Reducing Rowing Injuries: Highlights and Tips

This post summarizes the three parts of my new rowing injuries article series, plus a bonus part of other general injury tips that didn’t quite fit into either piece. I hope you will find the full articles helpful. If I only had five minutes to talk about each part, 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 wrote a version of the following four tips for a Green Racing Project athlete during some off-season away-training time, with an emphasis on healing injuries that had come up during the competitive season.

#1. Be mindful of fatigue overlap

Most injuries occur from a “pile-up” effect, rather than from one singular decision or event. This “straw that broke the camel’s back” incident typically occurs from compounding effects of some combination of sport training, strength training, recreational physical activity or activities of daily life, non-training stress, and lack of adequate recovery (food, water, sleep, enjoyment).

In my experience coaching college athletes, the GRP, and masters athletes alike, most “I tweaked something” reports begin with an unusual manual labor event, a new form of physical recreation taken just a little too far, or a lot of time spent sitting due to studies, work, or travel. Manual labor and off-training activity tends be a “triple-threat” of new movements, increased volume and/or intensity, and often decreased recovery via insufficient food, water, or sleep to make up for the novelty and increase. Increased sitting time tends to come with increased non-training stress, such as while cramming for a test, jamming on a work deadline, or dealing with traffic or air travel.

Avoid the pile-up by increasing the recovery and/or modifying the training load.

#2. First time doing something, or first time in a while? Take it easy and/or adjust training load.

New activities result in different stress on different parts of the body. It might all feel the same to the athlete at the broad level of strength and fitness, but we need to think at the micro-level here with how the tendons, ligaments, and other muscular and skeletal structures experience and heal from the new stress. We often cannot feel or exactly predict this during training, so the initial training needs to be easier than we think it should.

Consider each new strength training exercise, form of sport or cross-training, or significant adjustment to technique (or rigging) as a mini return-to-train phase. Even if you don’t do something like the 50/30 or 50/30/20/10 progression, at least take the first session or week with the new thing a little easier before pushing it to the same intensity as a familiar mode of training.

The best-case scenario is gradually bringing up the new form of training while backfilling our total training volume with familiar forms of training. For example, do a shorter or easier session with the new rigging or different technique, then get the remaining physiological training in via familiar cross-training. If you are changing from barbell conventional deadlift to hex bar deadlift, do an easy 5×5 for technique on the first session with the new deadlift, and then hit the familiar assistance work for the legs, hips, and back.

When we can’t reduce the new mode, adjust training load elsewhere to avoid fatigue overlap. I tend to sharply reduce strength training during training camps for this reason. I know athletes are typically experiencing a change in mode, an increase in workload, a change in routine from the new location, and often performance pressure. If we can’t reduce those risk factors, the next-best option is to reduce stress from the more controllable strength training.

#3. Manage frequency, volume, intensity, and specificity

Good sport and strength training programs manage these main four programming variables inherently or intentionally. We can consider these via the broad definitions below for any form of activity in sport, strength training, or recreation and daily life:

Frequency: How many times in a given period we do an activity or any training (per day, per week, per month, etc.)
Volume: How much total work we do in a given activity or across all training (reps, minutes, meters, etc.)
Intensity: How close to max effort we do a given activity or across all training (RPE, percent-1RM, heart-rate, pace, etc.)
Specificity: How close our training is to a given task (exercise selection, mode of training, duration of exertion, etc.)

We can generally only be high in two categories at a time. If we go high in three or all four categories, it needs to be for a very short amount of time or burnout or injury is likely to occur. Going high in all four is essentially how we overreach before tapering. Overreaching for too long without a taper to correct for the fatigue becomes overtraining. The categories interact, so we need to be mindful of overlap here too. For example, frequency and volume tend to go together, as more sessions in a given period also tends to increase total work in that same period.

#4. Slow progress is often better than leaps and bounds

There’s undeniable allure in the reach goal or big PR. Unfortunately, the reach goal often involves reach training, or training at level beyond what the athlete is prepared for, and this increases injury risk. Even when achieved, the natural question after a big PR is, what’s next? Does the reach training become the new normal training to hold this level of performance? Is that sustainable without overtraining and regressing or experiencing injury? Do we increase the reach training even further for another big PR at the next test?

Chipping away a few pounds, a couple reps, or a few seconds or splits is often the better way to go for long-term progress. Celebrate the little PR. In most cases, there’s another test or opportunity to perform. Not always, but the exceptions are usually clear. In training and performance, try to establish a baseline, then exceed that baseline by a little bit, then a little bit again, and a little bit again. Gradually raising the standard will ultimately lead to a bigger peak than trying to hit a big peak every time, plus reduce risk of an injury derailing all training.

A key point in our GRP athlete health initiative has been that it takes a long time and a lot of training to achieve one’s ultimate potential in rowing. Physical and mental health are prerequisites to be able to at least survive, if not thrive from training session upon session, week upon week, month upon month, season upon season, year upon year, and even Olympic cycle upon Olympic cycle.