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

Diagnosis

• 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:

• 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)

 

Read the next post in this series: Para Rowing Injuries – Part 3 on the Rowing Sports Medicine and Science Conference

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