Introduction: Low back pain (LBP) is a prevalent and disabling condition in elite athletes, with up to 90% of Olympians reporting LBP during their career, negatively affecting their sporting goals and overall quality of life. Recent research suggests that athlete psychological and social factors are as important to recovery from LBP as biological factors. However, the precise influence of these factors on recovery or the transition to chronicity remains unclear. This study aimed to use a qualitative approach to explore experiences, beliefs, disability and behaviours of elite Australian athletes with persisting LBP. Methods: Elite athletes with current LBP of > three months duration were recruited through the National Institute Network (NIN) of the Australia High Performance Sport system. Recruitment commenced in August 2023. Data were collected through semi-structured interviews to explore athletes` LBP experience and the biopsychosocial factors identified by them as impactful on their clinical trajectory. All interviews were conducted and audio recorded over Zoom. Interview recordings were transcribed verbatim and imported to NVivo to manage the data for subsequent analysis. Data analysis was conducted using Braun and Clarke`s reflexive thematic analysis. Results: The 14 athletes (11 female, 3 male) interviewed were Australian team representatives from nine different Olympic sports, with an average age of 25, SD=4.3 years and a mean of 11 years sport training experience. More than half of the athletes reported symptoms of moderate disability on the Oswestry LBP Disability Questionnaire (>21/100). The mean symptom duration was 52 weeks and current pain score (VAS) was 3.2/10 (+/-1.7). Twelve of the 14 athletes continued to train and compete in their sport despite their pain experience. Key themes included the role of an athletes` agency in advocating for their recovery needs, their acceptance of pain, and the active choice to continue to participate with symptoms. The culture and funding of the sport system in which an athlete undertook rehabilitation was described as influencing both positively and negatively an athletes` pain experience and recovery. All participants highlighted the impactful nature of clinician relationships on their recovery, with sub-themes focused on communication, diagnosis, and empowerment through knowledge sharing. Discussion: In capturing the athlete`s voice and lived experience of persisting LBP, our study highlights the culture, resources and relationships that athletes feel are necessary to optimise their rehabilitation journey. Elite athletes with persisting LBP demonstrated a willingness to endure discomfort and disability while pursuing training and competition. Empowering this continued participation were clinical and personal relationships and an athletes` knowledge and agency. Appreciating how sport culture, financial resources, and investment in an injured athlete influence outcomes are pivotal to optimising an athletes` rehabilitative journey. A clinical relationship where the athlete felt heard, understood, educated and empowered facilitated engagement and positive rehabilitation experiences. Impact/Application to the field: High performance sport can direct its attention and resources towards improving the specific factors that athletes report impact their LBP recovery. Clinicians can leverage the power of their therapeutic relationship to enhance an athlete`s rehabilitation journey. Declaration: My co-authors and I acknowledge that we have no conflict of interest of relevance to the submission of this abstract.
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