COMMON ROWING INJURIES Prevention and Treatment Jo A. Hannafin, MD, PhD Professor of Orthopaedic Surgery Hospital for Special Surgery, Cornell University Medical College Team Physician, US Rowing FISA Medical Commission

1. Prevention and Treatment
COMMON ROWING INJURIES
Jo A. Hannafin, MD, PhD
Professor of Orthopaedic Surgery
Hospital for Special Surgery, Cornell University Medical College
Team Physician, US Rowing
FISA Medical Commission

2. Rowing Injuries
Common sites include
– wrist and hand
– forearm
– shoulder
– rib
– hip
– knee
– back
The majority of rowing related injuries are secondary to
overuse/ overload, and poor mechanics associated with
rowing, ergometer training, running and strength training

3. Traumatic and Overuse Injuries Among
International Elite Junior Rowers
Tomislav Smoljanovic, Ivan Bojanic and Jo Hannafin
 Injury data collected from 398 junior rowers at WC, 2007
 73% reported overuse injury
– male rate 0.9 injuries per 1000 training sessions
– female rate 2.36 injuries per 1000 sessions
– low back > knee > wrist
 28% reported traumatic or acute onset of injury with 41% of
injuries to low back during water or erg training
– Risk factors included
• changing side
• fewer years of experience
• greater than 7 training sessions/week

4. Wrist
Treatment
• change in mechanics
• smaller handle
• thumb on top (erg)
• change sides
• rest and ice massage
• anti-inflammatory medication
• physical therapy modalities
• local injection
Crossover tendonitis
• repetitive feathering
• sweep to sculling
• large handle size
• “too-tight” grip

5. Forearm Compartment Syndrome
• TIGHT forearms
• pain, swelling
• symptoms relieved with
cessation of rowing
• most commonly related to
technique
• “death grip” on the handle
• feathering hand
• may require surgical release if not
responsive to change in technique

6. Epicondylitis
• localized to epicondyle of elbow
• lateral pain
• increases with feathering
• at catch and release
• medial pain
• increased with premature elbow
flexion
• prevention and treatment
• strengthening of forearm muscles
• avoid excessive fatigue
• light grip
• Ice after exercise
• tennis elbow strap during rowing

7. Hand Hygiene
• blister care
• thin calluses
• designated oars
• clean handles
• concerns:
• transmission of infection
• blood borne diseases
• MRSA

8. Shoulder Anatomy

9. Impingement Syndrome
• acute trauma
• mechanical injury
• repetitive overload
• poor scapular mechanics
• poor core control
• shoulder laxity or
undiagnosed instability
• over-reaching at catch
• lunge at catch

10. Treatment and Prevention of Impingement Syndrome
Treatment
• NSAID
• “relative rest”
• physical therapy
• rotator cuff strengthening
• scapular strengthening
• core stabilization
• subacromial cortisone injection

11. Prevention
• strengthening of rotator cuff,
scapular stabilizers and core
• external rotation
• bench pulls
• seated row
• proper mechanics on erg and in
boat
• avoid overreaching at the catch
• stable upright posture
• rapid control of posterior shoulder
musculature at the catch, early
drive, and finish

12. Shoulder Instability: Treatment
• rotator cuff strengthening
• surgical stabilization
• technical advice
• avoid over-reaching at the
catch
• avoid shooting the slide
• change sides
• make sure that the outside
shoulder is stable
• inside arm will compensate

13. Costochondritis
• inflammation of the rib-
cartilage articulation
• insidious onset
• may be associated with
clicking
• variable symptoms
• treatment
• modalities
• stretching
• local injections

14. Rib Stress Fractures
• occur during periods of intense training
• “steady state” training
• low stroke rate
• high load per stroke
• fall and winter
• long rows and erg pieces
• transition to race pace training
• “intercostal strains are uncommon!
• stress fractures are often misdiagnosed
• achy rib pain
• pain with cough or sneeze
• increased pain at catch or finish

15. Rib Stress Fractures
 symptoms
– ill defined thoracic
discomfort
– insidious onset
– progresses to sharp pain
– exacerbated by
• coughing, deep
breathing
• changing position
– localized discomfort on the
affected rib
– + chest wall squeeze test

16. Treatment of Rib Stress Fractures
• MODIFY activities
• rest from rowing until minimal pain
• early diagnosis results in earlier return to rowing
• cross training as tolerated to maintain aerobic fitness
• avoid impact loading
• bike > elliptical > running
• progression to return to rowing
• erg with low resistance and high stroke rate
• progress to increased time on erg with attention to
good technique
• large boat rowing with clamshell or change in
button to decrease load

17. Anterior Hip/Thigh Pain
Can result from anatomy or training
• hip flexor tendonitis
• “snapping hip”
• related to inadequate flexibility of anterior
hip musculature
• common during rapid growth spurt
• training errors on ergometer > water
• FAI (femoral-acetabular impingement)
• abnormal anatomy of hip joint
• cartilage injury and labral tears

18. Knee Pain
Can result from:
• anatomy
• patellar maltracking
• training errors
• inadequate strength
• core stability
• hip and thigh musculature
• poor flexibility
• quadriceps
• iliotibial band
• hip flexors
• hamstrings

19. Prevention and Treatment of Knee Pain
• improve hip and knee
flexibility and strength
• monitor for the presence of
a ”painful arc” with repetitive
bending
• avoid over compression
• modify foot position in boat
and on erg
• monitor mechanics if
running for cross-training
• develop platform of strong
core prior to free weight
strength training

20. Low Back Pain
• muscle strain
• lumbar disc disease
• disc bulge or tear
• disc herniation
• sciatica
• stress fracture
• spondylolysis
• spondylolisthesis

21. Lumbar Disc Disease
Risk factors
• poor core control
• tight hamstrings
• excessive time on
erg at low stroke
rate and high load
• poor form on
Olympic style lifting
• high loads on lower
lumbar discs during
rowing stroke

22. Muscle Activity and Spine Load

23. Peak Resistance:
1200
1250
1300
1350
1400
1450
1500
1550
18 20 22 24
Stroke Rate
N
Load at the Oar
Shear Load at L4

24. Prevention of Low Back Pain
• core stability
• hamstring flexibility
• good technique
• adequate warm-up
• appropriate rigging
• monitor ergometer load
• drag setting
• length of erg pieces
• early evaluation if back
pain develops

25. Ergometer
• stroke rate
• length of piece
• drag settings
• no need for “HEAVY” resistance
settings during steady state pieces
• entering the piece
• avoid beginning from a dead stop
• know drag factor of the specific erg
which can be affected by:
• damper or fan setting
• dirt (alters the drag factor)

26. Rowing Injuries
• monitor your teams injury record
• assess the injury patterns, and
correlate with your training schedule
• younger athletes may be more prone
to certain injuries during times of rapid
growth
• teach athletes to differentiate between
pain associated with training and pain
associated with injury
• longevity in sport is the goal!

27. HANK YOU!!!