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Clinical management of acute low back pain in elite and subelite rowers: a Delphi study of experienced and expert clinicians
  1. Kellie Wilkie1,2,
  2. Jane S Thornton3,4,
  3. Anders Vinther5,6,
  4. Larissa Trease7,8,
  5. Sarah-Jane McDonnell9,
  6. Fiona Wilson10
  1. 1Bodysystem Physiotherapy, Hobart, Tasmania, Australia
  2. 2Rowing Injury Prevention Education, GRowingBODIES, Hobart, Tasmania, Australia
  3. 3Fowler Kennedy Sport Medicine Clinic, London, Ontario, Canada
  4. 4Public Health and Family Medicine, University of Western Ontario Schulich School of Medicine and Dentistry, London, Ontario, Canada
  5. 5Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Copenhagen, Denmark
  6. 6QD-Research Unit, Copenhagen University Hospital, Copenhagen, Denmark
  7. 7Orthopaedics ACT, Woden, Australian Capital Territory, Australia
  8. 8School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
  9. 9Irish Institute of Sport, Dublin, Ireland
  10. 10School Of Physiotherapy, Trinity College, Dublin, Ireland
  1. Correspondence to Kellie Wilkie, BODYSYSTEM Physiotherapy, Hobart, Tasmania 7000, Australia; kelliewilkie{at}


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.

  • rowing
  • lower back
  • treatment
  • athlete
  • sporting injuries

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  • Twitter @KellieWilkie, @janesthornton, @DrLarissaTrease, @fionawilsonf

  • Contributors All authors were involved with the original design of the study and round 1 survey. KW, LT, JST, S-JM and FW were involved in the data analysis. KW, AV, JST, LT and FW were involved in the drafting and approving of the manuscript.

  • 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.

  • Patient consent for publication Not required.

  • Ethics approval Faculty of Health Sciences Research Ethics Committee, Trinity College, Dublin, in February 2018.

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

  • Data availability statement Data are available on reasonable request. All data relevant to the study are included in the article or uploaded as online supplemental information. Round 2 graphical representation is available on request.

  • 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.

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