Usually ordinary back pain, and fast bowling loads the back hardestStrong evidence
Most back pain after bowling is ordinary back pain, which the NHS says "usually improves within a few weeks". Fast bowling is the hardest on the back: a fast bowler sprints in, leaps and lands, and as the front foot lands the trunk arches, bends sideways and twists over a braced front leg. The ECB puts it this way: "Fast bowling places enormous load on the lumbar (lower) spine, with forces estimated to be approximately three times a bowler's bodyweight every delivery." A review describes forces from the ground of up to about five times body weight during the delivery stride, and links arching, side bending and twisting with injury to the pars interarticularis, the thin bridge of bone at the back of a vertebra.
Even so, most back trouble in bowlers is not a fracture: in 82 high-performance young fast bowlers (mean age 16.8), 27% had a soft tissue back injury over a season and 11% a stress fracture of a vertebra. In elite Australian men's cricket over 10 seasons, 12.5% of players were unavailable through injury at any one time, fast bowlers 20.6%, and lower back stress fractures accounted for 15% of all missed playing time. Spin bowlers, batters and fielders are injured far less.
Sources 1, 2, 3, 4, 5, 6
Young fast bowlers: the stress fracture to know aboutStrong evidence
In English county cricket, 57 lower back stress fractures in 368 professional fast bowlers over 7 years gave 2.46 a year for every 100 bowlers, and 4.90 at ages 18 to 22; 56% were between 18 and 22, and 93% were on the side opposite the bowling arm. In 40 English academy bowlers aged 14 to 17 without symptoms, 20.5% already had a bone stress injury on a screening scan. Over one Australian season, 16.3% of 98 youth bowlers aged 10 to 20, girls and boys, had one, and only a previous one independently predicted another (we read this study's abstract only). In yearly MRI (magnetic resonance imaging) scans of 51 adolescent bowlers, 11 developed stress lesions with symptoms in the fourth lumbar vertebra between the ages of 15 and 17, all on the side opposite the bowling arm.
Cricket Australia says adolescent pace bowlers are at the highest risk, "with around one in three experiencing this type of injury". So back pain in a young fast bowler that lasts more than a couple of weeks, is worse arching back or stops them bowling needs checking, even though most back pain in bowlers is still ordinary back pain.
Sources 7, 8, 9, 10, 11
Ten-pin bowling: the trunk is commonly hurt, but little is known about the backEmerging evidence
In ten-pin, the approach, the swing of a ball weighing up to 16 pounds, a slide on the front foot and a low, bent release load the back, the bowling arm and the thumb. US emergency department records from 1990 to 2008 estimated 375,468 bowling injuries, most often the finger (19.0%), the trunk (15.8%) and the ankle, foot or toe (14.9%), and 42.7% were sprains or strains; in people aged 65 or over, 72.4% came from falls, slips or trips. From 2014 to 2023, the trunk was the commonest region hurt (21.9%), 95% of people were treated and sent home, and adults had more overuse injuries than children or older adults.
In children and teenagers, lower back injuries were 6.8% of bowling injuries. In 101 elite US college ten-pin bowlers, 87% reported an injury, most often in the arm, in a survey with a 41% response. A 1988 review notes the "cumulative stress of pushing a heavy bowling ball thousands of times" (we read its abstract). The emergency department figures count the whole trunk, not the back alone, and no study of back pain in ten-pin or lawn bowlers was found, so the ten-pin advice on this page is our suggestion, not tested.
Sources 12, 13, 14, 15, 16, 17
When it isn't bowling: the causes the warning signs cover
Back pain can have causes bowling didn't create: cauda equina syndrome, a broken bone, infection, a burst aortic aneurysm and cancer are rare. The NHS asks for a 999 call for back pain with numbness around the genitals or bottom, new bladder or bowel changes, or pain, tingling, weakness or numbness in both legs, and a same-day check for back pain with a fever or feeling unwell. Sciatica on both sides, or weakness or numbness in both legs that is severe or getting worse, also needs 999. The NHS page on a slipped vertebra (spondylolisthesis) asks you to see a GP for lower back pain, or pain in the thighs or bottom, that doesn't go away after 3 to 4 weeks, and a hot, swollen joint with sudden severe pain can be an infection.
Other warning signs follow the pages behind them. Sudden, severe pain in the tummy or back can be a burst aortic aneurysm, a 999 call, the NHS says; the National Institute for Health and Care Excellence's (NICE's) guideline on spinal metastases covers new back pain in people who have had cancer; the NHS asks you to see a GP if it's hard to lift the front of your foot (foot drop); and ankylosing spondylitis tends to first develop in teenagers and young adults, the NHS says, which is why back pain and stiffness that persists at that age needs a GP. An NHS physiotherapy leaflet asks for an urgent GP appointment or NHS 111 for leg weakness that is getting worse, new leg pain with a history of cancer, human immunodeficiency virus (HIV), tuberculosis (TB) or inflammatory arthritis, or leg pain with a fever, weight loss or night sweats. After a fall, the NHS asks for a 999 call if someone may have injured their head, back, neck or hip or can't get up; heat exhaustion that doesn't settle within 30 minutes of cooling down can turn into heatstroke, an emergency, which matters on a long, hot day in the field; and a kidney infection, often pain in the side or lower back with burning when you pee, needs an urgent GP appointment or NHS 111, the NHS kidney infection page says.
From 50, past the menopause or on long-term steroid tablets, sudden back pain after a minor fall, lift, cough or sneeze, height loss or a curving spine can be a spinal fracture from thin bones, as the Royal Osteoporosis Society, the American Academy of Orthopaedic Surgeons (AAOS), the UK's osteoporosis guideline (from the National Osteoporosis Guideline Group, NOGG) and NICE describe. A stress fracture from ordinary activity, more than one stress fracture, periods that have stopped or eating too little for your training needs a GP: an NHS trust's leaflet covers caring for a stress fracture, the International Olympic Committee calls the energy problem relative energy deficiency in sport (REDs), and an Endocrine Society guideline covers periods that stop. And in 500 children followed from the age of 6 for 45 years, about 6% had a stress fracture at the back of a vertebra by adulthood, and a slip rarely got worse after the teenage years, so a teenager's pain on arching is something to get checked, not to fear.
Sources 1, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56
When a scan helps, and how it usually goesEmerging evidence
For ordinary back pain, NICE says: "Do not routinely offer imaging in a non-specialist setting for people with low back pain with or without sciatica." A young fast bowler with a suspected stress fracture is the exception, because the result decides how long they rest from bowling. A review by sports doctors and physiotherapists who work in cricket says these fractures can heal, but "this takes three-six months rather than the six-ten weeks that would be the typical unloading period if using symptoms (only) as a guide", and that MRI can follow the healing. No single examination test confirms one: a review found "No physical tests demonstrated diagnostic utility for spondylolysis".
Scans also find bone stress in bowlers without symptoms: in 65 junior elite bowlers scanned up to 6 times in a season, swelling inside the bone (bone marrow oedema) showed before every one of the 15 bone stress injuries; in elite adult bowlers, it was present on 46% of screening scans in bowlers without symptoms; and in England, injuries found by screening were milder and came back to bowling sooner than those found because of symptoms. Screening is for elite programmes; for club and school bowlers, the safeguards are the limits and getting back pain checked early.
A lower back stress fracture in a fast bowler takes months. English professionals lost a mean of 239 days per fracture; the ECB says a bowler "may be unable to compete for up to 8 months or, in some instances, longer", and Cricket Australia says such injuries "take up to 6-12 months to recover from". In 20 elite Australian bowlers, 25 of 31 fractures healed on MRI, a median of 203 days after diagnosis, and a repeat fracture at the same site took longer to heal than the first (a median of 276 days against 114). All 18 professional county cricketers with these fractures in one English club's series returned to professional sport, 8 after non-surgical care and 10 after a repair. Another fracture can follow: over 5 years after returning, 51% to 67% of young English fast bowlers stayed free of another. No one can promise a date.
Sources 18, 19, 20, 21, 22, 23, 7, 2, 11, 24, 25
