LOWER BACK PAIN

Andrew DarceySports Physiotherapist

Andrew Darcey

Overview

• Prevalence• Risk Factors• Cause of Pain• Hip Range / Posture• Management• Prevention

LOWER BACK PAIN• Elite Rowers

– Lower Back Pain (LBP), rib, wrist/forearm

LOWER BACK PAIN• School/Club Rowers

– LBP (Verrall and Darcey 2014)

• Elite: male>female• Junior: female>male• Low back pain is common in developing

rowers

LOWER BACK PAIN

• Lifetime prevalence in school age normals 45-50%, with 20-40% sore at any one time

• In rowers of a similar age – significantly higher lifetime and point prevalence – ARE WE LOSING A LOT OF ROWERS AT A YOUNG AGE TO LOWER BACK PAIN?

• Elite level – figures seem better than population norms

LOWER BACK PAIN• Common in General Population

– 60-80% of adults will have an episode of LBP– At any one time, 30% adults have LBP– Adolescents – 20% have had LBP by 16yo

• Ex-College Rowers Study (USA)– 50% have LBP after College– 32% have LBP at any one time– 2 x more likely to have LBP if had LBP in

College (>1wk) • If rower completes college rowing

without LBP, prognosis for LBP in later life BETTER than population

RISK FACTORS• Repeated Lx flexion, high training

volume (Adams & Dolan 1995, McNair 2000, McGregor et al 2007)

• Habitual sitting posture (Perich et al 2006)

• Deficits in lumbo-pelvic motor control (McGregor et al 2002)

• Limitations in anterior pelvic tilt(Reid & McNair 2000, Caldwell et al 2003, McGregor et al 2007)

• Deficits in back muscle & lower limb endurance (Roy et al 1990, Perich et al 2009)

• Lack of hamstring flexibility (Gajdoski 1994, Reid & McNair 2000)

• Ergometer (Gajdoski 1994, Reid & McNair 2000)

WHY DO ROWERS GET LOW BACK PAIN?

WHAT CAUSES THE PAIN?

• Discy in Nature• Affects L4/5 and L5/S1 Disc the most

WHAT CAUSES THE PAIN?

• Discy in Nature• Affects L4/5 and L5/S1 Disc the most

WHAT CAUSES THE PAIN?

• Flexion causes compression front of disc, pushing nucleus posteriorly

WHAT CAUSES THE PAIN?

• Flexion causes compression front of disc, pushing nucleus posteriorly

WHAT CAUSES THE PAIN?

WHAT CAUSES THE PAIN?

Increased flexion Lumbar Spine when Hips, Knees, Ankles are not flexible enough

WHY LACKING HIP FLEXION?

• FAI – Structural Change in Hip• Tight Hip Flexors• Tight Gluteals

WHY LACKING HIP FLEXION?

• FAI – Structural Change in Hip• Tight Hip Flexors• Tight Gluteals

WHY LACKING HIP FLEXION?

• FAI – Structural Change in Hip• Tight Hip Flexors• Tight Gluteals

WHAT CAUSES THE PAIN?

SWEEP ROWING

WHAT CAUSES THE PAIN?

FINISH POSITION

ROCK OVER & RECOVERY

• Hamstring flexibility & inner range hip flexor for APT• Optimal posture early - allow boat to move under• Aim - to not SLOW the boat down

ROCK OVER & RECOVERY

• Hamstring flexibility & inner range hip flexor for APT• Optimal posture early - allow boat to move under• Aim - to not SLOW the boat down

ROCK OVER & RECOVERY

• Hamstring flexibility & inner range hip flexor for APT• Optimal posture early - allow boat to move under• Aim - to not SLOW the boat down

ROCK OVER & RECOVERY

• Hamstring flexibility & inner range hip flexor for APT• Optimal posture early - allow boat to move under• Aim - to not SLOW the boat down

WHAT TO DO IF ATHLETE GETS LBP

WHAT TO DO IF ATHLETE GETS LBP

Recognise that whilst LBP is COMMON in rowers, it SHOULD

NOT BE TOLERATED

•Persistence of LBP can result in irreversible damage to spinal structures •Persistence of LBP results in changes in the brain & long term changes in pain sensitivity •Pain results in changes to how the trunk muscles & leg muscles are used when rowing & for ADLs

WHAT TO DO IF ATHLETE GETS LBP• What pain to worry about?

Sharp pain Pain that is getting increasingly

worse throughout a session Pain that persists after a session Pain > 48 hours

WHAT TO DO IF ATHLETE GETS LBP• Treatment

• Control pain Rest from activity Medication Hot packs/thermal braces Water/Pool sessions

WHAT TO DO IF ATHLETE GETS LBP• Treatment

Early intervention Use other training modalities (upright bike,

walk, swim) Unload – sometimes completely Manual therapy - treat above & below Consider warmth – thermoskin brace Consider active warmup Consider a test on the erg – 3x10min First session back – 8-10km paddle

PREVENTION• Stretching

PREVENTION• Warm-Up

PREVENTION• Core Stability

PREVENTION• Hamstring Flexibility

2 Mins – Once a Day

PREVENTION• Pelvic Rockover

Ability to tilt pelvis off the back of strokeAiming for 3 x 30reps

PREVENTION• Glute Flexibility

2 mins holds x 1/Day

PREVENTION• Sit to Stand

Trunk & Leg ConnectionPush Through HeelsDon’t Let Bottom PopRequires good Glute recruitment – Aim for 3 x 30reps

PREVENTION• Lateral Pelvic Control

Ability for pelvis to move independently from spineAbility to cope with boat moving under bodyAim for x 20 each side

PREVENTION• LOAD

• Look at how much your young rowers are doing• Senior Australian Rowers:

• 5-6 Rowing sessions per week• 2 Erg sessions per week• 2-3 Gym sessions per week• 2 Cross Training

• Are your Young Rowers doing more than this?

Rowing Musculoskeletal Screenings

• Flexibility– Ankles– Hips (Hamstrings, Hip Flexors, Gluteals)

• Thoracic/Lumbar Spine– Flexibility and Symmetry

• Scapula Control• Ergo Technique

Flexibility

• Important to allow:– Muscles to work at their optimal angles– Generate more force– Reduces strain on spinal structures– Allows better length of stroke

Hip FlexionHamstringsGluteals

Ankle DFCalves

Ergo Technique

• Hip Bunch up Catch:– Determined by flexibility of Spine, Hips, Knees and

Ankles

• Rockover:– Determined by strength of abdominals and hip

flexors, as well as flexibility of Hamstrings

RockoverAngle

Catch Angle

FinishAngle

Results

Colour CodedGreen: GoodYellow: Not Ideal – Needs WorkRed: Poor - Significantly Needs Work

Comment on Result of

Test

Exercises to Address any

weakness found

TAKE HOME MESSAGES

• LBP is common in school & club rowers • LBP is NOT normal & should not be

tolerated • Seek Medical / Physio assessment early • Ensure causative factors addressed

(Screening can help identify)• Ergometer rowing is ok if coached

technically

Questions?

FURTHER ADVICEContact:

Andrew DarceySport PhysiotherapistSASI Rowing PhysiotherapistAustralian Rowing Team Physiotherapist

76a Kensington Rd Western HospitalRose Park 168 Cudmore TceSA 5067 Henley Beach

SA 5022Ph: 8364 6800Email: andrew@lept.com.au