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The relationship between rowing-related low back pain and rowing biomechanics: a systematic review
  1. Frank James Nugent1,2,
  2. Anders Vinther3,
  3. Alison McGregor4,
  4. Jane S Thornton5,
  5. Kellie Wilkie6,
  6. Fiona Wilson7
  1. 1Physical Education and Sport Sciences Department, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
  2. 2Sport and Human Performance Research Cluster, Health Research Institute, University of Limerick, Limerick, Ireland
  3. 3Department of Physiotherapy and Occupational Therapy, Herlev Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
  4. 4Department of Surgery and Cancer, Imperial College London, London, UK
  5. 5Western Centre for Public Health and Family Medicine, University of Western Ontario, London, Ontario, Canada
  6. 6Bodysystem Physiotherapy, Hobart, Tasmania, Australia
  7. 7Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, Dublin, Ireland
  1. Correspondence to Dr Frank James Nugent, Physical Education and Sport Sciences Department, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland; frank.nugent{at}


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.

  • lumbar spine
  • pelvis
  • sports rehabilitation programs
  • rowing

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  • Correction notice This article has been corrected since it published Online First. The provenance and peer review statement has been included.

  • Contributors All authors were involved with the original design of the study. Data analysis was performed by FN, AMcG and FW. Drafting and approving of the manuscript was performed by FN, AV, AMcG, KW, JT and FW.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.