Risk Factors for Non-Contact Injury in Adolescent Cricket Pace Bowlers: A Systematic Review

Background: Adolescent cricket pace bowlers are prone to injury. Recognising the risk factors for non-contact injury in this population will aid future injury prevention strategies. Objective: To identify the risk factors for non-contact injury in adolescent cricket pace bowlers. Methods: We systematically searched PubMed, Cochrane Library, PEDro, SPORTDiscus, Embase, and the South African Journal of Sports Medicine to identify all experimental and observational studies reporting risk factors for non-contact injuries in pace bowlers (aged 12–19 years). The search syntax included terms relevant to cricket bowling, injury, and known risk factors for injury. The Newcastle-Ottawa Quality Assessment Scale and a modified Newcastle-Ottawa Quality Assessment Scale were used to assess the risk of bias in the cohort and cross-sectional studies, respectively. Results: Sixteen studies (five cross-sectional studies, 11 cohort studies) comprising 687 participants (96% male, 75% playing cricket in Australia) met the selection criteria and were included for qualitative synthesis. Three cross-sectional studies were rated as high risk of bias and two as very high risk of bias. For the cohort studies, three were rated as low risk of bias, and eight as high risk of bias. Injury was associated with bowling biomechanics (excessive lateral trunk flexion and pelvis/hip kinematics), reduced trunk endurance, poor lumbo-pelvic-hip movement control, and early signs of lumbar bone stress. Conflicting results were found by studies examining the mixed technique, bowling workload and quadratus lumborum asymmetry. Conclusions: The current systematic review identified a number bowling biomechanics and various neuromuscular deficiencies as risk factors for non-contact injury in adolescent pace bowlers. These factors may provide a useful target for future interventional research aiming to prevent injury in this population. Future studies should utilise prospective cohort designs, and ensure that participants are injury-free at baseline, confounding factors are well controlled and attrition rates are reported. Registration: This systematic review was registered a priori (PROSPERO, CRD42016043956)