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Cognitive functional approach to manage low back pain in male adolescent rowers: A randomised controlled trial

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Abstract

Background Low back pain (LBP) is prevalent among adolescent rowers. This study evaluated the efficacy of a cognitive functional approach to reduce LBP in this population. Methods Thirty-six adolescent male rowers reporting LBP participated. Nineteen were randomly allocated to the intervention group to receive a cognitive functional approach targeting cognitions, movement patterns, conditioning and lifestyle factors relevant to each rower for 8 weeks. The active control group (n=17) received usual care from their coaches (rowing skills and conditioning exercises). The primary outcome of the study was pain intensity as measured by the Numeric Pain Rating Scale during a 15 min ergometer trial preintervention and postintervention. Disability (Patient Specific Functional Scale and Roland Morris Disability Questionnaire) was measured preintervention/postintervention and at 12 weeks follow-up. Isometric muscle endurance of the back extensors and lower limb muscles, usual sitting posture and regional lumbar kinematic data during a 15 min ergometer row were measured preintervention/postintervention. Results Compared with the control group, the intervention group reported significantly less pain during ergometer rowing (Numeric Pain Rating Scale −2.4, p=0.008) and reduced disability (Patient Specific Functional Scale (4.1, p=0.01); Roland Morris Disability Questionnaire (−1.7, p=0.003)) following the intervention, and at 12 weeks follow-up. They also demonstrated greater lower limb muscle endurance (20.9 s, p=0.03) and postured their lower lumbar spine in greater extension during static sitting (−9.6°, p=0.007). No significant differences were reported in back muscle endurance and regional lumbar kinematics during ergometer rowing. Conclusion Cognitive functional approach was more effective than usual care in reducing pain and disability in adolescent male rowers. Clinical Trial Registry Number Australian and New Zealand Clinical Trial Registry Number 12609000565246.
... Different protocols, such as kinesio taping [32], cognitive functional approach, movement patterns, conditioning, and lifestyle factors [18,20] movement patterns, conditioning and lifestyle factors relevant to each rower for 8 weeks. The active control group (n=17, motor control [19,20,28] quadratus lumborum, and psoas muscles and the change in CSA of the trunk in response to an abdominal drawing-in task. ...
... Tactile sensory perception using 10-g Semmes-Weinstein monofilament, thermic perception using TIP THERM device, graphesthesia assessed by a touch monitor pencil, 2-point discrimination assessed by a digital caliper, and vibration perception assessed by a 128-Hz tuning fork measured in mid-thoracic spine 5 times.Results:No significant group differences in pain and sensory perception were identified at baseline. Over the 2-month study interval, repeated-measures analysis of variance revealed that the experimental group improved significantly relative to the control group on pain intensity (P=0.005 for cervical, P=0.004 for thoracic, and P=0.014 for lumbar, functional movement system Different protocols, such as kinesio taping (32), cognitive functional approach, movement patterns, conditioning, and lifestyle factors (18,20), motor control (19,20,28), segmental motion in the midthoracic spine (21), functional movement system (FMS) training (30), isokinetic and core stabilization (22,23), virtual reality training (26), dynamic and static stretching (24) Mézières method (25,29,31), semicustomized exercises (4), had been working on elite and semi-elite athletes. Figure 2 shows the average of the sports that have been worked on in the present studies. ...
... Except for three articles that did not have a control group and only compared training methods [19,24,28], the rest had a control group. In four studies, RMDQ was used to evaluate performance or functional disability [18,25,29,31]. To evaluate the pain level, VAS, NPR, and McGill pain questionnaires (short form) were also used [18,22,25,26,[29][30][31][32][33]. ...
Article
Purpose: Low back pain (LBP) is the most common musculoskeletal disorder reported in the community, leading to chronic pain and disability. This review aims to determine the effectiveness of prevention and management protocols on LBP in athletes. Methods: Searches were conducted from 2010 to 2022 from international databases, including Google Scholar, Science Direct, and PubMed using keywords related to back pain in athletes. Randomized controlled trials (RCTs) presenting the prevention and management protocol for back pain of athletes were included in this review. The physiotherapy evidence database (PEDro) scale was used to check the quality of articles. Results: Finally, 16 articles with 1,317 subjects met the inclusion criteria. These studies have mainly focused on the effect of taping, cognitive functional approach, movement patterns, conditioning, lifestyle, motor control, segmental motion, isokinetic, core stabilization, virtual reality training, dynamic and static stretching, Mézières method, functional movement screen, and semi-customized exercises in athletes at risk of LBP. The positive effect of stability and cognitive exercises were documented. Conclusion: The deep and superficial muscle integration exercises by correcting the body posture and correct muscle calling had the greatest effect on the balance of the muscles.
... Title and abstract screening eliminated 1936 of those reports, leaving 16 reports for full-text screen. After full-text screening, seven studies, represented by eight published reports (Ahlqwist et al., 2008;Candy et al., 2012;Dudoniene et al., 2016;Evans et al., 2018;Fanucchi et al., 2009;Jones et al., 2007aJones et al., , 2007bNg et al., 2015), were included. Jones et al., 2007a, reported slightly more outcome measures than Jones et al., 2007b, so both were reviewed. ...
... lounge chair (n = 1 study). One study (Ng et al., 2015) incorporated some psychosocial components (motivational interviewing, discussion of factors such as sleep patterns and coping) within an exercise-focussed intervention. Only one study did not include an exercise-based intervention in either treatment arm (Candy et al., 2012), instead testing an ergonomic intervention. ...
... By contrast, Evans et al. (2018) stated that participants did 'bridge, abdominal crunches, quadruped, side bridge, back extensions' (p. 1298), and Ng et al. (2015) provided supplemental materials that included a detailed list of exercises, with images, that they gave to participants. In addition, this document included a brief description of the cognitive and motivational interviewing approaches they used. ...
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Background and objectives: Persistent non-specific back pain is now established as a biopsychosocial phenomenon that can be meaningfully affected by individuals' cognitions, emotions, lifestyle factors, and family and social relationships. Recent guidelines for the treatment of adolescents with persistent non-specific back pain, as well as those for youth with mixed chronic pain, strongly recommend interdisciplinary care in which adolescents receive treatment for both mind and body. The objective of this scoping review was to examine the interventions evaluated in randomized trials for adolescents with persistent back pain to determine if they correspond to these guidelines and to reveal future research priorities. Databases and data treatment: The review protocol was registered in March 2022. We followed the PRISMA guidelines for scoping reviews. Twelve electronic databases were searched for relevant study reports. Data were charted on study characteristics, participant characteristics, and intervention details using the Template for Intervention Description and Replication (TIDieR) checklist. Results: The search yielded 1,952 records, of which eight reports representing seven randomized trials were eligible. The most common interventions were exercise therapy (n = 6) and back education (n = 4). Five studies employed multiple intervention components, but none was multidisciplinary. Studies primarily targeted posture or biomechanical factors. One study included an intervention addressing participants' fears and beliefs about pain. Conclusions: Randomized trials for adolescents with persistent back pain have primarily relied upon an outdated, biomechanical explanation of persisting pain. Future randomized trials should align with current treatment recommendations and measure outcomes across multiple biopsychosocial domains.
... Disagreement rate between the two authors in the screening process and in the full-text inspection process was 15.5% and 4.2%, respectively. Four studies [19][20][21][22] were eligible. Two studies [19,22] were from the same study project. ...
... However, one study [22] was excluded since the data reported were from the same subjects at a 3-year followup and no additional data were found that were eligible for extraction in the current systematic review. Consequently, three studies [19][20][21] were included the systematic review and assessed for the risk of bias. ...
... The three eligible studies [19][20][21] are summarised in Table 1. All studies were RCTs performed by the same research group. ...
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Background To apply the Bio-Psych-Social (BPS) model into clinical practice, it is important not to focus on psychosocial domains only since biomedical factors can also contribute to chronic pain conditions. The cognitive functional therapy (CFT) is the management system based on the BPS model for chronic nonspecific low back pain (CNSLBP). Objectives This study aimed to compare CFT with the other interventions for CNSLBP regarding pain, disability/functional status, QoL and psychological factors. Design This study was a systematic review and meta-analysis of a randomised controlled trial. Method Literature Search was conducted in electronic search engines. Enrolled participants included 1) CNSLBP and 2) primary, secondary, or tertiary care patients. CFT was the interventions included. Comparisons were any types of treatment. Results Three studies met the eligibility criteria. The total number of participants was 336. For pain intensity, MD [95% CIs] was -1.38 [-2.78 − 0.02] and -1.01 [-1.92 − -0.10] at intermediate and long term for two studies, respectively. About disability/functional status, SMD [95% CIs] was -0.76 [-1.46 − -0.07] at the intermediate for three studies and MD [95% CIs] was -8.48 [-11.47 − -5.49] at long term for two studies. About fear of physical activity, MD [95% CIs] was -3.01 [-5.14 − -0.88] and -3.56 [-6.43 − -0.68] at intermediate and long term for two studies, respectively. No studies reported scores associated with QOL. All the quality of the evidence was very low. Conclusions Three studies were included and the quality of all the evidence was very low. Although the study found statistically significant differences in some measures, the effectiveness of the CFT will need to be re-evaluated in the future. Trial registration PROSPERO registration number CRD42020158182 .
... In general, data collection took place in a school environment [27,32,35,37,40,42,47,48] or in clinical settings (e.g., laboratory, clinical research centers, primary care center) [28][29][30][33][34][35][36]38,44,45]. Four studies targeted young athletes [31,41,43,46]. Most studies were conducted in high-income countries. ...
... However, the content validity was not assessed in the included PROMs. Of 23 studies included, 15 used PROMs with measured properties tested only in adults [26][27][28][29][30][31]33,34,36,[39][40][41][43][44][45], four used PROMs tested in adults and in children/adolescents [35,38,42,46], and only four used PROMs with properties tested in children/adolescents exclusively [32,37,47,48]. ...
Article
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Purpose: We aimed to identify Patient-Reported Outcome Measures (PROMs) that assess disability in children and adolescents with low back pain (LBP), analyzing their adherence to the International Classification of Functioning, Disability and Health (ICF) biopsychosocial model; and to describe the measurement properties of these PROMs. Methods: We searched Pubmed, Embase and CINAHL databases. The review included searches up to March 2022. Meaningful concepts of the PROMs were linked to ICF domains, and we manually searched for the measurement properties of each included PROM. Results: We included 23 studies, of which eight PROMs were analyzed. We retrieved 182 concepts in total. Activities was the domain with the highest number of linked concepts, whereas personal factors had no linked concepts. The modified Hannover Functional Ability Questionnaire (mHFAQ) and the Micheli Functional Scale (MFS) had measurement properties tested in children and adolescents, but had no information about construct validity. Conclusion: Although most of the identified PROMs had broad coverage of their concepts in the ICF, only two PROMs had measurement properties tested in the population of interest in this review, in which the mHFAQ presented wide coverage in relation to the ICF. Further studies are needed to investigate content validity of these PROMs.
... Of the 60 articles, most were surveyed in athletes in Germany [14,18,49,[52][53][54][55][56][57][58][59][60][61][62], in Sweden [3,[63][64][65][66], and in Iran [36, 37, [67][68][69]. Moreover, also in Norway [11, 70,71], Poland [72][73][74], United States [50,51,75], the Netherlands [76,77], Belgium [78], Switzerland [12,79], Finland [80,81], Australia [82,83], Spain [84,85], Saudi Arabia [86,87], Estonia [88], Serbia [89], New Zealand [90], Ukraine [91], China [92], Austria [93], Brazil [94], and India [95]. Three articles [48,96,97] failed to report the study site, and one study was conducted in several countries [98]. ...
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Back pain in athletes varies with sport, age, and sex, which can impair athletic performance, thereby contributing to retirement. Studies on back pain in this population use questionnaires to assess components, such as pain intensity and location and factors associated with pain, among others. This study aimed to review validated questionnaires that have assessed back pain in athletes. This systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) by searching the databases Embase, MEDLINE, SPORTDiscus, CINAHL, and Scopus. The articles were selected regardless of language and date of publication. Titles and abstracts were independently selected by two reviewers; disagreements were resolved by a third reviewer. All the steps were conducted using the software Rayyan. The methodological quality of the questionnaire validation articles was assessed using a critical appraisal tool checklist proposed by Brink and Louw. The search returned 4748 articles, of which 60 were selected for this review, including 5 questionnaire validation studies. These articles were published between 2004 and 2022, which were performed in more than 20 countries, particularly Germany (14) and Sweden (5). Thirteen different instruments were identified, of which 46.1% were developed in Europe. The most commonly used questionnaires were the Oswestry Disability Index and Nordic Standardized Questionnaire. In addition, five questionnaire validation studies were selected for methodological quality assessment, with only two studies demonstrating high methodological quality. The following three instruments were identified for assessing back pain specifically in athletes: Micheli Functional Scale, Persian Functional Rating Index, and Athlete Disability Index. This review confirmed that all three instruments were specifically designed to assess this condition.
Article
Objective: To summarize the effects of physical therapist-led interventions based on the biopsychosocial (BPS) model in spinal disorders compared interventions with no BPS model through a systematic review and meta-analysis of randomized controlled trials (RCTs). Literature survey: We searched in the Web of Science, CENTRAL, MEDLINE, PsycINFO, CINAHL, and PEDro up to October 27th, 2022. Methodology: Pain intensity and disability as primary outcomes and psychological factors as secondary outcomes in spinal disorders. The included intervention was physical therapist-led interventions based on the BPS model. The control group received no physiotherapy intervention for BPS. Pooled effects were analyzed as standardized mean differences (SMD) and 95% confidence intervals (CI) and the random-effects model was used for the meta-analysis. The subgroup analysis was divided into low back group and neck pain group. Another subgroup analysis was conducted only of the groups that had received training of the BPS model. Synthesis: Fifty-seven studies with 3648 participants met the inclusion criteria. For pain intensity, there was a statistically significant effect in the short, medium and long terms. The SMD with 95% CI were -0.44 (-0.62, -0.27), -0.24 (-0.37, -0.12) and -0.17 (-0.28, -0.06), respectively. Outcomes were clinically significant, except in the long term. For disability, there was a statistically significant effect in the short, medium and long terms. The SMD with 95% CI were -0.48( -0.69 to -0.27), -0.44 (-0.64, -0.25) and -0.37 (-0.58, -0.15), respectively. All periods were clinically significant. The quality of the evidence was low for all of the main outcomes for all of the terms. Conclusion: Physical therapist-led interventions based on the BPS model effectively improve pain intensity and disability in spinal disorders based on low quality evidence. This article is protected by copyright. All rights reserved.
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OBJECTIVE: To evaluate whether cognitive functional therapy (CFT) is an effective treatment for adults with chronic low back pain (LBP) DESIGN: Intervention systematic review with meta-analysis. LITERATURE SEARCH: CENTRAL, CINAHL, MEDLINE, Embase, clinicaltrials.gov, EU clinical trials register (to March 2022). STUDY SELECTION CRITERIA: Randomised controlled trials evaluating CFT for adults with LBP. DATA SYNTHESIS: The primary outcomes were pain intensity and disability. Secondary outcomes were psychological status, patient satisfaction, global improvement, and adverse events. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach. Random-effects meta-analysis with the Hartung-Knapp-Sidik-Jonkman adjustment was used to estimate pooled effects. RESULTS: Fifteen trials were included (nine ongoing, one terminated), of which five provided data (n=507; n=262 CFT and n=245 control). There was very low certainty for the effectiveness of CFT compared to manual therapy plus core exercises (two studies, n=265) for reducing pain intensity (mean difference -1.02/10, 95% CI -14.75 to 12.70) and disability (mean difference -6.95/100, 95% CI -58.58 to 44.68). Narrative synthesis showed mixed results for pain intensity, disability, and secondary outcomes. No adverse events were reported. All studies were judged to be at high risk of bias. CONCLUSION: CFT may not be more effective than other common interventions for reducing pain and disability in adults with chronic LBP. The effectiveness of CFT is very uncertain and will remain so until higher quality studies are available.
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Background Low back pain (LBP) is highly prevalent in the rowing population. The body of existing research variously investigates risk factors, prevention, and treatment methods. Purpose The purpose of this scoping review was to explore the breadth and depth of the LBP literature in rowing and to identify areas for future research. Study Design Scoping review Methods PubMed, Ebsco and ScienceDirect were searched from inception to November 1, 2020. Only published, peer-reviewed, primary, and secondary data pertaining to LBP in rowing were included for this study. Arksey and O’Malley’s framework for guided data synthesis was used. Reporting quality of a subsection of the data was assessed using the STROBE tool. Results Following the removal of duplicates and abstract screening, a set of 78 studies were included and divided into the following categories: epidemiology, biomechanics, biopsychosocial, and miscellaneous. The incidence and prevalence of LBP in rowers were well mapped. The biomechanical literature covered a wide range of investigations with limited cohesion. Significant risk factors for LBP in rowers included back pain history and prolonged ergometer use. Conclusion A lack of consistent definitions within the studies caused fragmentation of the literature. There was good evidence for prolonged ergometer use and history of LBP to constitute risk factors and this may assist future LBP preventative action. Methodological issues such as small sample size and barriers to injury reporting increased heterogeneity and decreased data quality. Further exploration is required to determine the mechanism of LBP in rowers through research with larger samples.
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Introduction: Conservative treatments are usually the most indicated for the management of musculoskeletal pain; consequently, a detailed description of interventions enables the reproducibility of interventions in clinical practice and future research. The objective of this study is to evaluate the description of physical interventions for musculoskeletal pain in children and adolescents. Methods: We considered randomised controlled trials that included children and adolescents between 4 and 19 years old, with an acute or chronic/persistent musculoskeletal pain. We considered interventions including active and passive physical therapies – related to all types of physical modalities aimed to reduce the intensity of pain or disability in children and adolescents with musculoskeletal pain. The description of interventions was assessed using the TIDieR checklist. We searched on CENTRAL, MEDLINE, EMBASE, CINAHL, PsyINFO and PEDro up to October 2021. The description of physical interventions was presented using frequencies, percentages and 95% confidence intervals (CIs). We also calculated the total TIDieR score for each study. Results: We included 13 randomised controlled trials. The overall quality of description measured through the TIDieR checklist was poor, with an average of 11 (4.3) points out of 24. The item of the TIDieR that was mostly described was item 1 (brief name). The item that the description was mostly absent was item 10 (modifications). Conclusion: The descriptions of physical interventions for the treatment of musculoskeletal pain in children and adolescents are usually poorly described, indicating the need for strategies to improve the quality of description to enable truly clinical reproducibility.
Article
Objectives Rowing, when practiced as a sport, is currently typically conducted on sliding-seat boats which permit efficient lower limb use. Nevertheless, traditional fixed-seat rowing, with its own particular technique, is experiencing a revival and competitions utilizing this technique are held on a regular basis around the world. This paper investigated injuries sustained by competitive fixed-seat rowers when compared to rowers using the more widely studied sliding-seat technique. Method Two cohorts of male rowers, who train and compete on fixed-seat and sliding seat boats at national levels were asked to fill in a questionnaire looking into musculoskeletal injuries sustained as a result of their particular rowing style. Portuguese sliding-seat rowers rowed standard World Rowing (FISA) approved boats whilst fixed-seat rowers from Malta used traditional wooden boats and oars. Injury probabilities between the two cohorts were compared. Results Statistically significant diminution, P = 0.022, of knee injuries in the fixed-seat group was observed when compared to standard sliding-seat rowing, something which may be explained from the biomechanics of the stroke. Also, pelvic, other lower limb, neck and rib injuries were absent in the fixed-seat cohort. The incidence of back, shoulder, forearm and wrist injuries was comparable in both groups despite the increased reliance on the upper body, in the fixed-seat stroke. This means that contrary to common perception, fixed-seat rowing is a safe sport to practice. Furthermore, with its reduced risk of lower limb injuries, this technique could potentially form part of rehabilitation programs for rowers with such injuries.
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The most commonly reported injury site in rowers is the lower back. Research in recent years has focused on epidemiology and biomechanical analyses to try and understand mechanisms that contribute to this injury's onset. Injury surveillance mainly comprises retrospective questionnaires and reviews of medical records with a lack of prospective data. Of studies that reported 12-month data, the incidence of low back pain ranged from 31.8 to 51% of the cohort. Of the limited studies that specifically examined low back pain in rowers, (1) history of lumbar spine injury and (2) volume of ergometer training were the most significant risk factors for injury onset. Studies of technique on the rowing ergometer have indicated the importance of lumbopelvic rotation during rowing. Greater pelvic rotation at either end of the stroke is ideal-as opposed to lumbar flexion and extension; this tends to be poorly demonstrated in novice rowers on ergometers. Furthermore, technique can deteriorate with the demands of rowing intensity and duration, which puts the rower returning from injury at additional risk.
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Lumbar spine injury in rowers is common and ergometer rowing has been cited as a risk factor for this injury. The purpose of this study is to compare lumbar kinematics between ergometer and single scull rowing and to examine the effect of fatigue on kinematics. The sagittal lumbar spine motion of 19 elite male rowers (lumbar spine injury free in the previous six months) was measured with an electrogoniometer during a 'step test' on an ergometer and in a single sculling boat. Maximum range of lumbar flexion was recorded in standing for reference. Power output and heart rate were recorded during the ergometer tests. Heart rate was used as a surrogate for power output in the sculling test. Maximum lumbar flexion increased during the step test and was significantly greater on the ergometer (4.4 degrees +/- 0.9 degrees change), compared with the boat (+1.3 degrees +/- 1.1 degrees change), (3.1 degrees difference, p = 0.035). Compared to the voluntary range of motion, there is an increase of 11.3% (ergometer) and 4.1% (boat). Lumbar spine flexion increases significantly during the course of an ergometer trial while changes in a sculling boat were minimal. Such differences may contribute to the recent findings linking ergometer use to lower-back injury.
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Rowing should become the favourite sport of our young people as no other exercise can provide them with the physical and moral qualities that they need: energy, initiative and health —Pierre de Coubertin The FISA Sports Medicine Commission advises the FISA Council and member federations on rowing-related sports medicine issues. Rowing has been part of the Olympic programme since 1896; women’s rowing was introduced as an Olympic sport in 1976 and the lightweight category was included in 1996. The first World Championships for ‘Adaptive’ (persons with a disability) rowers was in 2002. Rowing was introduced into the programme of the Paralympic Games of 2008. Clinical issues in rowing Most rowing biomechanical and physiological research has been performed on rowing machines (‘ergometers’) on which rowers can closely mimic the movement of the rowing stroke. There has been less research on boats in water. Most rowing injuries are due to overuse/overload or poor mechanics. Lower back pain, wrist tendon disorders and rib stress fractures are the most common injuries reported. There has been a well-documented increase in the incidence of these injuries since the 1991 introduction of the hatchet ‘big’ blades. Lightweight rowing, where athletes compete within defined weight limits, shares many of the problems associated with other weight-controlled sports. The Sports …
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The primary objective of this study was to determine the lifetime and point prevalence of low back pain, the related pain intensity and the rowing-related aggravating factors for low back pain in adolescent rowers who participated in school-level competitions. The secondary objective was to determine whether between-gender differences existed in these data. Retrospective cross-sectional survey METHOD: 130 adolescent male and 235 adolescent female rowers aged between 14 and 16 years were recruited in this study. Participants completed a questionnaire to determine their lifetime and point prevalence of low back pain, their pain intensity and rowing-related factors that aggravated their low back pain. A high lifetime and point prevalence of low back pain were found in both adolescent male (93.8% and 64.6%, respectively) and female (77.9% and 52.8%, respectively) rowers. A significant between-gender difference was reported for both statistics (p<0.001). A significantly lower (p=0.003) level of pain intensity via a visual analog scale was found for males (4.1/10) when compared to females (5.0/10). Similar rowing-related aggravating factors were reported by males and females although fewer males reported that lifting the rowing shell aggravated their low back pain. A high lifetime and point prevalence of low back pain was reported by the adolescent rowers recruited in this study. While a greater proportion of adolescent male rowers reported low back pain, they reported a lower intensity of pain when compared to their female counterparts. Coaches, clinicians and rowers should be made aware of these findings such that future research and development can focus on promoting pain management strategies in this sport.