Biomechanical Evolution in Longitudinal Analysis of Lumbar Stress Injuries in Fast Bowlers: A Systematic Review

Fast bowling involves a highly complex and physically demanding motion sequence, placing fast bowlers under substantially greater workloads than other cricketing roles. Consequently, they experience a disproportionately high incidence of injuries, particularly to the lower back, with lumbar stress fractures being especially common in adolescent bowlers. These injuries are multifactorial, arising from repeated exposure to high spinal loads, underscoring the need for comprehensive biomechanical analysis and targeted preventive strategies to enhance safety and prolong athletic careers. This systematic review synthesizes 15 years (2008-2023) of research to identify injury patterns and biomechanical contributors, aiming to inform safer, sustainable training practices. A comprehensive search of MEDLINE, Embase, SPORTDiscus, CINAHL, Scopus, Web of Science, PubMed, and Google Scholar identified 21,550 records. After screening 21,406 titles and abstracts, 517 reports were sought for retrieval, and 491 were assessed for eligibility. Ultimately, 37 studies met the inclusion criteria. Eligible studies included prospective and retrospective cohort designs, analytical cross-sectional studies, and randomized controlled trials. Only peer-reviewed, full-text, English-language publications were considered, while case reports, reviews, and non-peer-reviewed articles were excluded. Screening and verification were conducted using RAYYAN and Mendeley, with an independent multi-reviewer assessment to ensure rigor. Findings highlight that shoulder counter-rotation exceeding 25°, trunk lateral flexion, and reduced knee flexion (<30°) at front-foot contact significantly elevate lumbar and lower-limb loading. Poor lumbopelvic control increases lumbar stress injury risk by up to 88%, whereas greater ankle dorsiflexion (>30°) demonstrates a protective effect via improved shock absorption. Preventive strategies should prioritize early biomechanical screening, workload regulation, and targeted lumbopelvic strengthening. Rehabilitation approaches must emphasize gradual workload progression and refined movement control, supported by long-term biomechanical monitoring to enhance performance and minimize injury risk.