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
- 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
- The dynamics of rib pain.
- Rib stress injuries and fractures – Physiopedia Page
- Thornton JS, Vinther A, Wilson F, Lebrun CM, Wilkinson M, Di Ciacca SR, Orlando K, Smoljanovic T. Rowing injuries: an updated review. Sports medicine. 2017 Apr 1;47(4):641-61.
- Rumball JS, Lebrun CM, Di Ciacca SR, Orlando K. Rowing injuries. Sports medicine. 2005 Jun 1;35(6):537-55.
- Thornton JS, Vinther A. Prevention of rib stress injury in rowers. What do we know and where do we need to go? Sports Orthopaedics and Traumatology. 2018 May 31. (Abstract)