Benita Olivier

International consensus statement on injury surveillance in cricket: a 2016 update

Cricket was the first sport to publish recommended methods for injury surveillance in 2005. Since then, there have been changes to the nature of both cricket and injury surveillance. Researchers representing the major cricket playing nations met to propose changes to the previous recommendations, with an agreed voting block of 14. It was decided that 10 of 14 votes (70%) were required to add a new definition element and 11 of 14 (80%) were required to amend a previous definition. In addition to the previously agreed ‘Match time-loss’ injury, definitions of ‘General time-loss’, ‘Medical presentation’, ‘Player-reported’ and ‘Imaging-abnormality’ injuries are now provided. Further, new injury incidence units of match injuries per 1000 player days, and annual injuries per 100 players per year are recommended. There was a shift towards recommending a greater number of possible definitions, due to differing contexts and foci of cricket research (eg, professional vs amateur; injury surveillance systems vs specific injury category studies). It is recommended that researchers use and report as many of the definitions as possible to assist both comparisons between studies within cricket and with those from other sports.

Static and dynamic balance ability, lumbo-pelvic movement control and injury incidence in cricket pace bowlers.

OBJECTIVES This study aimed to establish the difference in lumbo-pelvic movement control, static and dynamic balance at the start and at the end of a cricket season in pace bowlers who sustained an injury during the season and those who did not. DESIGN This is a longitudinal, observational study. METHODS Thirty-two, healthy, injury free, male premier league fast, fast-medium and medium pace bowlers between the ages of 18 and 26 years (mean age 21.8 years, standard deviation 1.8 years) participated in the study. The main outcome measures were injury incidence, lumbo-pelvic movement control, static and dynamic balance ability. RESULTS Fifty-three percent of the bowlers (n=17) sustained injuries during the reviewed cricket season. Lumbo-pelvic movement control tests could not discriminate between bowlers who sustained an injury during the cricket season and bowlers who did not. However, performance in the single leg balance test (p=0.03; confidence interval 4.74-29.24) and the star excursion balance test (p=0.02; confidence interval 1.28-11.93) as measured at the start of the season was better in bowlers who did not sustain an injury during the season. CONCLUSIONS The improvement in the lumbo-pelvic movement control and balance tests suggests that the intensity and type of physical conditioning that happens throughout the season may have been responsible for this improvement. Poor performance in the single leg balance test and the star excursion balance test at the start of the cricket season may be an indication that a bowler is at heightened risk of injury.

Injury and lumbar reposition sense in cricket pace bowlers in neutral and pace bowling specific body positions

BACKGROUND AND CONTEXT The cricket pace bowling action consists of a complex sequence of forceful actions, involving practiced, particular movements of the lumbar spine. The nature and repetition of the pace bowling action is known to be associated with a high incidence of low back injuries. PURPOSE This study aimed to establish whether lumbar proprioception (as measured by joint position sense) in the neutral lumbar spine position as well as lumbar positions corresponding to those at front foot placement and ball release positions of the cricket pace bowling action were related to previous injury and injury sustained during the cricket season under review. Injuries specifically sustained during the bowling action and those specific to the low back were explicitly investigated. STUDY SETTING Longitudinal study with participants tested at the start and monitored over the duration of a cricket season. PARTICIPANT SAMPLE Seventeen male cricket pace bowlers between the ages of 18 and 26 years participated in this study. OUTCOME MEASURES Physiological outcome measures were used. Lumbar position sense was established using electrogoniometry. METHODS Lumbar reposition error was measured in three positions (neutral lumbar spine, front foot placement, and ball release bowling positions). In each position, lumbar orientation was determined in the sagittal (flexion-extension) and coronal (left-right lateral flexion) planes. Wilcoxon matched-pairs ranks and Kruskal-Wallis tests were used to establish the relationship between variables. RESULTS Reposition error was associated with general injuries sustained in the past and during the cricket season under review, low back injuries, as well as injuries sustained during the bowling action (p<.05). CONCLUSION Lumbar position sense, as a measure of proprioception, was related to injury in general, injuries sustained during the bowling action, and, especially, low back injury sustained in the past. Low back injury prevention methods are particularly needed because of the high load nature of the pace bowling action. If the proprioception of the lumbar spine is improved in pace bowlers, their risk of lumbar injury can potentially be reduced.

The Effectiveness of Neural Mobilization for Neuromusculoskeletal Conditions: A Systematic Review and Meta-analysis

&NA; • STUDY DESIGN: Systematic review with meta‐analysis. • OBJECTIVES: To determine the efficacy of neural mobilization (NM) for musculoskeletal conditions with a neuropathic component. • BACKGROUND: Neural mobilization, or neurodynamics, is a movement‐based intervention aimed at restoring the homeostasis in and around the nervous system. The current level of evidence for NM is largely unknown. • METHODS: A database search for randomized trials investigating the effect of NM on neuromusculoskeletal conditions was conducted, using standard methods for article identification, selection, and quality appraisal. Where possible, studies were pooled for meta‐analysis, with pain, disability, and function as the primary outcomes. • RESULTS: Forty studies were included in this review, of which 17 had a low risk of bias. Meta‐analyses could only be performed on self‐reported outcomes. For chronic low back pain, disability (Oswestry Disability Questionnaire [0‐50]: mean difference, ‐9.26; 95% confidence interval [CI]: ‐14.50, ‐4.01; P<.001) and pain (intensity [0‐10]: mean difference, ‐1.78; 95% CI: ‐2.55, ‐1.01; P<.001) improved following NM. For chronic neck‐arm pain, pain improved (intensity: mean difference, ‐1.89; 95% CI: ‐3.14, ‐0.64; P<.001) following NM. For most of the clinical outcomes in individuals with carpal tunnel syndrome, NM was not effective (P>.11) but showed some positive neurophysiological effects (eg, reduced intraneural edema). Due to a scarcity of studies or conflicting results, the effect of NM remains uncertain for various conditions, such as postoperative low back pain, cubital tunnel syndrome, and lateral epicondylalgia. • CONCLUSION: This review reveals benefits of NM for back and neck pain, but the effect of NM on other conditions remains unclear. Due to the limited evidence and varying methodological quality, conclusions may change over time. • LEVEL OF EVIDENCE: Therapy, level 1a. • KEY WORDS: back pain, exercise, manual therapy, musculoskeletal conditions, neck pain, nerve mobilization, neurodynamics, physical therapy

Kinematic and kinetic analysis of the inter- and intra-applicator assessment of the Babinski reflex

AIMS OF THE STUDY The first aim was to quantify variability in the mechanical technique used by neurologists to elicit the Babinski reflex. The second aim of the study was to assess if the mechanical technique is an important determinant of the subsequent reflex response. MATERIALS AND METHODS In this study, twelve neurologists elicited the Babinski reflex five times on the same foot of the same participant using a special reflex hammer which recorded the force and duration of the stroke. Hallux movement, tibialis anterior maximum EMG amplitude and pain felt by the participant for each stroke were recorded. RESULTS A large inter- and intra-applicator variability was shown amongst the neurologists. The change in hallux angle was significantly correlated with the duration of the stroke (R(2)=0.18, P<0.01), maximum (R(2)=0.14, P=0.01) and average (R(2)=0.17, P<0.01) force used to elicit the reflex. No correlations were shown between the hammer forces and duration and the maximum amplitude of the tibialis anterior. Significant correlations were shown between the pain score and the maximum (R(2)=0.15, P<0.01) and average (R(2)=0.17, P=0.001) force used to elicit the Babinski reflex. CONCLUSION These results indicate that there was substantial variation when performing the Babinski reflex test within and between neurologists which could lead to differences in the resultant reflex and therefore may affect subsequent diagnoses.

Side-to-side asymmetry in absolute and relative muscle thickness of the lateral abdominal wall in cricket pace bowlers

Background. The abdominal musculature plays a protective role against lower-back injury. Knowledge of the asymmetry in abdominal wall thickness in healthy, injury-free cricket pace bowlers may provide a useful platform against which pathology could be assessed and the effects of training could be evaluated. Objective. To compare side-to-side differences in absolute muscle thickness and activity of the abdominal musculature and to compare these measurements at the start, with those at the end of a cricket season among a group of amateur pace bowlers. Methods. This was a controlled longitudinal prospective study. Rehabilitative ultrasound imaging was used to assess abdominal muscle thickness in 26 right-handed, injury-free cricket pace bowlers at the start and at the end of a cricket season. Thickness measurements were done at rest, during an abdominal drawing-in manoeuvre (ADIM) and the active straight-leg raise (ASLR) on the left (-L) and right (-R). Results. The absolute thickness of the non-dominant obliquus abdominis internus (OI) was higher than that of the dominant OI at the start (p=0.001; ES=0.87) as well as at the end of the cricket season (p=0.001; ES 1.09). At the start of the season, the percentage change during the ADIM, thus muscle activity, was higher for the non-dominant OI than for the dominant OI (p=0.02; ES=0.51). Absolute thickness of the dominant obliquus abdominis externus (OE) at rest was significantly higher at the end of the season compared with the start of the season (p=0.0001; ES=0.85). During ASLR-R, the activity of the left transversus abdominis (TA) was significantly higher than that of the right TA during ASLR-L (p=0.03) when measured at the end of the season. Conclusion. This study highlights the possible muscle adaptations in absolute muscle thickness and activity as a consequence of the asymmetrical bowling action.

Extrinsic and intrinsic factors associated with non-contact injury in adult pace bowlers: a systematic review protocol

Review question/objective Review question: which extrinsic and intrinsic factors are associated with non‐contact injury in adult cricket pace bowlers? Review objective: the objective of this review is to determine the extrinsic and intrinsic factors associated with non‐contact injury in adult pace bowlers. Background Cricket is generally considered to be a sport of low injury risk1 compared to other sports.2 In cricket, the pace bowler strives towards the adoption of a bowling technique with a relatively low injury threat that will, at the same time, allow for a fast (>120km/hr) and accurate delivery to the opposing batsman. However, of all the various roles of the cricket player, the pace bowler has the highest risk of injury, especially for low back and lower limb (lower quarter) injury.3,4 The reason for this high risk of injury is due to the inherent, high‐load biomechanical nature of the pace bowling action.3‐5 The high prevalence of injury amongst pace bowlers3,4 highlights the great need for research into factors associated with injury. Both extrinsic and intrinsic factors work in combination to predispose the bowler to injury. Extrinsic or environment‐related factors include bowling workload (the numbers of overs a bowler bowls), player position (first, second or third change) and time of play (morning or afternoon). A high bowling workload has been linked with a higher risk of injury in pace bowlers. Foster et al.5 found in an observational study that bowling too many overs in a single spell or bowling too many spells may increase the pace bowlers risk of sustaining a low back injury. In another observational study, Dennis et al.6 found that an exceptionally high bowling workload as well as an uncommonly low bowling workload is associated with injury risk. The major extrinsic factors for bowling injury identified by Orchard et al.1 are a high number of match overs bowled in the previous week, number of days of play and bowling second (batting first) in a match. Extrinsic factors are known to make the bowler more susceptible to injury, especially in the presence of intrinsic factors. Intrinsic, or person‐related, factors include muscle strength, flexibility, balance and biomechanics.7‐11 Intrinsic, strength‐related factors, such as shoulder depression, horizontal flexion strength for the preferred limb and quadriceps power in the non‐preferred limb are also significantly related to back injuries in fast bowlers.5 Both upper limb and lower limb‐related intrinsic factors are known to be associated with injury. A prospective study by Dennis et al.12 aimed to identify the risk factors for injury in adolescent cricket fast bowlers. Their findings concluded that bowlers with a hip internal rotation range of motion of ≤30° on the leg ipsilateral to the bowling arm were at a significantly reduced risk of injury compared with bowlers with >40° of rotation. Moreover, bowlers with ankle dorsiflexion lunge of 12.1‐14.0 cm on the leg contralateral to the bowling arm were at a significantly increased risk of injury compared to bowlers with a lunge of >14 cm. Reduced hamstring flexibility was also associated with lumbar disc abnormalities.13 Bowling‐related biomechanical risk factors for injury have been established such as trunk rotation of the shoulders by to a more side‐on position during the delivery stride.5 Portus et al.14 also reported that shoulder counter‐rotation was significantly higher in bowlers who reported lumbar spine stress fractures, while the non‐trunk injured group displayed a more flexed knee at front foot contact and ball release. In addition to the above kinematic risk factors, there are high ground reaction forces associated with the power phase ‐ between the front foot placement and ball release components of the pace bowling action.15‐17 A combination of kinematic bowling related issues as described above and high ground reaction forces may predispose the bowler to injury. Morton et al.18 conducted a systematic review on pace bowlers between the ages of 13.7 and 22.5 years on risk factors and successful interventions for cricket‐related low back pain. Young cricketers between the ages of 13 and 18 years are different to adults in terms of their physiology which impacts on their predisposition to injury and phases of healing.19,20 Young cricketers may differ from an adult population in that young pace bowlers who sustain injuries during their bowling career may have given up on the sport by the time they approach adulthood, and the composition of the adult pace bowler population group is therefore affected by natural selection which may cause this group to differ from the original population. Caution is thus advised when generalizing findings from this young population group to adult pace bowlers which emphasizes the need for studies amongst adult pace bowlers. Furthermore, the review by Morton et al.18 included articles that specifically investigated factors associated with low back pain. However, due to the interconnectedness between the spine and the lower limbs, kinematic variables affecting the spine will also affect the load placed on the lower limbs21,22 with subsequent risk of injury.23 The interdependent mechanical interactions in a linked segment system such as the system of motion of the low back can be caused by movement coordination patterns in other body segments.24 The systematic review by Morton et al.18 only included intrinsic factors while the proposed review will also look at extrinsic factors. Therefore, the primary objective of this review is to determine extrinsic and intrinsic factors associated with non‐contact injury in adult pace bowlers.

The Functional Movement Screen in the Prediction of Injury in Adolescent Cricket Pace Bowlers: An Observational Study

CONTEXT The Functional Movement Screen (FMS) has been found to be a valid preparticipation screening tool in the prediction of injury among various athletes in different sports. The validity thereof in the prediction of injury among adolescent cricketers is yet to be established. OBJECTIVE To determine if a preseason FMS total score is a valid predictor of in-season injury among adolescent pace bowlers. DESIGN Prospective observational quantitative study. SETTING Bowlers performed the FMS before the start of the season. Injury incidence was monitored monthly throughout the season. The student t test and Fishers exact test were used to compare the FMS scores of the injured and noninjured bowlers as well as the injured and noninjured bowlers who scored ≤ 14. PARTICIPANTS 27 injury-free, male, adolescent pace bowlers. MAIN OUTCOME MEASURES The FMS (scoring criteria and score sheet) and standardized self-administered injury questionnaire. RESULTS There was no difference between the noninjured group (16.55 ± 2.57) and the injured (16.1 ± 2.07) group in terms of FMS scores. There was no significant difference between injured and noninjured bowlers who scored ≤ 14. A total FMS score of 14 does not provide the sensitivity needed to assess injury risk among adolescent pace bowlers and no other accurate cut-off score could be calculated. CONCLUSION Preseason observed total FMS score is a poor predictor of in-season injury among adolescent pace bowlers. Further research should be conducted to determine if a specific FMS test will be a more valid predictor of injury.

The Interrater Reliability of Subjective Assessments of the Babinski Reflex

ABSTRACT The Babinski reflex is a clinical diagnostic tool; however, the interrater reliability of this tool is currently greatly contested. A comparison between rater groups with objective measurements of the Babinski reflex was therefore conducted. Fifteen recorded Babinski reflexes were assessed by 12 neurologists and 12 medical students as being either pathological or nonpathological. Kinematic and electromyographic variables were collected and used to assess which aspects of the Babinski reflex predict classification. Substantial interrater agreement within the neurologist and student groups (κ = .72 and .67, respectively) was shown; however, there were some differing aspects between what neurologists and students used to assess the reflex as determined by objective kinematic measurements.

Gross anatomy curricula and pedagogical approaches for undergraduate physiotherapy students: a scoping review protocol.

Review question/objective: This scoping review seeks to collate and describe the body of existing literature pertaining to curricula and pedagogies used in the gross anatomy education of undergraduate physiotherapy students. Specifically, the review questions are as follows: What approaches to gross anatomy curricula and pedagogies used to teach undergraduate physiotherapy students have been documented in available literature? What are the outcomes associated with the various approaches to anatomy curricula and pedagogies used to teach undergraduate physiotherapy students?