Get back in the boat fast! A guide to recover from rowing-related lower back pain

Research has shown that lower back pain is very common in rowers with 30-50% of rowers experiencing some type of lower back pain during a 12-month period. These injuries also account for 15-25% of all rowing injuries. This blog will discuss easy strategies that can help athletes to reduce their symptoms.

Let’s guide you through how we resolve lower back pain related to rowing here at Breathe using our Roadmap to Recovery:

• Step 1. Pain Reduction

• Step 2. Activation

• Step 3. Movement

• Step 4: Strengthening / Sports Performance

Pain reduction

Due to the repetitive nature of the sport, discogenic causes of back pain are more common, especially in younger athletes. Lower lumbar pain without radiation into the legs in conjunction with an absence of neurological findings normally indicates a central discogenic cause. However, herniation of discs can also cause symptoms down into the legs which is associated with longer return to sport times. Lower back pain in older athletes with a previous history of degenerative disc disease may be associated with the overloading of posterior elements and facet joints.

Despite lower back pain being common in the sport, there are easy approaches that athletes can take to help reduce the pain. In addition to pain reduction techniques such as soft tissue massage and stretching (particularly glutes, hamstrings and hip flexors), rowers and their coaches should ensure they are using the proper rowing technique.

Analysis of technique is crucial, ensuring emphasis on moving from the hips and not the lower back. The athlete’s spine should not be held rigidly straight. Rather, a relaxed ‘C’ shape forming a smooth arch allowing for even weight distribution. Figure 1 demonstrates this in 1a and 1b where the spine is one gentle curve with even distribution of flexion throughout its length. Conversely, 2a and 2b shows the spine in a flatter position with other areas of the back and very flexed or ‘kinked’ indicating an uneven distribution of forces which places the athlete at risk of injury. This is due to the overuse of the lumbar spine to create flexion rather than through an effective hip hinge. When this occurs repetitively under load, an overuse injury of discogenic origin is likely.

Figure 1. Technical analysis of rowing technique

A thorough clinical examination of the entire kinetic chain is important to determine a proper diagnosis and so that an individualised treatment plan can be formulated. However, lower back pain in rowers is usually caused by poor pelvic control, particularly when under fatigue. Rowers should flex through their hips and rock the trunk forward over their ‘sitting bones.’ This is particularly important in the transition from drive to recovery as it keeps the lower back in a neutral position. As fatigue sets in, there is a tendency to move through the lower back rather than the hips which loads the lower back unfavourably. Other key contributing factors to lower back pain in rowers include:

• reduced range of motion in the hip joints and muscles

• a sudden increase in training load

• poor recovery techniques between sessions

• rowing machine sessions >30 minutes

• previous lower back injuries.

In the early stages after lower back pain, ‘do no harm’ should be followed (Figure 2). There are no benefits from pushing through pain. In this phase, rowing should be replaced by other exercise or training which do not worsen symptoms (e.g. stationary bike). It is important for the rower to continue exercising in this phase, guided by their clinician. Pain relief medication may be helpful in pain reduction phase. This is because it can allow the athlete to return to normal movement patterns quicker.

Figure 2. Retrieved from: https://www.apemedical.com.au/initial-treatment-response/

Activation

On completion of the pain reduction phase, it is time to begin activating the muscles required to return to rowing. Management programs should be individually tailored to the athlete to identify the underlying issues which may have contributed to their pain (such as poor mobility or technique). Nevertheless, early muscle activation exercises should focus on the abdominals as well as regaining normal movement patterns of the hips and pelvis.

Some early activation exercises can include:

McGill’s ab curl: Requires rectus abdominus to contract and keep the spine in a neutral position.

Side plank: Complete on your toes or knees as able. This exercise is perfect to activate your external/internal obliques, transversus abdominus, gluteus medius/minimus and quadratus lumborum.

Rotational Control on Swiss ball: Brace your core to resist the rotational forces while moving your arms in and out. This will challenge all of the core muscles dynamically.

Hip Hinges: This exercise will encourage normal movement of the hip hinge. Brace your core.

Videos of these exercises:

Movement

Once the correct muscles have been activated, it is important to incorporate the rowing technique and biomechanics to reduce the stress on your lower back. This means a further focus on strengthening the muscles that assist with an effective hip hinge as well as the endurance of the trunk extensors.

Throughout this period, it is good to start short periods on the rowing machine, using a dynamic machine where possible. Start with 1 minute of light rowing and slowly build from there. In conjunction with the rowing machine, the following exercises may assist in your rehab:

Renegade rows: This exercise challenges the entire body, simultaneously activating muscles such as obliques, rhomboids, multifidus and triceps. Position yourself in a tall plank position, engage your core to keep a neutral spine then slowly lift one dumbbell up and down.

RDLs: The main muscles engaged when performing the RDL are the trapezius, forearm flexors, erector spinae, gluteus maximus, hamstrings (biceps femoris, semitendinosus and semimembranosus), adductor magus, and gastrocnemius. Keep your core engaged to keep a neutral spine throughout the hip hinging movement.

TRX Rows: This works the major muscles of the back such as the latissimus dorsi, rhomboids, trapezius, and rear deltoids with minimal stress to the lower back. Keep the core muscles engaged to avoid sagging as this will not allow for completion of the repetition.

Videos of these exercises:

Strengthening / Sports Performance

To avoid lower back pain in the future, it is important to continue weekly strength and conditioning sessions in addition to rowing sessions. These sessions should aim to continually progress your strength and mobility by focusing on dynamic movements which replicate the rowing technique (e.g., power cleans). Programs that incorporate the entire kinetic chain will have the most success in enhancing rowing performance and reducing further injury.

Reference:

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.

Wilson, F., Dr. (2016). Back pain in rowing – update on current understanding. Retrieved from https://bit.ly/3wKgMaD

Wilson, F., Gissane, C., & McGregor, A. (2014). Ergometer training volume and previous injury predict back pain in rowing; strategies for injury prevention and rehabilitation. British journal of sports medicine, 48(21), 1534-1537.

Yamashita, M., Ishida, T., Osuka, S., Watanabe, K., Samukawa, M., Kasahara, S., ... & Tohyama, H. (2023). Trunk Muscle Activities during Ergometer Rowing in Rowers with and without Low Back Pain. Journal of Sports Science & Medicine, 22(2), 3