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Spikes in acute workload are associated with
increased injury risk in elite cricket fast bowlers
Billy T Hulin,
1
Tim J Gabbett,
1
Peter Blanch,
2
Paul Chapman,
3
David Bailey,
4
John W Orchard
5
1
School of Exercise Science,
Australian Catholic University,
Brisbane, Queensland,
Australia
2
Centre of Excellence, Cricket
Australia, Brisbane,
Queensland, Australia
3
Cricket New South Wales,
Sydney, New South Wales,
Australia
4
Cricket Victoria, Melbourne,
Victoria, Australia
5
School of Public Health,
University of Sydney, Sydney,
New South Wales, Australia
Correspondence to
Dr Tim Gabbett,
School of Exercise Science,
Australian Catholic University,
Brisbane, QLD 4014, Australia;
tim_gabbett@yahoo.com.au
Received 11 April 2013
Revised 30 July 2013
Accepted 30 July 2013
Published Online First
20 August 2013
To cite: Hulin BT,
Gabbett TJ, Blanch P, et al.
Br J Sports Med 2014;48:
708–712.
ABSTRACT
Objective To determine if the comparison of acute and
chronic workload is associated with increased injury risk
in elite cricket fast bowlers.
Methods Data were collected from 28 fast bowlers
who completed a total of 43 individual seasons over a
6-year period. Workloads were estimated by summarising
the total number of balls bowled per week (external
workload), and by multiplying the session rating of
perceived exertion by the session duration (internal
workload). One-week data (acute workload), together
with 4-week rolling average data (chronic workload),
were calculated for external and internal workloads. The
size of the acute workload in relation to the chronic
workload provided either a negative or positive training-
stress balance.
Results A negative training-stress balance was
associated with an increased risk of injury in the week
after exposure, for internal workload (relative risk (RR)
=2.2 (CI 1.91 to 2.53), p=0.009), and external
workload (RR=2.1 (CI 1.81 to 2.44), p=0.01). Fast
bowlers with an internal workload training-stress
balance of greater than 200% had a RR of injury of 4.5
(CI 3.43 to 5.90, p=0.009) compared with those with a
training-stress balance between 50% and 99%. Fast
bowlers with an external workload training-stress
balance of more than 200% had a RR of injury of 3.3
(CI 1.50 to 7.25, p=0.033) in comparison to fast
bowlers with an external workload training-stress
balance between 50% and 99%.
Conclusions These findings demonstrate that large
increases in acute workload are associated with
increased injury risk in elite cricket fast bowlers.
INTRODUCTION
Professional cricket is an international team sport
consisting of limited over (predominantly 20-over
and 50-over) and multiple day (4 or 5 day) formats.
Time-motion analysis has established that fast
bowlers cover the greatest total distance in an
innings for 20-over (5.5 km) and 50-over (13.4 km)
matches, while also covering the greatest total dis-
tance in a full day of play during multiple day
cricket (22.6 km).
1
Compared with players in other
positions, fast bowlers covered 20–80% greater dis-
tance, exerted 2–7 times greater high-intensity (ie,
>4.01 m/s) distance and had at least 35% less
recovery time between high-intensity efforts.
1
In
addition to the greater movement demands, fast
bowlers are required to laterally flex, extend and
rotate throughout their bowling action, while also
absorbing forces as high as eight times their body
mass during the delivery stride.
2–4
A fast bowler
may be required to produce these movements and
absorb these forces on over 300 occasions during a
multiple day cricket match.
5
Compared with players in other positions, the
higher absolute workload of fast bowlers is also
associated with greater injury rates. Over a period
of 10 Australian cricket seasons (2001–2011), fast
bowlers, batsmen, wicketkeepers and spin bowlers
recorded injury rates of 18%, 7%, 4% and 6%,
respectively.
6
A survey of all West Indian cricket
matches between June 2003 and December 2004
concluded that 40% of all injuries were sustained
by fast bowlers and that fast bowlers missed a com-
bined total of more than 234 days of play due to
injury.
7
Similar research in South African cricket
has shown that 33% of all injuries over a 3-year
period were sustained by fast bowlers.
8
It is clear
that the performances of international and domes-
tic cricket teams have been hindered due to the
high injury rates sustained by fast bowlers.
Relationships between fast bowling workloads
and injury have been reported previously in first-
class cricketers.
59
Often, these relationships are
determined based on the number of balls bowled in
a week and the likelihood of injury within that
week. However, a delay of up to 3–4 weeks
between high workloads and increased injury risk
in fast bowlers has been documented.
5
The 14-day,
21-day and 28-day periods following bowling
volumes of greater than 50 overs in a match
showed injury risks of 9%, 13% and 16%, respect-
ively.
5
Moreover, when bowling volumes were
greater than 30 overs in the second innings of a
multiple day match, the risk of injury rose to 22%
during the 28-day period following the match.
5
While the total workload on the bowler was not
included in this study (ie, no training data were
included in the analysis), the results clearly demon-
strate that there is a delay in the increased risk of
injury following high workloads.
In a more comprehensive analysis of workloads,
which did include training deliveries, relationships
were found between bowling volumes and risk of
injury.
9
Interestingly, this research suggests a
‘window’ of deliveries (between 123 and 188 deliv-
eries per week) where fast bowlers have decreased
likelihood of injury within the week that the
bowling volume occurs. The average weekly
bowling volumes below (relative risk (RR)=1.4)
and above (RR=1.4) this ‘window’ show an
increased risk of injury.
9
Furthermore, in the same
study, it was demonstrated that bowlers with an
average of less than 2 days (RR=2.4) or more than
5 days between bowling sessions (RR=1.8) were at
a significantly increased risk of injury than bowlers
with an average of 3 –4 days between bowling
Hulin BT, et al. Br J Sports Med 2014;48:708–712. doi:10.1136/bjsports-2013-092524 1 of 5
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sessions.
9
These results suggest that underbowling and over-
bowling may increase the risk of injury.
Although the aforementioned studies
59
have offered valuable
insights, further additions to this knowledge could be offered in
two ways:
1. The analysis of bowling volumes by counting balls bowled in
isolation does not encompass other aspects that produce
total workload, such as fielding, batting and other condition-
ing requirements. Furthermore, links between perceived
effort (which can encompass all aspects of training) and
injury have been established in other sports.
10–13
However,
until now, no study has investigated the relationship between
external (eg, bowling volumes) and internal (eg, perception
of effort) measures of workload, or the relationship between
internal measures of workload and injury in elite cricket fast
bowlers.
2. Estimates of workload are often referred to in absolute
terms (ie, the amount of work the athlete has performed in
a week)
10–12
or in simple relative terms (ie, the amount of
work the athlete performed this week compared with last
week).
13
However, no study has assessed whether comparing
what an athlete has performed in a week (acute workload)
with what the athlete has been prepared for (chronic work-
load) is an appropriate model for evaluating workload and
predicting injury.
Previous studies have assessed a model designed to predict
‘performance’ by comparing acute and chronic workloads.
14–16
In this model where performance is estimated as ‘fitness’ minus
‘fatigue’, the chronic workload represents a marker of ‘fitness’,
while the acute workload represents a marker of ‘fatigue’. The
difference between the positive function of fitness and the nega-
tive function of fatigue provides either a positive (ie, chronic
workload is above the acute workload) or negative (ie, acute
workload is above the chronic workload) training-stress balance.
Therefore, the purpose of this study was to determine if the
assessment of internal and external workload and the compari-
son of acute and chronic workload is associated with subsequent
injury in elite cricket fast bowlers.
METHODS
Participants
The sample comprised all 28 fast bowlers (mean±SD age, 26
±5 years) that were contracted to either the New South Wales
(NSW) or Victorian cricket squad between 2006 and 2012.
Data were collected over five Australian domestic cricket seasons
(preseason through competition phase); of those five seasons,
11% (3) of the participants played three seasons, 33% (9)
played two seasons and 57% (16) played one season—equating
to 43 individual seasons of cricket in total.
Quantifying workloads
Workload data were collected from the NSW cricket squad
during seasons 2006/2007, 2008/2009, 2009/2010 and 2010/
2011 and from the Victorian cricket squad during the 2010/
2011 and 2011/2012 seasons. Workloads were estimated in two
ways. First, data were summarised into the total number of balls
bowled per week, in training and competition (external work-
load). Second, players were asked to provide a subjective rating
of perceived exertion (RPE) using a 10-point category ratio
scale
17
as an estimate of training intensity. Multiplying the
session RPE and the session duration, for either training or com-
petition, provided an estimate of internal workload.
17
Definition of injury
Injury reports were updated and maintained by medical staff
from NSW and Victoria. An injury was defined as any non-
contact injury that resulted in a loss of either match-time or
greater than one training session over a 1-week period. All ‘sore-
ness’ reported by players was excluded from the analysis.
Data analysis
Data were categorised into weekly blocks running from Monday
to Sunday. A fast bowler who performed no external or internal
work (ie, 0 balls bowled or 0 arbitrary units) would not have
produced a workload and therefore not have produced a risk of
injury due to overload. However, these data were included in
the analysis—in order to give insight into the risk of injury in
the week following no work. One-week data, together with
4-week rolling average data, were calculated for external and
internal workloads. The 1-week data represented the acute
workload (ie, ‘fatigue’), while the 4-week rolling average repre-
sented the chronic workload (ie, ‘fitness’). Training-stress
balance ranges (expressed as a percentage) were calculated by
dividing the acute workload by the chronic workload. Weekly
workloads that were below 1 SD for the individual’s chronic
workloads were removed from the analysis. This was performed
so that the analysis would not consider small absolute increases
of acute workload at low chronic workloads (ie, if a fast bowler
had a chronic external workload of six deliveries, a 300%
increase would be an acute workload of 18 deliveries). This
could be considered a low increase in absolute workload (12
deliveries); however, it would be expressed as a highly negative
training-stress balance (300%).
Data were categorised into discrete ranges based on the total
number of balls bowled and the internal workload performed
per week. Internal workload ranges were divided into 500 arbi-
trary unit increments. In this respect, 500 arbitrary units of
internal workload represented approximately one hard session
of training. External workloads were divided into five-over
increments (ie, increments of 30 balls bowled). Injury likeli-
hoods were calculated based on the total number of injuries sus-
tained relative to the total number of players exposed to the
workload. Injury likelihoods were calculated for the present
week (ie, the week in which the workload was performed) and
the following week.
The likelihood of sustaining injury was analysed using a logis-
tic regression model, with injury as the dependent variable, and
acute and chronic workloads for internal and external work-
loads as the predictor variables. Additional predictor variables
included the training-stress balance for internal and external
workloads. RR and 95% CI were calculated to determine which
workload variables increased or decreased the risk of injury. A
value greater or less than 1 implied an increased or decreased
risk of injury, respectively.
RESULTS
A summary of descriptive statistics for all participants’ workload
variables over the duration of the study is shown in table 1.
External workload
The relationships between injury risk and acute and chronic
external workloads are shown in figure 1A,B, respectively. There
was a relationship ( p=0.0001) between acute external work-
loads in the current week and injury, with higher external work-
loads associated with a lower injury risk. No relationship
(p=0.172) was found between acute external workloads and
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injury in the subsequent week. The relationships between higher
chronic external workloads in the current week ( p=0.002) and
subsequent week (p=0.017) were associated with lower injury
likelihoods.
Internal workload
The likelihood of injury in response to acute and chronic
internal workloads is shown in figure 1C,D, respectively. No
relationships were found between either acute (p=0.176) or
chronic ( p=0.210) internal workloads and injury in the current
week, or between acute (p=0.109) or chronic (p=0.381)
internal workloads and injury in the subsequent week.
Training-stress balance and injury likelihood in the current
week
Figure 2 shows the likelihood of injury at positive and negative
training-stress balance ranges in the current week. No relationship
was found between injury and internal workload training-stress
balance (p=0.230), or injury and the training-stress balance for
external workload (p=0.556) in the week that the training-stress
balance was measured.
Training-stress balance and injury likelihood in the
subsequent week
External workload
In relation to the external workload, a negative training-stress
balance was associated with an increased risk of injury (RR=2.1
(CI 1.81 to 2.44), p=0.01) in the following week. Negative
training-stress balance accounted for 51% (322) of all recorded
training-stress balance ranges. Sixty-three per cent (22) of all
injuries occurred 1 week after a negative training-stress balance.
Bowlers with an acute workload of more than 200% compared
with chronic workload had relative injury risks of 3.3 (CI 1.50
to 7.25, p=0.033) and 2.9 (CI 1.14 to 7.40, p=0.044) in com-
parison to players with a training-stress balance between
50–99% and less than 49%, respectively (figure 3).
Internal workload
In the subsequent week, a negative training-stress balance for
internal workload was associated with an increased risk of
injury (RR=2.2 (CI 1.91 to 2.53), p=0.009). Negative
training-stress balance accounted for 47% (344) of all recorded
training-stress balance ranges. Fifty-seven per cent (27) of all
injuries occurred 1 week after a negative training-stress balance.
Fast bowlers with an internal workload training-stress balance of
greater than 200% had a RR of injury of 4.5 (CI 3.43 to 5.90,
p=0.009) and 3.4 (CI 1.56 to 7.43, p=0.032) compared with
those with a training-stress balance between 50–99% and
0–49%, respectively. Additionally, fast bowlers with an internal
workload training-stress balance between 150% and 199% had
a RR of injury of 2.1 (CI 1.25 to 3.53, p=0.035) in comparison
to fast bowlers with a training-stress balance between 50% and
99% (figure 3).
DISCUSSION
This is the first study to investigate the relationship between
acute and chronic workloads and injury risk in elite cricket fast
bowlers. We used a performance model
14–16
that has previously
been described to quantitatively estimate the training prepared-
ness of an athlete by calculating the difference between chronic
workload (ie, fitness) and acute workload (ie, fatigue).
16
While
Banister et al
16
stated that preparedness for competition grows
as the chronic workload outweighs the acute workload, our
results indicate that injury risk increases as the acute workload
outweighs the chronic workload. Furthermore, the greater the
increase in acute workload relative to chronic workload, the
larger the increase in injury risk in the following week. This is
highlighted by the threefold and fourfold rises in injury risk for
external and internal workloads, respectively, when the
training-stress balance exceeded 200%. These findings demon-
strate that sudden increases in workload, above which fast
bowlers are accustomed, increase the likelihood of injury in the
following 1-week period.
The present study also highlights that greater external work-
loads over a 1-week and a 4-week period results in a decreased
risk of injury during the week of exposure. However, the rela-
tionship between greater acute external workloads and lower
injury risk in the current week may not necessarily be causal.
That is, injuries may occur due to a myriad of factors that are
unrelated to training or competition workloads.
2–41819
Indeed,
it is possible that fast bowlers sustained an injury, and as a result
of that injury, recorded a lower external workload in the current
week.
The results showing that higher chronic external workload
produced a lower injury risk could corroborate our findings in
relation to the 1-week delay in injury risk after a negative
training-stress balance. That is, higher external workloads over a
chronic period are likely to result in positive physical adapta-
tions,
14–16
potentially minimising the influence of fatigue and
therefore reducing the risk of injury. Our findings suggest that
increases in chronic workloads should be performed systematic-
ally, in an appropriate sequence and combination.
20
However,
this could be challenging, given that cricket is scheduled with
extended periods of 20-over cricket, which elicits the lowest
workload.
1
These low workloads possibly make it difficult for
fast bowlers to attain sufficient chronic external workloads to
promote the positive physical adaptations required to tolerate
the physical demands of multiple day cricket.
1
Future studies
should assess the time of season at which injury rates are highest
to see whether sudden changes in the format of cricket (ie,
20-over to multiple day cricket) are associated with increased
injury risk.
Our results demonstrate that the monitoring of acute and
chronic workloads can offer valuable insight into the likelihood
of injury. However, viewing either acute or chronic workloads
in isolation does not seem to be as valuable as comparing the
workload to which an athlete is accustomed, to the workload to
which that athlete has been subjected (ie, the training-stress
balance). Although the current study opted for acute and
chronic workloads of 1 and 4 weeks, respectively, the most
appropriate and valid method of developing a training-stress
balance is still unknown. Given that periodisation models have
traditionally used 1-week microcycles and 4-week meso-
cycles,
20–24
it could be argued that this arbitrary method is the
Table 1 Descriptive statistics for all participants’ workload
variables over the duration of the study
Workload variable Mean±SD Range
Acute (1-week total) Internal (arbitrary units) 2450±1688 0–9950
External (balls bowled) 96±80 0–414
Chronic (4-week average) Internal (arbitrary units) 2445±1070 0–6326
External (balls bowled) 96±58 0–248
Training-stress balance Internal (%) 100±46 0–327
External (%) 102±56 0–400
Hulin BT, et al. Br J Sports Med 2014;48:708–712. doi:10.1136/bjsports-2013-092524 3 of 5
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most convenient way for coaching, conditioning and sports
medicine staff.
While previous studies have investigated the relationship
between injury and external workloads, such as the amount of
training
9
and competition
59
deliveries that a fast bowler per-
forms, this study is the first to display a link between internal
workloads and injury in cricket fast bowlers, although internal
workloads were only significant when viewed as a training-stress
balance. Internal workload also encompasses all aspects of
Figure 1 Likelihood of injury at acute (A) and chronic (B) external workloads, and acute (C) and chronic (D) internal workloads.
Figure 2 Likelihood of injury in the current week for positive and
negative training-stress balance ranges.
Figure 3 Likelihood of injury in the subsequent week for positive and
negative training-stress balance ranges.
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training and competition, such as conditioning and fielding
requirements, perhaps explaining the higher training-stress
balance injury likelihood compared with external workload. In
addition to this, there is a component of the internal workload
that measures an athlete’s response to a given amount of work
(RPE). This may result in an uncoupling of the internal work-
load from the external workload (eg, if a bowler manages the
external workload well (low RPE), this may result in a lower
injury risk than if the bowler does not cope with the same exter-
nal workload (high RPE)). Therefore, coaches and medical staff
should gather information on the internal and external measures
of workload in order to gain insight into the likelihood of
injury, as well as the preparedness of elite cricket fast bowlers.
The training-stress balance for internal and external work-
loads revealed few relationships in the current week, with injury
risk being lowest at training-stress balances of greater than
200% for internal workload and 100–149% for external work-
load. These results may be of importance when fast bowlers are
placed in match situations that require a high workload.
Provided that bowlers are not suffering from residual fatigue
incurred during the previous week, high workloads resulting in
high fatigue may be achieved with minimal injury risk.
However, the 1-week delay in injury risk that this high fatigue
produces leaves that particular bowler exposed to injury at a
later date. Future research should investigate appropriate recov-
ery strategies after high fatigue, which could reduce delayed
injury risk.
In summary, we investigated the relationship between internal
and external workloads and injury risk in elite cricket fast
bowlers. We extend upon the work of others,
59
and the under-
standing of external workloads and injury risk, by also applying
an accepted performance model
16
in a novel fashion. The
results of this study demonstrate that a high chronic external
workload is protective of injury. Our results also demonstrate
that injury risk increases significantly in the week following
sharp increases in acute workload. Furthermore, the monitoring
and comparison of acute and chronic workloads can offer valu-
able insight into the likelihood of injury. It is clear that a nega-
tive internal and external training-stress balance is associated
with subsequent injury, which highlights the importance of
monitoring internal and external workloads and acute and
chronic workloads to minimise the risk of injury in elite cricket
fast bowlers.
Contributors TJG and PB undertook the planning for this project, with advice from
JWO. Data were collected and entered by PC and DB. BTH was responsible for
additional data entry and data analysis. Responsibility for the content of this paper
lies with BTH, TJG and PB.
Funding This work was supported and funded by Cricket Australia.
Competing interests None.
Ethics approval Cricket Australia.
Provenance and peer review Not commissioned; externally peer reviewed.
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What are the new findings?
▸ Elite cricket fast bowlers have an increased risk of injury in
the week following a negative training-stress balance.
▸ Greater increases in acute workload relative to chronic
workload lead to greater injury likelihoods.
▸ Higher external workloads over acute and chronic periods
are associated with a reduced risk of injury.
How might this impact on clinical practice in the near
future?
▸ Increases in chronic workloads must be performed
systematically, in an appropriate sequence and combination,
in order to reduce injury likelihoods.
▸ Acute and chronic workloads must be monitored and
compared, as the training-stress balance is associated with
increased injury risk in elite cricket fast bowlers.
▸ Data pertaining to external and internal workloads shou ld
be gathered and modelled as a training-stress balance.
▸ Adequate recovery strategies must be implemented in the
subsequent week to workloads that elicit high fatigue.
Hulin BT, et al. Br J Sports Med 2014;48:708–712. doi:10.1136/bjsports-2013-092524 5 of 5
Original article
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doi: 10.1136/bjsports-2013-092524
20, 2013
2014 48: 708-712 originally published online AugustBr J Sports Med
Billy T Hulin, Tim J Gabbett, Peter Blanch, et al.
bowlers
fastwith increased injury risk in elite cricket
Spikes in acute workload are associated
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