data across a range of mental health and well-being domains. Exploratory factor analysis (EFA; n=169 athletes) with parallel analysis identified the Sport Psychological Safety Inventory (SPSI) factor structure. Confirmatory factor analysis (CFA) validated the identified structure in separate validation subsamples of athletes (n=168) and coaches/HPSS (n=238). Results: EFA identified the 11-item, 3-factor SPSI. Factors assessed domains of the Mentally Healthy Environment, Mental Health Literacy and Low Self-Stigma. All scale items loaded strongly on their specific domain. CFA model fit indices validated scale structure for athletes and coaches/HPSS. Internal consistency and convergent and divergent validity were evident. Logistic regression indicated that incrementally higher Mentally Healthy Environment scores reduced the likelihood of athletes scoring in the 'moderate' range of general and athlete-specific distress, with a stronger endorsement of the Low Self-Stigma subscale reducing the likelihood of being identified for athlete-specific distress. Conclusion: Psychometric properties of the SPSI support scale utility among athletes and coaches/HPSS in elite sports settings, though further psychometric efforts are needed. This brief measure may support benchmarking efforts across elite sporting contexts to improve mental health culture and broader well-being among athletes and coaches/HPSS.

Upper Lumbar Bone Stress Injuries in Elite Cricketers.

OBJECTIVE: Describe the proportion of upper lumbar bone stress injuries (LBSI; T12-L3) relative to all LBSI, and the clinical presentation and diagnosis of upper LBSI in elite cricketers. DESIGN: Case series. SETTING: Professional domestic and international cricket teams over a 9-year period. PARTICIPANTS: Elite Australian cricketers. INDEPENDENT VARIABLES: Symptomatic upper LBSI diagnosed based on clinical findings and medical imaging. MAIN OUTCOME MEASURES: Prevalence, injury history, and clinical management. RESULTS: Twenty-four pace bowlers (22 male and 2 female) sustained 39 cases of upper LBSI (T12:2, L1:3, L2:20, L3:14). Upper lumbar vertebrae were involved in 41% (95% CI 31-51) of all LBSI in this cohort. Twenty-seven (69%, 54-81) cases had an injury that occurred only on the side contralateral to the bowling arm. Ipsilateral injuries tended to occur secondary to a contralateral nonunited defect. In all 7 cases with known radiology follow-up that had a contralateral then ipsilateral LBSI, the contralateral injury did not achieve bony union before the onset of the ipsilateral LBSI. For stress fractures with imaging follow-up, those who achieved bony union took longer to return to bowling training [median 152 days (IQR 117-188)], compared to those who achieved partial or no union [median 68 days (IQR 46-115)]. CONCLUSIONS: Upper LBSI in elite cricketers occurs in approximately 2 out of 5 cases of LBSI. Clinicians should allow sufficient time for upper LBSI to resolve and unite (if a fracture) because cases that returned to bowling training earlier were less likely to achieve bony union, and those that failed to unite commonly went on to have a recurrent LBSI. LEVEL OF EVIDENCE: Therapy/prognosis/diagnosis level 2b.

Athlete Experiences of Shame and Guilt: Initial Psychometric Properties of the Athletic Perceptions of Performance Scale Within Junior Elite Cricketers.

Guilt and shame are self-conscious emotions with implications for mental health, social and occupational functioning, and the effectiveness of sports practice. To date, the assessment and role of athlete-specific guilt and shame has been under-researched. Reporting data from 174 junior elite cricketers (M = 17.34 years; females n = 85), the present study utilized exploratory factor analysis in validating the Athletic Perceptions of Performance Scale (APPS), assessing three distinct and statistically reliable factors: athletic shame-proneness, guilt-proneness, and no-concern. Conditional process analysis indicated that APPS shame-proneness mediated the relationship between general and athlete-specific distress (p < 0.01), with this pathway non-contingent on sex or past 12-month help-seeking for mental health concerns (p's > 0.05). While APPS domains of guilt-proneness and no-concern were not significant mediators, they exhibited correlations in the expected direction with indices of psychological distress and well-being. The APPS may assist coaches and support staff identify players who may benefit from targeted interventions to reduce the likelihood of experiencing shame-prone states.

Evaluation of CogSport for acute concussion diagnosis in cricket.

OBJECTIVE: The diagnosis of sport-related concussion is a challenge for practitioners given the variable presentation and lack of a universal clinical indicator. The aim of this study was to describe the CogSport findings associated with concussion in elite Australian cricket players, and to evaluate the diagnostic ability of CogSport for this cohort. METHODS: A retrospective study design was used to evaluate CogSport performance of 45 concussed (male n=27, mean age 24.5±4.5 years; female n=18, 23.5±3.5 years) compared with 45 matched non-concussed (male n=27, mean age 27.3±4.5 years; female n=18, 24.1±4.5 years) elite Australian cricket players who sustained a head impact during cricket specific activity between July 2015 and December 2019. RESULTS: Median number of reported symptoms on the day of injury for concussed players was 7 out of 24, with a median symptom severity of 10 out of 120. CogSport performance deteriorated significantly in concussed cricket players' Detection speed (p<0.001), Identification speed (p<0.001), One Back speed (p=0.001) and One Back accuracy (p=0.022) components. These components, when considered independently and together, had good diagnostic utility. CONCLUSION: This study demonstrated good clinical utility of CogSport for identifying concussed cricket players, particularly symptoms and Detection, Identification and One Back components. Therefore, CogSport may be considered a useful tool to assist concussion diagnosis in this cohort, and the clinician may place greater weight on the components associated with concussion diagnosis.

Presence of bone marrow oedema in asymptomatic elite fast bowlers: Implications for management.

OBJECTIVES: 1) Quantify the intensity of bone marrow oedema (BMO) present in the lumbar vertebrae of asymptomatic elite adult fast bowlers; 2) relate the intensity of BMO to bowling workload and lumbar bone stress injury (LBSI), and; 3) evaluate the utility of MRI screening to reduce the risk of LBSI. METHODS: Thirty-eight elite Australian fast bowlers (21.6 ± 3.7 years) completed 48 screening MRI over 3 years. BMO intensity was quantified on MRI retrospectively. Standard practices for bowling workload monitoring and injury diagnosis were followed. RESULTS: Clinically significant BMO (signal intensity ratio ≥ 2.0) was observed in 22 (46%, 95% CI 31-61) screening MRI. These bowlers had a total of 77 (IQR 45-115) days off between seasons, compared to 66 (IQR 41-94) days off for bowlers with a BMO intensity less than 2.0 (p = 0.510). Fifteen bowlers received follow up MRI as part of individualised management based on their screening MRI, of which less than five went on to develop LBSI in the subsequent season. There was no difference in days or balls bowled in the 12 months following screening MRI between those who sustained LBSI and those who did not. CONCLUSIONS: BMO is common in asymptomatic bowlers. Identification of high-risk bowlers using screening MRI informs individualised management and may prevent progression to LBSI.

Neurocognitive changes associated with concussion in elite cricket players are distinct from changes due to post-match with no head impact.

OBJECTIVES: Determine intra-individual changes in CogSport performance in elite cricket players diagnosed with concussion, and differentiate this from changes which may be attributed to post-match with no head impact. DESIGN: Retrospective observational study of elite Australian male and female cricket players with diagnosed concussion and prospective cohort study of cricket players with no head impact post-match. METHODS: CogSport performance relative to an individual's baseline was compared between 46 cricket players diagnosed with concussion following a head impact sustained during a match, and 84 cricket players who played a match during which they had no head impact. RESULTS: CogSport performance post-match for players diagnosed with concussion was slower for detection speed (p < 0.001), identification speed (p = 0.007), and one back speed (p = 0.011). No changes in one card learning speed or any accuracy measures were observed. CogSport performance post-match with no head impact was faster but less accurate for one card learning (both p < 0.001). No changes in the other three test components were observed. CONCLUSIONS: Slower performance in three of four CogSport tasks (detection, identification, one back) may be indicative of concussion, as these intra-individual changes were not observed in players post-match with no head impact. The fourth task, one card learning, may not be a useful indicator of concussion as it was not observed to change with concussion yet was susceptible to change post-match with no head impact. CogSport may have clinical utility in assisting the clinical diagnosis of concussion in elite male and female cricket players.

Radiological healing of lumbar spine stress fractures in elite cricket fast bowlers.

OBJECTIVES: Review magnetic resonance imaging (MRI) of elite adult fast bowlers with a history of lumbar spine stress fracture for evidence of bone healing. The findings will determine whether bone healing can occur in this population, and whether MRI may be used as a tool to assess bone healing and inform clinical decision making. DESIGN: Retrospective cohort. METHODS: Participants were elite Australian fast bowlers who sustained a lumbar spine stress fracture confirmed on MRI and had at least one subsequent MRI. Two radiologists independently reviewed all images. RESULTS: Thirty-one fractures from 20 male fast bowlers were reviewed. Median maximum fracture size was 6mm (range 2-25mm). Twenty-five fractures achieved bone healing, with a median 203 (IQR 141-301) days between the initial MRI (to confirm diagnosis) and the MRI when bone healing was observed. Fracture size and signal intensity of bone marrow oedema were positively associated with the number of days to the MRI when bone healing was observed (r2=0.245, p<0.001 and r2=0.292, p<0.001 respectively). Fractures which occurred at the same site as a previously united fracture took longer to heal than the first fracture (median 276 days to the MRI when bone healing was observed compared to 114 days for first fracture; p=0.036). CONCLUSIONS: Lumbar spine stress fractures in elite adult fast bowlers are capable of achieving complete bone healing, as demonstrated in the majority of bowlers in this study. Larger fractures, greater bone marrow oedema, and history of previous injury at the same site may require longer healing time which may be monitored with MRI.

Prospective reporting of injury in community-level cricket: A systematic review to identify research priorities.

OBJECTIVES: Cricket is a popular sport enjoyed worldwide. Injuries in cricket are not well understood at community level but are important to understand for prevention to ensure the game continues to be enjoyed safely. This systematic review was designed to assess the quality of data collection and reporting, and to summarise the injury data, in studies of community cricket players. DESIGN: Systematic review. METHODS: Nine databases were searched to November 2018 using the terms "cricket*" and "injur*". A nine-item critical appraisal and three-item likelihood-of-bias evaluation was conducted on included studies. Data completeness was evaluated against recommendations in the international cricket consensus statement for recording/reporting injury and the Australian Sports Injury Data Dictionary (ASIDD). Descriptive injury data (n,%) are presented in tabular format for different subgroups (activity, position, population). RESULTS: Thirteen studies were included, of which eight were rated as unclear, one as high and three having a low likelihood-of-bias. The mean score for completeness of data against the consensus statement was 3.5/10 (95%C.I. 2.8-4.2). The mean score for completeness of data against the ASIDD was 4.4/6 (95%C.I. 3.9-5.0). Bruising and inflammation was the most common injury in junior cricket. Stress fractures were most common in studies of bowlers. Where studies included all activities, batting accounted for most injuries (7-49%). CONCLUSIONS: The included studies inconsistently addressed recommended items for injury surveillance in community sport and cricket. Most studies focused on junior levels or adolescent bowlers, with bruising/inflammation and stress fractures being most common, respectively.

Medical-attention injuries in community cricket: a systematic review.

OBJECTIVES: The aim was to identify and describe outcomes from original published studies that present the number, nature, mechanism and severity of medically treated injuries sustained in community-level cricket. DESIGN: Systematic review. METHODS: Nine databases were systematically searched to December 2019 using terms "cricket*" and "injur*". Original, peer-reviewed studies reporting injury for at least one injury descriptor (body region, nature of injury and/or mechanism of injury) in community-level cricketers of all ages were included. Qualitative synthesis, critical appraisal and descriptive summary results are reported within the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. RESULTS: Six studies were included: five reported hospital-treated data and one reported insurance claims data. Two had a low risk of bias. In hospital-based studies, fractures were the most frequent injury type. Upper and lower limb injuries (age ≥15 years) and injuries to the head (age <15 years) were the most common body region injured. Being struck by the ball was the most common mechanism for injury presenting to hospitals. Children were also commonly struck by equipment. One study using insurance claims data reported soft tissue injuries as the main of injury type. CONCLUSION: Hospital treatment data were most prominent, which emphasised injuries of a more serious nature or requiring acute care. These injuries were primarily fractures, dislocation/sprain and strains, bruising and open wounds with the majority resulting from players being struck by the ball. Research into whether properly fitted protective equipment, at an approved standard, is worn and is effective, is recommended.

Mental health screening: severity and cut-off point sensitivity of the Athlete Psychological Strain Questionnaire in male and female elite athletes.

OBJECTIVES: To examine the sensitivity/specificity of the Athlete Psychological Strain Questionnaire (APSQ) in both male and female elite athletes, and also assess internal consistency and convergent/divergent validity, and determine discriminative validity relative to current injury status. METHODS: Data were provided by 1093 elite athletes (males n=1007; females n=84). Scale validity and reliability values were benchmarked against validated measures of general psychological distress and well-being. ROC curve analysis determined a range of optimal severity cut-points. RESULTS: Bias-corrected area under curve (AUC) values supported three APSQ cut-points for moderate (AUC=0.901), high (AUC=0.944) and very high (AUC=0.951) categories. APSQ total score Cronbach coefficients exceeded those observed for the Kessler 10 (K-10). Gender ×injury status interactions were observed for the APSQ total score and K-10, whereby injured female athletes reported higher scores relative to males and non-injured female counterparts. CONCLUSION: By providing a range of cut-off scores identifying those scoring in the marginal and elevated ranges, the APSQ may better facilitate earlier identification for male and female elite athletes vulnerable to mental health symptoms and developing syndromes. Use of the APSQ may support sports medicine practitioners and allied health professionals to detect early mental ill health manifestations and facilitate timely management and ideally, remediation of symptoms.

Hand fractures and return to play in elite Australian cricketers.

INTRODUCTION: Hand fractures are one of the most common injuries sustained whilst playing cricket. Further research is required to inform future clinical management and risk-reduction strategies. METHODS: This retrospective cohort study reviewed all cases of hand fractures in elite Australian cricket players over a three-year period. Data included specific activity when injury occurred, location of injury, management (non-surgical or surgical) and days to return to play. RESULTS: Seventy (17%, 95% CI 14-21 of players; 43 male, 27 female) players sustained 90 hand fractures. Seventy-three (81%, 95% CI 72-89) fractures occurred whilst fielding the ball. Eighty-four (93%, 95% CI 86-97) fractures occurred to the 'exterior' bones of the hand: distal phalanx, middle phalanx, first and fifth rays. Thirteen (14%, 95% CI 9-23) fractures were managed with surgical internal fixation, of which 11 were to the phalanges, most commonly at the proximal phalanx (n = 5, 36% of all proximal phalanx fractures) or fifth ray middle and proximal phalanges (n = 5, 42% of all fifth ray phalangeal fractures). Fractures requiring surgical management typically had longer time injured (median 33 days, IQR 27-41) than fractures managed non-surgically (median 6 days, IQR 0-21) (p = 0.001). Total time to return to full unrestricted play was similar between surgical (49 days, IQR 45-52) and non-surgical (32 days, IQR 15-45) management (p = 0.197). CONCLUSIONS: Hand fractures sustained by elite male and female Australian cricket players were found to display a pattern of occurring to the 'exterior' bones of the hand. The results of this study may inform clinical decision making with respect to non-surgical or surgical management and anticipated return to play times. Further effort is needed to address risk reduction strategies including gloves and skill proficiency.

Audit of a cardiac screening policy for elite Australian cricketers.

OBJECTIVES: To report the compliance and results of an electrocardiogram (ECG) cardiac screening program in male and female elite Australian cricketers. DESIGN: cross-sectional study. METHODS: Elite cricketers were offered screening in accordance with Cricket Australia policy. Players who consented provided a personal and family history, physical examination and resting 12-lead ECG. An audit (1 February 2019) examined all cardiac screening records for male and female players in all Australian Cricket state squads from 16 years upwards. Data extracted from the Cricket Australia database included the number of players who underwent screening; signed waivers opting out; and had follow-up tests. ECGs were re-reviewed according to the International Criteria. RESULTS: 710 players were included in the cohort (mean age 20.4±4.9 years, 62% male). 692 (97.5%) players underwent recommended cardiac screening or signed a waiver opting out (1.1%). 173 (24.4%) players were screened (or signed a waiver) more than once. Follow-up testing was conducted for 59 (6.9%) cases. No players were excluded from sport due to a cardiac problem and no major cardiac incidents occurred to any player in the audit cohort. Review of 830 ECGs showed benign athlete heart changes, including sinus bradycardia (33.5%), left ventricular hypertrophy (16.3%), and incomplete/partial right bundle branch block (8.4%), were common but abnormal screening ECGs were uncommon (2.0%). CONCLUSIONS: An audit of a cardiac screening program in elite Australian cricketers found excellent compliance. A small proportion required follow-up testing and no player was excluded from sport due to a cardiac problem. ECG analysis suggested cricket is a sport of moderate cardiac demands, with benign athlete heart changes common.

MRI Bone Marrow Edema Signal Intensity: A Reliable and Valid Measure of Lumbar Bone Stress Injury in Elite Junior Fast Bowlers.

STUDY DESIGN: Comparative reliability and prospective validity. OBJECTIVE: First, to evaluate the reliability of four methods of assessing magnetic resonance imaging (MRI) bone marrow edema (BMO) of the posterior vertebral arch of the lumbar vertebrae of elite junior fast bowlers. Second, to evaluate the validity of the most reliable method for the early detection of lumbar bone stress injury. SUMMARY OF BACKGROUND DATA: MRI has demonstrated utility in identifying BMO in lumbar vertebrae. Methods to grade the severity of BMO may provide valuable insight to inform clinical management, particularly in elite athletes where detection of early-stage bone stress may prevent progression to more severe and costly bone stress injury. METHODS: Sixty-five male elite junior fast bowlers had repeat MRI scans during a cricket season. A subset of 19 bowlers' images were reassessed by experienced musculoskeletal radiologists to determine intra- and inter-rater reliability. All images were aligned with independent medical records of lower back symptoms and diagnosed bone stress injuries to establish the relationship of BMO and lumbar bone stress injury. RESULTS: Clinical detection of abnormal BMO, whether the pars region of the vertebra was considered in its entirety or subdivided into regions, had fair-to-moderate inter-rater reliability, and fair-to-almost perfect intra-rater reliability. Measurement of BMO signal intensity using an imaging software tool had excellent intra-rater and inter-rater reliability (ICC = 0.848, 0.837). BMO signal intensity was positively associated with subsequent LBSI (P < 0.001), and differentiated between asymptomatic and symptomatic bowlers (P < 0.001). CONCLUSION: Measurement of BMO signal intensity using an imaging software tool proved a reliable and valid measure of the severity of lumbar bone stress injury in elite junior fast bowlers. LEVEL OF EVIDENCE: 2.

Examining environmental constraints in sport: Spin characteristics of two cricket pitches with contrasting soil properties.

In the sport of cricket, the pitch is an organic surface that represents an important environmental constraint. While the soil properties of the pitch are known to influence the pace and bounce of medium and fast deliveries, it is unknown how the soil constructs or the seam of the cricket ball affect the pace, bounce, and deviation of a spinning delivery. A specialised spin bowling machine was used to deliver 276 (139 wrist spin, 137 finger spin) spinning deliveries onto two cricket pitches with contrasting soil properties. The pitches included a bespoke international pitch (BIP; higher sand content at 43.28%) and a common Australian pitch (CAP; lower sand content at 7.44%). Results indicated that the BIP showed significantly slower reflection pace and larger deviation, compared to the CAP. Irrespective of the pitch type, when the seam of the ball impacted the pitch, there was a significantly slower reflection pace and larger deviation. The reflection properties of the BIP resembled that of a "spinning pitch" which can be used as a form of representative practice for conditions similar to those that may be experienced in India. The impact of the seam on the pitch surface significantly altered the reflection of the ball and should be considered in future cricket research.

Vertebral artery dissection in sport: Expert opinion of mechanisms and risk-reduction strategies.

Experiential knowledge was collated to improve understanding of the mechanism of vertebral artery dissection (VAD) and inform recommendations for risk-reduction strategies in sport. Fourteen experts from fields of neurology, forensic pathology, biomedical engineering, radiology, physiotherapy, and sport and exercise medicine participated in semi-structured interviews. Experts were asked to provide their hypothesised mechanism of VAD, and suggest strategies to reduce the risk of VAD in non-motorised sports. Experts agreed that there is no single mechanism of VAD. Factors relating to predisposition, susceptibility, and an inciting event exist on a spectrum, as does the severity of the resulting VAD. Particularly concerning inciting events which may occur during sports participation include blunt force impact to the specific area behind and below the ear; and extreme movement of the neck, which may be facilitated by impact to the head or neck. Risk reduction strategies must be feasible within the particular sporting context. Strategies include rules, personal protective equipment, and education to reduce the risk of impact to the head or neck. Education may also serve to improve early recognition of VAD. VAD is a risk (low frequency, severe consequence) in sports in which athletes are exposed to head or neck impact from an object or opponent. Best practice risk management suggests that sports governing bodies should assess VAD risk and consider risk controls.

The incidence, prevalence, nature, severity and mechanisms of injury in elite female cricketers: A prospective cohort study.

OBJECTIVES: Incidence, prevalence, nature, severity and mechanisms of injury in elite female cricketers over two seasons from March 2014 to March 2016, inclusive. DESIGN: Prospective cohort study. METHODS: Injury data collected via Cricket Australia's Athlete Management System on all elite female players over two seasons were analysed. Profiles of the nature, anatomical location and mechanism of injuries were presented according to dominant player position. Injury incidence rates were calculated based on match playing hours. RESULTS: There were 600 medical-attention injuries; with 77.7% players reporting ≥1 injury. There were 79.5% acute injuries compared to gradual onset injuries. Of the all medical-attention injuries, 20.2% led to time-loss; 34.7% were match-time-loss injuries. Match injury incidence was 424.7 injuries/10,000h for all injuries and 79.3 injuries/10,000h for time-loss injuries. Of all the injuries, 31.8% were muscle injuries and 16.0% joint sprains. Wrist and hand (19.8%), lumbar spine (16.5%) and knee (14.9%) injuries were the most common time-loss injuries. Six players sustained lumber spine bone stress injury that resulted in the most days missed due to injury (average 110.5days/injury). CONCLUSIONS: There is a need to focus on specific injuries in female cricket, including thigh, wrist/hand and knee injuries because of their frequency, and lumbar spine injuries because of their severity.

Vertebral Artery Dissection in Sport: A Systematic Review.

BACKGROUND: Vertebral artery dissection (VAD) is a potentially catastrophic injury that may occur during sports participation. A comprehensive review is needed to collate documented cases to improve understanding and inform future preventative approaches. OBJECTIVE: This review aimed to understand the extent of VAD in sport and characterise trends suggestive of mechanisms of injury. METHODS: Electronic databases were searched using terms related to VAD and sport. Records were included if they described one or more cases of VAD attributed to sport. RESULTS: A total of 79 records described 128 individual cases of VAD in sport, of which 118 were confirmed by imaging or autopsy and included in analyses. Cases were attributed to 43 contact and non-contact sports. The median age of cases was 33 years (IQR 22-44), and 75% were male. There were 22 cases of fatal injury, of which ten involved an impact to the mastoid region and seven involved an impact to the head or neck. Non-fatal cases of VAD were attributed to impact to the head or neck (not mastoid region), movement or held position without impact, and in some cases no reported incident. CONCLUSIONS: VAD attributed to sports participation is uncommonly reported and the mechanisms are varied. Impact to the mastoid region is consistently implicated in fatal cases and should be the focus of injury prevention strategies in sport. Efforts may also be directed at improving the prognosis of cases with delayed presentation through clinical recognition and imaging. The review was registered on the international prospective register for systematic reviews ( http://www.crd.york.ac.uk/PROSPERO ) (CRD42018090543).