“…Comparing the significance of variables derived from studies that defined outcomes as varied as LBP in the absence of radiology [ 48 , 50 , 57 , 58 , 61 , 62 ], radiological abnormalities in the absence of LBP [ 43 , 53 – 56 , 65 ], or a combination of LBP, abnormal radiology and missed playing time [ 42 , 44 – 47 , 51 , 52 , 59 , 60 , 63 , 64 ] is problematic. Whilst the appearance of LBP has been reported to be a common finding in fast bowlers without accompanying missed playing time [ 9 ]; spondylolysis is the most common cause of LBP in young athletes [ 106 ], and LBSI should be suspected in a fast bowler presenting with LBP contralateral to their bowling arm side [ 12 ]. The significance of LBP as a surrogate for lumbar spine injury in fast bowlers is yet to be determined due to previously described attrition biases in the published literature [ 41 – 43 , 45 – 50 , 53 , 60 , 61 , 65 ], and studies being cross sectional [ 54 – 56 , 62 , 63 ], retrospective [ 57 – 61 , 64 ], or prospective with limited follow up periods [ 42 , 46 – 50 , 52 , 61 ].…”