Qualitative study finds agency and validation, not anatomy, drive recovery from persistent low back pain in Australian elite athletes (blogs.bmj.com)

• 17 Australian elite athletes from 10 Olympic sports interviewed about persistent low back pain experience.
• Validation from clinicians was central to developing agency and promoting recovery.
• Pain extended beyond physical symptoms, threatening identity, confidence, and sense of control.
• Mental health and pain had a bidirectional relationship; reframing pain as manageable aided engagement.
• Elite sport culture, including pressure to train and fear of being seen as weak, shaped pain experience.

"A qualitative study of 17 Australian elite athletes across 10 Olympic sports with persistent low back pain (>3 months) used semi-structured interviews and reflexive thematic analysis. Four themes emerged: burden beyond physical pain, validation as a driver of agency and recovery, bidirectional relationship between pain and mental health, and the influence of elite sport culture. Clinicians should validate pain, communicate clearly, and advocate for safe disclosure environments. Recovery requires protecting athlete autonomy and identity, not just prescribing exercises or interpreting scans."