Consensus statement for preventing and managing low back pain in elite and sub-elite adult rowers

Background: Low back pain (LBP) is the most frequently reported musculoskeletal disorder, and can result in long term pain and disability. Rowing is a sport associated with large volumes of training and high cumulative loading of the lumbar spine. The most frequently reported site of pain for rowers is the low back. Recent research has focused on epidemiology and biomechanical analyses to understand mechanisms that contribute to LBP onset. There has been a limited focus on management or prevention strategies. There are currently no guidelines for managing LBP in rowers or in athletes who participate in other sports. There are guidelines for managing LBP in the general population. While many principles of management are transferable, there is a need to consider issues that are particular to rowers. We aimed to synthesise evidence on low back pain (LBP) in adult rowers and to create a consensus statement to inform clinical practice. Methods: There were five key steps to develop the management guideline. In step one, seven expert clinicians and researchers examined current evidence, and identified five sections that comprised the scope of the consensus statement: epidemiology; biomechanics; management; the athlete’s voice and clinical expertise. In step two, working groups were established for each section of the consensus statement to discuss and summarise key issues relevant to their section. In step three, the evidence from each group was synthesised to create the overall consensus statement. In step four, modified Delphi processes were used to create summaries and recommendations. In step five, information from the consensus statement and that from a survey of clinical experts were combined to produce the management guideline. Results: The scope of the consensus statement included epidemiology, biomechanics, management, the athlete’s voice and clinical expertise. Prevention and management of LBP in rowers include education on risk factors, rowing biomechanics and training load. If treatment is needed, non-invasive management, including early unloading from aggravating activities, effective pain control and exercise therapy. Fitness should be maintained with load management and progression to full training and competition. The role of surgery is unclear. Management should be athlete focused and a culture of openness within the team encouraged. Discussion: Recommendations are based on current evidence and consensus and aligned with international LBP guidelines in non-athletic populations, but with advice aimed specifically at rowers. We recommend that research in relation to aspects of prevention and management of LBP in rowers be intensified. Conflict of Interest Statement: All authors acknowledge no conflict of interest relevant to the submission of this abstract.