Highlights to the "Reducing Rowing Injuries" Series
“Key points of the key points” to my new rowing injury guides
This post summarizes the last three parts of my rowing injuries series. I hope you will find the full articles helpful. If I only had five minutes to talk about each one, this is what I’d emphasize to rowers and coaches for overall injury management, low back pain, and rib stress injuries.
We started with “Rowing Injuries: Understanding, Preventing, and Managing” for a detailed overview of general principles that apply to all rowing injuries.
Most rowing injuries are non-contact and overuse injuries. This means they’re more under control by coaches and athletes than contact or acute injuries. Responsibility begins with the coach to create a positive culture of hard training with rowing-specific strategies for injury risk reduction and management.
A short-term injury may require 1-2 weeks of offloading to work around the injured area. We don’t anticipate much detraining in such a short time. Our main goal is keeping the athlete connected and engaged with pain-free movement and training to provide healing time before gradually returning to training.
A longer-term injury requires more time, creativity with workarounds, and typically benefits more from advice from medical professionals. 2-6 weeks is common for low back pain, while 6-10 weeks is common for rib stress injuries. The longer timeline makes it even more important to keep the athlete socially connected and engaged with pain-free training. The more we can preserve general fitness, strength, and muscle mass, while not interfering with the healing process, the better the injury outcomes.
Plan for an approximately 1:1 away-to-return timeline. The gradual progression in specific workload is important for technical and physical remodeling, as well as athlete psychology.
In my new low back pain (LBP) guide, I focused on the following major concepts:
LBP is so common in rowing–an average of 61% in a year of training, but up to 95% in some studies–that every coach and rower needs to be using some sort of risk reduction strategy. Prior injury is a risk factor for future injury, so preventing that first injury is absolutely key to reducing overall LBP.
Most LBP is not medically serious and will resolve in <6 weeks of “conservative therapy”: moving and training in ways that avoid and reduce pain. There is usually not a need for further medical intervention, but we should know the red flag conditions for medical attention. Without red flags, don’t use imaging (x-ray, MRI, CT, etc.) during this time to avoid cost, misdirection, and adverse athlete mindset around injury and back health. Minor interventions can help during this time, but are probably mostly placebo or short-term relief only. This can be helpful to ease pain and frustration, but doesn’t actually resolve the injury or prevent it from recurring on its own.
Longer-term LBP that lasts beyond six weeks or is so severe that it interferes with sleeping and walking likely requires medical support and greater intervention. A physical therapist, especially one who knows rowing, is very helpful here for more intensive rehab and advising on the do/don’t of training during a longer offloading time.
We likely need long-term or permanent training adjustments after returning from LBP to avoid risky situations even more. For example, the potential training benefits of heavy static erg training, added drag rowing/erging, and prolonged erging (30+ mins) may be not worth the risk of a setback in the rower with LBP history. This is not “softening” training, it’s individualizing it to the rower.
Key points to rib stress injuries (RSI):
Rib stress injuries are complex, probably the hardest rowing injury to prevent and solve. Minimize skeletal stress and strain by managing training load and building muscles to take the stroke force. As a bone injury, cumulative recovery is important to manage as a prevention and rehabilitation strategy. This means sleep, adequate calorie consumption, and micronutrients for bone mineral density and overall health and wellness.
A minor RSI caught early and offloaded quickly can recover in 1-2 weeks, followed by an equal amount of gradual retraining time. Proactive education on common symptoms and red flags is key to early detection, rapid offloading, and faster healing! RSI are often misdiagnosed as a soft tissue injury or “rib out-of-place,” especially when medical professionals are unfamiliar with rowing and the vastly increased rates of RSI in rowers compared to general populations.
Most RSI are long-term injuries due to the low blood flow of bones. A rower with a minor RSI might be able to handle everything except direct rib cage loading (ie. erging, rowing, upper body strength training). A rower with a more significant RSI may need more significant modifications, such as: cross-training below ventilatory threshold to avoid pain from heavy breathing, light strength training only to avoid pain from abdominal bracing, and no upper body loading at all. Any pain while training is delaying the healing process, so we must find truly pain-free forms of cross-training and strength training.
As with LBP, we likely need long-term or permanent training adjustments to avoid risky training methods and situations even more. Be especially mindful of equipment changes and rapid progression of training volume. Specifically, transitional phases between erging and rowing, training camps, and changing boat sides, types, or rigging. Rowers with RSI history will always need a little more attention to recovery, especially nutrition to maintain calorie balance and bone mineral density.
Remember to read rowing physical therapist Dr. Lisa Lowe’s articles on her website about low back pain and rib stress injuries, too! As a PT, Lisa’s emphasis is more on diagnosis and rehabilitation. As a strength coach, mine is more on management and returning to training.
I have one more coming next for Part 4 of 4, a short post of general tips on reducing injuries. I hope this series has been helpful for you. Let’s keep working to get and keep rowers healthy. I welcome your questions and comments on the articles, here on Substack, or via email.