An Audit of Injuries in Cricket in Scotland in the 2008 Season
Cricket is a popular sport played and followed by millions around the globe. It is a relatively non contact sport with a low to moderate risk of injury. However, in the last decade, the incidence of injury has been shown to be on the rise. This is possibly due to increase in workload for the modern cricketer.
Aim of the study
The aim of the study was to audit the prevalence and patterns of injuries in cricket in Scotland over a complete season. A study of this nature has never been undertaken in Scotland. This study will act as pilot study for a long term injury surveillance program in Scottish cricket. Cricket researchers have long been in favour of a ‘world cricket injury surveillance report’. This study, we reckon, will contribute to such a report when undertaken.
A questionnaire was sent to Cricket Scotland who in turn engaged 150 professional cricket players from the Scottish international team, SNCL Premier League, SNCL division I and division II. Involvement of the team coaches through the initiative of Cricket Scotland was sought to increase the compliance for return of the questionnaire.
We received feedback from 26 of the 150 players that we approached. The numbers of injuries reported throughout the season were 18. An increased prevalence of injuries was apparent at the start of the season with 27% of all injuries occurring in April. Of all the players, 42% suffered injuries at some point of time during the season. Most of the injuries (66%) occurred in match situations. Acute injuries accounted for 60% of the. As expected, bowling was responsible for 36.84% of injuries while fielding caused 52.36% of injuries.
Upper limb injuries contributed to 57.89% of the injuries. Finger injuries in the form of fractures or contusions had a prevalence rate of 15.29%. Lower limb injuries accounted for 31.58% of all injuries with knee and shin stress fracture being more common. Hamstring injuries having prevalence rate 16.67%. During the entire season, there was not a single case of head, neck or face injury. Midsection injuries accounted for 10.53 % of injuries with 5.26% prevalence rate for side or abdominal muscle strain.
35.29% of injuries took more than 6 weeks to heal enough for the player to participate in a match again, while almost half of the injured players took more than 4 weeks to recover from injury.
Only 8.33% of international cricketers had access to a medical support team while 75% of players did not have injury advice at all. At the domestic level, medical support as well as provision of sports injury advice was lacking for 100% of players. Likewise, none of the clubs we came across had implemented injury data collection or monitoring program.
The injury patterns and prevalence rates identified showed similarities to previous studies, especially for lower limb and fingers injuries. Bowling and fielding were recognised as major contributors for injury. The time lost due to injury as shown in the study is a concern. It is interesting to note that none of the domestic players had access to medical back up in the form of a doctor or a physiotherapist. Even at the international level only one player had a sports doctor to attend to his injuries. In summary, we identified a need for the provision of medical support to players for helping them to realise their full potential.
A national database for cricket injuries within the confines of the Scottish government similar to the ACC or the SMAGG should be implemented. The ICC should look to help full as well as associate members in setting up injury prevention programs. It should allocate funds and provide expertise in the form trained personnel for the same. Appointment of injury statisticians for recording of injury data in every first class, one day or twenty 20 match should be looked at. At the end of every match an injury report should be sent to the team management, the SNCL which in turn will pass it on to the ICC. This collection of data should be anonymised as much as possible to help safeguard players’ interests.
Cricket is a popular sport played and followed by millions around the globe. It is a relatively non contact sport with a low to moderate risk of injury as compared to sports like hockey or football.1;2 However, in the last decade, the incidence of injury has been shown to be on the rise.3 This is possibly due to increase in workload for the modern cricketer. Intense competition, higher levels of fitness and skills required and increase in the number of matches played throughout the season has resulted in this trend. Furthermore, pressures of international travel and acclimitisation to foreign playing conditions in a matter of days have added to the stress.
Although the popularity of cricket is on the rise, worldwide research into injuries has been dismal. The International Cricket Council (ICC), which governs the game, boasts a membership of 104 countries including 10 full, 34 associate and 60 affiliate members. However, most of the statistical data on incidence and prevalence of injuries comes from just four countries, namely, Australia, South Africa, England and the West Indies.
Australia was the first country to introduce long term injury surveillance in professional cricket in the summer of 1998-99.2 The Sports Science Medicine Advisory Group (SSMAG) set up by Cricket Australia is responsible for the collection and maintenance of a long term injury database.3 Recently, the English and the South African Boards have set up their own injury surveillance programs. In New Zealand, the Accident Compensation Corporation is responsible for recording all sporting injuries. The rest of the test playing nations, however, along with the associate members of the ICC do not have programs implemented to record cricketing injuries. Although cricket has a vast following in the subcontinent, availability of statistical data regarding injuries is lacking. Similarly, a study of the nature and prevalence of injuries in cricket has never been undertaken in Scotland.
In the backdrop of researchers pushing for a ‘world cricket injury report’, all test playing and associate member countries should set up injury surveillance programs to identify patterns along with prevalence and incidence of injuries. This would enable comparisons of data across varying sets of playing conditions prevailing in different countries.
2. Injuries in Cricket
Although cricket is a non contact sport, injuries are quite common, especially in fast bowlers.4-7 Some instances of death due to cricket have also been documented in literature.8
Importance of Injury Surveillance
Long term injury surveillance in sport is the basis for prevention of injuries. Identification of causes with subsequent designing and implementation of interventions forms the ‘sequence of prevention’ of injuries.9
Surveillance of injuries across nations has however proved to be more difficult than previously thought. Over the years, different studies have sought to define injury in cricket and devise methods for injury surveillance.10-14 However, disparity in the definitions used by different researchers has been a problem in comparing injury rates from across the world. 3;12;15 Orchard et al. defined injury in cricket as “any injury or medical condition that either (a) prevents a player from being fully available for selection for a major match or (b) during a major match, causes a player to be unable to bat, bowl or keep wickets when required by either the rules or the team’s captain” 3;12.whereas,Leary et al. defined injury in cricket as an event which caused a player to seek medical attention.10
Overall Incidence of Injuries
Different studies report injury incidence in cricket varying from 2.6 to 333/ 10,000 player hours.1;2;16;17 Of all the Accident and Emergency department presentations in Australia, 8% cases were cricket related injuries, making cricket the 5th commonest injury prone sport in Australia.2 In South Africa, Stretch found that there was an injury incidence per player of 1.6 to 1.91 per season; also 49% of all players get injured sometime throughout a season.13 Leary et. al. in their 10 year study of professional English county cricketers found the acute injury incidence to be 57.4 per 1000 days of cricket.10
Injuries by anatomical site
Lower limb injuries are the most common with an incidence of 45% to 49.8% where as trunk (20-32.6%) and upper limb (18.9 to 29 %) were the other sites commonly involved.7;10;13 The tissues mostly involved are muscles and other soft tissues (41.0%), joints (22.2%), tendons (13.2%), and ligaments (6.2%).7 Muscle strains were found to be most common. Of the lower limb injuries, hamstring injuries were reported to be most common by Orchard et al (11% of all injuries).2 Most of these were in the form of muscle strains and tears especially in bowlers and fielders.18
Knee injuries, usually comprise of joint sprains (27.6%), tendonitis (26.5%) and contusions (16.3%).10 Orchard et al reported that knee ligament injuries were uncommon in cricket. An interesting observation was that cricketers were more likely to suffer from knee ligament injuries during the game of football that cricketers play as a form of pre-match warming up or cross training. Groin injuries in bowlers (8% of all injuries in bowlers) and batsmen (9% of all injuries in batsmen) had an overall incidence of 7%. 2 Stress fractures of the tibia, fibula and foot, and ankle sprains occurred mostly in fast bowlers and had a combined incidence of 6% in the study conducted by Orchard et al.2
Upper limb injuries make up 19.8% to 34.1% of all injuries in cricket.2;17;18 Most of these are finger injuries due to ball impact occurring during fielding or batting.1;7;18;19 Contusions account for a major share of finger injuries (40%) while fractures/dislocations (28.9%) and joint sprains (23%) are the other finger injuries commonly encountered.10
Although, most of the finger injuries in cricket have a satisfactory treatment outcome, cricketers report a residual component of occasional pain or minor swelling and / or deformity.19 Most of the wicket keepers have been known to carry finger injuries but rarely report them for the fear of being made to miss the match.
Shoulder injuries usually occur in fielders and bowlers while batsmen and wicket keepers are characteristically spared.10;18 Shoulder tendon injuries were reported to comprise of 6% of all injuries by Orchard et al. 2, Supraspinatus tendon was seen to be mostly affected. Incidence of shoulder dislocation or subluxation was shown to be low 1%. Upper limb lacerations or fractures were reported to have a low incidence and occurred mostly in batsmen.2
Side strain occurring on the non dominant arm in bowlers is quite notorious to heal.2 Incidence of side or abdominal muscle strain is 9% of all injuries; 1% of all cricket injuries are side strains due to a stress or traumatic fracture of the rib.2
The overall incidence of back and trunk injuries accounted was 18% to 33% of all injuries.7;16-18 Fast bowlers were found to be at particular risk of developing lower back injury.4;20-24 So much so that Foster et al. and Bell have likened the injuries in fast bowlers to en epidemic.4;25
The incidence for head, neck and face injuries vary from 5% to 25 % usually resulting from impact of the cricket ball causing lacerations or contusions and rarely concussions.1;2;13;16-18 Weightman and Brown reported a quarter of cricket injuries to be concussions due to a ball impact on the head.1 This was probably due to the fact that use of helmets in cricket was not in fashion when the study was conducted.
Of the cervical spine injuries, 63.6% were in the form of sprains or strains resulting from batting for long periods of time.7
Jones and Tullo reported an incidence of 9% for eye injuries in sports in the UK.26 Although, eye injuries in cricket are rare, some studies have reported a few cases associated with cricket.27;28 These are usually more severe.
Seasonal Variation of injuries
Injuries in cricket are shown to occur more at the start of the season and then at the end of the season.7;10 The highest incidence number of injuries mostly muscle, tendon and ligament injuries occur at the start of the season (April-27.3%).10 While injuries like fractures or dislocations occur with the same frequency throughout the season. Stretch reported a similar incidence of higher injuries at the start of the season (32.3%) compared to than mid-season (21.7%) or towards the end (12.5%) or offseason (12.5%).18
Role performed in the team
Stretch reported an injury incidence according to activity as follows: bowling (41.3%), fielding and wicket keeping (28.6%), and batting (17.1%).18 A study by Orchard et al, however reports that wicketkeepers had the lowest injury incidence (2%) probably because of minimal sprinting, throwing or bowling.2 Bowlers usually sustained lower limb or back injuries while fielders and wicket keepers usually suffered upper limb (42.9%) or lower limb injuries (40.6%). Batsman on the other hand suffered mainly lower limb injuries (54.4%).
Delivery and follow through of the fast bowler (25.6%), overuse (18.3%), and fielding (21.4%) were the main mechanisms of injury.18
Young fast bowlers tend to get injured more often.7;13;14;18 Also the incidence of overuse injuries in cricketers in the age group of 19-24 years tends to be higher than their older counterparts.7 An important observation in a study by Stretch is that all 14 stress fractures occurred in young cricketers with 13 of them due to bowling.7
Chronicity of injury
Acute injuries account for 64.8% of all injuries while 16.6% are chronic and 25.4% of the injuries are of acute on chronic nature. Majority of injuries are first time injuries (64.5%) while recurrent injuries from the previous season account for 22.8% of injuries.13
Recovery time of injuries
In a study by Stretch, 47.8% of injured players were able to return to play within a week while 28.4% took 3 week. However, 23.8% of the players were not able to train or play matches even more than 3 weeks after the incidence.7
3.1 Aim of the Study
The aim of the study was to audit the prevalence and patterns of injuries occurring in cricket in Scotland over a complete season. A study of this nature has never been undertaken in Scotland. This study will act as pilot study for a long term injury surveillance program in Scottish cricket. Cricket researchers have long been in favour of a ‘world cricket injury surveillance report’. This study, we reckon, will contribute to such a report, if and when it is undertaken.
3.2 Study design
The study was a retrospective, questionnaire based study carried out online with the support of Cricket Scotland. The involvement of Cricket Scotland, the national governing body for the sport in Scotland, we hoped, would increase the response rate for the questionnaires and thus the reliability of the audit. We feared that compliance would be an issue. However, we were hopeful that involvement of the club coaches via the governing body for cricket in Scotland would maximise the return rate.
The first class structure for cricket in Scotland, Scottish National Cricket League (SNCL) is divided into three levels, the SNCL Premiere League, the SNCL division I and the SNCL division II. Each of these levels consists of 10 teams, playing each other home and away. In addition, there is an under 19s Scottish cricket team. Each of the first class teams plays an extra game with the under 19s, making a total of 19 matches over the season for each team.
Cricket Scotland distributed the questionnaire to 150 elite cricketers from the international team as well as those in the three divisions of the SNCL. The audit assessed areas such as nature of injury, body part affected, mechanism of injury, recovery time, etc as well as the provision of medical support at the club – (see attached questionnaire). Data was recorded from the feedback received from the questionnaire. Data analysis was done on a prevalence percentage basis and comparisons made with the limited existing studies.
3.3 Ethical Approval
Ethical approval for undertaking this study was sought from and granted by the Faculty of Medicine Ethics Committee for Non Clinical Research involving Human Subjects, University of Glasgow, Scotland.
The subjects involved in the study were 150 elite cricket players from the Scottish national team and clubs in the top 3 divisions of the Scottish National Cricket league (SNCL).
3.5 Data Analysis
Minitab 15.1 was used to carry out statistical analysis whereas Microsoft Excel 2007 was used to provide graphical analysis of the data. Also, for comparison with the existing data, literature searches were carried out using Reference Manager Professional Network Edition 12.0. The databases used were Pubmed and ISI Web of Knowledge for the period of 1970 to 2009 with key words for search being cricket, injury, surveillance, patterns, incidence, and prevalence. The review considered all papers up to May 2009 relevant to definition, incidence, prevalence, causes and prevention of injuries in cricket.
During the study, Cricket Scotland distributed the questionnaires to 150 cricket players from the international team and the three divisions of the SNCL. To improve the response rate, the coaches were instructed get the players to fill in the questionnaires.
We received feedback from 26 of the 150 players that we approached. Of these, almost 77% were of current international status with 85% having represented Scotland at some point in their careers. In the SNCL, 73.08% of all players represent the premier division, 19.23% division 1 while only one player each featured in division 2 and domestic matches outside the SNCL. 73% of the players that responded were in the age group of 19-25 while 15.38% were in the under 19 age group of and 12% in the over 24 age group. Batsmen comprised of 35% of players while bowlers and all-rounders formed a major share of 64%. Only one wicketkeeper featured in the study. The percentage of players who appeared in more than 30 matches over the season was 46% while 23% played between 11-30 matches.
The numbers of injuries reported throughout the season were 18. An increased prevalence of injuries was apparent at the start of the season with 27% of all injuries occurring in April. This then leveled off as the season progressed. Of all the players, 42% suffered injuries at some point of time during the season. Most of the injuries (66%) occurred in match situations. Acute injuries accounted for 60% of the injuries while acute or gradual recurrence of a previous injury was responsible for 35% of the cases. As expected, bowling was responsible for 36.84% of injuries while fielding (along with catching and throwing) caused 52.36% of injuries with throwing alone was responsible for 10% of all injuries.
Regional Distribution of injuries
Upper limb injuries contributed to 57.89% of the injuries, with shoulder tendon injury accounting for 27.27% of all upper limb and 15.79% of all injuries. Injuries to the fingers in the form of fractures or contusions had a prevalence rate of 15.29% for all injuries and 27.27% of all upper limb injuries. Lower limb injuries accounted for 31.58% of all injuries with knee and shin stress fracture being more common. Hamstring injuries having prevalence rate 16.67%. During the entire season, there was not a single case of head, neck or face injury. Midsection injuries accounted for 10.53 % of injuries with 5.26% prevalence rate for side or abdominal muscle strain.
35.29% of injuries took more than 6 weeks to heal enough for the player to participate in a match again, while almost half of the injured players took more than 4 weeks to recover from injury.
Injury Advice and Surveillance
In our analysis we found that only 8.33% of international cricketers had any access to a medical support team in the form of a physiotherapist while 75% of players at did not have injury advice at all. Also, of all the players, only 7.69% had some sort of injury prevention advice at their club. At the domestic level, provision of sports injury advice as well as medical support was lacking for 100% of players.
Likewise, none of the clubs have implemented injury data collection or monitoring program.
Table I. Type of injuries in the 2008 season
Type of Injury
Head / Face
Tendon / muscle
Dislocation / subluxation
Arm / Elbow / Forearm
Wrist / Palm
Lumbar stress fracture
Ham / Quad
Shin /Ankle / Foot
Total 13 5
The prevalence of injuries in Scottish cricket players both international and domestic over a season was ascertained in this study. Players in Scotland do not feature in as many matches over a season as players from places like Australia or India. As such, injury rates have not reached alarming proportions but the injury patterns and prevalence rates do show some similarities. The distribution of injuries according to anatomical site is similar to other studies, especially prevalence rate for lower limb fingers injuries. Bowling and fielding were recognised as major contributors for injury. Seasonal variations are also similar to a previous English study.10
The time lost due to injury as shown in the study is a concern. Proper injury prevention advice can help in avoiding injuries (most notable being those due to bowling). It is interesting to note that none of the domestic players had access to medical back up in the form of a doctor or a physiotherapist. Even at the international level only one player had a sports doctor to attend to his injuries.
In summary, we identified a need for the provision of medical support to players for helping them to realise their full potential. An injury free player is more likely to perform to the best of his ability ensuring good performance of the team. A successful team in turn can attract sponsors thereby further enhancing the injury aspect of the game.
A national database for cricket injuries within the confines of the Scottish government similar to the ACC or the SMAGG should be implemented. The ICC should look to help full as well as associate members in setting up injury prevention programs. The ICC should allocate funds and provide expertise in the form trained personnel for the same. Appointment of injury statisticians for recording of injury data in every first class, one day or twenty 20 match should be looked at. At the end of every match an injury report should be sent to the team management, the SNCL which in turn will pass it on to the ICC. This collection of data should be anonymised as much as possible to help safeguard players’ interests.
6.0 Methodological Limitations
The response we got for the questionnaire was not as good as expected. Unforeseen logistics and strategic problems due to prior commitment of the Scottish international team due to the World twenty 20 Cup and the domestic teams in the being busy in the final stages of the season hampered the feedback from the players.
The selection of players from the elite level did serve the purpose of determining injury prevalence at the highest level. However, patterns of injury at the school and junior level need to be identified as well.
Since it was a retrospective study, the authenticity of injuries reported form memory by the players can be questioned. Injuries should ideally have been diagnosed and recorded by professional medical personnel like a physiotherapist or a sports doctor.
Furthermore, this study looked into injuries over just one season. Having said so, this study can prove to be a pilot project on which future research can be based.
6.3 Statistical and Analytical
We calculated prevalence of the different types of injuries. However, the study did not look into the incidence rates of different injuries. The incidence rates along with prevalence rates as done by some previous studies would have been a better reflection of injuries affecting professional cricketers in Scotland.
7.0 Future Research
In the future, researchers should ideally look to conduct a prospective study over a number of years to identify the consistent injury patterns. Also, diagnosis and recording of injuries by professional medical staff with maintainence of an nationwide epidemiological injury database should be aimed at.
Also, impact of provision medical support staff on improved performance of the players and the team as a whole needs to be looked into.
8.0 Reference List
(1) Weightman D, Browne RC. Injuries in Eleven Selected Sports. Br J Sports Med 1975; 9(3):136-141.
(2) Orchard J, James T, Alcott E, Carter S, Farhart P. Injuries in Australian cricket at first class level 1995/1996 to 2000/2001. Br J Sports Med 2002; 36(4):270-274.
(3) Orchard JW, James T, Portus MR. Injuries to elite male cricketers in Australia over a 10-year period. J Sci Med Sport 2006; 9(6):459-467.
(4) Foster D, John D, Elliott B, Ackland T, Fitch K. Back injuries to fast bowlers in cricket: a prospective study. Br J Sports Med 1989; 23(3):150-154.
(5) Hardcastle P, Annear P, Foster DH, Chakera TM, McCormick C, Khangure M et al. Spinal abnormalities in young fast bowlers. J Bone Joint Surg Br 1992; 74(3):421-425.
(6) Hardcastle PH. Repair of spondylolysis in young fast bowlers. J Bone Joint Surg Br 1993; 75(3):398-402.
(7) Stretch RA. Cricket injuries: a longitudinal study of the nature of injuries to South African cricketers. Br J Sports Med 2003; 37(3):250-253.
(8) Brasch R. How did sports begin? Sydney: Camberwell: Longman; 1971.
(9) Van MW, Hlobil H, Kemper HCG. Incidence Severity Aetiology and Prevention of Sports Injuries A Review of Concepts. Sports Medicine 1992; 14(2):82-99.
(10) Leary T, White JA. Acute injury incidence in professional county club cricket players (1985-1995). Br J Sports Med 2000; 34(2):145-147.
(11) Mitchell R, Hayen A. Defining a cricket injury. J Sci Med Sport 2005; 8(3):357-358.
(12) Orchard J, Newman D, Stretch R, Frost W, Mansingh A, Leipus A. Methods for injury surveillance in international cricket. J Sci Med Sport 2005; 8(1):1-14.
(13) Stretch RA. The incidence and nature of injuries in first-league and provincial cricketers. S Afr Med J 1993; 83(5):339-342.
(14) Stretch RA. The seasonal incidence and nature of injuries in schoolboy cricketers. S Afr Med J 1995; 85(11):1182-1184.
(15) Finch CF, Elliott BC, McGrath AC. Measures to prevent cricket injuries: an overview. Sports Med 1999; 28(4):263-272.
(16) Corrigan AB. Cricket injuries. Aust Fam Physician 1984; 13(8):558-9, 562.
(17) Crisp T. Cricket: fast bowler’s back and thrower’s shoulder. Practitioner 1989; 233(1469):790-792.
(18) Stretch RA. Incidence and nature of epidemiological injuries to elite South African cricket players. S Afr Med J 2001; 91(4):336-339.
(19) Belliappa PP, Barton NJ. Hand injuries in cricketers. J Hand Surg Br 1991; 16(2):212-214.
(20) Bartlett RM, Stockill NP, Elliott BC, Burnett AF. The biomechanics of fast bowling in men’s cricket: a review. J Sports Sci 1996; 14(5):403-424.
(21) Bell PA. Spondylolysis in fast bowlers: principles of prevention and a survey of awareness among cricket coaches. Br J Sports Med 1992; 26(4):273-275.
(22) Dennis R, Farhart P, Goumas C, Orchard J. Bowling workload and the risk of injury in elite cricket fast bowlers. J Sci Med Sport 2003; 6(3):359-367.
(23) Dennis R, Farhart P, Clements M, Ledwidge H. The relationship between fast bowling workload and injury in first-class cricketers: a pilot study. J Sci Med Sport 2004; 7(2):232-236.
(24) Engstrom CM, Walker DG. Pars interarticularis stress lesions in the lumbar spine of cricket fast bowlers. Med Sci Sports Exerc 2007; 39(1):28-33.
(25) Bell P. Cricket: injury in long trousers. Br J Sports Med 1999; 33(3):151-152.
(26) Jones NP, Tullo AB. Severe eye injuries in cricket. Br J Sports Med 1986; 20(4):178-179.
(27) Abedin A, Chen HC. An uncommonly serious case of an uncommon sport injury. Br J Sports Med 2005; 39(8):e33.
(28) Aburn N. Eye injuries in indoor cricket at Wellington Hospital: a survey January 1987 to June 1989. N Z Med J 1990; 103(898):454-456.
Cover Letter for the Questionnaire
An Audit of Injuries in Cricket in Scotland in the 2008 Season.
With increased participation in cricket in Scotland, sports doctors and physiotherapists have become aware of a corresponding increase in cricket related injuries. Also, researchers worldwide have felt the need for a global injury incidence report to identify risk factors for subsequent designing and implementation of interventions for prevention of injuries. Some data regarding injuries in cricket is available from Australia, South Africa, England and the West Indies. However, epidemiological collection of data of injuries from the rest of the world is dismal, to say the least.
In Scotland as well, there has never been any audit of injuries in cricket, time lost due to injuries, implementation of injury prevention program and provision of medical support to players.
This audit aims to look at the type and prevalence of injuries that occurred over the 2008 season in cricket in Scotland, allowing an insight into the mechanisms of injury in cricket. We hope that this will assist the development of medical support and injury prevention programmes. This study would also contribute to a ‘World Injury Incidence Report’ to be undertaken in the near future.
This audit is being conducted by the Department of Sport & Exercise Medicine, University of Glasgow with the support of Cricket Scotland.
We are grateful for your valuable time spent in answering the questionnaire. If you have any questions regarding the study or the questionnaire please do not hesitate to contact either:
Do you play international cricket?
Please indicate the level of domestic cricket that you play in.
SNCL Div 1
SNCL Div 2
Does your club provide access to sports injury advice and treatment?