"There's definitely something wrong but we just don't know what it is": A qualitative study exploring rowers' understanding of low back pain.

OBJECTIVES: Low back pain is highly prevalent in rowing and can be associated with significant disability and premature retirement. A previous qualitative study in rowers revealed a culture of concealment of pain and injury due to fear of judgement by coaches or teammates. The aim of this study was to explore rowers' perspectives in relation to diagnosis, contributory factors, and management of low back pain. DESIGN: Qualitative secondary analysis. METHODS: We conducted a secondary analysis of interview data previously collected from 25 rowers (12 in Australia and 13 in Ireland). A reflexive thematic analysis approach was used. RESULTS: We identified three themes: 1) Rowers attribute low back pain to structural/physical factors. Most rowers referred to structural pathologies or physical impairments when asked about their diagnosis. Some participants were reassured if imaging results helped to explain their pain, but others were frustrated if findings on imaging did not correlate with their symptoms. 2) Rowing is viewed as a risky sport for low back pain. Risk factors proposed by the rowers were primarily physical and included ergometer training, individual technique, and repetitive loading. 3) Rowers focus on physical strategies for the management and prevention of low back pain. In particular, rowers considered stretching and core-strengthening exercise to be important components of treatment. CONCLUSIONS: Rowers' understanding of low back pain was predominantly biomedical and focused on physical impairments. Further education of rowers, coaches and healthcare professionals in relation to the contribution of psychosocial factors may be helpful for rowers experiencing low back pain.

Estimation of vertical ground reaction force parameters during athletic tasks using 2D video.

BACKGROUND: Given that elevated vertical ground reaction forces (vGRF) have been reported to contribute to various lower-extremity injuries, there is a need for a practical method to characterize movement behavior that is representative of elevated impact forces. RESEARCH QUESTION: Can images obtained from 2D video be used to predict vGRF parameters during athletic tasks? Specifically, we sought to determine whether the 2D thigh angle obtained at peak knee flexion could be used to predict the peak vGRF and vGRF impulse during single limb and double limb landings and movements that involve a change of direction. METHODS: 2D sagittal plane video and vGRFs were obtained simultaneously from 39 participants (15 males and 24 females) during 5 athletic tasks (drop jump, lateral shuffle, deceleration, triple hop, side-step-cut). Linear regression analysis was performed to determine if the 2D thigh angle at peak knee flexion predicted the first peak of the vGRF and vGRF impulse during the deceleration phase of each task. RESULTS: The 2D thigh angle predicted the peak vGRF for all tasks except cutting (R2 = 0.17 to 0.47, all p < 0.01). However, the 2D thigh angle predicted the vGRF impulse for all 5 tasks (R2 = 0.13 to 0.39, all p < 0.025). SIGNIFICANCE: An increased 2D thigh angle (which is representative of increased hip and knee flexion) was able to predict lower peak vGRFs and vGRF impulse during athletic tasks. The 2D thigh angle is a potential clinical method to characterize movement behavior that may expose individuals to high impact forces.

Clinical Estimation of the Use of the Hip and Knee Extensors During Athletic Movements Using 2D Video.

Given that increased use of the knee extensors relative to the hip extensors may contribute to various knee injuries, there is a need for a practical method to characterize movement behavior indicative of how individuals utilize the hip and knee extensors during dynamic tasks. The purpose of the current study was to determine whether the difference between sagittal plane trunk and tibia orientations obtained from 2D video (2D trunk-tibia) could be used to predict the average hip/knee extensor moment ratio during athletic movements. Thirty-nine healthy athletes (15 males and 24 females) performed 6 tasks (step down, drop jump, lateral shuffle, deceleration, triple hop, and side-step-cut). Lower-extremity kinetics (3D) and sagittal plane video (2D) were collected simultaneously. Linear regression analysis was performed to determine if the 2D trunk-tibia angle at peak knee flexion predicted the average hip/knee extensor moment ratio during the deceleration phase of each task. For each task, an increase in the 2D trunk-tibia angle predicted an increase in the average hip/knee extensor moment ratio when adjusted for body mass (all P < .013, R2 = .17-.77). The 2D trunk-tibia angle represents a practical method to characterize movement behavior that is indicative of how individuals utilize the hip and knee extensors during dynamic tasks.

'You're the best liar in the world': a grounded theory study of rowing athletes' experience of low back pain.

OBJECTIVES: Low back pain (LBP) is common in rowers and leads to considerable disability and even retirement. The athlete voice can help clinicians to better understand sport-related pain disorders. We aimed to capture the lived experience of LBP in rowers. METHODS: Cross-sectional qualitative study using a grounded theory approach. Adult competitive rowers with a rowing-related LBP history were recruited in Australia and Ireland. Data were collected through interviews that explored: context around the time of onset of their LBP and their subsequent journey, experiences of management/treatment, perspectives around present beliefs, fears, barriers and expectations for the future. RESULTS: The 25 rowers (12 women/13 men) who participated were aged 18-50 years; they had a mean 12.1 years of rowing experience. They discussed a culture of concealment of pain from coaches and teammates, and fear of being judged as 'weak' because of the limitations caused by LBP. They reported fear and isolation as a result of their pain. They felt that the culture within rowing supported this. They reported inconsistent messages regarding management from medical staff. Some rowers reported being in a system where openness was encouraged-they regarded this a leading to better outcomes and influencing their LBP experience. CONCLUSIONS: Rowers' lived experience of LBP was influenced by a pervasive culture of secrecy around symptoms. Rowers and support staff should be educated regarding the benefits of early disclosure and rowers should be supported to do so without judgement.

Rowers with a recent history of low back pain engage different regions of the lumbar erector spinae during rowing.

OBJECTIVES: Despite the high prevalence of low back pain (LBP) in rowers, there are few studies investigating changes in lumbar muscle activation in rowers with a recent history of LBP. Such knowledge is relevant to understand potential mechanisms contributing to the maintenance and recurrence of LBP in rowers. For the first time, we evaluate the spatial distribution of erector spinae (ES) activity in rowers with and without a recent history of LBP, using a novel application of high-density surface electromyography (HDEMG). DESIGN: Cross-sectional study. METHODS: Asymptomatic rowers (N=10) and rowers with a recent history of LBP (N=8) performed 7×4-min exercise bouts (rowing ergometer) until volitional exhaustion. HDEMG signals were acquired bilaterally over the lumbar ES and the root mean square (RMS) amplitude and entropy were analyzed. In addition, the y-axis coordinate of the barycentre (RMS-map) was used to assess changes in ES spatial activation. RESULTS: As the load increased, rowers with LBP showed higher amplitude (p<0.01) and less complexity (entropy) of the HDEMG signals (p<0.001). In addition, rowers with LBP showed opposite displacements of the barycentre, specifically showing a caudal shift of muscle activity at high intensities (p<0.001). CONCLUSIONS: Both the magnitude of activation and distribution of ES activity were altered in rowers with a recent history of LBP. The lower complexity of signals together with the caudal displacements of the barycentre suggest an inefficient recruitment of the ES as the load progressed. Modification of the rowing technique in conjunction with feedback from HDEMG might prove useful in future studies.