The relationship between rowing-related low back pain and rowing biomechanics: a systematic review

Assessment of Self-report, Palpation, and Surface Electromyography Dataset During Isometric Muscle Contraction

Measuring muscle fatigue involves assessing various components within the motor system. While subjective and sensor-based measures have been proposed, a comprehensive comparison of these assessment measures is currently lacking. This study aims to bridge this gap by utilizing three commonly used measures: participant self-reported perceived muscle fatigue scores, a sports physiotherapist's manual palpation-based muscle tightness scores, and surface electromyography sensors. Compensatory muscle fatigue occurs when one muscle group becomes fatigued, leading to the involvement and subsequent fatigue of other muscles as they compensate for the workload. The evaluation of compensatory muscle fatigue focuses on nine different upper body muscles selected by the sports physiotherapist. With a cohort of 30 male subjects, this study provides a valuable dataset for researchers and healthcare practitioners in sports science, rehabilitation, and human performance. It enables the exploration and comparison of diverse methods for evaluating different muscles in isometric contraction.

The acute effects of kinesio-taping on movement kinematics and muscle co-activation in rowing athletes

BACKGROUND

Rowing-related low back disorders may occur from inconsistent technique, high trunk flexion and training volumes, overactivation of paraspinal muscles, and fatigue.

OBJECTIVE

To examine if kinesiology tape (KT) affixed to the trunk dorsum affects muscular co-activation and neuromuscular control to limit dangerous rowing movements and associated injuries.

METHODS

Participants (n= 18) completed two 2000 m rowing trials under BASELINE and KT conditions. KT was applied to the skin superficial to the paraspinals bilaterally with 60% pre-strain. Participants were instructed to minimize any sensation of tension. Whole body kinematics were obtained using inertial measurement units (IMUs), and surface electromyograms (EMGs) were recorded from trunk and lower extremity. Changes in joint range-of-motion (ROM) and co-activation indices (CAIs) were analyzed for shoulder, lumbar, hip, and knee.

RESULTS

Responding participants (n= 5) were identified by reduced maximum lumbar flexion during the KT condition. As expected, significant differences occurred in maximum and minimum lumbar flexion/extension between responders and non-responders to KT. Additionally, there was significant reduction in mean trunk muscle co-activation in both those who did and did not respond to KT through reductions in maximum lumbar flexion.

CONCLUSION

KT can be an effective at reducing mean trunk co-activation during a rowing trial in the flexed catch position. Variable responses suggest that further work is necessary to optimize the efficacy of sensory cues derived from KT during rowing movements.

Advanced muscle imaging in adolescent elite rowers utilizing diffusion tensor imaging: Association of imaging findings with stroke typology

PURPOSE

Muscular overuse injuries are a common health issue in elite athletes. Changes in the muscular microenvironment can be depicted by Diffusion Tensor Imaging (DTI). We hypothesize that the biomechanics of different stroke typologies plays a role in muscle injury and tested our hypothesis by magnetic resonance imaging (MRI) examination of the lumbar spine muscles of adolescent rowers utilizing DTI.

METHODS AND MATERIALS

Twenty-two male elite rowers (12 sweep, 10 scull rowers) with a mean age of 15.8 ± 1.2 years underwent 3-Tesla MRI of the lumbar spine 6 hours after cessation of training. Apparent diffusion coefficient (ADC) and fractional anisotropy (FA) were calculated for the erector spinae and multifidus muscle. Student's t-test was used to test differences of DTI parameters between sweep and scull rowers and a Pearson correlation was utilized to correlate the parameters to training volume.

RESULTS

ADC values in the erector spinae and multifidus muscle were significantly higher (p = 0.039) and FA values significantly lower (p < 0.001) in sweep rowers compared to scull rowers. There was no significant association between DTI parameters and training volume (r ≤ -0.459, p ≥ 0.074).

CONCLUSIONS

Our DTI results show that lumbar spine muscle diffusivity is higher in sweep rowers than in scull rowers. Altered muscle diffusivity is suggestive of microscopic tissue disruption and might be attributable to biomechanical differences between stroke typologies.

Low back pain in adolescent rowers: Association to muscle changes detected by magnetic resonance imaging

Adult elite rowers are at risk of developing low back pain (LBP). However, LBP data on adolescent elite rowers is currently insufficient. Therefore, the aim of this study was to assess LBP prevalence, LBP intensity and training characteristics in male adolescent elite rowers and a healthy control group. Twenty rowers (mean age 15.8 ± 1.2 years) and a non-athletic control group matched by age and gender (n = 13) were prospectively enrolled and underwent LBP assessment with a validated questionnaire and magnetic resonance imaging (MRI) of the lumbar spine muscles, which included a T2-mapping sequence. From the quantitative image data, T2 relaxation times were calculated. The prevalence of LBP in the last 24 hours and 3 months in the rowing group was 55.0% and 85.0%, respectively, compared to 23.1% and 30.8% in the control group (p < 0.001). Rowers had significantly longer T2 relaxation times of the paraspinal muscles compared to controls (p ≤ 0.041). LBP intensity was associated with longer T2 relaxation times (p < 0.001). Adolescent rowers had a higher prevalence of LBP compared to an age-matched control group. The observed increase in T2 relaxation might be explained by muscle soreness due to strenuous exercise, which is correlated with short-term pain intensity.

"A feeling for run and rhythm": coaches' perspectives of performance, talent, and progression in rowing

The understanding of rowing performance has been predominantly gained through quantitative sports science-based research. In combination with this objective information, coaches' experiences may provide important contextual information for how this quantitative evidence is implemented into training programmes. The aims of this study were to (1) explore coaches' perspectives of performance indicators for competitive rowing in junior rowers, and (2) identify coaches' recommendations for developing effective technique and movement competency among junior rowers who have the potential to transition to elite competition. Twenty-seven semi-structured interviews were conducted with experienced rowing coaches through purposive sampling of an accredited coaching network. Participants' coaching experience ranged from 5 to 46 (M = 22, SD = 10) years. Data were analysed using thematic analysis. Three overarching themes were identified including, (1) getting the basics right, (2) targeting types of talent, and (3) complexities of performance. Based on these findings, sequence and boat feel, supported through the movement competency provided by hip flexibility and the trunk musculature, were considered critical for executing correct technique. Developing talent and understanding successful performance are both complex concepts when considering the individual athlete. Coaches' perspectives provided insight into key components of performance to enhance our understanding of how to better develop junior rowers.

Kinematics of Cervical Spine during Rowing Ergometer at Different Stroke Rates in Young Rowers: A Pilot Study

Background: Research on biomechanics in rowing has mostly focused on the lumbar spine. However, injuries can also affect other body segments. Thus, the aim of this pilot study was to explore any potential variations in the kinematics of the cervical spine during two different stroke rates on the rowing ergometer in young rowers. Methods: Twelve young rowers of regional or national level were recruited for the study. The experimental protocol consisted of two separate test sessions (i.e., a sequence of 10 consecutive strokes for each test session) at different stroke rates (i.e., 20 and 30 strokes/min) on an indoor rowing ergometer. Kinematics of the cervical spine was assessed using an inertial sensor capable of measuring joint ROM (angle of flexion, angle of extension, total angle of flexion–extension). Results: Although there were no differences in the flexion and total flexion–extension movements between the test sessions, a significant increase in the extension movement was found at the highest stroke rate (p = 0.04, d = 0.66). Conclusion: Young rowers showed changes in cervical ROM according to stroke rate. The lower control of the head during the rowing stroke cycle can lead to a higher compensation resulting in an augmented effort, influencing sports performance, and increasing the risk of injury.

Patterns of Intervertebral Disk Alteration in Asymptomatic Elite Rowers: A T2* MRI Mapping Study

Background:

Repetitive loading of the back puts elite rowers at risk for acute and chronic back injuries.

Hypothesis:

That asymptomatic elite rowers would demonstrate characteristic intervertebral disk (IVD) alterations on T2* magnetic resonance imaging (MRI) mapping compared with asymptomatic nonrowers.

Study Design:

Cross-sectional study; Level of evidence, 3.

Methods:

This study included 20 asymptomatic elite rowers (mean age, 23.4 ± 3.03 years; 9 women, 11 men) studied at 2 different times, once before (t₁) and once after (t₂) the competition phase. MRI including T2* mapping was performed on a 3-T scanner. The authors derived normative T2* data from a previous study on 40 asymptomatic volunteers (20 men, 20 women) who were not competitive rowers; based on complete T2* data sets, 37 controls were included. T2* values were compared between groups in 4 lumbar IVDs, and midsagittal T2* values were compared in 5 zones: anterior annulus fibrosus (AF), anterior nucleus pulposus (NP), central NP, posterior NP, and posterior AF. The Pfirrmann grade was used for morphological assessment of disk degeneration. Statistical analysis was conducted using the Mann-Whitney U test, Wilcoxon matched-pairs test, and Spearman rank correlation coefficient.

Results:

Lower T2* values were noted in the rower group compared with the controls (37.08 ± 33.63 vs 45.59 ± 35.73 ms, respectively; P < .001). The intersegmental comparison revealed lower mean T2* values among rowers (P ≤ .027 for all). The interzonal comparison indicated significantly lower mean T2* values for the rowers in all zones except for the anterior NP (P ≤ .008 for all). Lower mean T2* values were observed for the rowers at t₁ versus t₂ (39.25 ± 36.19 vs 43.97 ± 38.67 ms, respectively; P = .008). The authors noted a higher level of IVD damage according to Pfirrmann assessment in the rower cohort (P < .001); the Pfirrmann grade distributions of rowers versus controls, respectively, were as follows: 51.3% versus 73.7% (grade 1), 20.5% versus 19.5% (grade 2), 21.8% versus 6.8% (grade 3), 5.1% versus 0% (grade 4), and 1.3% versus 0% (grade 5). The authors also noted a correlation between low T2* and high Pfirrmann grade at t₁ (r =–0.48; P < .001) and t₂ (r =–0.71; P < .001).

Conclusion:

The cohort of elite rowers revealed more degenerative IVD changes compared with controls. The T2* values suggest that repetitive loading of the spine has demonstrable short-term and possibly permanent effects on the lumbar IVD.

The validity of using inertial measurement units to monitor the torso and pelvis sagittal plane motion of elite rowers

In elite sport, inertial measurement units (IMUs) are being used increasingly to measure movement in-field. IMU data commonly sought are body segment angles as this gives insights into how technique can be altered to improve performance and reduce injury risk. The purpose of this was to assess the validity of IMU use in rowing and identify if IMUs are capable of detecting differences in sagittal torso and pelvis angles that result from changes in stroke rates. Eight elite female rowers participated. Four IMUs were positioned along the torso and over the pelvis of each athlete. Reflective markers surrounded each IMU which were used to compute gold-standard data. Maxima, minima, angle range and waveforms for ten strokes at rates of 20, 24, 28 and 32 strokes per minute were analysed. Root mean square errors as a percentage of angle range fell between 1.44% and 8.43%. In most cases when significant differences (p < 0.05) in the angles were detected between stroke rates, this was observed in both IMU and gold-standard angle data. These findings suggest that IMUs are valid for measuring torso and pelvis angles when rowing and are capable of detecting differences that result from changes in stroke rate.

The Sagittal Integral Morphotype in Male and Female Rowers

The goal of this study was to describe the integrated spinal assessment of the sagittal morphotype in rowers to determine whether the intense practice of rowing causes a modification of the sagittal curvatures of the spine, its relationship with the rowing technique, and training background. The second goal was to analyse how the dorsal and lumbar curves behave in the three phases of the rowing gesture, and to determine which phases can be detrimental to the correct development of the spine during growth. We analysed the spine curvatures in the sagittal plane of 29 females and 82 males, which were measured with an inclinometer in standing, slump sitting, maximal trunk flexion and during rowing performance. The average value of thoracic kyphosis in the rowers was 30° (mean, 30 + 8.27°). Thoracic hyperkyphosis was found in only two rowers (1.8%). Lumbar lordosis was within normal range in 84.1% of the males (mean, 27 + 9.57°) and 75.9% of female rowers (mean, 33°). Functional thoracic hyperkyphosis was observed in 57.4% of the males and 17.1% of the females. Functional lumbar hyperkyphosis was observed in 28 of the 69 males (40.5%) and five of 22 females (17.2%). Rowing seems to provide adequate spine alignment in the sagittal plane on standing. The integrated spinal assessment of the sagittal morphotype showed that half or our rowers presented with functional thoracic hyperkyphosis, and 43.2% presented with functional lumbar hyperkyphosis. Spine behaviour during the rowing technique shows that the thoracic kyphosis (98.2%) and lumbar spine (91%) perform within normative ranges and could explain the adequate positioning of the spine in the sagittal plane on standing. Years of rowing training tend to reduce thoracic kyphosis in males.

The Calculation, Thresholds and Reporting of Inter-Limb Strength Asymmetry: A Systematic Review

The prevalence of inter-limb strength differences is well documented in the literature however, there are inconsistencies related to measurement and reporting, and the normative values and effects associated with inter-limb asymmetry. Therefore, the aims of this systematic review were to: 1) assess the appropriateness of existing indices for the calculation of asymmetry, 2) interrogate the evidence basis for literature reported thresholds used to define asymmetry and 3) summarise normative levels of inter-limb strength asymmetry and their effects on injury and performance. To conduct this systematic review, scientific databases (PubMed, Scopus, SPORTDiscus and Web of Science) were searched and a total of 3,594 articles were retrieved and assessed for eligibility and article quality. The robustness of each identified asymmetry index was assessed, and the evidence-basis of the identified asymmetry thresholds was appraised retrospectively using the references provided. Fifty-three articles were included in this review. Only four of the twelve identified indices were unaffected by the limitations associated with selecting a reference limb. Eighteen articles applied a threshold to original research to identify "abnormal" asymmetry, fifteen of which utilised a threshold between 10-15%, yet this threshold was not always supported by appropriate evidence. Asymmetry scores ranged between and within populations from approximate symmetry to asymmetries larger than 15%. When reporting the effects of strength asymmetries, increased injury risk and detriments to performance were often associated with larger asymmetry, however the evidence was inconsistent. Limitations of asymmetry indices should be recognised, particularly those that require selection of a reference limb. Failure to reference the origin of the evidence for an asymmetry threshold reinforces doubt over the use of arbitrary thresholds, such as 10-15%. Therefore, an individual approach to defining asymmetry may be necessary to refine robust calculation methods and to establish appropriate thresholds across various samples and methodologies that enable appropriate conclusions to be drawn.

Low back pain prevalence and risk factors in Italian adolescent male soccer players: results from an online survey

OBJECTIVE

The purpose of this retrospective survey was to analyse the prevalence of low back pain (LBP) among Italian adolescent soccer players, and to identify potential risk factors.

METHODS

Participants were requested to answer an online survey based on the standardized Nordic questionnaires for musculoskeletal symptoms.

RESULTS

Data were obtained from 204 male soccer players aged 14-17 years competing at the national and regional level. More than half of the players had experienced LBP in their lives. One-way ANOVA revealed that the players with LBP were taller, heavier and with a higher BMI (all p values<0.00001). When considering the playing position, ANOVA revealed that 14-15 years-old strikers displayed higher LBP scores than all other roles (all p values<0.05). Accordingly, strikers were exposed to a higher risk of LBP than midfielders (RR=1.48; 95%CI:1.10-2.01; p=0.01) and goalkeepers (RR=1.48; 95%CI:1.02-2.971; p=0.04), but not defenders (RR=1.23; 95%CI:0.93-1.63; p=0.15). Within the 14-15 age-class, strikers were, again, those most exposed to LBP risk (all p values<0.05).

CONCLUSIONS

Anthropometric and soccer-related features should be monitored to ensure early identification of potential risk factors for LBP. This information should be considered along with the specific playing position as strikers emerged as the roles most exposed to LBP risk.

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.