Rowing MSK Injuries

If you are a rower or if you work with rowers (as a coach, trainer, or therapist), the following information will help you prevent and manage common rowing injuries. This post summarizes an article recently published in Sports Medicine by Thornton et al. (2016). It discusses only musculoskeletal (MSK) injuries.

Recall in a previous post that progressive overload is one of the most important principles of athletic training to reduce risk of injury.

Like the running stride, the rowing stroke is made up of sequential and rhythmical body movements that facilitate power and efficiency. If you are unfamiliar with rowing technique or terms, follow this link for a youtube introduction for beginners.

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Rowing injuries may be the result of any number of factors relating to training programs, equipment, technique, biomechanics, strength, and flexibility. Remember that good training programs are individualized — this may be as simple as the addition of hip mobility exercises for one athlete and hip strengthening exercises for another during the warm-up. Athletes, coaches, trainers, and therapists working together helps improve the identification of factors causing or contributing to injury or limiting performance.

Commonly injured areas or common areas for pain in the rowing athlete and some considerations for management include:

  1. Back
    1. Rowing places high loads and stresses on structures in the back. These structures include the spine (vertebrae, intervertebral discs, and facet joints), muscles, ligaments, and fascia.
    2. A slight c-shaped curvature of the spine is recommended to support the high loads experienced during the drive of a rowing stroke.
    3. Consider evaluating and optimizing back extensor, core, and gluteal muscle strength/capacity, in addition to posture, spinal position sense, hip range of motion, and hip flexor and hamstring flexibility/length.
    4. Some conditions to consider include: lumbar disc herniation with or without radiculopathy (commonly referred to as sciatica), spondylolysis & spondylolisthesis, muscle strain, ligament sprain, facet syndrome (or capsulitis), and joint dysfunction.
    5. Note: pain often signifies injury, but pain is complex and can also occur in the absence of any structural damage. Differentiating between nociceptive, inflammatory, and pathological or neuropathic pain is important in determining appropriate management strategies. A biopsychosocial approach to low back pain is recommended.
  2. Chest/Rib
    1. Rib stress injuries (RSIs) are thought to occur as a result of immense muscular forces acting on the ribs.
    2. Evans & Redgrave (2015) have developed a guideline for diagnosis and management. Follow the link for more information.
  3. Shoulder
    1. Like the back, risk for shoulder injury may be increased due to imbalances in muscle strength or length, and/or dysfunctions in joint motion.
    2. The goal for management is to find and address these imbalances and offer tips to improve technique.
    3. Consider strengthening the rotator cuff and shoulder blade stabilizers (includes serratus anterior and rhomboids), and stretching latissimus dorsi and pectoralis minor and major. In addition to an evaluation of joints in the shoulder complex, consider evaluating neck and thoracic spine, and rib joint mechanics.
  4. Knee
    1. The rowing stroke demands full knee range of motion. If the patella is not tracking properly, this can cause abnormal wear and tear of joint surfaces leading to patellofemoral pain syndrome (PFPS). Knock-kneed (genu valgum) predisposition can also contribute. Another condition to be aware of is iliotibial band syndrome. Although classically associated with runners, rowers may also be at risk.
    2. Consider evaluating and optimizing strength of hip musculature and the quadriceps group (specifically vastus medialis), in addition to hamstring flexibility.
    3. If an athlete is not responding to care, consider meniscal injury.
  5. Hip
    1. In addition to full knee motion, the rowing stroke requires extreme hip flexion. Pain in the groin may indicate femoroacetabular impingement or labral tears.
    2. A recent issue in the British Journal of Sports medicine contains several articles on femoroacetabular impingment syndrome (FAI Syndrome). One in particular sought multidisciplinary consensus on diagnosis and management. Follow this link for full access to the article.
    3. Management of FAI Syndrome includes conservative, rehabilitative, and surgical options.
  6. Forearm/Wrist
    1. Wrist and forearm injury can often be attributed to poor technique and fatigue, and exacerbated by poorly fitted equipment and lousy weather conditions.
    2. Some conditions to keep in mind include: exertional compartment syndrome (ECS), lateral epicondylitis, De Quervain’s tenosynovitis, and intersection syndrome.
    3. In addition to technique and equipment modifications, management may include ice, stretching, soft-tissue release techniques, taping, and rest.

As always, talk to your health care practitioner for personalized management that meets your needs. A dialogue between athletes, coaches, therapists, and trainers can optimize the recovery process.

References

Evans, G. & Redgrave, A. (2015). Great britain rowing team guideline for diagnosis and magement of rib stress injury: part 2 – the guideline itself. Br J Sports med, 50, 270-272

Griffin, D., Dickenson, E., O’Donnell, J., Agricola, R., Awan, T., Beck, M., …, & Bennell, K. (2016). The warwick agreement on femoroacetabular impingement syndrome (FAI syndrome): an international consensus statement. Br J Sports Med., 50(19), 1169-1176

Thornton, J., Vinther, A., Wilson, F., Lebrun, C., Wilkinson, M., Di Ciacca, S., …, & Smolianovic, T. (2016). Rowing injuries: an updated review. Sports Med., [Epub ahead of print]