In “past, present, future”, we ask clinical or academic experts to reflect on selected Sports & Exercise Medicine topics. Today Fiona Wilson on Back Pain, with an emphasis on Rowers.




Tell us more about yourself.

I am a physiotherapist from Manchester with over 30 years of experience in clinical and research areas. I have lived and worked around the world but have been in Dublin for the last 25 years. My career focus has always been on sports medicine, but I got many general hospital experience in my early career, which has been very important to me. My sports of interest are rowing and rugby. I row myself and was a successful, competitive elite rower when I was younger, but now I enjoy the social side of Masters rowing. I was the lead physiotherapist for Rowing Ireland for over 10 years, so I gained much clinical experience with high-performance athletes. My more recent focus has been on research in rowing medicine, particularly low back pain. My other research passion is rugby medicine, where I focus on brain health and wellbeing. I have been an academic at Trinity College Dublin since 2001, where I am Head of the BSc Physiotherapy programme, and I also practice clinically at Dublin Spine and Sports Physiotherapy. I am proud to be the first physiotherapist to be a World Rowing Sports Medicine Commission member.


What was hip and happening 10 years ago?

I was finishing my PhD 10 years ago, and even so recently, it was still relatively novel for physiotherapists with a clinical interest in doing a PhD. I was observing a huge growth in interest in research in Sports Medicine and a final move towards professionalism in sport for those who were not there yet. Mostly in Olympic sports, where robust systems were being set up to support athletes professionally. In rowing back pain, we were still quite focused on biomedical approaches to managing ‘injury’ focusing on specific diagnoses. ‘Core stability’ was still the primary approach in managing back pain, although its focus on isometric training- driving trunk stiffness, was starting to be questioned. Our focus was on cessation of pain as a key outcome measure before return to sport, with rest still a common tool of choice in acute injury phases.


What are we doing now?

We now see ourselves as managing the U-shaped relationship with exercise. Too little or too much is associated with disease or injury. Rather than trying to ‘fix’ the injured athlete, we are trying to prevent injury, with load monitoring being a concept embedded in all injury prevention and management programmes. We also now see athletes holistically and understand the effects of commodification of professional athletes and how it can affect their mental and physical health and wellbeing. Exercise prescription is now a crucial part of managing many more diseases, from chronic disease to acute illness. Thinking more specifically to an area like rowing back pain, we now approach management with a biopsychosocial model, thinking beyond pathologies and more about how the athlete experiences conditions and their environment’s effect on their condition and response to treatment. We now de-load (quickly) rather than unload, and recognise that maintaining as much training stimulus as possible is key. Our greatly improved understanding of pain means that we now have rowers returning to training more quickly using a pain monitoring model rather than waiting for a complete cessation of symptoms. Our trunk rehabilitation has moved away from a generic ‘core’ approach to a more dynamic trunk loading approach, focusing on creating fluid movement rather than hypervigilance, a risk in programmes focused on isometric phases. We recognized how the rowers’ relationship with their coaches and peers and the culture of the system they are training in can influence their experience. We encourage early disclosure of pain and injury and educate coaches to quickly modify load in response to this, which is likely to improve outcomes.


Where do you think we will be 10 years from now?

Exercise to prevent and manage chronic disease will continue to be a core treatment, and exercise medicine professionals will lead in research in this area. Expanding into diseases where they had not been before.

Our role in athlete safeguarding will become more important. We have started to recognise the effects of too much focus on performance and not enough on participation. The ‘win at all costs’ and the ‘no funding without medals’ is leading to poorer athlete physical and mental wellbeing. It also leads to dropout at community levels, leaving the public with fewer opportunities for exercise participation, particularly in adolescence.  Our role will be to advocate for athlete health and support programmes that support well-being and performance. We will also be involved in designing and supporting public health interventions using exercise for health. We will also expand our role in managing professional athletes’ health into their retirement and through their lifespan.


Would you like to learn more on this topic? Here is a selection of studies on ‘Back Pain’ published in our journal
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