Physio’s corner: lower back pain in rowing

“Finding things your body can do was more meaningful to me than labelling my back pain.”

There are many annoying injuries in rowing and lower back pain is definitely one of them. 

Here are 3 things you should know about low back pain and why you should take it more seriously:

1. The forces exerted on the spine at the catch can be up to 4.6 times the athletes body weight because of the body’s position (end range flexion and rotation) (Morris et al., 2000)
2. In a 12 month study, the possibility of an athlete having low back pain ranged from 31.8 to 51%(Wilson et al., 2014)
3. Adolescent boys are 65% and adolescent girls are 53% likely to have a low back injury. (Ng et al., 2014)

You guys should know by now that I believe education is one of the most important pillars in your rehab. We’re curious people and understanding what’s going on and why it’s happening makes us more likely to complete our injury rehab and be successful.

Let’s break it down and understand it.

There are 3 categories of back pain I want to tell you about.

The first culprit is non-specific low back pain (NSLBP). NSLBP is back pain that does not have a definite or known cause. This can be broken down into three more categories based on the duration of time you experience your symptoms. Acute is less than 6 weeks. Sub-acute is between 6 to 12 weeks. Chronic is for 12 weeks or more. This can include symptoms like: constant dull aches (not sharp shooting pains that feel like electric shocks), the pain can change when you exercise. You can also feel restricted in certain movements.

The second type is nerve related pain. This can include symptoms like tingling, pins and needles, numbness, weakness, sharp shooting pains. Certain movements can also aggregate your symptoms.

The third type is a combination of the first two: both NSLBP and nerve related pain.  

It’s basically a combination of the two types above. 

Here’s an infographic to help understand some of the most common symptoms for back pain:

I know what it’s like to want answers as much as you do, especially when you’re in pain and unable to do what you love. Something I have come to realise during my own injury rehab this season is that sometimes having a diagnosis and name isn’t as important as focusing on finding things your body can do pain free.

“So I have this low back pain and my symptoms are most similar to non-specific low back pain not nerve related pain. What can I do in the next 24 hours to improve it?”

There are three things we need to consider: symptom management, mobility and range of motion and movement.

Symptom management is effectively treating your symptoms and trying to reduce them as much as possible. Strategies like heat have been found to be particularly useful, just like swimming (aka hydrotherapy), and where needed pain medication or topical gels.

Mobility and range of motion is all about maintaining your current ability to move and trying to improve it if it is limited because of your injury and pain. This is where exercises like happy cat sad cat (or cat camel), pelvic tilts and hip circles can be really useful. You can do mobility movements or stretch – something is better than nothing. Try different ones and find exercises that provide relief and do more of it.

A common mistake is focusing on only the lower back.

Our lower back is made up of our lumbar spine, lots of muscles and nerves. It connects out thoracic spine and ribcage to your pelvis and hips. You cannot only think and only treat your lower back. Limitations in your hips or thoracic spine can result in your lower back becoming injured. The same applied for your biomechanics and how you move in the boat and gym.

Movement is, understandable, all about moving. Stopping any type of movement is the WORST thing to do, especially with back pain. Now, stopping any movement is different to reducing the amount you do or changing what you do. Lowering the drag factor or swapping the erg for the RP3 or bike are a good first step to reducing the load and keeping you moving. 

3 key takeaways:

1. Low back pain is not a ‘one size fits all’. Your pain will be different to mine and the next person. Understand what is going on and experiment to find strategies that work for you.

2. Change and modify but don’t stop!

3. Stopping and only having bed rest is not going to be productive to helping your pain and your future self will not thank you.

This is only educational content and does not substitute for medical advice. If you are in pain or have a low back injury then please seek professional medical advice.

Sophie Hudson is a registered physiotherapist. For more information or advice, please contact @sophiehudsonphysio

References:

Morris FL, Smith RM, Payne WR, Galloway MA, Wark JD. Compressive and shear force generated in the lumbar spine of female rowers. Int J Sports Med. 2000 Oct;21(7):518-23. doi: 10.1055/s-2000-7409. PMID: 11071056.

Wilson F, Gissane C, McGregor A. Ergometer training volume and previous injury predict back pain in rowing; strategies for injury prevention and rehabilitation. Br J Sports Med. 2014 Nov;48(21):1534-7. doi: 10.1136/bjsports-2014-093968. Epub 2014 Sep 25. PMID: 25257230.

Ng L, Perich D, Burnett A, Campbell A, O’Sullivan P. Self-reported prevalence, pain intensity and risk factors of low back pain in adolescent rowers. J Sci Med Sport. 2014 May;17(3):266-70. doi: 10.1016/j.jsams.2013.08.003. Epub 2013 Aug 11. PMID: 23994346.

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