Rowing Australia has set out protocols for Chest Wall Pain. These protocols have been built over 20 years of treatment by sport physicians and physiotherapists treating rowers.
Rib stress fractures are more common in rowers than you might think. The problem arrises when you do excessive training and don't give your body enough time to recover. Add in some poor thoracic mobility and significant drops in weight such as in lightweight rowing and you have the perfect set of conditions for a stress fracture or stress reaction.
What is a Stress Fracture/ Stress Reaction?
Stress Reaction - A rib stress reaction is a precursor to a stress fracture. As you perform exercise you bones will
RIB STRESS FRACTURES/ STRESS REACTIONS PROTOCOLS:
Set by RA (See doc below for more info)
Rib stress reaction - precursor to fracture. In the stress- reaction phase the bone structure is breaking down and becoming weaker which is why we need to have 5 days out the boat to stop that process.
Rib stress fracture - commonly near the rib angle but not always.
Subjective & Objective Measures -
Pain at night
Pain with ADL’s
Pain whilst doing a sit up
Pain whilst doing a push up
Pain couching/ deep breath
Pain on rib spring
If athletes at presenting with 3 or 4 of these measures you should be thinking along the lines of Rib Stress Reaction/ Fracture.
Warning signs -
Significant deceases in thoracic rotation - particularly with pain
Check training load. These usually occur after a camp or few heavy weeks of training.
More prominent in lightweight rowers - particularly females.
Female Athlete Triad
Ask them how quickly they have dropped the weight. This is more common in athletes who have dropped weight quickly and/or are not managing their weight loss with a dietitian.
Ask when was their last period?
Out of the boat for 5 days and they still have pain
We need to make sure these are identified early as once they have a stress fracture it is a long time out of the boat and with modified training. They also reoccur quite often.
Treatment Protocol -
5 days out of the boat to deload the rib
Thoracic mobility above and below the area
Address any other areas of the body restricting thoracic mobility.
ST and massage should be addressed - diaphragm, abdominals, serratus, lats, intercostals, pecs, r/cuff, erectors - avoid deep work directly above the area.
Referral to physio for diagnosis preferably one with a rowing background. Ivan Hooper/ Rod McLean (good rowing physios in Brisbane)
Click the button for Rowing Australia's Injury First Aid for Chest Wall Pain