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Rib Stress Fractures in Rowers

On March 16, 2011, in Exercises, Injury Prevention, Shoulder, Sports Performance, Thoracic Spine, by jcubos

I recently received a facebook message from a good friend who works with elite rowers. He (and his medical staff) were concerned about the occurrence of rib fractures in their sport and therefore asked for recommendations on specific exercises to improve scapular mobility AND stability:

“We’re having a injury-ridden season this year, and we’ve been trying to determine why. We do see very common trends among the men, and we believe it’s the guys’ lack of scapular stability and endurance in the stabilizer muscles, and general thoracic cage stability…We see a lot of mid-back injury and especially rib injuries, and very commonly rib stress-fractures.
Now, these guys have the best Strength and Conditioning team around, however the medical team feels that they’re…not getting enough stability and shoulder blade mobility exercises (they basically need to improve the stability of the scap to work in a large range of motion).
Anyway, I was wondering what you thought were the best couple of exercises for scap stability and serratus anterior activation. Now these guys are elite athletes, they’re amazing machines actually, so they can probably do some advanced stuff, but I think we need some activation exercise, and then followed by integrating this into some advanced functional movements!”

Admittedly, I have never worked with a rower in my life. However, having examined some of the current literature (Vinther et al, Warden et al) it seems as though the exact causal mechanism for such injury is not clear cut. That said, first things first.

Stress Fractures = Bone Resporption > Bone Repair

(at sites of microfractures secondary to repetitive loading)

Courtesy of auntminnie.com (what a great site!)

While certainly stress fractures may be associated with abnormal (low) levels of bone mineral density and its associated factors, several causal mechanisms have been proposed to describe its etiology. Namely:

• Sheer forces resulting from co-contraction of the serratus anterior and external oblique
• Increased co-contraction levels of the serratus anterior and lower trapezius
• Poor eccentric control of shoulder flexion
• Faulty motor patterning (timing) between the lower body and the upper body
• Inadequate knee-extension strength to elbow-flexion strength ratios

From a training and periodization standpoint, it is quite easy for those on the outside to immediately suggest that such athletes are “doing too much too soon”. However, seeing that such fractures are quite common regardless of the level of athlete, we cannot simply point the finger at loading parameters. Anything and everything from biomechanics and motor control to poor nutrition to improper rest is fair game. Certainly a thorough assessment must take precedence but with respect to the above question posed, here are some recommendations for simultaneously improving scapular mobility and stability.

Scapular Mobility:

(I really like this video)

Assisted Push Pull / Twister (sorry, I couldn’t find a video on youtube)

Scapular Stability/Eccentric Shoulder Flexion:

With respect to motor patterning between the lower and upper of the body, I would consider utilizing such exercises as deadlift and jump squat variations, however, I will leave this for another post. Hopefully some of the above strategies will prove useful when incorporated into the overall training programs of these athletes. Certainly several of the exercises above are anterior chain dominant however, these athletes are exceptionally strong posteriorly and so ensuring balance between the two seems prudent. They are by no means definitive, but when indicated for the right individual, I think they can be helpful. What are your suggestions?
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1. Money Moves Anther effective exercise for improving thoracic mobility....
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Tagged with: Ribs • Rowers • Rowing • Stress Fractures