Monash University Accident Research Centre - Report #138 - 1998
Authors: A.C. McGrath & E. Cassell
Full report in .pdf format [230KB]
Lawn bowls is a popular sport and leisure activity in Australia played by an estimated 75,000 to 80,000 Victorians. Health professionals recommend the sport to older people because it provides low impact, therapeutic exercise in a social and supportive atmosphere.
There are no comprehensive data on lawn bowls injuries. Data from hospital emergency department surveillance systems revealed that presentations for lawn bowls injuries are uncommon. This is possibly explained by the lower physical intensity of bowls compared with other sports and the likelihood that bowlers may seek treatment elsewhere (for example from General Practitioners, physiotherapists and chiropractors ) or self treat their injuries.
In total there were 29 lawn bowls injury cases recorded on the new Victorian Emergency Minimum Dataset (VEMD) and the superseded Victorian Injury Surveillance System (VISS). Approximately three-quarters (76%) of the injured players were female, indicating they may be at higher risk of injury because ABS sports participation data indicate they comprise only 39% of participants in lawn bowls. Injuries were caused by falls (59%, including trips and slips on the green during play, when traversing the ditch and on steps and paths in areas around the clubhouse or carpark); overexertion (31%, sprains and strains); and being struck by a bowl (7%). Injuries included: sprains and strains (35%); fractures (35%); cuts and bruises (23%). Eight of the 29 cases (28%), all female and aged over 60 years, were admitted to hospital.
The research literature search found no published or unpublished studies on the patterns, causes and prevention of lawn bowls injury. Consequently, this report covers studies that examine injury among older athletes engaged in other sporting activities and includes a detailed discussion of countermeasures to injury implemented in other sports that are transferable (with appropriate modifications) to lawn bowls. Recommendations include: extension of coaching to improve players technique, pre-participation screening, pre-season conditioning, warm-up and stretching programs, improved footwear design, education of coaches and trainers and the provision of appropriate first aid and rehabilitation. Fall hazards need to be eliminated from the sport, playing environment and club facilities.
It is strongly recommended that lawn bowls clubs collect comprehensive injury data that need to be collated, analysed and reported periodically to assist the development of targeted injury prevention measures.
Lawn bowls is a popular sport and leisure activity in Australia. It is estimated from the 1995/96 Australian Bureau of Statistics (ABS) population household survey that 296,000 Australian men and women play bowls. It is the fifth most popular sport in Australia behind aerobics, golf, tennis and netball. Most participants (92%) are over 45 years old, 61% are male and 39% are female. The sport is played for the challenge and competition, personal enjoyment in terms of being active and spending time outdoors, and social reasons. Also, participation is recommended to older people by health professionals because the sport provides low impact, therapeutic exercise in a social and supportive atmosphere.
There is a notable lack of information on lawn bowls injuries. No data are collected at club or association level. Also, there are no published or unpublished epidemiological studies indicating the frequency and pattern of injury among bowls players. The only information that was available was from hospital emergency department surveillance systems.
Data on lawn bowls injury from Victorian, Australian and New Zealand hospital emergency department databases reveal that presentations are uncommon. The low frequency of cases presenting to E.D. departments is probably explained by the lower physical intensity of bowls compared with other sports. Also, anecdotal evidence and research on sports injuries among other groups of older athletes suggest that lawn bowls injuries are more likely to be intrinsic in nature sprains, strains and joint problems which are not well-captured in hospital emergency department data collections. Players with these injuries are more likely to consult general practitioners, other health and sports injury treatment practitioners (for example physiotherapists, chiropractors and masseurs) or self-manage their injury. There are no comprehensive data collections on these types of treatments in Victoria, although a survey of sports medicine clinics is in progress.
There were 29 cases of lawn bowls injury recorded on Victorian hospital emergency department surveillance systems. Fifteen cases (3 males; 12 females) were identified on the new Victorian Emergency Minimum Database (VEMD) over the two-year period (1995-97). These data are drawn from 25 Victorian hospitals. The number of cases extracted from the database probably underestimates the actual number of lawn bowls injury presentations because the specific sport being played at the time of injury is inconsistently reported in VEMD sports injury case records. Another 14 cases (4 males; 10 females) were recorded on the superseded Victorian Injury Surveillance System (VISS) database that collected adult injury data from 4 Victorian hospitals for various periods between 1988 and 1995.
Injuries were caused by falls (59%, including trips and slips on the green during play, when traversing the ditch and on steps and paths in areas around the clubhouse and car park); overexertion (31%, sprains and strains); being struck by a bowl (7%) and foreign body in eye (3%). Injuries included: sprains and strains (35%); fractures (35%); cuts and bruises (23%); and one case of shoulder injury, not specified (3.3%). The most common sites of injury were the ankle and the wrist. Approximately three-quarters (76%) of the injured players were female, indicating they may be at higher risk of injury because ABS sports participation data indicate they comprise only 39% of bowls participants. Eight of the 29 cases (28%), all female and aged over 60 years, were admitted to hospital.
A similar pattern of injury was evident when Australian data on lawn bowls injuries, from the National Injury Surveillance Unit (NISU) in Adelaide, were analysed. The NISU database recorded 65 lawn bowls injury cases (from 50 participating hospitals across Australia) during the period 1986-1997. Seventy-one per cent of injured bowlers were female; 65% were aged over 60 years. The major causes of injuries were falls, including trips and slips (54%); overexertion resulting in sprains and strains (28%); and being hit by the bowl (18%). The injurious falls were fairly evenly divided between loss of balance, slips (mostly on the green but a few on steps, bank and paths) and trips (mostly over bowls). Fractures (37%) and sprains and strains (31%) were the most common types of injury. Eleven cases (17%) were admitted to hospital.
Anecdotal evidence from the Royal Victorian Bowls Association (RVBA) suggests that the common scenarios for falls in lawn bowls are:
Older people, especially older women, are particularly vulnerable to fall-related fractures that can cause longer-term disability and may reduce quality of life and independence. Because of the older age of participants in lawn bowls, clubs and associations need to be vigilant about eliminating fall hazards from the game, the playing environment and club facilities (including the car park).
Our literature search found no published or unpublished research studies on the pattern, causes and prevention of injury in lawn bowls. Consequently, this review covers studies that examine sports-related injury in active older people (mostly athletes) and provides a detailed discussion of measures to prevent injury in other sports that are transferable (with appropriate modifications) to lawn bowls.
Generally, the research evidence on the effectiveness of many of the countermeasures to sports injury is inconclusive. Sports injury research on recreational players is a relatively new discipline and large controlled studies that can provide definitive answers are rare. More large-scale epidemiological studies are needed to identify the pattern of sports injury in the general population of lawn bowls players and the role of various risk factors in causation. Clubs and associations can contribute to this endeavour by systematically collecting injury data. Basic scientific studies are also required to better understand the mechanisms of injury. Lastly, controlled evaluations in the field are needed to trial whether the various countermeasures to injury are effective. The recommendations for research and countermeasure implementation in this report are based on a critical analysis of available research evidence as well as discussions with the experts acknowledged in this report.
SPECIFIC RECOMMENDATIONS FOR COUNTERMEASURE IMPLEMENTATION, RESEARCH AND DEVELOPMENT
Bowls and bags
Education and coaching
Preventing overuse injuries
First aid and rehabilitation
Sponsoring Organisation: Sport and Recreation Victoria