Maximal sustainable energy intake during transatlantic ocean rowing is insufficient for total energy expenditure and skeletal muscle mass maintenance.

Studies of extreme endurance have suggested that there is an alimentary limit to energy intake (EI) of ∼2.5 × resting metabolic rate (RMR). To gain further insight, this study aimed to simultaneously measure EI, total energy expenditure (TEE) body mass and muscle mass in a large cohort of males and females of varying ages during a transatlantic rowing race. Forty-nine competitors (m = 32, f = 17; age 24-67 years; time at sea 46 ± 7 days) in the 2020 and 2021 Talisker Whisky Atlantic Challenge rowed 12-18 hday-1 for ∼3000 miles. TEE was assessed in the final week of the row using 2 H2 18 O doubly labelled water, and EI was analysed from daily ration packs over this period. Thickness of relatively active (vastus lateralis, intermedius, biceps brachaii and rectus abdominus) and inactive (gastrocnemius, soleus and triceps) muscles was measured pre (<7 days) and post (<24 h) row using ultrasound. Body mass was measured and used to calculate RMR from standard equations. There were no sex differences in males and females in EI (2.5 ± 0.5 and 2.3 ± 0.4 × RMR, respectively, P = 0.3050), TEE (2.5 ± 1.0 and 2.3 ± 0.4 × RMR, respectively, P = 0.5170), or body mass loss (10.2 ± 3.1% and 10.0 ± 3.0%, respectively, P = 0.8520), and no effect of age on EI (P = 0.5450) or TEE (P = 0.9344). Muscle loss occurred exclusively in the calf (15.7% ± 11.4% P < 0.0001), whilst other muscles remained unchanged. After 46 days of prolonged ultra-endurance ocean rowing incurring 10% body mass loss, maximal sustainable EI of ∼2.5 × RMR was unable to meet total TEE suggesting that there is indeed a physiological capacity to EI.

Respiratory problems in rowers: outcomes from a systematic assessment of an elite squad.

OBJECTIVES: To characterise the respiratory health of elite rowers using a systematic screening approach to assess respiratory health (SARAH) and identify the associations between SARAH findings and acute respiratory illness (ARI) and chest wall injury (CWI). METHODS: A systematic screening approach was conducted in a cohort of elite rowers. The assessment employed validated respiratory questionnaires and multiple physiological measures. An analysis of ARI and CWI incidence and burden from the 18 months before the SARAH assessment was conducted. RESULTS: Full respiratory surveillance was completed in 48 rowers (50% female, aged 27 [25-28] years). The incidence and burden of ARI were similar between male and female rowers. The incidence of CWI was greater in female rowers compared to males (1.6 versus 0.4 per 1000 athlete training days, respectively; incidence rate ratio of 4.3, 95% C.I. 1.5 to 12.2, p=0.005) and more common in younger rowers with greater lung function. SARAH detected at least one respiratory problem in 39 (81%) rowers, and two or more problems in 26 (54%). Sino-nasal problems (44%), allergy-related problems (42%) and breathing pattern disorder (42%) were the most prevalent problems identified. Exercise-associated cough was reported in 34 (71%) rowers, with objective evidence of asthma found in only five (10%). CONCLUSIONS: In elite rowers, respiratory problems, including ARI and CWI, are common and impact health. A systematic screening approach identifies multiple underlying respiratory problems, presenting the opportunity to optimise athlete health and improve training availability.

Wearable Multi-Sensor Positioning Prototype for Rowing Technique Evaluation.

The goal of this study is to determine the feasibility of a wearable multi-sensor positioning prototype to be used as a training tool to evaluate rowing technique and to determine the positioning accuracy using multiple mathematical models and estimation methods. The wearable device consists of an inertial measurement unit (IMU), an ultra-wideband (UWB) transceiver, and a global navigation satellite system (GNSS) receiver. An experiment on a rowing shell was conducted to evaluate the performance of the system on a rower's wrist, against a centimeter-level GNSS reference trajectory. This experiment analyzed the rowing motion in multiple navigation frames and with various positioning methods. The results show that the wearable device prototype is a viable option for rowing technique analysis; the system was able to provide the position, velocity, and attitude of a rower's wrist, with a positioning accuracy ranging between ±0.185 m and ±1.656 m depending on the estimation method.

Physiological and biomechanical responses to exercise on two different types of rowing ergometers in NCAA Division I oarswomen.

BACKGROUND: Stationary (SE) and dynamic (DE) rowing ergometers, that are utilized for indoor training and physical assessment of competitive rowers, may elicit different physiological and biomechanical responses. The present study used SE and DE ergometers to examine submaximal and peak physiological and biomechanical responses during an incremental rowing test. METHODS: Twelve National Collegiate Athletic Association (NCAA) Division I oarswomen performed seven-stage rowing tests with the last stage performed with maximal effort. Heart rate (HR), lactate (LA), oxygen uptake (VO2), ventilation (VE), stroke rate (SR), gross efficiency (GE), and rating of perceived exertion (RPE) were obtained; while trunk, hip, knee, shoulder, and elbow ranges of motion (ROM) were measured. RESULTS: SR was higher at maximal stage DE (29.3 vs. 34.8 strokes/min, p = 0.018, d = 1.213). No difference occurred in responses of maximal stage HR, RPE, VO2, VE, LA, or GE between the two ergometers. Submaximal LA and SR were greater on the DE for all submaximal stages. Submaximal VE was greater on the DE for all submaximal stages except Stage 3 (p = 0.160, d = 0.655). VO2 was higher on the DE Stages 2-5. GE was higher on the SE for Stages 2-5. Athletes showed increased trunk (p = 0.025, [Formula: see text] = 0.488) and knee (p = 0.004, [Formula: see text] = 0.668) ROM on SE. CONCLUSION: Rowing on the DE appears to elicit a greater stroke rate and more optimal joint angles especially at high intensities. Hence, the DE is worthy of consideration as a preferred ergometer for women rowers.

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 Wireless Rowing Measurement System for Improving the Rowing Performance of Athletes.

The rowing technique is a key factor in the overall rowing performance. Nowadays the athletes' performance is so advanced that even small differences in technique can have an impact on sport competitions. To further improve the athletes' performance, individualized rowing is necessary. This can be achieved by intelligent measurement technology that provides direct feedback. To address this issue, we developed a novel wireless rowing measurement system (WiRMS) that acquires rowing movement and measures muscle activity using electromyography (EMG). Our measurement system is able to measure several parameters simultaneously: the rowing forces, the pressure distribution on the scull, the oar angles, the seat displacement and the boat acceleration. WiRMS was evaluated in a proof-of-concept study with seven experienced athletes performing a training on water. Evaluation results showed that WiRMS is able to assess the rower's performance by recording the rower's movement and force applied to the scull. We found significant correlations (p < 0.001) between stroke rate and drive-to-recovery ratio. By incorporating EMG data, a precise temporal assignment of the activated muscles and their contribution to the rowing motion was possible. Furthermore, we were able to show that the rower applies the force to the scull mainly with the index and middle fingers.

Mental Effort in Elite and Nonelite Rowers.

Mental effort (intensity of attention) in elite sports has remained a debated topic and a challenging phenomenon to measure. Thus, a quasi-ecological laboratory study was conducted to investigate mental effort in elite rowers as compared with a group of nonelites. Findings suggest that eye-tracking measures-specifically, blink rates and pupil size-can serve as valid indicators of mental effort in physically demanding sport tasks. Furthermore, findings contradict the notion that elite athletes spend less cognitive effort than their lower-level peers. Specifically, elites displayed similar levels of self-reported effort and performance decrement with increasing mental load and significantly more mental effort overall as measured by pupil-size increase (relative to baseline) during rowing trials as compared with the nonelites in the sample. Future studies on eye tracking in sports may include investigations of mental effort in addition to selective attention during physically demanding tasks.

Effects of cycling and rowing on serum concentrations of prostate-specific antigen: A randomized study of 101 male subjects.

OBJECTIVE: To determine the effects if cycling and rowing on serum prostate-specific antigen (PSA) levels. METHODS: Male volunteers (n = 101), aged 20-80 (mean, 49.9) years were randomized to exercise at the first or second study visit. They performed 1 h of either cycling or rowing on a stationary machine. To determine exercise-induced effects on the PSA level, serum total PSA (tPSA) and free PSA (fPSA) concentrations were evaluated before and after exercise and another sampling was performed at the second study visit. Pre-exercise and postexercise tPSA and fPSA concentrations were compared using the Wilcoxon matched-pairs test. The results were analyzed using the Mann-Whitney U-test. RESULTS: A significant (p < 0.001) average increase in tPSA after exercise (1.14 ± 1.11 ng/ml to 1.24 ± 1.26 ng/ml [mean, +8.8%]) was observed after both cycling and rowing, without significant differences between the sports (p = 0.54). The exercise-induced increase in PSA concentration affected participants aged ≥50 years (difference, 0.16 ± 0.37; p < 0.001), but not those aged <50 years (difference, 0.01 ± 0.06; p = 0.23). The effect size was clinically irrelevant in all except two outliers, in whom a distinct increase of PSA level by averages of 1.80 ng/ml (+55%) for tPSA and 1.25 ng/ml (+227%) for fPSA following cycling was observed. CONCLUSION: Rowing and cycling generally do not have a clinically relevant effect on PSA levels. However, outliers exist. Our findings do not support abstaining from exercise during the days approaching PSA sampling.

Prediction of 2000-m on-water rowing performance with measures derived from instrumented boats.

PURPOSE: Rowing instrumentation systems provide measures of stroke power, stroke rate, and boat velocity during rowing races, but how well these measures predict race performance has not been reported previously. METHODS: Data were collected per stroke from 45 2000-m races using Peach PowerLine and OptimEye S5 GPS units. The boat classes assessed were nine male singles, eight female singles, three male pairs, and six female pairs. Random effects and residuals from general linear mixed modeling of stroke velocity adjusted for stroke power, stroke rate, and mean headwind provided measures interpreted as technical efficiency, race conditions, and stroke-velocity variability. These measures, along with mean race power, mean stroke rate, and mean headwind were then included in multiple linear regressions to predict race velocity from official race times. Effects were assessed for 2 SD changes in predictors and interpreted using interval hypothesis tests. RESULTS: Effects of mean race power, mean stroke rate, and mean headwind on race velocity ranged from small to extremely large and were mostly decisively substantial. Effects of technical efficiency and race conditions ranged from trivial to extremely large but were generally unclear, while stroke-velocity variability had trivial-small and mostly unclear effects. Prediction error was small to moderate and decisively substantial. Men's pairs lacked sufficient data for analysis. CONCLUSION: On-water rowing race performance can be predicted with mean race values of power, stroke rate, and headwind. Estimates from stroke data are potentially useful predictors but require impractical numbers of boats and races to reduce their uncertainty.

Effects of computer-aided rowing exercise systems on improving muscle strength and function in older adults with mild knee osteoarthritis: a randomized controlled clinical trial.

BACKGROUND: Osteoarthritis (OA) is common in aged adults and can result in muscle weakness and function limitations in lower limbs. Knee OA affects the quality of life in the elderly. Technology-supported feedback to achieve lower impact on knee joints and individualized exercise could benefit elderly patients with knee OA. Herein, a computer-aided feedback rowing exercise system is proposed, and its effects on improving muscle strength, health conditions, and knee functions of older adults with mild knee OA were investigated. METHODS: Thirty-eight older adults with mild knee OA and satisfying the American College of Rheumatology (ACR) clinical criteria participated in this randomized controlled clinical trial. Each subject was randomly assigned to a computer-aided rowing exercise (CRE) group (n = 20) or a control group (CON) (n = 18) that received regular resistance exercise programs two times per week for 12 weeks. Outcome measurements, including the Western Ontario and MacMaster Universities (WOMAC), muscle strength and functional fitness of the lower limbs, were evaluated before and after the intervention. RESULTS: Participants' functional fitness in the CRE group exhibited significantly higher adjusted mean post-tests scores, including the WOMAC (p = 0.006), hip abductors strength (kg) (MD = 2.36 [1.28, 3.44], p = 5.67 × 10-5), hip adductors strength (MD = 3.04 [1.38, 4.69], p = 0.001), hip flexors strength (MD = 4.01 [2.24, 5.78], p = 6.46 × 10-5), hip extensors strength (MD = 2.88 [1.64, 4.12], p = 4.43 × 10-5), knee flexors strength (MD = 2.03 [0.66, 3.41], p = 0.005), knee extensors strength (MD = 1.80 [0.65, 2.94], p = 0.003), and functional-reach (cm) (MD = 3.74 [0.68, 6.80], p = 0.018), with large effect sizes (η2 = 0.17-0.42), than those in the CON group after the intervention. CONCLUSIONS: Older adults with knee OA in the CRE group exhibited superior muscle strength, health conditions, and functional fitness improvements after the 12-week computer-aided rowing exercise program than those receiving the conventional exercise approach. TRIAL REGISTRATION: The Institutional Review Board of the Taipei Medical University approved the study protocol (no. N201908020, 27/05/2020) and retrospectively registered at ClinicalTrials.gov (trial registry no. NCT04919486, 09/06/2021).

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 Rowing-Specific Reinvestment Scale.

This research project aimed to develop and validate a rowing-specific reinvestment scale. In Study 1, a 24-item questionnaire was developed and the content validity was assessed using experts (N = 7) and pilot-tested in rowers (N = 24). Next, rowers (N = 282) completed the questionnaire with the remaining items, and exploratory factor analysis (EFA) was conducted. This further reduced the number of items and revealed two factors, rowing specific conscious motor processing (RS-CMP) and movement self-consciousness (RS-MSC). In Study 2, rowers (N = 270) completed the scale that was evaluated using confirmatory factor analysis (CFA). Moreover, the construct validity of the scale was investigated by asking them to complete measures of movement-specific reinvestment, perceived performance, self-consciousness, and state anxiety. Actual performance was also determined based on their race finishing position. Study 1 EFA resulted in a 2-factor model with six items assessing RS-CMP and six items assessing RS-MSC. Study 2 supported the factor structure of scale; CFA indicated an acceptable model fit with good internal consistency. Content validity was also supported, with evidence of concurrent, convergent, discriminant, and predictive validity. In conclusion, these studies provided good initial evidence for the validity and reliability of the RSRS.

Development of a Coaching System for Functional Electrical Stimulation Rowing: A Feasibility Study in Able-Bodied Individuals.

BACKGROUND: Functional electrical stimulation (FES) during rowing has substantial effects on cardiovascular health in individuals with spinal cord injuries. Currently, manual stimulation control where stimulation is operated by rowers is mostly utilized. However, it takes time to obtain the skill to initiate FES at the optimal timing. The purpose of this study was to develop a coaching system that helps rowers to initiate FES at the optimal timing. METHODS: The optimal range for FES application was identified based on the electromyography of the left quadriceps in 10 able-bodied individuals (AB). Then, the effects of the coaching system on the timing of button-pressing, power, and work were investigated in 7 AB. RESULTS: Vastus lateralis (VL) activation began consistently before the seat reached the anterior-most position. Therefore, seat position at the onset of VL was used as the variable to control the switch timing in the coaching system. The results revealed significantly higher power and work outputs in the coaching than the no-coaching condition (median power coaching: 19.10 W, power no-coaching: 16.48 W, p = 0.031; median work coaching: 109.74 J, work no-coaching: 65.25 J, p = 0.047). CONCLUSIONS: The coaching system can provide the optimal timing for FES, resulting in improved performance.

Common Health Issues Encountered by Ultraendurance Ocean Rowers.

INTRODUCTION: Ocean rowing is an extreme ultraendurance sport in which athletes push themselves to their mental and physical limits while rowing across an ocean. Limited academic attention has meant health issues facing this population are poorly understood. This report provides a descriptive analysis of the injuries and illnesses encountered by ocean rowers at sea and suggests potential preventative measures. METHODS: Retrospective self-reported data were collected from ocean rowers via an online 29-question survey, classified by medical system, and totaled to produce a report of the most frequently encountered symptoms. RESULTS: Seventy-one ocean rowers, accounting for 86 ocean rowing attempts, completed the survey. Dermatologic symptoms formed 52% (n=169) of all reported issues, followed by musculoskeletal injuries (14%; n=45), mental health symptoms (11%; n=36), gastrointestinal symptoms (5%; n=16), and neurologic symptoms (2%). Gluteal pressure sores were the most common dermatologic symptoms (24%; n=40), hallucinations the most common mental health symptoms (69%; n=25), hand and finger issues the most reported musculoskeletal problems (36%; n=16); vomiting (38%) and headaches (50%) were the most common gastrointestinal and neurologic issues, respectively. Seasickness was reported in 42% of expeditions (n=33). CONCLUSIONS: This report presents the physiological, mental, and medical challenges facing ocean rowers. Dermatologic and musculoskeletal issues were most common and varied greatly in severity. Over 90% of reported infections occurred as a dermatologic complaint, demonstrating the importance of preventative measures such as hygiene and wound care. Continued work with a larger population is required to further understand the physiological stress and medical complaints associated with transoceanic rowing.

Blisters and Calluses from Rowing: Prevalence, Perceptions and Pain Tolerance.

Background and Objectives: Rowing is a sport that involves constant gripping, pulling/pushing, and rotational movements of the hands, in a cyclic periodic manner with every stroke, with hundreds of strokes being taken within a short period of time. Dermatological issues on rowers' hands (fingers and palms) in the form of blisters and calluses are common knowledge within the community, but their prevalence and the rower's perceptions and pain tolerance to them has never been systematically evaluated. This work addresses these lacunae. Materials and Methods: Analysis of data collected from a survey on a sample of competitive (117) and noncompetitive rowers (28) who row on-water (total 145). Results: It was found that approximately 69% of rowers participating in this study have calluses on their hands for most of their time (considered by them as not painful). The incidence of blisters was found to be lower (but perceived as more painful). Their incidence was found to be fairly independent of the frequency and intensity of training, but they seem to affect most rowers equally at the beginning of season or during a change of position (nonconditioned hands). Blisters and calluses were reported to be mainly located on the proximal phalanges and metacarpo-phalangeal joint area of both hands, i.e., on the lower parts of the fingers and the upper inner palms. Conclusions: Rowers demonstrated a sense of acceptance of these dermatological issues, even a sense of pride in what they represent. The incidence of blisters becoming infected was estimated to be so low that most rowers would not have encountered such serious, albeit rare, consequences.

Results for World Rowing Federation and Olympic events 1893-2019.

Results in rowing have improved and here we estimate results for Olympic and World rowing championships based on the winning results from 1893 to 2019 obtained in the current seven Olympic events for men (n = 556) and women (n = 239). Data were collected from the official World Rowing Federation online records and from published results and the development analysed by linear regression analysis for the year of competition. Results improved by about 0.7 s per year (15 ± 9.4%) (mean ± SD). Depending on the event, 2020 predicted mean time for the winning boat for men is 363 s (range 326-397) vs. 404 s (362-439) for women (10.3 ± 1.1% slower). The ten-year coefficient of variance for the original boats in Olympic and World Rowing Federation regatta remaining within the Olympic programme, single scull and eight, decreased from 9 ± 2% (1893-1903) to 2 ± 0.4% (2009-2019). Reduced variability in winning times illustrates the standardization of the rowing course and boats, and the improvement in performance point to that body size becomes ever more important for success in competitive rowing.

Fluctuations in cardiac stroke volume during rowing.

Preload to the heart may be limited during rowing because both blood pressure and central venous pressure increase when force is applied to the oar. Considering that only the recovery phase of the rowing stroke allows for unhindered venous return, rowing may induce large fluctuations in stroke volume (SV). Thus, the purpose of this study was to evaluate SV continuously during the rowing stroke. Eight nationally competitive oarsmen (mean ± standard deviation: age 21 ± 2 years, height 190 ± 9 cm, and weight 90 ± 10 kg) rowed on an ergometer at a targeted heart rate of 130 and 160 beats per minute. SV was derived from arterial pressure waveform by pulse contour analysis, while ventilation and force on the handle were measured. Mean arterial pressure was elevated during the stroke at both work rates (to 133 ± 10 [P < .001] and 145 ± 11 mm Hg [P = .024], respectively). Also, SV fluctuated markedly during the stroke with deviations being largest at the higher work rate. Thus, SV decreased by 27 ± 10% (31 ± 11 mL) at the beginning of the stroke and increased by 25 ± 9% (28 ± 10 mL) in the recovery (P = .013), while breathing was entrained with one breath during the drive of the stroke and one prior to the next stroke. These observations indicate that during rowing cardiac output depends critically on SV surges during the recovery phase of the stroke.

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.

Clinical management of acute low back pain in elite and subelite rowers: a Delphi study of experienced and expert clinicians.

OBJECTIVES: Rowing-related low back pain (LBP) is common but published management research is lacking. This study aims to establish assessment and management behaviours and beliefs of experienced and expert clinicians when elite and subelite rowers present with an acute episode of LBP; second, to investigate how management differs for developing and masters rowers. This original research is intended to be used to develop rowing-related LBP management guidelines. METHODS: A three-round Delphi survey was used. Experienced clinicians participated in an internet-based survey (round 1), answering open-ended questions about assessment and management of rowing-related LBP. Statements were generated from the survey for expert clinicians to rate (round 2) and rerate (round 3). Consensus was gained when agreement reached a mean of 7 out of 10 and disagreement was 2 SD or less. RESULTS: Thirty-one experienced clinicians participated in round 1. Thirteen of 20 invited expert clinicians responded to round 2 (response rate 65%) and 12 of the 13 participated in round 3 (response rate 92%).One hundred and fifty-three of 215 statements (71%) relating to the management of LBP in elite and subelite rowers acquired consensus status. Four of six statements (67%) concerning developing rowers and two of four (50%) concerning masters rowers gained consensus. CONCLUSION: In the absence of established evidence, these consensus-derived statements are imperative to inform the development of guidelines for the assessment and management of rowing-related LBP. Findings broadly reflect adult LBP guidelines with specific differences. Future research is needed to strengthen specific recommendations and develop best practice guidelines in this athletic population.

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

BACKGROUND: Low back pain (LBP) is common in rowers. Understanding rowing biomechanics may help facilitate prevention and improve rehabilitation. OBJECTIVES: To define the kinematics and muscle activity of rowers and to compare with rowers with current or LBP history. DESIGN: Systematic review. DATA SOURCES: EMBASE, MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Web of Science and Scopus from inception to December 2019. Grey literature was searched. STUDY ELIGIBILITY CRITERIA: Experimental and non-experimental designs. METHODS: Primary outcomes were kinematics and muscle activity. Modified Quality Index (QI) checklist was used. RESULTS: 22 studies were included (429 participants). Modified QI score had a mean of 16.7/28 points (range: 15-21). Thirteen studies investigated kinematics and nine investigated muscle activity. Rowers without LBP ('healthy') have distinct kinematics (neutral or anterior pelvic rotation at the catch, greater hip range of motion, flatter low back spinal position at the finish) and muscle activity (trunk extensor dominant with less flexor activity). Rowers with LBP had relatively greater posterior pelvic rotation at the catch, greater hip extension at the finish and less efficient trunk muscle activity. In both groups fatigue results in increased lumbar spine flexion at the catch, which is greater on the ergometer. There is insufficient evidence to recommend one ergometer type (fixed vs dynamic) over the other to avoid LBP. Trunk asymmetries are not associated with LBP in rowers. CONCLUSION: Improving clinicians' and coaches' understanding of safe and effective rowing biomechanics, particularly of the spine, pelvis and hips may be an important strategy in reducing incidence and burden of LBP.