Lower Back Pain – Debunking the Myths

  1. First of all, what are the different types of back injuries you can suffer whilst rowing, and which is the most common/dangerous?

 It is exceptionally rare for anyone to sustain a back injury from rowing which is dangerous. As rowing is a non-contact sport, it is associated with back injuries which usually develop over some time and, as such, are not associated with significant trauma. We tend not to categorize lower back pain according to the structure which is damaged anymore. Some years ago, we talked about a ‘disc injury’ or a ‘ligament injury’, but we now tend to categorize according to the pattern of the pain that develops. In rowing, that is normally called something like a ‘flexion pattern disorder’. This means that any structures which are loaded by bending forward may be overloaded and producing symptoms. The biomechanics of rowing mean that multiple structures may be causing pain, but any good clinician treats the pain and the person rather than the structure. It is never possible to determine exactly what is causing the pain, but the worst cases are often a disc protrusion which is causing irritation of a nerve root. The most common however, tend to be a bit vague with overload of multiple structures in the lower back. All of these will usually resolve spontaneously and fully with the correct management.

 

  1. Typically, what are the causes of back injury within rowing?

 The biomechanics of rowing are largely to blame. Basic rules of ergonomics suggest lifting multiple times, particularly to the point of fatigue where the supporting structures of the back may no longer work so well, puts the back at risk of injury. Rowing is like lifting something with a bent spine every time a stroke is taken. However, the human spine is a very robust structure which is why it is possible to row and not sustain a back injury. We know from research that doing a large volume of ergometer sessions, particularly those over 30 minutes long, increases risk of the injury. Poor technique, where the trunk is not flexed over from the hips or the spine is very rigid or flexed, is also linked with injury. In my experience working with rowers, I observed that the weights room could be a source of risk as many rowers have poor technique, particularly with exercises like power cleans. A history of previous back pain increases the risk, which suggests that either genetic predisposition or even perhaps inadequate rehabilitation of the original injury is to blame.

 

  1. Can poor technique on the water and in the gym actually cause back injuries?

 This is definitely associated with injury. Research has shown us the back can be well protected from the volume of loading if it is moved effectively. This means spreading the load through the spine (the back should look like a stretched out letter ‘C’) and swinging forward from the hips. Professor Alison McGregor, who has done some great research with GB Rowing, talks about the trunk looking like an ‘inverted pendulum’ or a metronome which is used in music classes. Any good clinician will work with both the rower and their coach to correct technique as part of the rehab process. The key in the gym is not to sacrifice quality for quantity; good weight lifting technique is much more important than the volume lifted.

 

  1. How important are core exercises to back injury prevention?

 Good rehabilitation specialists have reconsidered the role of the core recently. Many core programs overemphasize stability over function. The back (or rather trunk) should be strong and have good endurance in a dynamic manner. Core exercises such as ‘the plank’ do little to protect the back from the rigors of rowing demands. Trunk exercises should improve the endurance of back muscles whilst moving through rowing specific movements with lots of dynamic activity, thus allowing fluid ‘stability’. An example of this type of exercise would be a dorsal raise at the end of a bench which hinges from the hips, lifting the trunk up and down. Reformer Pilates are also effective as they demand dynamic movement as well as stability exercise.

 

  1. Does it matter if I scull or sweep when it comes to back injury?

 In theory, the lower back is more at risk when twisting is added to lifting (as in sweep rowing), but there is only weak evidence that sweep rowing is higher risk than sculling. There may be multiple factors associated with this beyond rowing. Learning to be a good single sculler means that the rower has a good feel for correct technique, compared to sweep rowing in a larger boat such as an eight where technical errors may be more easily forgiven. Of course, it is useful to be able to row on both sides as years of rowing on one side can eventually cause changes in muscle development, making one side of the trunk stronger and sometimes causing some curving of the spine. A simple answer is that it is optimal for everyone to learn in a sculling boat.  Whilst there may be some increased risk, juniors should place a strong emphasis on sculling rather than sweep rowing, especially while the spine is still growing.

 

  1. What are some basic things I can do to prevent injury to the back?

 Learn and adopt good technique, both in the boat and the gym. If possible, fit in some sculling to improve technique and ‘feel’ for good movement. Avoid long ergometer sessions where possible and never use the ergo to warm up for a weights session. Do not do a weights session after a long rowing session when you may be fatigued. Ensure that your hip mobility is really good. You should be able to do a full squat keeping your heels down and without your bottom tucking underneath you as you squat downwards. Do some good quality trunk strengthening which involves flowing movements. Avoid exercises like ‘the plank’ with its isometric holding; you would not expect to improve your leg drive at the catch by holding a deep squat for a few minutes! A really basic piece of advice is to rest when fatigued (within reason!) and to optimize recovery. There is some very interesting research emerging about how good sleep quality reduces injury risk.

 

  1. Stretching is often quoted as crucial to preventing injury and strain. What are the best back/core stretches?

 Particular muscle groups are implicated during back injuries. The hips need to be really mobile and a lot of stretching around this joint is really crucial. Some yoga positions, such as the pigeon stretch, can be useful; this calls for a really good range of hip movement, but we are beginning to understand that this is important. Good hamstring length is equally important and this allows a good position of the pelvis in the boat. The ability to lift the chest up means that the upper back needs to be mobile; sometimes rowers can become stiff or ‘kyphosed’. Again, yoga can be good at stretching the whole spine. The body can be quite a finely tuned machine and if one area is stiff, another area can ‘over move’ or become overloaded to compensate.

 

  1. How damaging can back injuries be to rowing, and wider life?

 Low back pain is an extremely common problem in the general population, so many rowers would have been likely to sustain an episode of low back pain whether they had rowed or not. The good news around rowing and low back pain is that the vast majority of injuries will recover very well and the health benefits of the exercise involved in rowing will afford lifelong payback. The bad news is orientated around poorly managed low back pain. Rowers should seek advice from well recommended, properly qualified clinicians. Treatment should be based around exercise and active management. Manipulation of the spine or other alternative treatments are very unlikely to be appropriate and are not based on evidence. Surgery and injections are rarely needed. Sometimes a period of rest is really important and, if you are being told to do this, it is important to follow this advice. A graduated return to training following very good rehabilitation is important. For most rowers other than internationals (who generally have excellent medical staff support), rowing is for recreation and conservation; following good medical advice will ensure that back pain does not affect the rest of your life.

 

 

Fiona Wilson

Fiona Wilson is a Chartered Physiotherapist and Assistant Professor in the School of Medicine, Trinity College Dublin. She has over 25 years experience in clinical and research medicine, specialising in sports and exercise. She is an ex-rower and has worked in international rowing for over 20 years as physiotherapist to the South African Team and later as Lead Physiotherapist for Rowing Ireland for over 10 years. Her research has specialised in rowing injuries; in particular low back pain and she has published widely in this area. She led a special rowing edition of the British Journal of Sports Medicine and presented her low back pain work at the 2015 World Rowing Championships medical meeting. She is passionate about disseminating evidence based injury advice/information to the rowing community.

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