Batting head injury in professional cricket: a systematic video analysis of helmet safety characteristics Craig Ranson, 1 Nicholas Peirce, 2 Mark Young 2 1 Cardiff School of Sport, Cardiff Metropolitan University- UWIC, Cardiff, Wales, UK 2 Science and Medicine Department, England & Wales Cricket Board, Loughborough, UK Correspondence to Dr Craig Ranson, Cardiff School of Sport Cardiff Metropolitan University-UWIC Cyncoed, Cardiff CF23 6XD, Wales, UK; cranson@cardiffmet.ac.uk Received 15 October 2012 Revised 20 January 2013 Accepted 26 January 2013 To cite: Ranson C, Peirce N, Young M. Br J Sports Med Published Online First: [ please include Day Month Year] doi:10.1136/ bjsports-2012-091898 ABSTRACT Background Batters in cricket are continuing to sustain head and facial injuries despite wearing protective helmets. Objective To gain an understanding of the types and mechanisms of head injuries sustained by batters wearing a helmet. Methods Injury type, location and mechanism were categorised via analysis of 35 videos of National or International cricketers sustaining a head injury while batting. Results 53% of the injuries occurred following ball impact to either the helmet faceguard and peak, or the faceguard alone. Ten injuries (29%) resulted from the ball penetrating the gap between the helmet peak and faceguard. 29% of the injuries involved the ball contacting the face following penetration of the gap between the helmet peak and faceguard. Fractures, lacerations and contusions were the most common injuries associated with face or faceguard impacts while concussion was more commonly associated with impacts to the side or rear of the helmet shell. Many of the injuries described resulted in prolonged or permanent absence from cricket. Conclusions Significant head and facial injuries occur in cricket batters despite wearing of helmets. Cricket helmet design and associated National and International Safety Standards should be improved to provide increased protection against head injury related to ball impact to the faceguard and shell of the helmet. INTRODUCTION Cricket is a sport played with a hard ball delivered at high speeds by bowlers who sometimes aim dir- ectly at the batter. The potential for injury is well recognised. 1 Batting helmets in cricket are designed to protect against impact from the ball, which can be bowled towards the batter from a distance of 20 m at speeds exceeding 145 km/h. Two primary components generally make up the helmet; the helmet shell and a detachable faceguard usually in the form of a metal ‘grill’. Helmets have now become a universally accepted protective item for the modern professional batter and they rarely take the field without wearing one. Further, in the UK it is compulsory for cricketers under 18 years of age to wear a helmet while batting. Owing to a lack of coordinated international cricket injury surveillance 2 the incidence and preva- lence of head injuries sustained by batters, and therefore effectiveness of helmets, remains relatively unknown. Nevertheless, the England and Wales Cricket Board (ECB) injury surveillance programme has documented a number of helmet-related facial and head injuries. Furthermore, in recent years, there have been a considerable number of high- profile examples of international and first-class pro- fessional batters who have suffered serious head and facial injuries while wearing a helmet. This raises the question as to whether batting helmets are of suffi- cient standard to prevent, or minimise the severity of these types of injuries. There are British/European and Australian/New Zealand standards in place for cricket helmets; however, they were published and remain unrevised since 1998 and 1997, respectively. In the only study of its kind, McIntosh and Janda 3 published ‘Evaluation of cricket helmet performance and comparison with baseball and ice hockey helmets’ in which drop and projectile impact tests were con- ducted on a variety of cricket, baseball and ice hockey helmets. The authors concluded that the projectile test method used for baseball helmets may be superior to drop tests employed within cricket helmet standards, and that cricket helmet performance was not satisfactory at realistic impact speeds. A recent sporting helmet review paper commen- ted that although many sports helmets have been shown to be effective in preventing moderate to severe traumatic brain injury, questions were raised regarding the robustness and appropriateness of cricket helmet evaluation procedures, particularly with regard to protection against facial injuries. 4 Thus, there appears to be a need to clarify the nature of potential cricket helmet failures. Video analysis of sports head injury mechanisms has been used to good effect in at least two recent papers. Caswell and colleagues 5 classified the mechanisms and game characteristics of 14 head injuries in high-school girls’ lacrosse and Athiviraham and coworkers 6 analysed the Major League Baseball video footage to investigate the location of the ball to batting helmet impacts in relation to concussive injury incidence and severity. The aim of this project is to gain a more thorough appreciation of the most vulnerable areas of cricket helmets by analysing high- quality video footage of a collection of cases of batters injured by being struck on the head while wearing a helmet. This information is vital to inform improvement of cricket helmet design and associated safety testing standards. METHODS Data collection The cases analysed in this study were taken from an expanding database of over 50 batting Ranson C, et al. Br J Sports Med 2013;0:1–5. doi:10.1136/bjsports-2012-091898 1 Original article BJSM Online First, published on February 16, 2013 as 10.1136/bjsports-2012-091898 Copyright Article author (or their employer) 2013. Produced by BMJ Publishing Group Ltd under licence. group.bmj.com on February 18, 2013 - Published by bjsm.bmj.com Downloaded from