Rib and side pain in rowers

What it is

Rib stress injuries are one of the most characteristic injuries in rowing. The serratus anterior and external oblique pull on the ribs from opposite directions during the stroke, and the repeated bending forces produce a stress reaction and then a fracture.

The pattern is the same as any bone stress injury: load exceeding the rate of bone adaptation, frequently with low energy availability and low bone density underneath. It is more common in women, in lightweight rowers and during periods of high volume - which points at the fuelling as much as at the training.

What it feels like

• Localised pain in the side or front of the ribcage
• Worse on the drive phase and on the catch
• Sharp pain on a deep breath, coughing or sneezing
• Tender to press on one specific rib
• Worse lying on that side and rolling over in bed

What causes it

Most people have more than one of these at once, and they feed each other. Read the list looking for the two or three that sound like your week rather than for the one true answer — the ones that describe you are the ones worth acting on.

Opposing muscle forces on the ribs

Serratus anterior pulls the ribs one way and the external obliques the other during the stroke. The repeated bending stress on the rib is what produces the injury.

High training volume

Rib stress injuries cluster in periods of high volume, particularly winter training blocks and increases in ergometer work.

Ergometer training

Associated with a higher incidence than water rowing, probably through the fixed position and the higher stroke count in a session.

Low energy availability

Common in rowing, particularly in lightweight crews making weight. It suppresses bone formation directly and is present in a large share of athletes with bone stress injuries.

Low bone density

Rowers can have surprisingly low rib bone density despite high loading elsewhere, and the combination with high rib loading is the setup for the injury.

Sweep rowing and asymmetry

Sweep rowers load one side asymmetrically. Rib injuries are more common on particular sides depending on which side the rower is on.

Technique changes

A change in blade type, rigging or technique alters the loading pattern on the ribs and is a recognised precipitant.

Being female

Rib stress injuries are more common in female rowers, related to bone density, energy availability and relative loading.

Continuing to train through it

The most common route from a stress reaction that would settle in weeks to a fracture that costs a season.

Not asking about fuelling

A rib stress injury in a rower should prompt questions about energy intake and, in women, about menstrual function. It frequently does not.

Who tends to get it

• Competitive rowers, particularly in high-volume winter training
• Lightweight rowers making weight
• Female rowers, in whom incidence is higher
• Anyone with low energy availability or menstrual disturbance
• Rowers who have recently changed rigging, blade type or technique

What makes it worse, and what settles it

The qFIT routine for this

Ready-made routineRotation Sports (Golf, Racquet & Throwing)

qFIT already has this one built. It runs massage first, then stretching, then strength — the order that works on a body that is already sore — and every activity in it carries the reason it is there.

The button below opens your Checklist with this routine already selected, so instead of your whole list you land on just its Categories, Targets and Exercises, each with its checkbox, ready to tick as you work through them.

Have more than one problem? Tick yours under My Problems on My Profile and your Checklist's Routine list gains Recommended for my problems — every routine for the problems you picked, merged into one. Your picks stay private; that filter is the only thing they feed.

Get it checked if…

Focal rib pain with a cough, breathlessness, or after trauma needs imaging - a rib stress fracture takes weeks off

And whatever the body part: chest pain or unusual breathlessness on exertion; a fever alongside the pain; unexplained weight loss; pain that is constant and unrelated to how you move; new numbness, weakness or loss of bladder or bowel control; or one calf that is swollen, warm and painful. Any of those, stop and get assessed.

How it usually goes

Rib stress injuries typically take four to eight weeks to settle with rest from rowing, and returning too early is the main cause of prolonged problems. The more important question is why it happened: high volume, low fuelling and low bone density are the usual combination, and returning to the same pattern reliably produces another. A rib stress injury should trigger a conversation about energy availability rather than only about training load.

Prevalence basis: Rowing sports medicine surveys

Others the same routine covers

These share the Rotation Sports (Golf, Racquet & Throwing) routine, so the work is the same. If one of them also sounds like you, that is a reason to expect more from it, not less.

This is general information, not a diagnosis, and it cannot examine you. If it matches you, use it to ask better questions of a clinician rather than to replace one.