2021 consensus statement for preventing and managing low back pain in elite and subelite adult rowers.

PURPOSE: To synthesise evidence on low back pain (LBP) in adult rowers and to create a consensus statement to inform clinical practice. METHODS: There were four synthesis steps that informed the consensus statement. In step one, seven expert clinicians and researchers established the scope of the consensus statement and conducted a survey of experienced and expert clinicians to explore current practice. In step two, working groups examined current evidence relating to key scope questions and summarised key issues. In step three, we synthesised evidence for each group and used a modified Delphi process to aid in the creation of the overall consensus statements. Finally, in step four, we combined information from step three with the findings of the clinician survey (and with athlete and coach input) to produce recommendations for clinical practice. 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 should 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 should be considered. 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. CONCLUSION: 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 all aspects of prevention and management of LBP in rowers be intensified.

Prevalence and risk factors for back pain in sports: a systematic review with meta-analysis.

OBJECTIVES: We aimed to determine the prevalence of low back pain (LBP) in sport, and what risk factors were associated with LBP in athletes. DESIGN: Systematic review with meta-analysis. DATA SOURCES: Literature searches from database inception to June 2019 in Medline, Embase, Cumulated Index to Nursing and Allied Health Literature (CINAHL), Web of Science and Scopus, supplemented by grey literature searching. ELIGIBILITY CRITERIA: Studies evaluating prevalence of LBP in adult athletes across all sports. RESULTS: Eighty-six studies were included (30 732, range 20-5958, participants), of which 45 were of 'high' quality. Definitions of LBP varied widely, and in 17 studies, no definition was provided. High-quality studies were pooled and the mean point prevalence across six studies was 42%; range 18%-80% (95% CI 27% to 58%, I2=97%). Lifetime prevalence across 13 studies was 63%; range 36%-88% (95% CI 51% to 74%, I2=99%). Twelve-month LBP prevalence from 22 studies was 51%; range 12%-94% (95% CI 41% to 61%, I2=98%). Comparison across sports was limited by participant numbers, study quality and methodologies, and varying LBP definitions. Risk factors for LBP included history of a previous episode with a pooled OR of 3.5; range 1.6-4.0 (95% CI 1.9 to 6.4). Statistically significant associations were reported for high training volume, periods of load increase and years of exposure to the sport. CONCLUSION: LBP in sport is common but estimates vary. Current evidence is insufficient to identify which sports are at highest risk. A previous episode of LBP, high training volume, periods of load increase and years of exposure are common risk factors.

The prevalence, incidence and severity of low back pain among international-level rowers.

BACKGROUND/AIMS: There is a paucity of prospective cohort studies investigating the incidence of low back pain (LBP) in rowing. We investigated (1) the prevalence and incidence of LBP among international-level rowers in New Zealand, (2) the relationship between training volume and LBP and (3) the effect of LBP on rowers' ability to train and compete. METHODS: This was a prospective cohort study of 76 New Zealand representative rowers, including 46 men (mean age 22, SD=4) and 30 women (mean age 21, SD=4). Data were collected using an online questionnaire repeated monthly for 12 months. RESULTS: The prevalence of LBP ranged from 6% to 25% throughout the year. The incidence of episodes of LBP was 1.67 per 1000 exposure-hours. A total of 72 episodes of LBP were reported by 40 rowers (53%) during 12 months. Of these, 45% had an incidental effect on training. 29% minor, 18% moderate and 9% had a major effect as determined by the length of time the training was interrupted. There was a high correlation between new LBP and total training hours per month (r=0.83, p<0.01). A previous history of LBP was a risk factor in developing new LBP (OR 2.06, 95% CI 1.22 to 3.48, p=0.01). Age was also a risk factor, with the likelihood of developing LBP increasing for every year (OR 1.08, 95% CI 1.01 to 1.15, p=0.02). CONCLUSIONS: LBP is common among New Zealand representative rowers. There is a high correlation between training load and the development of LBP.

A kinematic analysis of a strongman-type event: the heavy sprint-style sled pull.

This study sought to (a) characterize the kinematics aspects of a popular strongman-type event, the heavy sprint-style sled pull, and (b) gain some insight into the kinematic factors that could distinguish the within- and between-subjects' fastest and slowest trials. Six resistance-trained subjects with experience in the heavy sled pull gave informed consent to participate in this study. Subjects performed three 25-m sets of sled pulls with a load of 171.2 kg with 3 minutes of rest between sets. Kinematic variables were obtained from 2 video cameras positioned perpendicularly 11 m from the intended direction of the sled pull. Camera 1 recorded the first 5 m (acceleration phase) and Camera 2 recorded the last 5 m (maximum velocity phase). Effect sizes and paired and independent t-tests were used to determine the within- and between-subject effects, respectively, with significance set at p < 0.01. Heavy sled pulls shared many kinematic similarities to acceleration phase sprinting, although the sled pull had somewhat smaller step lengths and step rates, longer ground contact times, and a more horizontal trunk. Within- and between-subject analyses of the fastest and slowest trials typically revealed more significant differences in the maximum velocity than the acceleration phase. Although the fastest trials were often characterized by significantly greater step lengths, step rates, and shorter ground contact times, differences in the segment/joint angles were less consistent. Based on the impulse-momentum relationship, our results imply that greater anteroposterior forces/impulses were produced in the fastest sled pulls. Accordingly, the heavy sled pull may improve acceleration sprinting performance in many athlete types and the ability to break and make tackles in contact sports such as American football and the rugby codes.