Clinical management of acute low back pain in elite and sub-elite rowers. A Delphi study of experienced & expert clinicians

      Background: The lumbar spine is the most frequently reported site of pain in elite and sub-elite rowing populations with 12-month Low Back Pain (LBP) prevalence of 32-53%. LBP results in significant performance cost through lost training and competition time. There are no studies to date on LBP assessment or management in this population. Collection of insights and development of consensus-derived statements are particularly useful where evidence-based clinical practice guidelines are yet to be established. The aim of this study was to establish assessment and management behaviours and beliefs of experienced and expert clinicians when elite and sub-elite rowers present with an acute episode of LBP; secondly, to investigate how LBP management differs for developing and masters rowers.
      Methods: A three round Delphi survey method was used. National rowing federation clinicians participated in an internet-based survey (round one), answering open ended questions about assessment and management of rowing related LBP. Statements were generated from the survey for expert clinicians to rate (round two) and re-rate (round three). Consensus was gained when agreement reached a mean of seven out of ten and disagreement was two standard deviations or less.
      Results: Thirty-one experienced clinicians participated in round one. Thirteen of 20 invited expert clinicians responded to round two (response rate 65%) and 12 of the 13 participated in round three (response rate 92%). One hundred and fifty nine of 221 statements (72%) relating to the management of LBP in elite and sub-elite rowers acquired consensus status. Four of six statements (67%) concerning the developing rower and two of four (50%) concerning masters rowers acquired consensus status.
      Discussion: This Delphi survey presents consensus-derived statements to guide clinical assessment and management of LBP in elite and sub-elite rowers from first presentation to return to sport (RTS). Results concur with evidence for adult LBP management: education and remaining active are recommended with less emphasis on imaging, pharmacological interventions and surgery. Initial priorities are; identification of red & yellow flags, pain control, keeping active with cross-training, regaining rowing-specific movement patterns and education of rower and coach. Rehabilitation priorities are; increasing on-water training with concomitant reduction in cross-training, multidisciplinary RTS planning and addressing modifiable risk factors. There are different management considerations for LBP in developing and masters rowers. The findings of this study are a representation of current clinical expertise.
      Conflict of Interest Statement: All authors acknowledge no conflict of interest relevant to the submission of this abstract.