Common, usually minor, and different in each kind of bowlingEmerging evidence
"Bowling" means three different actions, and each loads the knee differently: the fast bowler's landing in cricket, the ten-pin slide, and the low crouch or kneel of lawn bowls. Most bowling injuries are minor. In ten-pin, the knee isn't among the commonest places hurt in US emergency department records: the finger (19.0%), the trunk (15.8%) and the ankle or foot (14.9%) led from 1990 to 2008, and from 2014 to 2023 falls were the leading cause and 95% of patients were treated and sent home. In children and teenagers the knee was 7.4% of bowling injuries, and in 101 elite US college bowlers injuries to the arms were the commonest.
In elite Australian men's cricket over 10 seasons, fast bowlers were unavailable through injury 20.6% of the time against 12.5% for all players, but knee cartilage injuries ran at 2.0 and other knee injuries at 1.7 new injuries per 100 players a season, against 8.7 for hamstring strains. In elite women, hamstring strains, concussion, front-of-thigh strains and stress fractures of the shin, foot and ankle led; in 408 Sydney grade cricketers, the knee was 7.5% of injuries, behind the lower back (20%). In a survey of 2,294 current and former cricketers, bowlers had about twice the odds of a knee injury of batters, an association from a survey, not proof that bowling caused it.
Sources 1, 2, 3, 4, 5, 6, 7, 8
Fast bowling: the front knee brakes the landingEmerging evidence
A fast bowler runs in, bounds and lands on the front foot (the left for a right-arm bowler), and that leg brakes the body while the trunk bends and turns over it. In 20 elite English bowlers, the front foot met the ground at about 6.7 times body weight vertically and 4.5 times body weight as braking, and a larger plant angle and a heel-first landing went with lower peak forces. Faster bowlers didn't need bigger peaks. A 2026 3D motion study found the front knee works mainly by braking (eccentric control) and that "enforcing a fully braced knee is often unrealistic". A review of injury risk factors in adult fast bowlers lists knee angle among the technique factors linked with injury.
Fielding adds sprints, sudden stops, dives and slides, which load the knee like other field sports. No cricket study counts fielding knee injuries on their own.
Sources 9, 10, 11, 12
The fast bowler's front knee: a bone and cartilage bruise at the inner frontEmerging evidence
In 7 international fast bowlers with pain in the landing knee, the main complaint was pain at the inner front of the knee that stopped them bowling, and every one had a swollen knee when first seen. Magnetic resonance imaging (MRI) showed bone swelling on the inner end of the thigh bone, and the authors believe repeated overload, as the shin bone meets the thigh bone when the knee snaps straight on landing, is the cause. Four of the 7 had cartilage loss.
This rests on one case series of 7 elite men, so how common it is in club cricket isn't known. It is a reason to get a fast bowler's swollen front knee checked by a sports doctor rather than bowling through it, not a reason to worry about every sore knee after bowling.
Source 13
Ten-pin: the slide knee bends and brakesEmerging evidence
The approach ends in a slide on the foot opposite the bowling hand (the left for a right-hander), with that knee bending deeply as the ball is released. The knee load figures come from two small studies: in 6 elite bowlers the slide foot took a peak of 166% of body weight, and in a lab study of 8 healthy men aged 45 to 73, which we read as ten-pin (the paper says bowling), the knee was bent as far at its peak load as on the way down stairs, and that peak load was as high as on the way up, and its authors write that "The greatest challenge for the knee of healthy older males during bowling is eccentric control of knee flexion". In 10 competitive bowlers, the slide leg's hip bone density was 12% to 16% higher than the other side's, a sign that the slide loads that leg.
No study of knee pain in ten-pin bowlers was found. In US emergency departments, 72.4% of bowling injuries in people aged 65 or over came from falling, slipping or tripping, adults had more overuse injuries, and teenagers had more knee injuries than younger children. A single case report describes a torn inner meniscus from bowling on a games console.
Sources 14, 15, 16, 1, 2, 3, 17
Lawn bowls: the crouch, the kneel and fallsEmerging evidence
Each delivery is a step forward into a low crouch or a kneel, and the sport is played mostly by older adults. What we know about injuries comes from fact sheets, not studies: Sports Medicine Australia says most players are men over 55, lists "falls, overexertion, repetitive bowling movements and being struck by a bowl" as common causes, and says injuries to the hip, thigh, knee and lower leg are the commonest, and a Victorian health service says "Falls are the most frequent cause of injuries in lawn bowls". No study of knee pain in lawn bowlers was found.
There is a reassuring side. In older women, regular bowlers had stronger knee straightening muscles and better balance than women who didn't play, a comparison at one point in time, not proof that bowls caused it.
Sources 18, 19, 20
Arthritis in older bowlers, and what sport does to kneesEmerging evidence
From mid-life, a stiff, achy knee is often osteoarthritis. The National Institute for Health and Care Excellence (NICE) diagnoses it without a scan in people aged 45 or over with joint pain on activity and morning stiffness of 30 minutes or less. In 846 former cricketers aged 30 and over, the knee was the commonest site of joint pain (23%) and of osteoarthritis (22%); after allowing for past injury, bowlers' odds of knee pain weren't clearly higher than batters' (adjusted odds ratio 1.2, 0.7 to 2.1). Former elite English cricketers reported diagnosed osteoarthritis and knee replacements about 3.6 to 3.8 times as often as a matched population, but fewer heart problems, and 98% said cricket had enriched their lives.
Across sports, a Swedish population study found the extra risk of knee osteoarthritis linked with sport "was explained by knee injuries", and a review found knee arthritis in 7.7% of sport participants against 7.3% of people who didn't play. Looking after an injured knee matters more than giving up the game.
Sources 21, 22, 23, 24, 25
When a scan or test mattersStrong evidence
Most knee pain after bowling needs no scan. After a fall or a twist, clinicians use the Ottawa knee rule to decide on an X-ray (see the warning signs): across 6 studies of 4,249 adults it picked up 98.5% of fractures, and a negative result "accurately excluded knee fractures after acute knee injury". NICE says not to use imaging routinely to diagnose osteoarthritis unless something is unusual.
Scans show a lot that doesn't hurt. In people aged 50 to 90, meniscus tears on MRI ranged from 19% of women in their 50s to 56% of men aged 70 to 90, and among people without arthritis on X-ray, tears were found in 32% with knee pain and 23% without. A scan matters for a knee that is locked, after a pop with swelling within hours (in 1,145 such knees, MRI found an ACL tear in 52% and a meniscus tear in 41%), and for a fast bowler with pain and swelling at the inner front of the landing knee.
Sources 26, 21, 27, 28, 13
How it usually goesEmerging evidence
Aches settle in days. NHS inform says new pain or a flare-up of a long-standing knee problem should begin to settle within 6 weeks without seeing a professional, and the NHS says a meniscus tear can get better on its own, though it can take a while. In 140 adults aged 35 to 60 with a worn meniscus tear, 12 weeks of supervised exercise did as well as keyhole surgery at 2 years; 19% of the exercise group later had surgery, with no extra benefit.
All 7 international bowlers with the front knee bone bruise returned to international cricket, at an average of 6 months without surgery and 8 months with it. With arthritis, exercise improves function by about 11 to 13 points out of 100 on average, and NICE warns that joint pain may rise when you start. After a knee replacement, people returned to low-impact sport a mean of 13 weeks later, with return rates to bowls of 41% to 80% across studies. These are averages from small groups, and no one can promise a date.
Sources 29, 30, 31, 13, 32, 21, 33
When it isn't bowling: the causes the warning signs cover
Some knee pain has causes bowling didn't create, and the warning signs follow the pages behind them. A knee that changed shape, swelled fast or went with a pop needs A&E, in the words of the NHS dislocated kneecap page, and the Ottawa knee rule, tested in emergency departments, picks out who needs an X-ray after an injury. A pop at the front of the knee with a knee you can't straighten can be a torn quadriceps or patellar tendon, as the American Academy of Orthopaedic Surgeons (AAOS) describes; steroids, some antibiotics and conditions such as gout and diabetes can weaken these tendons. A hot, swollen knee can be a joint infection, which the NHS septic arthritis page says needs urgent treatment, or gout, which the NHS gout page covers; swelling in several joints with long morning stiffness can be rheumatoid arthritis. A swollen, throbbing calf can be a blood clot or a burst Baker's cyst, and sudden breathlessness a clot that has reached the lungs, as the NHS DVT, Baker's cyst and pulmonary embolism pages explain. Numbness around the genitals or both legs weak needs a 999 call, as the NHS sciatica page says. Spreading redness with a fever can be cellulitis, which the NHS cellulitis page says needs a 999 call when it comes with signs of a serious infection.
In older bowlers, a fall needs a 999 call if someone may have hurt the head, back, neck or hip, as the NHS falls page says, and NICE offers a full falls assessment to people who have fallen in the last year and are at higher risk, such as those injured in the fall; a broken hip is occasionally felt mainly in the knee, as two case reports describe. Sudden, severe inner knee pain from about 60 with no injury can be a small fracture under the joint surface that early X-rays miss, the AAOS says. After a knee replacement, the NHS lists the signs of a problem and says not to kneel on the new knee until your doctor says you can; numbness by the scar is a common reason kneeling is hard, a review says, and a trial found teaching people to kneel helped. For a meniscus tear whose symptoms haven't settled after three months of non-surgical treatment, the Evidence-Based Interventions programme says an MRI scan should be considered. NHS inform says to talk to a professional if kneecap pain hasn't improved within 6 weeks. In young bowlers, a limp with knee or thigh pain can come from the hip, as the NHS limping and irritable hip pages say, and a tender bump below the kneecap is usually Osgood-Schlatter or Sinding-Larsen-Johansson. One spot on the shin bone that hurts with impact can be a stress fracture, as Health New Zealand describes, and bone pain that is constant or worse at night needs checking, the NHS bone cancer page says, though that is rare.
Sources 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75, 76, 77, 78, 79, 80, 81, 82, 83
