Low Back Pain in Rowing: Part II

InPart I of this article we laid the foundation for possible causes of low back pain in rowers. In this article I will provide possible rehab solutions for low back pain.

“Pain is a request for change.” – Anat Baniel

Pain changes everything. It effects our movement, mood, and life. To resolve acute pain you’re going to have to embrace doing things differently. I am going to cover a series of steps to help you move in the right direction and alleviate some of these symptoms. Please note, if you are in chronic pain and the symptoms are lingering I strongly recommend seeing a medical professional such as a physical therapist or chiropractor – one who is an SFMA professional. You can search for them here

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In Part I

, we looked at the Joint by Joint Approach, Lower Crossed Syndrome, and the role of the psoas. In Part II,  I am going to go through a systems approach to alleviating the musculoskeletal pain most rowers experience by improving thoracic and hip mobility, reflexive core stabilization and correcting muscle imbalance.

“If you don’t own breathing you don’t own movement.” -Karel Lewit

We must start with the breath because it is at the center of all movement. I go into great detail about the importance of the breath in this article Intrinsic Core

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I recommend watching this video to do a self-assessment on your own breathing. Once you are breathing from your diaphragm and not your neck and shoulders you are in a position to create reflexive stability in your body.

We are going to use the RAIL system (as mentioned in the video above) that I learned from Dr. Perry Nickelston of Stop Chasing Pain at his workshop Moving Beyond Mobility. RAIL stands for

• Release
• Activate
• Integrate
• Locomotion

Note: I’ve listed a few exercises underneath each area of the RAIL system. Some exercises may work well for you and other may not – you have to try them out and see what improves your movement and relieves your low back pain!

First, we are going to release the areas that may have restrictions. You will want to foam roll your back, glutes, and open up your hips. This will allow the central nervous system to take the “brakes” off and provide a window of opportunity to make a change.

• Foam Roll Back and Quadriceps
• T-Spine Crunches
• Foam Roll Glutes (Video Courtesy of Strength Coach Will)
• Elevated Pigeon Stretch (This is a great one for any taller athletes and really opens up the hips!)

Next we are going to do an exercise that activates many of the muscles around the pelvis. The half-kneeling hip flexor stretch is more than a mobility drill. Back in Part I of this article I discussed Janda’s Lower Crossed Syndrome. The half-kneeling hip flexor stretch also activates the glutes and abdominals and pulls the pelvis into neutral as well as releases the psoas. This exercise by itself has been a game changer for many of my clients.

• Half-Kneeling Hip Flexor Stretch

The next step is to begin to Integrate this into movement. We do this step on the ground for 2 reasons: It’s a lower threshold environment so it’s easier to learn and it’s safer. The rolling patterns are a neurodevelopmental sequence – one we all perform as babies. This exercise hits the ‘Reset’ button and helps us once again start to stabilize from the center out.

• Rolling Patterns

The final step of the RAIL system is Locomotion. Crawling is a great way to build reflexive core stability, cross body patterning, and strength. Take your time and build up to 5’ continuous. Be sure to maintain good technique and not let the hips or shoulders drop/sag.

• Crawling

“Anterior Stability for Posterior Power” – Brent Morehouse

After you have implemented the RAIL system it’s time to focus on building anterior stability as well as anti-rotation capability. We’ll start from the safest position possible to higher threshold positions with these exercises. All of these exercises help to strengthen the muscles in and around the core. Part of the focus is to re-learn how to reflexively stabilize.

• Deadbugs
• Lying Paloff Press (Video Courtesy of Strength Coach Will)
• HardStyle Plank

Further Recommendations

These exercises will only be effective if you are aware of the change in your movement and body after you have done them. You cannot fall back into old habits and behaviors so be mindful of how you are moving and make a point to make a permanent change.

Whether you are rowing or strength training you should be hinging through your hips – always. If you are moving from your hips you’re sparing your low back a lot of unnecessary stress. I break down the hip hinge for both rowing and strength training in this video.

If you are training early in the morning there are a few extra steps you want to include before your session: Take a hot shower before you train. Yes, I know this sounds really annoying but hear me out first, ok?

By taking a hot shower you are helping to raise your body temperature and you’re also standing up. By standing up and moving around with the added heat of the hot shower you are reducing the water that annulus has accumulated overnight making it much safer to do spine-bending movements after the first hour of waking. If you do not want to shower then make sure you spend extra time warming up before your session. This means you should be breaking a sweat before you begin your first training piece.

There are a few key points I want to re-emphasize to close out this series:

•  Start with your breath – it’s at the center of all movement.
• “Stability Rules the Movement Road” – this quote from Dr. Perry Nickelston is so critical to making progress. Mobility precedes stability but for you to hold onto those changes in mobility you must enhance your body’s ability to reflexively stabilize – otherwise you will just regress!
• Play – Take some time and try each of the exercises. What works for one person may not work for another so figure out what works for you and helps improve your movement and reduces pain. Discard the exercises that don’t work.
• Patience – You did not get into pain overnight and it will not clear it up overnight. It takes a daily commitment to doing some of these resets to start seeing progress. Commit to them.

References

1. McGill, Dr. Stuart. Ultimate Back Fitness and Performance, 5th Edition. 2014. Print.
2. Nickelston, Dr. Perry. Primal Movement Chains: Moving Beyond Mobility Manual.2015. Print.
3. Cressey, Eric. Workout Routines: 6 Tips for Adjusting to Exercise in the Morning. EricCressey.com. 4/12/2012. Website.
4. Page, Phil. Frank, Clare C. Lardner, Robert. Assessment and Treatment of Muscle Imbalance: The Janda Approach. 2010. Print.

Joe DeLeo is a former collegiate rower turned strength coach. His practice focuses on working with endurance athletes to get stronger so they can perform their best. He also has tremendous experience rehabbing rowing-related injuries and stresses. He focuses on three modalities to train his athletes and clients: bodyweight, kettlebells, and indian clubs.

He is a Certified Strength and Conditioning Specialist through the National Strength and Conditioning Association. He holds certifications as a Functional Movement Specialist, Rocktape FMT II, and is a Level I Girya with StrongFirst.