by A research group including authors of the World Rowing Low Back Pain taskforce (rower-scholars Fiona Wilson, Jane Thornton, and Kellie Wilkie) published a new paper examining interview responses from 25 experienced rowers about low back pain. The paper is open source and you can read the whole thing here. The discussion section is basically a “greatest hits” of athlete misconceptions, combined with the researchers’ analysis and additional information for why the misconceptions can interfere with healing, delay recovery time, and fail to reduce injury rates. I’ll pass along some specific quotes here and why they resonated with me.
The rowers’ answers followed three consistent themes.
- Attributing low back pain to specific physical/structural factors
- Viewing rowing as a risky sport for low back pain
- Focusing on physical management strategies for rehab, management, and prevention of low back pain
“Participants generally appeared to make sense of their pain through a biomedical model and most believed that their LBP related to structural pathology or physical impairments…However, these traditional biomedical beliefs are not in keeping with the current understanding of LBP as a biopsychosocial phenomenon.”
There is rarely a “smoking gun” kind of singular problem with chronic/general low back that can be rehabilitated in isolation. The “biopsychosocial model” seeks to go beyond the structural or biomedical model to explore additional factors that we know can influence pain, such as mental and emotional stress (especially those caused by the sporting environment), beyond simple evaluation of joints, muscles, and connective tissue problems.
“MRI findings such as disc degeneration and vertebral endplate changes are prevalent in asymptomatic individuals and routine use of MRI in LBP has been found to produce a negative perception about the back, and is associated with poor functional outcomes.”
Imaging can show problems that aren’t problems, and can fail to show problems that are problems, and relying on imaging can reinforce the idea that backs are fragile. They suggest that “Imaging should be used judiciously in both the general and sporting population and should be clearly explained using clear, non-threatening language that makes sense to the patient.”
“There was a perception among participants that LBP is inevitable in rowing.”
Yes, low back pain is common in rowing, but there’s a world of difference between “common” and “inevitable.” Don’t be one of those, “we tried nothing and nothing is working!” people.
Rowers and coaches can do a lot to reduce risk of injury by managing training load. This includes total training volume (meters/minutes per week), overlap of volume and intensity (high volume training PLUS using hatchets, static ergs, can/weights, etc.), and progression of volume and intensity (especially around return-to-train phases, when most injuries occur), plus also considering cross-training and strength training.
“The athletes described specific types of exercises such as stretches and core-strengthening as being important for LBP management and prevention. However, evidence suggests that core-strengthening or stabilization exercises may be less effective than other types of exercise…
…Furthermore, some of the rowers reported being advised by coaches and/or the medical team that core-strengthening exercises were necessary for protection of the spine and others described unhelpful behaviours in relation to everyday activities such as bending and sitting with a straight back. This advice and behaviour are unfounded and unhelpful. Healthcare professionals treating athletes with LBP should avoid promoting rehabilitative exercises on the basis of correcting vulnerability.”
We cannot “do core” our way out of low back pain injury risk or incidence. Simply doing planks, or even seated rockbacks (my favorite), or any other exercise or stretch does not on its own offset the bigger factors in my prior paragraph: rowing/erging volume, intensity, progression, and overall load management. Presenting preventative strategies (even good ones!) without addressing the bigger picture isolates the problem to the individual instead of examining the systemic factors that first put the individual in this position.
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