What did I do?
The aims of my thesis were to understand the injury epidemiology across various levels and formats of professional cricket in England and Wales, while quantifying the long-term health, financial and performance impacts of injuries on players, teams and organisations.
Why did I do it?
Since the publication of the original and updated consensus statements on injury surveillance methods in cricket,1 2 numerous studies have reported the injury epidemiology in professional men’s cricket. Despite this, inconsistencies in reporting remain due to differing recommendations between the cricket-specific and the International Olympic Comittee (IOC) consensus statements on injury surveillance methods. There was also limited evidence on the injuries in other levels of cricket, particularly academy cricket. At the outset of my PhD, the cricket landscape was evolving rapidly, with franchise white ball leagues gaining global popularity and the England and Wales Cricket Board (ECB) establishing their own franchise cricket competition, The Hundred, in 2021. Yet despite this growth, little was known about the injuries that occur during men’s and women’s franchise cricket.
Understanding the injury situation is essential for injury prevention, but recognising the broader impact of injuries is equally important for holistic athlete care. At the time, there was no evidence of the financial cost of injuries to players, teams and organisations in cricket. Quantifying the loss of earnings and medical expenses through insurance and salary data can help demonstrate the economic value of effective injury prevention to key stakeholders.
How did I do it?
My thesis comprised four studies (figure 1). The first part was underpinned by the initial step in the Team-sport Injury Prevention cycle,3 aiming to establish the extent of the injury situation. As such, the first study was a systematic review and meta-analysis of the injury epidemiology in professional men’s cricket, and the long-term health of retired professional cricket players. Injury incidence and exposure data were recalculated for consistency with the updated cricket-specific consensus statement and recent publications.
Figure 1
Summary of the four PhD studies on injury epidemiology and impact of injury in professional cricket.
The next two studies addressed the limited understanding of injuries in professional academy male players and men’s and women’s franchise cricket through prospective cohort studies.4 5 The injuries, recorded as part of the ECB Injury Surveillance Programme, were reported in accordance with the cricket-specific consensus statement. The incidence (time-loss and non-time loss), prevalence (percentage of players unavailable on any given day), injury event, location and activity at injury were reported.
Finally, a seven year retrospective cohort study quantified the direct and indirect financial costs of injuries and examined associations with team performance in professional men’s cricket,6 analysing insurance claims, salary costs and epidemiological data.
What did I find?
The systematic review and meta-analysis revealed pooled match injury incidences of 168 and 140 injuries/1000 days of play, for the match time-loss and general time-loss injury definitions, respectively. Shorter match formats showed significantly higher rates than multi-day cricket. The lumbar spine, hand and thigh were the most common injury locations, with fast bowlers experiencing the highest incidence and prevalence. Limited studies on retired players (n=4) precluded definitive conclusions regarding long-term health outcomes.
Study two found similar rates of time-loss (59.7/100 players per year) and non-time loss (55.3/100 players per year) injuries in male academy cricketers, with 8.5% of players unavailable on any given day of the year. Most injuries occurred during matches, with bowling the highest-risk activity. The lumbar spine emerged as the most common and prevalent injury site, with stress fractures accounting for 36% of cases, a notable finding for developing athletes. Study three revealed comparable injury profiles between men’s and women’s franchise competition ‘The Hundred’, with fielding the activity presenting the highest injury incidence, and lower limb time-loss and upper limb non-time loss the most frequent in both competitions.
The final study estimated that approximately £3 million was spent annually on injuries by individual cricket counties and the ECB with all costs covered by these organisations, with indirect costs representing 77% of the total injury costs. The lumbar spine, knee and hand were the costliest body locations. A significant negative association between the cost of injury and team success was established in Division One County Championship Cricket.
What is the most important clinical impact/practical application?
Collectively, this research demonstrates that injury patterns in cricket vary across levels and formats, with each necessitating tailored prevention strategies. Professional men’s cricket demands focus on thigh, hand and lumbar spine injuries in shorter formats, alongside bowling-specific interventions. In franchise women’s cricket, prevention strategies should focus on thigh, hand and shoulder injuries. Additionally, enhanced fielding injury prevention protocols are required for both men’s and women’s franchise cricket. Academy programmes should prioritise lumbar spine stress fracture prevention in young fast bowlers through load monitoring and technical modifications. The £3 million annual financial burden provides compelling economic evidence for investing in such injury prevention programmes.
Ethics statements
Patient consent for publication
Ethics approval
This study involves human participants and was approved by University of Bath, Research Ethics Approval Committee for Health (REACH reference numbers: EP 20/21 065, 20/21 052, 20/21 087). Participants gave informed consent to participate in the study before taking part.
Acknowledgments
I would like to thank my PhD supervisors Dr Sean Williams, Prof Keith Stokes, Dr Carly McKay and Prof Nick Peirce for the guidance throughout this journey and all co-authors of the individual studies. I also wish to thank the University of Bath and England and Wales Cricket Board for funding my PhD.
