with modification of equipment as needed to decrease
load per stroke, adjust oar/foot height, or even switch
side rowed (for sweep rowers) (Karlson, 2000).OVERUSE KNEE INJURIES
- The rowing stroke maximally loads the knee when it is
in the fully flexed position. As a result, patellofemoral
pain is a common complaint among rowers. As with
patellofemoral problems in other sports, this is more
common in women and in those with anatomy that
predisposes them to abnormalities in patellar tracking.
Tracking problems can be further exacerbated by the
position of the shoes fixed in the rowing shell. Their
height, spacing, or orientation may be mechanically
inappropriate for the rower’s anatomy, resulting in
increased symptoms (Karlson, 2000). - Usual treatment of patellofemoral pain, focusing on
strengthening of the vastus medialis muscle to
improve patellar tracking is recommended. Shoe posi-
tion should be checked and modified if not appropri-
ate for the athlete.
TENDINITIS (PATELLAR, QUADRICEPS,
AND FOREARM)
•Tendinitis can occur in the patellar or quadriceps
tendon from repeated flexion/extension with the
rowing stroke. Pain is noted over either tendon,
worsened by use, and relieved by rest. Usual treat-
ment modalities are employed for relief of symptoms,
with a focus on modifying training and equipment
errors.
- The rowing stroke predisposes to forearm tendinitis in
the dorsal wrist both from tightly gripping the oar
during the stroke and from feathering the oar at the
finish. Feathering requires rapid extension of the
wrist, which further stresses an already strained fore-
arm. Rowers will complain of pain in the dorsal wrist,
specifically at the intersection of the first and third
dorsal wrist compartments (Karlson, 2000; Edgar,
1995; Fulcher, 1998). Physical examination will
reveal pain and swelling at this location, and in more
severe cases crepitance may be noted.
•Treatment of forearm tendinitis involves relative rest
as well as technique modification. Medical modali-
ties, such as ice, brief immobilization, nonsteroidal
anti-inflammatory medications, and on occasion local
steroid injection into the affected tendon sheath may
all be employed (Fulcher, 1998). Technique modifica-
tion involves stressing a looser grip on the oar, as well
as a grip that places the wrist in as flat a position as
possible (Karlson, 2000).
NERVE ENTRAPMENT SYNDROMES•A number of different nerve entrapment syndromes
are seen in rowers. These range from digital nerve
compression in individual fingers to carpal tunnel
syndrome in the upper extremity and frank sciatica in
the lower extremity.- Digital nerve compression results from a tight grip on
the oar with direct pressure on the neurovascular
bundle. Equipment and grip modification can alleviate
the vast majority of these cases. - Carpal tunnel syndrome is also frequently the result of
an overly tight grip on the oar as well as repeated
extension of the wrist at the finish of the stroke. In
addition to standard treatment, technique modifica-
tion, involving a looser grip as well as equipment
modification, with shaving the oar handle to give it a
smaller diameter may help with these symptoms. - Sciatica can result from an improperly fitted seat that
places pressure on the sciatic nerve. Additionally,
there are small holes in the seats of rowing shells
designed to fit the ischial tuberosities as the rower
moves through the rowing stroke. If the holes are
improperly spaced for the individual rower, nerve
compression can result with associated numbness.
This is especially common if women use seats
designed for men that don’t accommodate their wider
pelvis (Karlson, 2000).
RIB STRESS FRACTURE- Stress fractures of the ribs have been seen with
increasing frequency in rowers (Hickey, 1997;
McKenzie, 1989; Brukner and Khan, 1996; Christian
and Kanstrup, 1997). This is thought to be secondary
to equipment changes that have put more loads on the
oar during the stroke (Karlson, 1998). Thought to be
caused by the pull of the serratus anterior muscle on
the scapula during the rowing stroke, these fractures
are seen most frequently in the posteriorlateral region
of ribs 5–9 (Karlson, 2000; 1998). - Rib stress fracture usually presents with slow onset
of chest wall pain in the posteriorlateral location. As
with other stress fractures, pain is initially only with
the inciting activity, but will progress to pain at rest
if the overuse continues. Ultimately, a bony callus
may be noted at the site of the stress fracture.
Diagnosis may be made with a plain film demon-
strating callus formation, or a bone scan in question-
able cases.
•Treatment for rib stress fracture, as with most other
stress fractures, involves rest, frequently for up to 6
weeks to allow complete healing (Karlson, 2000;
474 SECTION 6 • SPORTS-SPECIFIC CONSIDERATIONS