Cricket Injuries in Bowlers: Low Back Pain, Ankle Injuries and What to Do About Them

Fast bowling asks a huge amount of your body. You go from a full sprint into a delivery stride where forces of around five times your body weight go through your front leg as it lands and travel up into your spine (Elliott, 2000). You repeat that six times an over, spell after spell, match after match.

A review by Soomro and colleagues (2018) found that how you bowl and how much you bowl are the major risk factors for bowling injuries.

Why fast bowlers get hurt

When your front foot lands, you go from running at speed to stopping almost instantly. Your trunk arches back, bends sideways and twists all at once while your arm comes over fast. The force coming up from the ground as that foot lands is around five times body weight (Elliott, 2000). Mechanical factors like these play an important role in lower back injuries in fast bowlers (Elliott, 2000).

Your bowling action matters

Not all bowling actions carry the same injury risk. Research sorts fast bowling actions into three types (Elliott, 2000):

Side-on. Your hips and shoulders line up, both facing roughly side-on to the batsman when your back foot lands.
Front-on. Your hips and shoulders are both facing more toward the batsman.
Mixed. Your lower body faces front-on while your upper body is side-on (or the other way around). Your shoulders twist back against your hips (counter-rotation), so there’s more twisting and side-bending through the lower back during the delivery stride.

The mixed action is the concern. Elliott (2000) described how it comes from shoulder counter-rotation, and counter-rotation of 12 to 40 degrees during the delivery stride has predicted more lower back stress fractures, disc changes and muscle injuries. Mixed-action bowlers also bend sideways and arch the lower back more as the front foot lands. The thin bridge of bone at the back of each vertebra is vulnerable when the spine repeatedly bends, twists and arches like this (Elliott, 2000).

If you’re a coach or parent, having a young bowler’s action assessed before they start bowling high volumes is a sensible step.

Low back pain and stress fractures

Low back pain is a major problem for fast bowlers. A 2023 review by Farhart and colleagues noted that lower back injuries in fast bowlers cost more playing time than any other injury in cricket, and that they remain common.

A key injury to watch for is spondylolysis. This is a stress fracture of the pars interarticularis, the small bridge of bone that links the joints at the back of each vertebra. Teenage bowlers are a particular concern. A 2022 study by Keylock and colleagues tracked fast bowlers aged 14 to 17 and found that 20.5% already had a stress injury in a lower back bone at the start. The researchers suggested the risk may rise as bowlers step up to senior teams in their late teens and bowl more and harder, while the spine is still maturing.

Spondylolisthesis

When a stress fracture happens on both sides of the same vertebra, that bone can slip forward on the one below. This is spondylolisthesis, and fast bowlers need to be aware of it. It needs proper assessment and regular check-ups.

The small facet joints at the back of the spine can also get irritated, especially low down in the back. Facet joint pain is usually felt in one spot in the lower back and gets worse when you arch back or twist, exactly the movements of bowling. It can also spread into the buttock and thigh, which is sometimes mistaken for sciatica.

Ankle injuries

Bowlers’ ankles work hard. The front foot takes the impact of the delivery stride (Elliott, 2000). In injury surveillance data from elite South African cricketers, Olivier and colleagues (2023) found that bowling accounted for 30% of foot and ankle injuries. A sprain of the ligaments on the outside of the ankle was the most common foot and ankle injury. Pinching at the back of the ankle (posterior ankle impingement) also showed up in bowlers. The authors link it to the pointed-toe position of the front foot just after it lands (Olivier et al., 2023).

Osgood-Schlatter disease in young bowlers

Young cricketers going through growth spurts are vulnerable to Osgood-Schlatter disease, a painful condition at the top of the shin bone just below the knee. It happens when the kneecap tendon pulls again and again on the bump at the top of the shin while the growth plate there is still developing.

We look at workload, thigh and hamstring flexibility and any parts of their movement that add strain to the tendon.

How chiropractic care helps cricket bowlers

We use spinal manipulation, muscle work and targeted rehab, with a plan built around what bowling asks of your body.

Spinal manipulation. Bowling asks your mid and lower back to move a long way at high speed. A 2021 review by Gevers-Montoro and colleagues noted that treatment guidelines almost all recommend spinal manipulation for spine pain, and that it may work as well as other recommended treatments for everyday neck and back pain without a specific cause.

Managing stress fractures and slips. Orchard and colleagues (2023) explain that in most cases a recent, one-sided stress fracture can heal, but this takes three to six months off bowling rather than the six to ten weeks that symptoms alone might suggest. An MRI can be used to check healing before a gradual return to bowling (Orchard et al., 2023). Chiropractic care fits into this process through gentle joint work, muscle treatment, core and pelvic control exercises and a step-by-step plan back to bowling.

Ankle and leg rehab. For ankle injuries, treatment includes gentle joint work, muscle treatment and a programme that builds calf strength, ankle movement and single-leg balance step by step.

Prevention: what you can do

A few things are worth working on:

Get your bowling action assessed. Reducing shoulder counter-rotation is one of the main things you can change to lower the risk of a back stress injury (Elliott, 2000). Coaching towards a side-on or front-on action is one way to do that.
Manage bowling loads. Build recovery into your week and avoid sudden jumps in workload, particularly for teenage bowlers stepping up to senior cricket (Keylock et al., 2022). Bowling for long periods is linked to more back injuries (Elliott, 2000).
Don’t ignore niggles. A dull ache in your lower back after bowling is not something to push through. Get it assessed.

When to get assessed

If you’re bowling through back pain, have a sore ankle that flares up every match or are a young bowler with knee pain that is limiting your cricket, it’s worth getting it looked at sooner rather than later.

At our Sandton practice, we regularly treat bowlers and look closely at the specific demands bowling places on the body. We can treat an existing injury or look at the risk factors in your bowling.

Get in touch or book an appointment.

Frequently Asked Questions

Why do fast bowlers get back stress fractures?

When the front foot lands, the trunk arches back, bends sideways and twists all at once under a heavy load. In a mixed action, the lower body faces front-on while the upper body stays side-on, so the shoulders twist back against the hips (counter-rotation). Counter-rotation of 12 to 40 degrees during delivery has predicted more lower back stress fractures (Elliott, 2000). Mixed-action bowlers also bend sideways and arch the lower back more when the front foot lands.

How common are back stress injuries in young fast bowlers?

Common enough to take seriously. Keylock and colleagues (2022) tracked adolescent fast bowlers and found that 20.5% already had a stress injury in a lower back bone at the start of the study. Having a young bowler's action assessed before they bowl high volumes is a sensible step.

Should I bowl through lower back pain?

No. A dull ache in your lower back after bowling is worth getting assessed rather than pushing through. It can come from irritated small joints in the spine (facet joints) or from a stress fracture, and the two are managed very differently.

How is a pars stress fracture in a bowler managed?

Orchard and colleagues (2023) explain that most recent, one-sided stress fractures can heal, but this takes three to six months off bowling rather than the six to ten weeks that symptoms alone might suggest. Then comes a gradual return to bowling. Chiropractic care fits into that process through gentle joint work, muscle treatment, core and pelvic control exercises and a step-by-step plan back to bowling.

What is Osgood-Schlatter disease in young cricketers?

It's a painful condition at the top of the shin bone just below the knee. The kneecap tendon pulls again and again on a growth plate that is still developing. We look at how much they bowl, thigh and hamstring flexibility and any parts of their movement that add strain to the tendon.

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