by Rowing injuries are typically defined as pain limiting the ability to fully participate in training as planned for more than 24 hours. This excludes minor tweaks or aches that just require a little extra warmup time, recovery attention, or occasional slight modifications to training for a day or less. More significant pain that limits an rower for more than a day can be stressful, aggravating, and disrupt training and impair performance. This article is a detailed guide to understanding, preventing, and managing common rowing injuries.
Key Points: The best rowing injury prevention and management occurs with an interdisciplinary program including the rower, rowing coach, strength coach, physical therapist, physician, dietitian, sport psychologist, and potentially more if available. Understanding and reducing pain requires a biopsychosocial model that considers biomedical, psychological, and social elements of training and outside life, as well as rowing-specific knowledge. We improve injury recovery outcomes when we can preserve fitness, strength, and muscle mass through pain-free forms of cross-training and strength training while healing, whether for a short-term or longer-term rowing injury. Rowers returning from injury should use specific training strategies to achieve approximately a 1:1 return timeline, spending as much time returning to full training as the rower was away or doing modified training. A gradual return progression to full training and performance improves recovery outcomes and reduces risk of reinjury or other injury.
Table of Contents:
- Get Qualified Professional Help
- Biopsychosocial Understanding of Pain and Injury
- Training or Competing Through Pain
- Short-Term Rowing Injuries: Offloading and Reducing Pain
- Longer-Term Rowing Injuries: Rehabilitation and Modified Training
- Returning to Training and Performance
- Wrap-Up and Guides to Low Back Pain and Rib Stress Injuries
Get Qualified Professional Help
I’m just a strength coach with a library card, not a medical professional who can diagnose and help athletes rehabilitate injuries. The strength coach helps healthy athletes get stronger, fitter, more muscular, and more powerful in ways that have the potential to improve performance and reduce risk of injury for their sport. The rowing coach helps the rower apply these general athletic qualities to rowing training to improve rowing performance. We refer rowers experiencing illness or injury to appropriate medical professionals for diagnosis and getting healthy. We assist from there until the rower is cleared to return to partial or full strength training and rowing. Role clarity is important to make sure that each professional is acting within our scope of professional training and ability.
Experiencing injury and recovering from injury can be mentally and emotionally challenging as well as physically. Athletes experiencing injury may feel frustrated by the injury, rehabilitation, or return process, as well as potentially removed from their athletic identity, daily routines, and social support system of teammates and coaches. Sport psychology counselors are a great resource to help with this stress. They are trained in psychological counseling and sport education. They almost always come from athletic backgrounds themselves with their own experiences to relate to athletes. The Association for Applied Sport Psychology (AASP) is the main worldwide education and certification body. Athletes can use AASP’s counselor-finder here for location, virtual/in-person, language, specialization, etc.
Medical professionals can be helpful for diagnosing the cause of the injury and prescribing a rehabilitation plan. I typically refer to a physician (team or “sports doctor”) or physical therapist (PT) when the injury persists for more than a week or two, if the pain is moderate or severe, and/or if the injury recurs during the return to full training and performance. I’ve written a list of my go-to rowing PTs here. I haven’t updated that article much since publication in 2021, and it’s by no means comprehensive. These are just some of the people I go to first when I have a question or want to refer someone for an in-person or virtual appointment.
Working with a PT who knows rowing is a huge shortcut on the diagnosis and rehab process. The people in my contact list all have experience in rowing, as former or current rowers themselves, in coaching, and/or a lot of experience working with rowers. They know the common injuries and red flags for diagnosis, the mechanisms of injury and the dos and don’ts of training during rehab. They can advise on what the rower needs to do to return to full training and greater performance again. If this isn’t available, try to at least find a “Sports PT,” instead of a more general population, medical, or geriatric specialist. A Sports PT with more experience with endurance athletes will likely be even better. They might know running, cycling, and swimming more than rowing, but they are at least more familiar with repetitive motion, high output efforts instead of more contact or reactive injuries like in general or field sports.
Biopsychosocial Understanding of Pain and Injury
Modern injury research and rehabilitation attempts to understand and resolve pain as a biopsychosocial phenomenon. This means engaging with the athlete in several different domains. The biomedical domain is primarily focused on structural pathologies, physical impairments, and specific treatments for those structures and impairments. The psychological domain considers the athlete’s own internal thoughts and mental attitudes about pain. The social domain adds an external element of how the athlete engages with others in training, competing, and life outside of sports. We then add to this with understanding of sport-specific and injury-specific risks, including technique, training load and progressions, equipment, and more.
The key idea is that pain, injury, and recovery rarely results from just one isolated domain. Many rowers do the exact same strength and sport training, yet some get injured while some (or hopefully many or nearly all) do not. The answer does not lie in one extreme. From the biomedical side, one weakness, tightness, or anatomical structure cannot single-handedly cause or resolve injury. From the psychological side, neither injury nor recovery is “all in your head,” and yet, athlete mindset still matters. From the social side, general stress and relationships cannot cause or resolve injury on their own, and yet this still matters for health and performance. I try to make sense of all of this with the following major principles.
Pain is usually multifactorial: There is rarely one singular cause of injury. We generally do not rely on an exhaustive biomedical diagnostic examination to begin the healing process. Researchers generally recommend against routine scanning or imaging (x-ray, MRI, CT, etc.) without a red flag condition or potential major intervention being considered (eg. surgery or long-term offloading). Unnecessary scanning adds cost, risks misdirection from asymptomatic findings, and can contribute to an adverse mindset around health and recovery. There can still be problematic movements or musculoskeletal structures that benefit from mobility, flexibility, and/or strengthening. It is best for the athlete to work through this with a physical therapist, alongside sport and strength training. Isolated practice and lack of communication between practitioners is unlikely to produce beneficial long-term results.
There are individual and sport-specific risk factors: We acknowledge the role of psychosocial stress in injury, pain sensitivity, and healing response. Consider high-stress times of the year, such as selection camps, intense racing, academic or employment deadlines, and more. Athletes are usually under higher training load during these times and may also experience heightened psychosocial stress around performance. This combines to increase risk of injury. Coaches can identify these periods of increased risk and take extra care to avoid more risky training methods. Individual athlete lifestyle factors including sleep, nutrition, and managing non-training stress are also important to reduce risk of injury and improve rehabilitation outcomes.
Seek understanding of individual athletes: Athletes experience stress differently due to personality, training response, and life factors. Implement some specific interventions to reduce pain and/or risk of injury, but don’t count on this entirely to prevent or resolve injury. Interventions that reduce immediate pain and stress can take advantage of a short-term real or placebo effect to ease pain, frustration, and allow for pain-free training to begin or increase. Continue to work to solve potential underlying injury causes and manage sport risks to avoid long-term regression if or when the short-term effect fades. Finally, maintain elements of risk management and rehab as the injured rower returns to full training. Many common rowing injuries should be considered “in management” as opposed to “one-and-done.”
Athletes are less likely to experience injury when they are happy, medically healthy, well-fed, well-rested, and prepared to improve from the training load technically, physically, and mentally. Reducing risk of injury then requires some level of awareness and management of these many factors to reduce overlap of multiple risk factors. Coaches need to set athletes up for success with knowledge of sport-specific risks, appropriate equipment, reasonable workloads, intentional progressions, technical coaching, and responding to objective and subjective athlete feedback. Athletes need to take advantage of this with attention to good technique, sticking to the training plan, managing recovery (including nutrition and sleep) outside of training, and providing feedback to coaches. Everyone involved in the sport training environment–coaches, athletes, and staff–can help improve the social environment of training and life as an athlete to reduce risk of injury and improve outcomes in sport performance and beyond.
Training or Competing Through Pain
Rowers may try to train or compete through pain due to the rower’s own self-pressure or from real or perceived pressure from teammates and/or coaches. There are situations in which the rower, coach, and support staff may make an informed decision to train or compete through pain. This is only potentially worthwhile in rare situations of, for example, a crucial selection event, erg test, or race at the highest level that cannot be rescheduled. This needs to be a carefully considered and informed decision between the rower, coaches, and support staff (including a medical professional). Everyone needs to be on the same page about the rower’s limitations, performance pressure, and potential consequences. Consider the benefit of impaired participation with the risks of further injury. Can the rower still perform well enough to be worth it? Are the longer-term risks minor enough to be worth it?
The answer is usually to withdraw the rower (and nearly always for juniors and masters). It is still important to have an open, informed discussion with the rower and other program stakeholders to consider this as individually as possible. A “zero-tolerance” policy of automatically or by default withdrawing athletes due to pain or injury actually risks creating a culture of injury concealment. Athletes already tend to be afraid of losing training time and competitive advantage or opportunity due to injury. They will become more afraid, and less likely to communicate around injuries, if they know for sure that they will be withdrawn! Read this 2021 study by Dr. Fiona Wilson and colleagues for more here, drawing from analyzed interviews of 25 rowers who experienced low back pain.
Coaches who care about this need to work harder to proactively and positively message around pain and injury. The “culture of concealment” described in Wilson et al. (2021) is likely to be the default without a clear alternative vision and consistent behavior to demonstrate that vision. I find that rowers are afraid of losing training time first and foremost, followed by competitive opportunities. The vast majority of rowing is training, not competing, after all. Rowers like it that way: Training, and training hard, is an important part of rowers’ athletic identity. They don’t want to lose this, usually for themselves first, and then for perception of others second.
Strength coaches have an important opportunity to serve injury-conscious rowing coaches, rowers, and programs by providing alternative forms of training. Using cross-training and strength training can help reduce risk of injury, work around pain in rowers experiencing injury, and help rowers make successful returns from injury. We can show rowers that addressing injury and getting healthy doesn’t result in lost training time, doesn’t isolate them from their teammates, and not only doesn’t detract from future performance, but actually enhances it. These are all critical factors discussed in the Wilson et al. 2021 low back pain interview study.
Short-Term Rowing Injuries: Offloading and Reducing Pain
The first step to healing pain or injury is finding ways to reduce pain. Identify the movements or types of training that cause pain and avoid those until pain decreases. Resist the urge to “test” pain with movements “to see if it’s still there,” or by returning to previously painful training too quickly. We need to offload the injured area for long enough to get out of the initial phase of high inflammation and immediate pain response. The increased sensitivity to pain has to decrease before we can even make a good diagnosis, let alone progress in rehabilitation and returning to training.
Offloading means avoiding the painful stimulus with the goal of reducing pain. It does not mean stopping all forms of training. Any pain-free form of training is potentially beneficial for the athlete’s physical and mental health. Continuing modified training can help the athlete stay connected to their athletic identity, daily routines, and support system of teammates and coaches. Pain-free aerobic cross-training helps preserve cardiovascular fitness. Pain-free strength training helps preserve strength and muscle mass.
The more that we can maintain fitness, strength, and muscle mass, while not conflicting with the healing and rehabilitation, the better the return-to-train process will be later. Athletes who offload from all forms of training typically experience worse outcomes from healing and retraining due to low physical activity and social isolation. The detraining that results from stopping all training can become more of a problem than the original injury itself! The athlete, sport coach, and support staff should all work together to find pain-free forms of training to preserve health, fitness, strength, and muscle mass.
Walking can be a great form of low-intensity, pain-free cross-training. Get a steady stride and some rhythmic arm-swing going, right up to the “ventilatory threshold” point at which maintaining a conversation or singing a song out loud becomes challenging. We can make additions to increase challenge, such as using a weighted vest, an inclined (uphill) treadmill, or stadium stairs or a stair-stepper machine. Stationary cycling is often tolerable, as long as the athlete can get into a comfortable position for longer or more intense training. The dynamics of the seated position can often be uncomfortable for low back pain, the same with rib stress injury and hands-on-handlebars position, and cycling probably won’t work for any leg injury. Pain-free cross-training must be truly pain-free! There is no “tolerable pain” threshold for offloading.
The more controllable the training, the less likely for an accident to derail healing. Walk on a stable, predictable surface, not on bumpy trails, slippery roads, or icy surfaces. Use stationary cycling instead of outdoor cycling. In a 2020 study of Rowing Australia training during two Olympic cycles, road cycling accidents caused a third of all acute injuries and resulted in an average of 31 days lost per injury!
Minor self-care interventions may also help reduce pain during this initial phase of healing. This may include stretching, mobility, and light movements for the injured area, such as unloaded strength training exercises. Minor interventions also include foam rolling, self-massage, professional massage and other manual therapy, ice, heat, TENS unit, and more. We are not expecting to cure or heal the injury with these interventions. If they help reduce pain, then they can help in the short-term while we work to resolve long-term cause or risks of injury.
Minor rowing injuries may heal with one or two weeks of offloading to avoid pain and minor interventions to reduce pain, followed by an equal amount of time returning to full training. See the “Returning to Training” section ahead for how to gradually reintroduce the previously painful training stimulus. If the pain becomes moderate or severe, persists for more than a week or two, or returns during a gradual return to full training, consider this a longer-term injury and refer to a medical professional for diagnosis and rehabilitation.
Longer-Term: Rehabilitation and Modified Training
A long-term injury that hasn’t responded to 2-6 weeks of offloading or modified training, or returns during a progressive return-to-train phase, requires greater and longer intervention. This may include physical therapy, offloading for a longer duration to facilitate healing, and other training and lifestyle modifications. All of the information from the prior “Short-Term” section applies as far as offloading and modifying training to avoid pain. We are just continuing this for longer, plus hopefully receiving advised rehabilitation from a physical therapist (PT).
The PT should advise on diagnosis, rehabilitation, and recommended and contraindicated training. This may include recommendations for cross-training, strength training, sport training, and off-training activities such as recovery interventions and modifications to activities of daily living. As a strength coach, I also want to know what the athlete is doing for rehabilitation that we don’t need to do more of with strength training.
The key things to learn from the PT are:
- What kind of training should the athlete do that facilitates healing?
- What activities or training should the athlete NOT do that interferes with healing?
- What strength training is redundant with PT and can or should be avoided?
The PT sets the “do/don’t/redundant” guidelines. The athlete, sport coach, and support staff can then continue finding pain-free training that follows these guidelines. We want to continue to support the athlete’s mental and physical health, as well as preserve general fitness, strength, muscle mass as much as possible while not conflicting with the rehabilitation. Specific training and strength training recommendations depend on the injury, PT guidance, and individual athlete.
The athlete will generally benefit from staying connected with the team or group program. There are lots of opportunities in rowing to help out in the training environment, and the social engagement plus still feeling like a valued member of the team can be a big help in recovery. An athlete with a significant injury might need a week or two away to process and prepare for the recovery phase. Longer than this tends to turn into isolation or self-isolation. This is worse for recovery, healing, and returning to full training and performance. I aim for as little time away from the social training environment as possible without putting too much pressure on the athlete. Coaches need to have a plan for rowers experiencing injury beyond, “let us know when you’re ready to come back.” Rowers under this guidance tend to disconnect entirely and quit, or rush the rehab and return process in order to get back with the team again, which often leads to reinjury.
Athletes usually appreciate learning about the injury, why it happened, and how we can rehabilitate and return from the injury to full training and performance. Connecting with another rower who has experienced similar injury can be helpful to hear their experience and what they had to do differently while injured and after injury. If the coach doesn’t have experience with the injury, try to connect with another coach who does so that the rower and coach can both learn what it will take to recover and return. Including the PT in this conversation can also be very helpful to develop the post-injury return plan. Online resources vary in quality, but some searching may reveal an article, podcast, video, or some other resources out there by someone qualified to talk about their injury experience and advice.
Returning to Training and Performance
I advise rowers and coaches to expect an approximately 1:1 away-to-return timeline when returning from injury. If the injury was minor and resolved with a week or two of offloading, plan for another week or two to gradually reintroduce the previously painful stimulus. If the injury was more significant and resulted in longer rehabilitation, assess the return timeline based on the total time of offloaded or modified training. A rower who offloaded or modified training for six weeks should plan to spend about six weeks getting back to full training.
Note that this is just returning to full training. Returning to full performance can take longer. This timeline depends on the severity of the injury, the amount of offloading or modified training time, the success of the rehabilitation, and any long-term psychological or physical effects that the rower experiences.
It is possible that a rower who experienced a significant or long-term injury will never return to exactly the same kind of training or training load they did before injury. After all, this training resulted in injury. The rower can absolutely return to prior and greater levels of performance by making long-term modifications to training.
The National Strength and Conditioning Association (NSCA) offers starting points for return-to-train (RTT) protocols in their 2019 consensus paper, “Safe Return to Training Following Inactivity.” The “50/30/20/10 rule” describes a weekly percent reduction from the athlete’s approximate pre-departure training volume. In RTT week 1, the athlete does 50% of the prior training volume. In week 2, the athlete does 70%, a 30% reduction from prior training volume. In week 3, the athlete does 80%. In week 4, 90%. Assuming no complications during the RTT phase, the athlete may resume normal training on Week 5.
(Note: If this sounds familiar, I wrote and talked a lot about returning to training in the extreme examples of 2020-2021, beginning with my article here, with updates and links to two USRowing webinars I did on the topic.)
The RTT phase is important for physical and technical remodeling, as well as psychological comfort. An RTT phase with a rapid progression risks reinjury to the injured area or, perhaps even more frustrating, injury to a different area. The injured area may be stronger from rehabilitation, while other areas may have experienced detraining. A rapid progression might send the athlete right back to rehab for a different injury. A gradual RTT phase also gives the athlete time to improve any technical factors that may have contributed to injury. This improves long-term performance outcomes and reduces risk of future reinjury. Physical structures are experiencing remodeling as well. Specific training imposes specific stress on physical structures. A gradual progression gives these areas time to become strong and durable to this stress.
The NSCA guidance is focused on field and sprint sports. They discuss cardiovascular training all together without guidance on intensity zones for endurance sports. The following adaptations are my own, using a simple three-zone intensity system based on blood lactate and approximate heart rate correlations. Here’s a nice 7-minute video by physiologist Dr. Stephen Seiler to explain the three-zone model. The low-intensity zone is up to 2mM blood lactate (BLa), up to approximately 75% of heart rate maximum (HRmax). The middle-intensity zone is between 2mM and 4mM BLa, up to approximately 90%HRmax. The high-intensity zone is over 4mM BLa, above 90%HRmax. I recommend that the RTT progression is all low-intensity, when possible with external performance timelines. This provides the most controllable planning for the coach, the most gradual stimulus for a recovering athlete, and the most effective technical remodeling time.
Here are RTT plans for three main scenarios: returning from all training, returning from modified training, and returning from minor injury or illness.
Returning from All Training
If the athlete experienced significant detraining, such as illness or an injury that essentially prevented cross-training or strength training, use the full 50/30/20/10 progression for total training volume. Use the athlete’s pre-injury training volume across all modes of training to calculate the 100% number, and then follow the five-week progression.
- Week 1: 50% training, low-intensity zone only
- Week 2: 70% training, low-intensity zone only
- Week 3: 80% training, low-intensity zone only
- Week 4: 90% training, low-intensity zone only
- Week 5: 100% training, with one or two moderate or high-intensity zone sessions
Returning from Modified Training
If the athlete maintained a training status through pain-free cross-training and strength training, then we can focus on retraining the specific mode of training. Calculate the 100% number based on the athlete’s sport-specific pre-injury volume, and then follow the five-week progression in the specific mode. Continue doing pain-free cross-training for the remaining training volume, inversely proportional to the sport-specific training volume. For example:
- Week 1: 50% sport (low-intensity), 50% cross-training (normal distribution)
- Week 2: 70% sport (low-intensity), 30% cross-training (normal distribution)
- Week 3: 80% sport (low-intensity), 20% cross-training (normal distribution)
- Week 4: 90% sport (low-intensity), 10% cross-training (normal distribution)
- Week 5: 100% sport, resume normal intensity distribution
This progression with backfilled volume allows us to progressively retrain the sport-specific mode of training while preserving general fitness through cross-training. The low-intensity sport progression is an important time for technical remodeling. If a technical error contributed to the athlete’s injury, this gradual progression is the opportunity to correct it under low-fatigue training load. The injured area is also undergoing physical remodeling during this time.
Returning from Minor Injury or Illness
A rower who experienced a minor illness or injury that required a week or two offloading may use the two-week “50/30” progression variation. If they significantly reduced all training volume and may have experienced some detraining, calculate the 100% number based on the total pre-injury training volume. Do 50% of that number in Week 1, and then 70% of that number in Week 2, and then 100% in Week 3 if there are no complications. If the athlete was able to preserve total training volume through cross-training, calculate the 100% number based on sport-specific pre-injury volume. Use backfilling to preserve total training volume while progressing sport-specific volume.
- Week 1: 50% sport (low-intensity), 50% cross-training (normal distribution)
- Week 2: 70% sport (low-intensity), 30% cross-training (normal distribution)
- Week 3: 100% sport, resume normal intensity distribution
It’s possible that a one-week “50/0” variation can work for a mild illness or injury resulting in one week or less of offloading time. This might be a minor cold or an injury just above a “tweak,” such as a cramp or ache from sleeping funny. Start with 50% of specific sport training volume in the first week back. The rower and coach can decide from there if they want to go to 70% volume during Week 2, or straight to 100%. The key is to think about progressive reloading. We do not want to go “full send” straight back to 100% of pre-departure training. We definitely do not want to “make up for lost time” by doing even more training than pre-departure.
There are some specific training risk factors and strategies we should consider with rowing injuries. The higher per-stroke loads of static erging commonly cause more pain and injury than dynamic erging or on-water rowing (see: Wilson, 2014). In the 2020 Rowing Australia injury study, they found that switching from testing on static ergs to dynamic ergs (Concept2 sliders) for the 2009-2012 Olympiad was associated with less missed training time due to low back pain. Switching back to statics in 2013 resulted in more missed training time due to low back pain. Prolonged erging of 30+ minutes continuously is also a risk factor for injury and a common aggravating factor for injury (see: Wilson, 2021). If possible, coaches and rowers should consider using dynamic ergs (including sliders) at least for rowers returning from injury or at risk of injury, if not for all rowers’ prolonged (steady state) training. One author at WorldRowing proposes intervals of 10 minutes on, 1 minute off, during low-intensity erging to reduce back pain. The 1-minute rest doesn’t affect heart-rate much at all while training, and just standing to break up the movement may help ease and avoid back pain. This also makes 10-minute intervals easy to track and manage, so that the rower can gradually add training volume without making too big of an increase from one session to another.
Rowing Injuries Wrap-Up and Specific Guides to Low Back Pain and Rib Stress Injuries
These basic principles of managing rowing injuries apply to any injury. An individual or team support staff of qualified professionals, including a sport psychologist and physical therapist, as well as a strength coach and rowing coach, can help avoid or ease the short-term and long-term frustration of injury, rehabilitation, and return to full training and performance. Minor injuries can respond well to short-term offloading for a week or two to avoid the painful stimulus. A longer-term injury will require more offloading time and often benefits from specific advice from medical professionals to rehabilitate before returning to training. Try to preserve strength and fitness as much as possible through pain-free forms of training, usually cross-training and strength training. Rowers returning from injury should expect approximately a 1:1 away-to-return time for full training. Use some specific training strategies such as the 50/30/20/10 progression to ensure a gradual return to full training and performance. Avoid jumping immediately to pre-injury training volumes, and definitely don’t increase training to “make up for lost time.”
Low back pain and rib stress injuries are two of the most common and costly rowing injuries. Low back pain can affect an average of 61% of adult rowers in a given year of training, causing the highest frequency of missed practice time. Rib stress injuries are less common, around 10% of rowers in a year of training, but as a bone injury they take far longer to heal and cause the most total missed training time per injury. Rowers and coaches can implement specific training strategies to reduce risk of these injuries and prevent them at the source. We can also use management strategies when injury does occur to help the rower heal and return to full training and performance.
Read the specific guides below for “What Rowers and Coaches Need to Know” about low back pain and rib stress injuries. These are updated from my 2018 article, “The Research on Low Back Pain and Rib Stress Injuries.” The older article will stay for those interested in the details of research and biomechanics on rowing injuries. The new guides focus on practical advice on specifics of prevention, management, and returning from low back pain and rib stress injury. Click/tap the pictures below to go to the guides, or follow these links: Guide to Rib Stress Injuries — Guide to Low Back Pain.
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