If it was possible to prevent injuries from occurring then sports science and sports medicine (SSSM) professionals would have discovered their Holy Grail. The simple fact is, we are dealing with the unpredictable and individual nature of human bodies in relatively unpredictable sporting contexts, dealing with many interacting factors.
With the aim being to prevent the occurrence and subsequent recurrence of an injury, it is about doing everything practically possible and creating awareness in order to ‘control the controllables’. Injury prevention, or rather, injury minimisation forms the foundation for everything the SSSM professional does.
Physical stress is actually necessary to improve in all physical parameters – the body will specifically adapt to applied load or stimuli over time. Too much load applied too quickly, however, can be counterproductive and will ultimately result in tissue breakdown. Finding the optimal balance for each individual player seems to be the key.
Also, note that psychological or mental stress too is a real factor. Intermittent periods away from the game should not be criticised as it forms an important tool in the management of psychological fatigue or ‘burnout’. Player wellness monitoring via daily feedback of factors such as perceived training effort, quality of sleep, muscle soreness or nutrition is also used in determining if and when monotony and burnout is setting in.
Most of the cricket research focus has been on bowlers, especially fast bowlers, but all types need to be monitored. An older coaching approach has believed that one needs to bowl and bowl in order to improve.
A more contemporary scientific approach would be to ‘train to play and not play to train’. In other words, one cannot simply go out and play at the highest level and expect to both perform and prevent getting hurt. Load exposure, which is applied through competitive match play as well as strength and conditioning training, is both a necessary and positive stress on the body. It results in creating a stronger, more skillfuland ‘stress-resistant body’. Equally, a lack of stress (no training) on the body results in a weaker, less stress-resistant body which is more injury-prone.
Regular fitness testing by the team trainer allows for the monitoring of the players’ physical condition. The combination of load data, testing results and qualitative information collected, can signal when further intervention is required.
Load management is not just about the number of matches played or total balls bowled, but includes assessment of other parameters using the latest in wearable technologies such as GPS and heart-rate data, used to track the volume of effort, intensity and load, both during practice and matches. Overuse is the one factor that the research shows consistently predicts injury over and over again. Clearly this is one area that should be managed optimally.
An important factor that we cannot actually influence is the age of the player. Younger cricketers have skeletally immature bodies, and accordingly require additional consideration of their workloads. Informed coaches are becoming more aware that young bowlers cannot safely match the bowling loads of older players. However, technique correction is easier at a younger age, so coaches have a critical role to play there.
On this note, a current hot topic in sports medicine is early specialisation. The research is quite critical of this happening in terms of its impact on the physical development of the adolescent. This can be compounded if the player shows talent and ends up playing across more than one team, and inadvertently being exposed to excessive load.
Guidelines are sketchy for now, but perhaps younger cricketers need to be more all-rounders during their development. From the injury management viewpoint, orthopaedic surgeons also often face big challenges operating on skeletally immature players.
The terms injury prevention and recovery are used almost synonymously nowadays and the latter is a subject all on its own. The recovery behaviour of players post-match and post-training is a big determinant in their preparation for future competition and consists of both active and passive elements.
Ensuring players get adequate sleep is probably the most critical element in preventing accumulative fatigue, with optimal nutrition being a close second. Passive elements also include the use of compression clothing and massage. Active elements include ice/contrast baths or using the hotel pool for a stretch post-match as well as spending time maintaining mobility of their bodies using props such as foam rollers, massage balls and stretchy bands. Thankfully, cricket administrators have also become more aware of the need to spread out match fixtures and improve travel schedules, allowing the players time to recover – note that travel days do not really count when it comes to recovery. Coaches are also demonstrating a greater understanding of the individual nature of recovery by scheduling practice sessions/days off ahead of the season as well as optional instead of mandatory practice sessions.
The SSSM professionals in the team support staff also have a significant role to play in collecting relevant objective and subjective data about players. Early diagnosis and management of injury is often the result of performing musculoskeletal screening and functional movement analysis.
Research has shown that certain physical traits are associated (but not predictive) with certain injury presentations, hence it can be useful to regularly screen for these. Being in such repetitive sport in terms of its movements, cricketers tend to develop patterns of overuse and reduced mobility which, if left unchecked, could potentially lead to injury.
SSSM professionals have a wide range of interventions in their ‘tool box’ which they can then access to assist in this process, but nothing beats getting the players to actively participate in their individualised injury prevention programmes or pre-habilitation as some call it.
The biggest predictor of injury in sport is a history of injury, so it makes sense to control this significant risk factor and ensure full rehabilitation of current and past problems is complete.
In reality, we still see injuries occurring frequently despite SSSM becoming more scientifically advanced, evidence-based and efficacious by nature. Perhaps, it is because we are missing the basic fact that players are paid to put their bodies on the line, whereas a ‘normal’ person can enjoy being fit and healthy with much lower or zero injury risk.
With everything we know outlined above, there is still a calculated risk every time a player takes the field. There is not a lack of knowledge, but perhaps a problem with the lack of implementation of all of the factors by the players and support staff and the subsequent consequences of not acting. Consider the pressures on cricketers to play and perform in every match, and we can see why injury prevention is such a challenge.