Cricket fast bowling places enormous load upon the lumbar spine and elite fast bowlers often accumulate thousands of repetitions of this movement at high intensity per year. This presentation highlights the remarkable and unique bone adaptation of the lumbar spine across the career of elite cricket fast bowlers to be able to tolerate this high load, high volume activity. In addition, this presentation will focus on fast bowling specific risk factors to lumbar bone stress injury, including bowling technique, lumbar bone mineral density, bowling volume, and strength and conditioning.