Preventing Lower Back Pain in Rowers

Welcome to the first instalment of rowing related Sports Medicine information for Junior Rowing News!

This article will give you some tools that you can utilise immediately to reduce your chances of having lower back pain this rowing season. The information is designed for the rower, the coach, the parents and other healthcare practitioners that may not be familiar with treating rowers.

Lower back pain is notoriously common in rowers, with 95% of adolescent males and 78% of adolescent females suffering in some way according to a study by Ng et al.  in 2014. Whilst these numbers can seem alarming, it is important to note that the levels of discomfort identified in this study were varied, and the percentages relate to those rowers who had back pain at any stage, even if just a mild discomfort after a row on one occasion.

There is a lot of variability with lower back pain which makes a one size fits all approach to prevention very challenging to implement. Let’s start with researched methods of preventing lower back pain, and then we can look at some of the more anecdotal information.

Preventing Pain and Injury:

Gluteal stretches (buttock muscles) and hip flexor stretches (muscles at the front of the hip) must be done at the end of every rowing session for 1 minute each side – pictured below. In addition to a core strengthening program, these stretches were found to reduce the incidence of mid and late-season lower back pain (Perich et al., 2011). These can be implemented as a crew during debriefs after a row. Rowing is a unique sport that requires great mobility and the hips are a huge component of this. 

Avoid long periods of time on the rowing ergometer – there are three risk factors for lower back pain: previous history of lower back pain, rowing, and ergometer use. The first two are non-modifiable, as in we cannot do anything to change them. However, excessive use of the rowing ergometer (over 30mins) has correlated with lower back pain (Teitz, O’Kane, Lind & Hannafin, 2002). If I am treating a rower with back pain in the clinic, particularly during the season, rowing ergometer sessions are the first element to be scratched from the training program. Try low-intensity stationary bike work or break up the ergometer sessions into smaller pieces instead.

Hamstring strengthening was found to reduce the time lost on water due to lower back pain (Koutedakis, Frischknecht & Murthy, 1997). As such, it is essential to include some hamstring strengthening exercises in your conditioning program. My favourite exercise is the hamstring bridge (similar to a typical bridge but with the feet elevated on a chair, digging the heels into the chair to lift the bottom off the ground and then lowering your bottom down slowly – approximately 1-2 seconds to raise and 2 seconds to lower). Start with 3×8-12 depending on how difficult it feels – you will want to aim for a 4-6/10 on the difficulty scale. Perform this 4x a week.

A strength and conditioning program, done regularly and with good technique, will not only improve your performance but also prevent injury. Rowing programs can be very simple, a push exercise (push up), pull exercise (pull/chin-up), a squat, a lunge and a bridge will tick most boxes. Add in some core strengthening exercises, and you have a simple starting program. The technique should be the emphasis, no weights until your technique is on point. If you are unsure, see if you can chat to a physiotherapist or strength and conditioning coach before you progress.

The final point… Keep your training consistent! Coming back from injury, illness or when coming back from a break, try build your training gradually. An easy guide is that the inverse amount of time you are off the water due to the reasons above is the same amount of time you need to increase your training up to optimal levels again, e.g. two weeks off should be followed by at least two weeks to build the training load back up to where it was before. The muscles and joints in your back need to be suitably conditioned to cope with training. This will reduce your chances of picking up any injury, lower back included.

Conclusions:

An exciting care pathway is being developed for lower back pain in rowers by some of the leading sports medicine experts in the world, which will enable a verified means of managing lower back pain from initial diagnosis to return to sport. Watch this space.

I would like to give credit to Dr Larissa Trease and Kellie Wilkie, the Rowing Australia Sports Doctor and Physiotherapist respectively for the 2016 Rio Olympics. They are a big part of why I started ‘The Rowing Physio’ and gave me the foundation for my knowledge base when it came to transitioning from a rower and coach to a physiotherapist with a special interest in treating rowers.

If you have any questions, please do not hesitate to get in touch with me on Instagram @therowingphysio.

Matt Anthis

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Photos by Roesie Percy, Fergus Mainland and Matt Anthis

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References

Koutedakis, Y., Frischknecht, R., & Murthy, M. (1997). Knee Flexion to Extension Peak Torque Ratios and Low-Back Injuries in Highly Active Individuals. International Journal Of Sports Medicine, 18(04), 290-295. doi: 10.1055/s-2007-972636.

Ng, L., Perich, D., Burnett, A., Campbell, A., & O’Sullivan, P. (2014). Self-reported prevalence, pain intensity and risk factors of low back pain in adolescent rowers. Journal Of Science And Medicine In Sport, 17(3), 266-270. doi: 10.1016/j.jsams.2013.08.003.

Perich, D., Burnett, A., O’Sullivan, P., & Perkin, C. (2010). Low back pain in adolescent female rowers: a multi-dimensional intervention study. Knee Surgery, Sports Traumatology, Arthroscopy, 19(1), 20-29. doi: 10.1007/s00167-010-1173-6i.

Teitz, C., O’Kane, J., Lind, B., & Hannafin, J. (2002). Back Pain in Intercollegiate Rowers. The American Journal Of Sports Medicine, 30(5), 674-679. doi: 10.1177/03635465020300050701.

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