Stress fractures to the ribs occur in rowers, golfers, canoeists, lacrosse players, and baseball pitchers. They are more common in sports involving an element of trunk rotation with scapula movement across the rib cage.

A stress fracture is described as an overload of the bone caused by repetitive loading due to a particular movement. Any load on the bone will create stress in the bone. However, given enough recovery time, the bone heals and becomes stronger. This is known as Wolfe’s law. But, if the bone load is too high or too frequent, then the bone does not repair quickly enough, a stress response occurs, and a fracture follows.

In rowing, repetitive loading is created by several factors. Muscles such as the serratus anterior and abdominals that directly attach to the ribs can lead to loading on the ribcage due to contraction. Bad rowing technique, perhaps caused by poor hip flexibility, which requires excessive compensatory thoracic rotation, may lead to rib breakdown.

Other causes include equipment issues such as the oar type (lighter carbon oars increase rib loading) and bigger boats with more drag and position in the boat (bow rowers have less incidence due to lower stroke rate and force). Rib cross-section and density also influence the chance of stress fractures, and women have a higher chance due to the greater likelihood of bone density issues. Finally, training variables such as volume, intensity, type of loading, and off-water training can also be factors in stress fracture development.

The signs and symptoms are usually straightforward. These include generalized rib pain with a focused spot of tenderness, pain rolling onto the ribs whilst sleeping, and pain with deep breathing. They can be confirmed with a bone scan (black spot) and/or MRI (white spot).

Unfortunately for the rower, the immediate management of the injury involves rest. Usually, 4-6 weeks away from rowing will be enough to allow bone healing, followed by a progressive increase in rowing load over another 4 weeks before the athlete is back to full training.

Additional Topics: Chiropractic and Athletic Performance

Chiropractic care is a popular alternative treatment option that focuses on diagnosing, treating, and preventing injuries and/or conditions associated with the musculoskeletal and nervous system, primarily the spine. Many athletes and civilians seek chiropractic care to restore their natural health and wellness; however, chiropractic has been demonstrated to benefit athletes by increasing their athletic performance.