THE O C CURRENCE OF CYCLING INJURIES IN THE W ESTERN PROVINCE: A DESCRIPTIVE STUDY by Bakkes ES, Hendry JA, Uys MS, University o f Stellenbosch INTRODUCTION AND MOTIVATION D escriptive studies are the natural pre­ cursor to other studies, and are essential in providing researchers w ith base-line infor­ m ation b efo re m ore involved types of studies are em barked upon. D escriptive studies generally exam ine the occurrence and distribution of diseases or injuries ac­ cording to group characteristics such as sex, race, age, socio-econom ic status or geographical distribution. A n attem pt is then m ade to explain the observed find­ ings. This can aid in the identification of possible causal (aetiogical) factors, and fre­ quently generates hypotheses for further stud y1. The lack o f inform ation regarding the occurrence o f cycling injuries in South Africa, together w ith the increasing popu­ larity of th l sport, prom pted this descrip­ tive study. The pa^t two decades has seen a sharp increase in the popularity of both com peti­ tive and "fu n " cycling2. C ycling appears to be a relatively "s a fe " sport as there are no repetitive, high-im - pact, full-w eightbearing m ovem ents in­ volved, as is the case in running. The ap­ parent safety of the sport prom pts both medical and supplem entary health profes­ sionals to encourage the use o f cycling for the prom otion and m aintenance of health, as w ell as for rehabilitation purposes3'4. Sportsm en too, frequently use cycling for rehabili ta tion purposes follow ing injury or operative procedures to the knee. Cycling injuries can be grouped into two m ain ca­ tegories: • Injuries rela ted to falls, crashes, or colli­ sions • Injuries related to over-use5. F alls and accidents are regard ed by som e authors as the m ain cause o f all cv- 6 7cling injuries ' . H ow ever, o v er-u se in­ ju ries, and in particular over-use injuries of the knee-joint, are of particular interest to m a n y m e d ic a l p r a c t i t i o n e r s an d physiotherapists. D uring steady cycling, fo rce s e q u iv a le n t to b od y w e ig h t are exerted on the pedals. D uring interm ittent accelerations (eg. inclines, race start), these forces can exceed three times the body mass. M ore com petent cyclists m aintain a high tempo ("sp in ") o f 80-100 revolutions per m inute resulting in exceptionally fast alternating flexion and extension o f the knee6,8. Incorrect positioning of the cyclist can resu lt in stressfu l fo rces b ein g re­ peatedly exerted on the knee-joint. This may result in the incidence of new injuries, or the aggravation of underlying patho- logy. METHODOLOGY Study design: In th is d e s c r i p t i v e s tu d y , th e re ­ searchers exam ined the occurrence o f cy­ cling injuries over the 1 year period O c­ tober 1988 to O ctober 1989. The distribu­ tion o f injuries according to cycling status (am ateu r/fu n/ seriou s) and registration w ith clubs and Pedal Pow er A ssociations w as examined. Sampling: The population consisted of 3 264 cy­ clists w ho com pleted the Burger-Sanlam 100km /50km race on 21 O ctober 1989. The sam ple consisted o f 923 cyclists (28%) ran­ dom ly selected as they crossed the finish­ ing line. Data on 21 cyclists w as incom plete leaving a final study sam ple of 902 cyclists. Measurement: Each subject w as interview ed and infor­ ma tion regarding the follow ing w as ob­ tained: • Personal data • C y c l i n g s t a t u s (A m a te u r / p r o fe s - sional/serious-fun/fun-rider) • M em bership w ith clubs/Pedal Power Associations • O ccurrence o f injuries and falls (used s y n o n y m o u s ly w ith c o llis io n s and crashes) in the p reced in g 12 m onth period. RESULTS AND DISCUSSION: Cycling status: The distribution according to cycling status can be seen in Figure 1 (page 63) w hich illustrates that the m ajority o f cy­ clists (852/923) w ere either fun- or serious fun-riders, w ith only a very sm all propor­ tion (50/923) being classed as amateurs. These findings confirm the popularity of "fu n " cycling . W hile this distribution may not necessarily reflect the proportions of cyclists (according to cycling status) of the total population w ho took part in the Bur- ger/Sanlam race, it has been the authors' experience that the large num ber of fun- riders (52%) is characteristic o f the Burger- Sanlam race. The total lack o f participation by professional riders may be due to the Rapport cycle tour running concurrently. In South Africa there are only a small h a n d fu l o f h ig h ly -co m p e titiv e cy clists (am ateurs) w ho are registered w ith the SA Cycling Federation. It was therefore ex­ pected that they would be out-num bered by the serious fun-riders (5% vs 40%). The status of 21 cyclists could not be deter­ mined and these cyclists w ere excluded from further study. ABSTRACT * 0 n 21 O ctober 1989, a total of 902 randomly selected cyclists were questioned at the finish of the B urger-S anlam 100km /50km race to determine the prevalence of cycling injuries in the preceding year. O f the total sam ple 551 cyclists (61 %) reported they had been injury- free during the 12 month period prior to the investigation. The remaining 351 cyclists had sustained a total of 681 injuries during the same period ie approxim ately 2 injuries p er cyclist per year. The most co m m o n ly reported injuries were over-use injuries resulting in pain and discom ­ fort in the back and neck regions (41%), with pain in the knee joint being the second most frequently reported injury (29%). This descriptive study has provided valuable base-line inform ation on the types and fre­ quency of injuries sustained by South African cyclists. In particular, the high num ber of over­ use injuries associated with faulty ergonom ics has generated hypotheses fo r fu rth e r study. An intimate knowledge of the ergonom ics re­ lated to the sport, as w ell as attention to educa­ tional program m es is also strongly indicated. ABSTRAK N Op 21 O ktober 1989 is ’n totaal van 902 fiets- ryers, wat ewekansig gekies is, aan die einde van die Burger-Sanlam 100km/50km wedren ondervra, om die prevalensie van fietsrybeser- ings die afgelope ja a r te bepaal. Van die hele steekproef was 551 fietsryers (61 %) die vooraf- gaande ja a r besering-vry. Die oorblyw ende 351 fietsryers het ’n totaal van 681 beserings in dieselfde tydperk gehad D.w.s. o n geveer 2 beserings per fietsryer per jaar. Beserings wat m ees algem een voorgekom het was oorbruiksbeserings met gevolglike pyn en ongem ak in the rug en nek areas (41%), met pyn in die knie-gewrig as die tw eede mees a lg e m e n e k la g te (2 9 % ). D ie b e s kryw e n d e studie het w aardevolle inligting aangaande die tipes en frekwensie van beserings o n der Suid Afrikaanse fietsryers ve rs k a f. Veral die hoe aan- tal oorbruiksbeserings wat met foutiew e ergon- omika geassosieer was het hipoteses vir ver- dere studie gegenereer. Indiepte kennis van die ergonom ika van die sportsoort en opvoedkundige program m e word ^ b e s lis aanbeveel.__________________________ y Registration status: All 50 am ateur (100% ) w ere m em bers of a cycling club or Pedal Pow er A ssociaton (PPA) in com parison w ith only 70% o f the serious fun-riders and 36% o f the fun rid­ ers. Club m em bership is com pulsory for all am ateurs, w hile m em bership o f a PPA is optional. This w ould explain the high p ro­ portion of am ateur cyclists in this category. The percentage o f fu n-rid ers w h o are m em bers of an organised body (like a PPA) is low (36% ). P P A 's are re g io n ally o r­ ganised and ensure a good standard of organisation, safe routes and the strategic continued on page 63... t IS® R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. ) E.M.G. MYOTRAC & MYODAC 2 As used in McConnell Technique Palm sized EMG f o r clinical use Strengthening Rehabilitating Relaxing Work simulation monitoring ■ i l l S P.O. B ax 334 Rondebosch 7700 TEL: (021) 61-8066 ThermiPaq’s Ceramic packs Hot/Cold Transfer Technology 6 ' x 1 2 " T h e r m ip a q p e r fo r m a n c e W 0 O) 0 <=>■§ C CO cu .E5 D C o Q. E .o Dual use Freezer to Microwave Dry or Moist heat therapy Outperforms competitor products Standard 2 Treatment level cover and double sided Velcro strap Also a v a i la b l e : C om pact T E N S , E l e c t r o d e s , I n t e r f e r e n t i a l , U ltra so u n d , e t c . R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. ) placem ent of w ater tables. P PA 's also pub­ lish a new sletter w hich could inform the cyclist about scientific training m ethods and the causes and treatm ent of injuries. M em bership of a PFA w ould therefore presuppose a relatively high level of edu­ cation of the cyclist and a correspondingly low prevalence o f injuries. H ow ever, a study of the W estern Province m agazine Life Cycle show s that the content is largely com prised of readers opinions, race criti­ cism s and articles on the w earing of hel­ mets. There are few articles on the causes and treatm ent of injuries, and no articles on the im portance of correct ergonom ics w ith a view to the prevention o f injuries. ...continued from page 61 each of the different cycling status groups is given in Figure 2. 6 0 0 SOD 4 0 0 3 0 0 200 100 0 AMATEUR SER IO U S FUN R ID E R S FUN R ID E R S UNIDENTIFIED ■ N o . o f u m p t a a u b j. Figure 1: Sample distribution As only 36% o f the fun-riders group w ere m em bers o f cycling clubs or PPA 's, the authors expected the occurrence of in­ juries am ongst the fun-rider group to ex­ ceed that o f the other two groups. Occurrence of injuries: General The types and frequency o f injuries as reported by the 902 sam ple subjects for the 12-m onth period O ctober 1988 October 1989 can be seen in Table 1. TABLE 1: The occurrence of injuries in all cyclists: O ctober 1988 October 1989 NUMBER P ER C EN T Injury-free 551 61 Falls 134 19,8 Knee pain 195 18,6 Pain/dicomfort 281 41,3 Muscle 32 4,7 Other 39 5,7 Table 1 indicates that m ore than half the total group (61%) w ere injury-free during the preceding 1 year period. Pain and dis­ com fort, excluding pain in the knee-joint, was most frequently reported (41% of all injuries). Pain in the knee-joint w as the second most frequently reported injury (29% of all injuries), w ith "fa lls " (which included crashes, collisions or accidents) being the third m ost frequently reported injury (20% o f all injuries). It was postulated that the m ore serious the level of com petition, the higher the proportional increase in injuries. An exam ­ ination of the percentage of injuries for FALLS KNEE-PAIN PAIH/DI8C0W U U 8 0 .E OTHER ■ AMATEUR n ■ SO ED FUN RIDERS n ■ 481 I SERIOUS RIDERS n-371 Figure 2: Occurrence of inuries: percentage per group T he p roportions o f cy clists w ho re­ ported being injury free during the preced­ ing 12-m onth period varied from 34% (17/50) for the am ateur cyclists, to 41% for the serious fun-rider group (152/371) and 53% for the fun-rider group (255/481). If one exam ines the distribution o f cyclists sustaining injuries in each of the different groups, the percentage of am ateur cyclists su stain in g in ju ries exceeds that of the serious-fun and fun-rider groups for all types of injuries. The large proportion o f am ateur cyclists w ho sustain injuries m ay be attributed to factors such as high speeds, increased ag­ gression, and increased time and intensity o f training. Serious fun-riders are less com ­ petitive than am ateurs and cycle for indi­ vidual perform ance, w hile fun-riders cycle m erely for pleasure. W hile 523 cyclists reported being in­ ju ry-free during the preceding 12-m onth p eriod , the rem ain in g 379 subjects re­ ported a total of 681 injuries during the sam e period. W hile 34% o f am ateurs in this study, w ho m ade up the sm allest group, experi­ enced some degree o f pain or discom fort this com prises only 3% of the total num ber o f injuries. This is in marked contrast with the other two groups (serious-fun and fun- riders), w here pain and discom fort com­ prised 18% and 21% of all injuries respec­ tively. W hile physiotherapists may, there­ fore, treat injuries sustained b y highly com petitive am ateur cyclists, they can ex­ pect to see large num bers of injuries from the other two categories of cyclists as well. Occurrence of injuries: Specific In this study, falls w ere the third m ost frequently reported injury, and com prised 20% of all injuries (See Table 1). This is in contrast w ith Tow n (1985) w ho regards falls as "th e most im portant source o f in­ ju ries am ongst cy clist"7. The percentages o f falls in this study is higher than the prevalence of 13% as reported b y Kruze et al10, whose study sam ple consisted of 528 students who cycled for sport, recreation or com petitive reasons. (The sam ples in th e se tw o s tu d ie s a re th e re fo r e co m ­ parable.) The percentage of reported falls per cy ­ cling status group was: • am ateurs (26%) • serious fun-riders (20%) • fun-riders (9%) The low num ber o f falls reported in the fun-rider group m ay be attributed to sev­ eral possible factors such as low er speeds, less com petitiveness and aggression, and few er hours and kilom eters on the cycle. The percentage of falls reported by the am ateur cyclists in this study (26%) is m ar­ kedly higher than the 3.2% as reported by M cLennan et al (1988) w hose study sample consisted only of am ateurs9. This finding m ay be a reflection o f the inexperience of our am ateur cyclists due to lack o f interna­ tional com petition, or the fact that prior to this study, little or no seeding w as done in m ost cycle races. M cLennan et al (1988) report that the prevalence o f falls in the U SA was reduced from 3.2:% to 1.5% after a four-year period during w hich an injury-prevention pro­ gram m e w as im plem ented 9. In com pari­ son w ith this reduced percentage, South A frican cyclists appear to have a much higher frequency o f falls w hen com pared to their A m erican counterparts ie., a seven- teen-tim es higher occu rrence o f falls. O f even greater concern is the fact that all of the falls reported in M cL en n an 's study oc­ curred during races held at 1,500 m etres above sea-level, w h ere acute m ountain- sickness (w hich im pairs concentration and reflexes) plays a m ajor causative role in the incidence o f falls9. It is evident from the results in this study that there is a need to increase the standard and safety o f all as­ pects o f cycling in South A frica. Clubs and P P A 's could play an im portant and active role in this respect. T he injuries sustained from falling can be divided into m inor and m ajor injuries. Minor injuries: Bruises and abrasions: The three ca­ tegories o f riders show ed no m arked dif­ ferences with regard to m inor injuries sus­ tained, w ith the freq u en cy o f b ruising ranging from 92% in the am ateur group to 95% in the fun-rider group. A brasions oc­ curred less frequently, varying from 31%- 35% in the three groups. Ballham et al (1988) on the other hand, reported a much higher occurrence of abrasions (46.7% ) oc­ cu rrin g am o ngst a group of cyclists of m ixed cyclin g statu s12. T h is is slightly higher than the percentage found in this study. It is possible that the percentage in this study is an under-estim ation, as it be­ cam e apparent, w hile interview ing sam ple subjects, that m any did not regard bruises and abrasions as "in ju ries". Major injuries: Fractures: The am ateur riders in this study had a 23% occurrence of fractures as R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. ) a result of falls. This is slightly low er than the 49.3% am ongst Am erican am ateurs as reported by M cLennan et al (1988)9. The apparently higher proportion o f fractures in the Am erican study should, how ever, be com pared w ith caution, as the sam ple size w as very large (n = 5482) and all falls had occurred in races exceeding 1500 metres above sea-level. In this study 16.5% of the serious fun- rider and fun-rider groups sustained frac­ tures, w hich is com parable w ith the find­ ings o f Tucci and Barone (1988) and Biburz et al (1986) o f 20% an d 14.1% re sp ec­ tively11,2. D islocations and sprains: O nly 6% of cyclists sustained a dislocation or sprain as a result of a fall. Head injuries: In South Africa the w ear­ ing of helm ets is optional, although it may be a pre-requisite for participation in cer­ tain com petitions. In this study 8.2% of cyclists reported suffering a head injury afte r fallin g . M cL e n n an e t a l(1988) re­ ports a prevalence of 15% decreasing to 0% after the successful im plem entation o f an accident-prevention program m e and the introduction o f legislation enforcing the w earing o f helm ets o f a specified safety standard9. In view of the possible severity of this type o f injury, it would appear that South Africa has a definite need for the im plem entation o f sim ilar precautionary measures. In ad dition, educational p ro­ gram m es regarding road safety, ensuring the good m echanical functioning o f cycles and other safety m easures (such as the w earing o f protective clothing; teaching cyclists how to slip, fall, slide etc) are im ­ perative. Areas of pain and discomfort (knee joint excluded): It can be seen from Figure 2 that there w as an alm ost equal distribution of reports o f pain and discom fort am ong the three groups of cyclists (30% -34% ). M ost cyclists are likely to experience som e degree of pain or discom fort, particularly when unfit or cycling long distances. The degree of pain and d iscom fort m ay be further in­ creased if positioning on the cycle is faulty or the w rong equipm ent is used. M ore than half o f the cyclists in each of the three groups experienced pain or dis­ com fort in the back and neck regions. This is frequently due to the sustained position of flexion on the cycle, faulty ergonom ics, poor training techniques and/or w eak ab­ dom inal and/or back m usculature. By cor­ recting the positioning on the cycle, streng­ thening the trunk m usculature, and regu­ larly stretching the neck and low er back, these sym ptom s can be prevented6'13,5,14. It is therefore im portant for the physiother­ apist to give attention to the latter p rob­ lem s (including an exam ination of the cy­ clist on his cycle) rather than just treat the presenting com plaints sym ptom atically. Pain and discom fort in the buttocks was m ost evident in the fun-rider group and was probably due to their being unaccus­ tomed to the long distance o f betw een 50km -100km they had ju st com pleted. R e­ lief can be found by correct positioning, regular training and the correct saddle size. A ccording to N oakes et al (1990), van V elden et al (1990) and Bohlm an JT (1981), pain and discom fort in the hands is a com ­ m on problem o f cyclists15,3'6. In contrast w ith their findings, how ever, only 3.2% o f the cyclists in this study reported this com ­ plaint. Pain and discom fort in the upper limb region can be further m inim ised by co rre ct p o sitio n in g w ith re su lta n t im ­ p ro v e d w e ig h t-d is t r ib u tio n , fre q u e n t changes of hand position and an improved level o f fitness. M u s c le in ju rie s d id n o t fe a tu re as prom inently as w as expected. O nly 2.5% of all injuries fell into this group. Seven o f the am ateur riders experienced serious muscle injuries in com parison with only 15 cyclists in the serious- and 10 cyclists in the fun- rider groups. A lthough not as com petitively inclined as the am ateurs, the serious- and fun-rider cyclists still form a sizeable group who m a y r e q u i r e th e i n t e r v e n t i o n o f a physiotherapist in order to prevent a re­ currence o f the inj ury. In this study, muscle tears and tendinitis occurred equally fre­ quently. The occurrence o f dehydration, hypo­ thermia and hypertherm ia ranged from 14% in the am ateurs to 2% in the fun-rider group. The high sum m er tem peratures in South Africa, during w hich most of the com petitions take place, again highlights the urgent need for adequate education of cyclists to increase their aw areness o f these potential problem s. Pain and discomfort in the knee joint: O f all the cyclists in this study 21.6% reported having experienced pain or dis­ com fort in the knee-joint in the preceding 12-m onth period (See Table 1). Thirty per­ cent o f the am ateurs, 26% o f the serious fun-riders and 18% of the fun-riders had been afflicted by knee pain (See Figure 2). A subsequent investigation o f this group show ed that in 80% of the cases this pain resulted from incorrect ergonom ic adjust­ m ents leading to an incorrect critical knee angle. The critical knee-angle is defined as follows: W ith the cranks in the horizontal posi­ tion, a perpendicular line, w hich falls ju st posterior to the patella o f the knee joint, should fall through the ball of the foot and the axle of the pedal, or as close as possible to it. It has been the author's observation that fu n-rid ers often train irregularly. They possibly also run the highest risk of having ergonom ic faults with regard to frame size, sad dle-height and p o sitioning on the cycle. H ow ever, co n trary to exp ectatio n s, the p ercentage of knee-pain experienced in this group was the low est. H ow ever, as fun-riders generally follow a training pro­ g ram m e o f low in ten sity , the effect of ergonom ic faults w h ich m ay have con­ tributed to the d evelopm ent o f knee-pain, could well have been obscured. The occurrence of knee-pain am ongst the am ateurs was high (30% ), and could be due to over-use and/or faulty ergonom ics. M ore than h alf the cyclists experiencing knee-pain w ere m em bers o f PPA 's. There­ fore, although these cyclists have access to clubs, trainers, and possibly the new est inform ation regarding training m ethods, it would appear that little inform ation from PPA new sletters regarding correct ergon­ om ics is conveyed, or if so, successfully reaches its target group. In the light o f these find ings, it is im per­ ative for physiotherapists treating cyclists w ith sym ptom s o f knee-pain to refrain from treating pu rely sym ptom atically. An exam ination o f the cyclist on his bike, to ensure that the critical knee-angle is cor­ rect, m ust be included in the rehabilitation p rogram m e. This is further em phasised when it is considered that sixty cyclists in this group had suffered previou s injury or surgery to the knee-joint. They had started cycling on the recom m end ation that it was a relatively "safe s p o rt" and ideal for reha­ bilitation purposes. In the case of these c y c lis ts a v e ry c a re fu l e x a m in a tio n is needed to distinguish betw een the prior knee injury and incorrect ergonom ics as the cause of their knee pain. CONCLUSION The above d escriptive stud y has exam ­ ined the occurrence o f injuries in a select sam ple o f cyclists w ho participated in the Burger-Sanlam race in O ctober 1989. Al­ though 61% o f the subjects reported that no injuries had been sustained in the preced­ ing 12-m onth period, a total o f 681 injuries w ere reported. Pain and d iscom fort in the back and neck regions w ere m ost com m on, w ith pain in the knee-joint b ein g the sec­ ond m ost frequently reported injury. The percentage o f cyclists reporting in­ ju ries over the preceding 12-m onth period w as low est in the fu n-rid er group. The p e rce n ta g e o f fa lls e x p e rie n ce d b y all groups o f riders w as high, and indicates the need for the im plem entation o f acci­ d e n t-p re v e n tio n and e d u c a tio n a l p ro ­ gram m es. Pedal Pow er A ssociations and clubs should play a m ore dynam ic and educational role with regard to the causes and prevention o f injuries. Legislation to enforce the com pulsory w earing of hel­ mets is also strongly indicated. Cyclists should be m ade aw are of the im portance o f correct positioning in order to prevent over-use injuries particularly of R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. ) THE PREVA LENCE OF LOW BACK PAIN IN CRICKETERS - AN U N D ERG RADUA TE EPIDEM IO LO G IC AL STUDY by Ian Harris, Dept o f Physiotherapy, University o f Cape Town INTRODUCTION C ricket in South Africa plays a major socio-econom ic role and, through innova­ tions such as the one day limited overs and day-night gam es, is increasingly draw ing the attention of large crow ds throughout the country. Cricket is becom ing far m ore aggressive and faster1 and is placing greater strains on the cricketer's body. The lum bar area of the cricketer is one of the areas that is being placed under increased strain, especially in the fast bow ling action2. This is taking place at a time w hen, w ith increased p ro­ fessionalism , cricketers can least afford to be affected by disabling injuries, such as Low Back Pain (LBP). LBP in itself has far reaching affects on the general com m unity w ith as m uch as 5% of all time absent from w ork being attributed to LBP3. W ith thead ded stresses and strains o f m odern cricket, epidem ic levels o f LBP are expected am ongst cric­ keters. The problem o f LBP is further ag­ gravated by the d ifficulty of m aking an accurate diagnosis. LBP is often charac­ terised by the stooped appearance associ­ ated w ith old age w hich could be harm ful to the self esteem o f a cricketer w ith LBP. Therefore, LBP is not frequently discussed by the cricketing fraternity, m aking it ex­ trem ely difficult to ascertain the tru eextent of LBP in cricketers. T h e dearth o f research on cricket in South Africa and the changing nature of the gam e challenges science and m edicine to explore the various aspects o f the game. METHOD A questionnaire w as given directly to 110 cricketers, 55 from the first team s of five cricket clubs and from five schools in the W estern Cape during the 1991/92 sea­ son. The questionnaire consisted of an in­ itial set of close-ended questions as well as a fu rth er set of op en -en d ed q u estio ns w hich allow ed the respondents to voice their opinions. A grading scale of pain severity was used to m easure LBP. The pain being graded as follows: G rade 1, an ache but could con tin u e playing, G rad e 2, pain w hich forced the player to leave the field and G rade 3, pain w hich prevented the playing of a match. Each respondent w as classified as either a fast bowler (FB), slow bow ler (SB), batsm en (BAT) and a w icket keeper (WK). N um erous cricket practices and mat­ ches w ere visited in order to gain general inform ation on w arm -up m ethods, differ­ ent techniques show n and to obtain a feel for the cricketers' personalties and idio­ syncrasies. The data obtained from the question­ naire w as presented by means of descrip­ tive statistics w ith null hypotheses being formulated and tested b y appropriate stat­ istical tests. RESULTS The return response w as 90%. The mean age w as 20.2 years w ith a range of betw een 15 and 35 years, with 55.6% o f respondents being above 18 years old and 44.4% w ere younger than 18 years. The m ean num ber o f years playing cricket w as 12.3 years with a range betw een 3 and 27. The respondents consisted of 37.4% FB, 58,6% BAT, 27.3% SB and 11.1% WK. PREVALENCE OF INJURY LBP w as present in 61.6% o f the cric­ keters and, o f these, 78,7% cited cricket as being the cause o f the LBP. SEVERITY OF INJURY G rade 1 injuries w ere most prevalent (72.1% ), alth ou gh G rad e 3 inju ries oc- ABSTRACT ^ The prevalence of Low Back Pain (LBP) in cricketer's was determ ined and possible cau­ sa tive factors w ere in vestigated. Q u estion­ naires were sent to 110 cricketers playing for their first times of both clubs and schools during the 1991/92 season. The return response was 90% with a prevalence of LBP at 61.6% . Of these 78.7% cited cricket as being the primary cause of their LBP. The injuries were predom i­ nantly grade 1 (72.1% ), followed by grade 3 (23.1 %) and grade 2 (6.6% ). G rading w as made according to the effect the pain had on the cricketers game. Fast bowlers proved to be more at risk of developing LBP with a group prevalence of 75.6% followed by w icket keepers at 63.6% , batsmen at 56.8% and slow bowlers at 48.1%. Cricketers had rather a poor general knowledge of ways of protecting their backs. Recom mendations were made to help reduce the high prevalence of LBP, especially amongst Fast bowlers and in cricketers in general. curred in a large group (21.3% ). A further indicator o f severity is the large num ber (62.3%) o f cricketers w ho required treat­ m ent for their LBP. GROUP PREVALENCE The la rg e s t p ro p o rtio n o f LBP w as am ongst the fast b ow lers (75.6% ) which proved to be statistically significant with an obtained p-value of 0.06 using the Chi- squared test. Furtherm ore, it w as found that there w as a higher prevalence of LBP in F B 's w ith a front-on action (85.7% ) than in those w ith a sid e-on action (72.4% ). The group o f front-on bow lers w as too small for statistical testing. OTHER FACTORS O f the factors investiga ted (age, num ber o f years playing, w arm -up, various types of exercises, know led ge o f prevention of injuries), the only one that proved to be significant w as the lack o f know ledge that cricketers had o f w ays to protect their backs. O f those cricketers w ho had LBP, only 55.7% said they knew how to protect their backs. Age did n ot prove to be a significant predictor of LBP. ...continued from page 64 the knee-joint. P hysiotherapists treating cycling-related injuries should not treat purely sym ptom atically, and a thorough know ledge of the above-m entioned factors is im perative. The d istinguishing trade­ mark o f the effective practitioner in this c a s e w ill n o t b e h e r k n o w le d g e o f physiotherapy, b u t her know ledge of the sport. REFERENCES 1. Friedm an GD. P rim er o f Epidem iology 1980. M cG raw Hill, New York. 2. K iburz Z, Jaco b s R, R eckling F et al. Bicycle A ccidents and Inju ries am ong Adult Riders. Am ]nl Sports M ed 1986;14(5):416-419. 3. van V elden DP, Roberts T, H um an E et at. F ietsry v irA Im al (1st Ed.) 1990. T afelb erg U it- gew ers, K aapstad. 4. M cLeod W D , Blackburn TA. Biom echanics of K nee Rehabilitation w ith Cycling. A m Jnl Sports M ed 1980;8(3):175-180. 5. Reilly T. Sports Fitness an d Sports Injuries (3rd Ed.) 1981. F aber & Faber, London. 6. Bohlm an JT. Injuries in C om p etitive Cycling. The Phys & Sports M ed 1981;9(5):117-126. 7. Tow n GP. Science o f Triathlon Training and Competition (1st Ed.) 1985. H um an K inetics Publishers, Cham paign, Illinois. 8. H annaford DR, M oran GT, Hlavad HF. Video A nalysis and Treatm ent of O ver-u se Knee Injury in Cycling: A Lim ited C linical Study Clin in Podiatric M ed an d Surg 1986;34:671- 678. 9. M cLen nan JG , M cLen nan JC , U ngersm a J. A ccident P reven tion in C om p etitive C ycling Am Jnl Sports M ed 1988:16(3):266-273. 10. K ruze DL, M cBeath A A . Bicycle A ccidents and Inju ries A m Jnl Sports M ed 1980;8:342- 344. 11. T u cci JJ, Barone JE. A Stu dy o f U rb an Bicy­ c l i n g A c c i d e n t s A m J n l S p o r t s M e d 1988;16(2):181-184. 12. B alham A, A bsou d E m , K otecha MB. A Stu dy o f Bicycle A ccidents Injury A m Jnl Sports M ed 1988;16(6):405-408. 13. M alh oney F. B icycling M agazine's com plete G uide to Riding an d R acing Techniques. 1979. 14. D ubb I, Jacob s L, Sutton P. Inju ries in C y ­ clists. P hysio Forum 1989;3/90:12. 15. N oakes T, Beneke G, Beneke M et al. Lore o f C ycling 1990. O xford U n iv ersity Press, Cape Tow n. I R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. )