Rib Stress Injuries in Rowers – Part 2 on the Rowing Sports Medicine and Science Conference

This is part 2 of a 3 part series on what I’ve learned at the 2018 Rowing Sports Medicine and Science Conference

Rib stress injuries and fractures in rowers was a frequently repeated topic at the conference.  An alarming amount of rowers experience these type of injuries and therefore it is important to take note of the following: 

  • Rib stress injuries (RSI) are responsible for 10% of rowing injuries, and 8-22% of elite rowers experience this.
  • RSI can lead to a minimum of 3-6wks of training time loss where fracture healing can take anywhere from 55 to 167 days. This can be career ending for an elite rower.  
  • Frequency seems to be equal between sweepers and scullers
  • Early detection of rib stress reaction is necessary to prevent a stress fracture
  • RSI is mostly located on the 6th and 9th ribs on the posterior, lateral and axillary area.

Different theories exist for the development of RSI:

  • Serratus anterior and the external obliques resist each other, but research has shown there is no co-contraction during the rowing action, so this theory is unlikely
  • The external obliques compress and result in a forceful expiration during rib cage compression with full compression in the catch.   This compression might lead to RSI.
  • Trapezius and Latissimus Dorsi cause rib cage compression and may be the cause of RSI
  • In para rowing the chest strap might be an extra factor in the development of RSI


  • Clinical tests are superior over imaging.  Most cases don’t require imaging.
  • However not all athletes with RSI experience pain and symptoms
  • The 7 chest wall hallmark signs are: night pain, pain with activities of daily living, pleuritic pain, coughing, expiration, rib compression or spring test, push up testing.
  • When imaging is used MRI is most frequently but ultrasound is gaining popularity

Protective factors

  • Load and variability management is important.  An acute workload is important during training but it is crucial to prevent spikes.
  • Avoid detraining during rest seasons or injury
  • Check for Vit D and calcium deficiencies

Online resources:


Read the next post in this series: Para Rowing Injuries – Part 3 on the Rowing Sports Medicine and Science Conference (Will be published 27 Feb 2019)

Read the first post in this series: Low Back Pain in Rowers – Part 1 on the Rowing Sports Medicine and Science Conference