Side strains are common injuries in cricket, suffered by over half of elite fast bowlers and causing a high rate of unavailability. They particularly impact younger fast bowlers and most commonly occur early in a cricket season in the presence of low match workloads. The most common clinical features on presentation are reduced active trunk lateral flexion range of motion and pain on contractile tests. Imaging is routine in elite cricket; however, the reliability of reporting various MRI parameters varies considerably and should only be conducted by radiologists experienced with this injury. The most commonly injured structure is the internal oblique muscle. The only MRI parameter associated with time to return to play (RTP) is the presence of a muscle tear. Mean time to RTP at elite level is 39 days, with 44% requiring more than 6 weeks. Bowlers with a muscle tear achieve RTP of 43 days mean compared to 26 days for those without a muscle tear. Costoiliac impingement develops in over 30% of elite bowlers during recovery from side strain, and recurrence occurs in about 30% of elite bowlers, usually within 2 years of primary injury. Rehabilitation may be structured in four stages and must include restoration of range of motion, strength, bowling speed and workload to prepare the player for a successful RTP.