Injuries in Rowing

Rowing is one of the original Olympic Sports. Rowers compete with their feet strapped into footboards in the frame of their racing vessel, called a shell, moving the boat with oar strokes while moving through each stroke on sliding seats. Athletes row with either two oars each (sculling) or one oar (sweep rowing) to the port (right) or starboard (left) side of the shell. An additional competitor, the coxswain steers and manages the boat for sweep crews of eight and some smaller scull and sweep crews. There are heavyweight (open) and lightweight categories for competition. Womens Rowing was introduced to the Olympics in 1976. 2000m is the standard race distance. Paralympic Rowers race 1000m in categories based on their functionality: Legs, Trunk and Arms (LTA); Trunk and Arms (TA); and Arms and Shoulders (AS).

The rowing stroke is broadly divided into the drive phase and the recovery phase. The drive begins with the oar blade entering the water (“the catch”) and the athlete applying leverage through the oar, first the with lower extremities, then the core and trunk, and finally completing the stroke with the upper extremities (the “finish”), then the blade is elevated from the water and rotated (“feathered”). During recovery the drive is reversed to bring the oar and rower into position for the next drive. The arms extend, the torso flexes, and the knees flex while the seat rolls toward the feet bringing the hips toward the footboard and coiling the rower’s body into position for the drive. At the end of the recovery the oar is rotated back (“squared”) for the next catch. When weather is not suitable, typically during winter, rowers train on land. Dry or land training is generally a combination of ergometer (rowing machine) and weight/resistance/strength training. Land based training has been implicated in up to 50% of injuries in elite rowers.¹

Rowing is among the most physically strenuous human sport activities; athletes perform repetitive explosive full-body movements in rapid succession. Racing 2000 meters rowers effort is about 75% aerobic and 25% anaerobic.² Oxygen consumption (VO2 Max) can surpass 70 mL/kg/min in Olympic rowers³ and lactate of 28 mmol/L rank among the highest measured levels in sport.⁴ These demands combined with the mechanics of the rowing stroke, training load, equipment, technique, individual athlete biomechanics may result in injury.

Common rowing injuries include: low back injury; rib stress injury; shoulder impingement and instability; knee pain; wrist/forearm tendinopathy. Hip Femoroacetabular Impingement (FAI) and Relative Energy Deficiency in Sport (RED-S) have also been increasingly identified in rowers. This article will give an overview of the sport, common rowing injuries, and approach to the injured rower.

Low Back

The lumbar spine and low back are the most commonly reported region of injury in rowing. Over 12 months, reported incidence of rowing related low back pain ranged from 32-53%.^5,6,7 In rowers low back injuries are typically related to training volume, technique, and kinematics. Lumbar extensor fatigue as well as deficiency in hip motion and/or pelvic rotation may contribute to increased strain on the lumbar spine. Specific injuries such as lumbar disc bulge and herniation, facet joint capsule sprain, spondylolysis, and spondylolisthesis are also encountered.³

Rib Stress Injury

Stress fracture and stress reaction of the ribs and chest wall are thought to be related to repetitive high strain muscular loads across the thorax. Ribs 5-9 are the most commonly injured, and 9% incidence has been reported.⁸ While several risk factors have been theorized, there is a relative paucity of strong evidence underpinning each. Great Britain Rowing Team has published guidelines for the diagnosis and management of rib stress injuries.^9,10

Shoulder

In rowing the upper extremity is the third most common site of injury. Changes in shoulder gird le positioning and dynamic stability occur about the shoulder in rowers, particularly in the outer shoulder of sweeps rowers due to the asymmetry of the sweeps rowing motion. Anteriorly positioned humeral head, tight posterior capsule, and relative rotator cuff deficiency result in impingement and dynamic instability, and, less commonly, tears of the glenoid labrum.³

Knee

Repetitive stress conditions of the knee are relatively frequent in rowers. Patellofemoral pain syndrome, patellar tendinopathy, and iliotibial band friction syndrome are most common. Patellofemoral conditions likely relate to the high compressive and tensile forces across the patellofemoral articulation and extensor mechanism in deep flexion, while anatomic factors and cross training with running or cycling may be factors in IT band pathology.³

Forearm and Wrist

Forearm and wrist conditions relatively common to rowers include intersection syndrome, De Quervain’s tenosynovitis, lateral epicondylitis, and exertional compartment syndrome. Intersection syndrome is colloquially termed “Oarsman’s Wrist” and results in dorsal radial forearm pain from the compressive effect of the first dorsal compartment tendons on the second dorsal compartment tendons at the crossover point. Volar exertional compartment syndrome may occur if athletes initiate the drive with their elbow instead of the shoulder. Contributing factors may include equipment such as handle size and rigging, improper technique such as tight trip and excessive wrist motion during feathering, fatigue, and wet conditions.¹¹

Other Injuries and Sports Medicine Considerations

Hip FAI has recently been increasingly recognized in rowers. Related disorders of energy availability, disordered eating, and body composition have also received increased attention. Lightweight rowers in particular may be at risk for sub-clinical disordered eating.³ While the term female athlete triad has been used historically, low energy availability and “exercise hypogonadism” has been described in male athletes too.¹² Abrasions and blisters are common among rowers and typically require care and monitoring as well as attention to cleaning of shared equipment such as oar handles. Measures should be taken to mitigate environmental exposures such as dehydration, heat illness, hypothermia, etc that may result from local weather conditions during training or competition. There are unique considerations for Olympic competitors and their sports medicine team related to international travel and competition.¹³ Likewise, there are sports medicine considerations unique to junior, masters¹⁴, and para-rowers, and to athlete sex¹⁵ that are beyond the scope of this article.

Approach to Injured Rower

Injury assessment includes a comprehensive evaluation that should include: training program for changes in intensity, volume, frequency; equipment factors; rowing and training technique; athlete injury history; athlete biomechanics and kinetics / dyskinesia, strength and mobility or flexibility imbalances. Timing in season and transitioning from water to land can be factors in injury risk. Athlete nutrition, sleep and recovery should also be assessed. Video analysis may be helpful in identifying improper technique and observing breaks in form that occur with fatigue. While these concepts are straightforward, evaluation of these factors requires a thoughtful, detail oriented, meticulous review of training factors and thorough physical examination supported by relevant imaging. During periods of injury training load should be adjusted and activities modified to allow for healing and recovery, but complete rest may result in deconditioning that increases risk of recurrent injury upon return to sport.¹⁶ Wearable technology to monitor performance, technique, fatigue, and recovery may be increasingly utilized in the future for injury prevention, performance optimization, and ensuring efficient and successful rehabilitation of injuries. In summary, most rowing injuries are related to repetitive stress, specifically volume of training and technique¹⁷, and most rowing injuries can be managed with nonsurgical interventions.

References:

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