Rib stress fractures and stress reactions are something that remedial massage therapists and allied health professionals, who work with rowers, need to keep at the back of their minds as a potential cause of your pain. They occur much more often than you would think. By the time you have the first signs of rib pain it's often a long road back to competitive rowing. It's why we wanted to take some time to talk to you about rowing and rib pain.
Your Ribs Have An Important Job!
Your ribs connect from the vertebra in your thoracic spine and attach to your sternum (breast bone) either directly or indirectly via ligaments. In between them you have intercostal muscles, which help you breath. Above them are muscles that support your shoulders, the middle back and even some that attach from your shoulders and go all the way down into your pelvis. The ribs job is to protect the majority of your vital organs from injury.
Thoracic Mobility and Rowing
Thoracic mobility is very important for rowers. It helps you to sit up at the finish and make sure you can hold your oars in the water for as long as possible. You also need to have great thoracic rotation to be able to rotate around pin in sweep rowing. The key to effective rowing is to make your stroke as long and as power through the water as possible. Therefore improving your thoracic mobility is one way to help improve your rowing performance and prevent rib injuries.
What Can Restrict Thoracic Mobility:
There are a number of reasons why your thoracic mobility will become restricted here are a few:
Both in the boat and when you are seated for long periods of time - like at work. Holding yourself in the same position for long periods of time means that your muscles are constantly working to keep you upright. Add poor posture to the mix and those muscles have to work even harder than normal.
Like we discussed above, your intercostal muscles sit between your ribs and there are a number of layers of muscles that sit about them. Any tightness in these muscles can impact on thoracic mobility.
Sport and Exercise
Will tighten up your thoracic spine purely because a lot of the muscles that you use to breath attach into the thoracic spine. The harder you work, the more these muscle work - so it's a constant battle to keep the muscle loose.
Rowing, Swimming, Cycling, Gym, Running. Almost every sport known to man involves your thoracic spine and the muscles that support it, because of where it is in the body. The problem is that thoracic mobility is more important to sports like rowing and swimming which is why it is so important to focus on it.
Recovery Time & Training Load
We will touch on this later but excessive increases in your training load or frequency, combines with inadequate recovery time is a sure way to speed up the process of decreasing thoracic mobility.
What is a Stress Fracture/ Stress Reaction?
Your bones are constantly repairing themselves. As you perform exercise your bones are placed under stress - the load of your body, gravity and/or any weight that you are trying to move - such as when you load up through the catch and try to push the boat through the water. Your bones can withstand a certain amount of stress, otherwise they would break all the time. As you increase the load on your bones micro-damage occurs.
Micro-damage is a perfectly normal process and is necessary to help your bones to become stronger and cope with more load. When your body is functioning effectively your bones will quickly repair this damage, so you will never feel it.
The problem arrises when you don't give your body enough time to repair itself. This can occur if you quickly increase the frequency, duration or intensity of your training. This is known as overtraining. You have decreased thoracic mobility causing excessive load to certain parts of your bone, you have poor rowing technique or your boat is rigged too heavily for you.
Your bones have cells in them called osteclasts. These guys act like Pac Man. Their job is to remove old and damaged bone. You also have cells called osteoblasts. They are like Bob the Builder, constantly trying to keep up with Pac Man by building new bony matrix, as pac man removes the old damaged bits.
When you over train Bob can't keep up with Pac Man, which is where you run into trouble. You bone can't rebuild at the rate that it is being broken down. This is when injury can occur. Your bones become weaker and weaker because the rate of repair is being exceeded by the rate of breakdown.
First you will experience what is a called a stress reaction:
Stress Reaction - A rib stress reaction is a precursor to a stress fracture. The rate that your body can repair bone is slower than you are breaking it down. At this point along your bone, the bone is becoming thinner and thinner which means it is becoming weaker. At this point there is still no fracture however, you will begin to experience pain. At this point the damage is reversible so long as you stop and let Bob catch back up to Pac Man .
A stress fracture will occur if you don't stop.
Stress Fracture - A stress fracture is a small crack/ break in the bone caused by overuse. Bob has not kept up with Pac Man and the bone becomes weaker and weaker until a small crack occurs. At this point you are dealing with a break in a bone which takes a long time to heal and, depending on the area, can often involve complete immobilisation for a period of time.
Common Warning Signs of A Stress Reaction/ Fracture:
Rowing Australia produces a protocol to help allied health professionals to quickly identify stress reactions and stress fractures.
They recognised to following signs and symptoms to identify a potential rib stress reaction/ fracture:
Sudden increase in training load: including increases in frequency, intensity, duration or reduced recovery time.
Changes to your rigging/ oar length - this can increase the load on your body leading to bone stress.
3 or 4 of the following symptomsin your ribs/ thoracic area:
A significant decrease (or pain) in thoracic rotation
Pain at night
Pain in your ribs/ thoracic areawith ADL’s (Activities of Everyday Life - Like opening a door or lifting up a heavy bag)
Pain whilst doing a sit up
Pain whilst doing a push up
Pain couching/ deep breath
Pain on rib springing (pressing down on your ribs)
Significant changes in diet or weight loss - Malnutrition/ or significant weightloss can lead to bone density problems increasing your likelihood of bone stress related injuries.
Females - unfortunately stress fractures are more common in females, especially those with abnormal/ absent menstrual cycles. Again this is related to bone density.
Age - Osteoporosis will predispose you to stress fractures.
Previous Stress Fractures - Unfortunately once you have had one, you are likely to have another in the same area.
Out of the boat for 5 days and you still have rib pain. A high indicator of a stress fracture compared to a stress reaction.
The first thing your remedial massage therapist or allied health professional will tell you to do is take 5 days off. This is generally enough time for Bob to catch up to Pac Man. The rate of bone repair to catch back up to the rate of breakdown.) If pain is still present you will usually be referred onto a physio and asked to asked to get a scan to see what is happening in your ribs.
Common treatment protocols:
Alteration to training load/ changing your rigging - If it is recognised that you have simply increased your training load too quickly you or your rigging is too heavy, your coach and your allied health professional can sit down and come up with a strategy to help you improve without risking injury through over use.
Rest - unfortunately if it is a stress fracture you have to wait for the bone to repair. WHICH IS WHY EARLY DETECTION IS SO IMPORTANT.
Massage - to improve thoracic mobility by loosening tight tissue inhibiting your range of movement.
Stretching & Foam Rolling - to muscles affecting your thoracic rotation and to improve your joint mobility. (Follow the link to see what we recommend)
Stroke Correction - Sometimes if your rowing technique isn't quite right you can place excessive load on your thoracic spine. For example opening up too early at the catch.
Strength training - once the bone is healed your health practitioner will slowly progress your strength training to help strengthen the bone.
Slow return to sport. (Under the supervision of your physio/ allied health professional)
Are you experiencing any of the symptoms above?
The key to stress fractures is PREVENTION! Once you have one, it's a long period of rest to allow the bone to repair.
If you are experiencing any of the symptoms above it is important that you go and see an allied health professional that understands your sport. Our remedial massage and myotherapy team are all trained in rowing related injuries.
Book now to help prevent your injuring putting you out of the boat for weeks on end.