After serving as the Clinical Lead Physio for GB Rowing Team’s high performance development programme, (2015-2019) managing the next generation of Olympic athletes, I have amassed a great deal of experience in treating rowing specific injuries. I also support a number of high Performance clubs on the Tideway including TSSBC, ICBC and ULBC

My Sports Med MSc dissertation was on “Risk Factors in Rib Stress Injuries in the Rowers Athlete”, and support several clubs and athletes to manage Rib Stress Injury (RSI) presentations.

Rowing services offered include:

-Assessment and treatment of rowing related injuries

-Erg technique assessment

-Stable and strong trunk assessment

-S&C programming out of injury

– Advice on S&C to improve your performance

Rib Stress Injuries (RSI)

These injuries can be extremely disruptive to an athletes training. Evidence around the management is pretty thin, and many published articles based on small numbers and case study based. Having treated a great many of these and studied this at Master level, I have formed my own empirical experience to manage RSIs successfully.

RSI are an umbrella term for anything from a soft tissue injury right up to a rib stress Fracture. I describe how these injuries sit on a continuum, starting at an intercostal type muscle strain strain, progressing to a bone stress injury as the ‘micro trauma’ in the rib builds up and with continued training, healing fails to keep pace with the micro trauma, eventually leading to a failure in the architecture of the rib – a Rib Stress Fracture.

I see many rowing athletes each season with these difficult and stubborn injuries. They have a significant impact on training as the athlete, in my experience, tries to ignore the problem assuming it is a soft tissue injury, but it does not get better and begins to prevent the athlete doing even normal activities of daily living, such as sleeping, breathing, moving.


From the scientific literature and my [unpublished] dissertation (I will get around to it) the overriding risk factors are sudden change in volume/intensity of training. This is on top of a number of biomechanical factors, such as poor shoulder stability, for example.

Presentation of an athlete with RSI:

Normally present with a bruised feeling in the rib area, below the armpit is more common, but I do see a number on the back around the shoulder blade every year.

Rib markers are positive for pain with:

  • Cough
  • Deep breath
  • Sitting up/lying down/ sleeping on the affected side

Acute initial management:

  • Offload the area that is sore – stop the aggravating activity! Normally this is done on a bike for a few days and if it improves quickly this is often a soft tissue injury that will improve fairly quickly. However if  it does not then this is likely to be a bone stress or worse…..speak to your coach and see a healthcare professional trained in managing these problematic injuries.

If you experience one of these injuries – go see someone about it!





***This was written as an article of interest and not medical advice. If you are at all concerned by pain around your trunk you should always consult an healthcare professional to rule out other causes.