Rowing - Specific Scripts / Injuries - Prevention and Cure
Lower Back Pain/Injury
Low back pain is probably the most commonly occurring complaint amongst rowers. It is often said that all oarsmen and women will suffer from some low back pain at some stage in their careers. It occurs in all groups of rowers and with all degrees of severity, causing some simply a nagging ache, and others a sharp, debilitating pain, that makes exercise and often life in general unbearable. The onset of low back pain is something that needs to be treated seriously by both, the coach and the athlete. It is not necessarily the end of the athletes rowing career, in fact, most problems are simply to due to correctable problems with strength, flexibility or technique. However, if left untreated, these problems can escalate and cause irreparable damage to an athlete in the long-term. There are three main types of back pain:
The intervertebral disc is made up of two parts. A tough outer coating called the annulus fibrosis and a soft, gel-like inner called the nucleus pulposis. The disc sits in between each vertebra and has three primary functions:
Why does it hurt?
When the disc is repeatedly stressed by constant flexing, twisting and loading of the spine, it can become injured. The spinal cord runs down through the vertebral column, adjacent to the vertebra and their discs. In a normal spine, the cord is able to slide up and down within its canal as we move, freely and painlessly, supplying nerves to the legs. When we injure the disc, it can bulge back and press on the spinal cord, impinging its movement and causing restriction and pain. This is called disc prolapse, not slipped disc!
This can happen in rowers due to a number of reasons:
1. the outer covering of the disc is at its weakest posteriorly or closest to the spinal cord.
2. when we bend forward, the vertebra rocks over and there is increased pressure on the posterior wall of the disc.
3. when we twist, we also increase the pressure on the disc.
4. when we load the spine as in lifting or pulling, we increase the pressure on the disc
5. when we sit for long periods, we deform the disc gradually stretching the posterior wall and weakening it. Sitting also increases pressure within the disc (up to 200% over lying)
People with chronic disc problems are advised not to sit for long periods, not to bend or twist their back and not to lift heavy objects. As rowers, we do all these things in combination, so it is hardly surprising, that we get some degree of back pain.
Common causes of disc pain
1. poor technique / poor posture in the boat / set-up in the boat
2. poor weightlifting technique / too much weight for the athlete
3. pre-existing poor posture, injury or disease
4. poor abdominal strength
5. poor back musculature strength
6. poor flexibility of the lower back, pelvis and legs
What to look for?
Disc pain has characteristic features, that separates it from other types of pain:
1. can be chronic or acute
2. will usually come to notice with an acute episode on top of a chronic ache
3. pain can be intense
4. pain will often radiate through the back and often down into the legs
5. pain will be made worse by rowing, bending forward, sitting for long periods
6. in severe cases there may be some leg muscle weakness
7. pain will often improve with lying flat or gentle walking
Facet Joint Pain
The facets are part of the bony vertebral bodies. They extend from the back of the vertebra and interlock with the facets of vertebra above and below. The articulate as we move and they shape and limit the direction and extent of the movement we have at each vertebral level. There are many points of articulation and these points are called facet joints. Facet joints can suffer from the same problems that all other joints do, they can be jarred or stretched too far, they can become inflamed with overuse, misuse or disuse and they can become stiff and sore after activity.
What to look for?
Pain will differ from disc pain in the following ways:
1. can be either acute or chronic, but will tend to cycle in intensity
2. will usually be quite localized, and can be very sore with direct pressure
3. if often better in the morning after sleep and worse at the end of the day or after training
4. will often get worse during training
5. will often go away by itself with rest
Muscular back pain
Muscles in the back, like anywhere else in the body can be strained or sprained or simply overused. Muscle strain is usually an acute onset, precipitated by a single incident of lifting or strong contraction. Pain is usually throughout the muscle and will be worse on any movement. The area may be hot and inflamed. Simple treatment of rest, ice and gentle exercise after a couple of days should solve the problem. If it is persistent or particularly severe, medical assistance should be sought.
What to do?
For all types of back pain, regardless what you think it might be, any pain, that is intense, long-lasting, restricts movement, hurts overnight or is made worse by rowing is severe and needs to be treated immediately. The steps are simple, and mainly common sense:
1. take it seriously, if it goes away once, it will come back
2. stop rowing
3. see a doctor or physiotherapist straight away
In most cases, the underlying problem can be identified and corrected with minimal fuss. Left alone to get worse, the problems become more severe and the athlete may not be able to return to their highest level after the injury. Early treatment is good treatment.
There are many causes for knee pain, but in rowers, most of these can be excluded. The most common causes by far in rowing are:
1. tracking problems of the patella (especially in young women)
2. overuse tendonitis of the quadriceps tendon
Both types of injury will consist of sharp pain at various points of knee movement, sometimes severe enough to limit movement significantly. There will be pain under the kneecap if malalignement of the patella is involved. The pain will come on over time, steadily worsening with increased time and intensity of training. It will generally be worse with rowing, weights or running and will often get generally better with rest, ice, and a decrease in training intensity. These injuries are most often due to either congenitally poor alignment of the kneecap, pre-existing injury to the knee, muscle imbalance, poor technique and overuse.
What to do?
See a doctor or physiotherapist straight away, there is simple and effective treatment for the vast majority of knee problems, only a few may require surgical management.
Rib Stress Fracture
Not as common as other injuries, but is more problematic than most. Occurs usually in elite level rowers, those who are training 12-20 times per week and who are rowing 150km+ per week. It is caused by repeated pulling on the rib or the muscles surrounding the rib cage. It can be caused again by poor technique (both rowing and weights), or simple overuse as described above. It is characterized by sharp pain over the ribs, often radiating backwards, made worse by deep breathing and usually occurs on one side only. Apparently occurs in sweep oar rowers and scullers equally. It is a complex problem and needs the assistance of an expert in sport and rowing injuries.
Is characterized by pain, swelling and weakness in the wrist, usually over the back surface. Is caused by overuse of the tendons on the back of the wrist causing them to become inflamed and sore. Will usually occur in the inside arm as a result of the feathering motion. It often occurs in either the novice rower, unused to the action, or in the more experienced athlete following a sharp increase in rowing training. Treatment is again simple, rest, ice and compression to decrease pain and swelling, a review of the feathering technique and a temporary reduction in intensity of training. Severe or persistent cases again may require professional involvement.
Not a commonly described problem, but seem to occur in many oarsmen and women from personal experience. It is a persistent ache in the upper back, neck and shoulder, usually in the outside arm of a sweep oar rower. It is characterized by spasmic and tenderness of shoulder and back muscles and a feeling of heaviness and weakness of the affected arm. Neck spinal joints are often stiff and tender and several pressure points will be found in the upper back on the affected side. It is invariably worse with increased training levels in the boat and improves with rest. In severe cases it may interfere the sleep, because of the constant ache. Rest, massage, stretching and minor alterations in technique seem to be the best treatment for this problem.
In the junior rower, bones are still growing. Long bones grow in two main segments. One, the diaphysis, is the main shaft of the bone. Several smaller bones, called epiphyses, grow at each end of the diaphysis and where major tendons attach to the bone. The pieces are attached in the young athlete by cartilage that gradually calcifies into full strength bone by about the age of 18-20 depending on the individual. Whilst the athlete is still growing, these points of cartilage are where the growth of the skeleton takes place. They are strong, but not as strong as bone.
When lifting heavy weights or undergoing heavy training loads, the repeated or excessive pull on certain epiphyses by tendons and muscles can tend to pull the epiphysis away from its main bone. Common sites in rowing are the knee, hip and elbow. There can be constant aching of the site, often bad at night and not necessarily aggregated by training. This sort of injury needs to be reviewed by a doctor and will always be treated with a reduction in training intensity and altered types of training.
For this reason, among others, it is vital to introduce young athletes to the sport gradually. Slowly increase the amount and intensity of training, and when setting weights programs, aim for muscular endurance ahead of outright strength, using low weight and high repetition. Good gains in strength will still be made, and the chance of permanently injuring a young athlete will be decreased. There is plenty of time for rowers to increase their maximal strength, once their skeletal structure is fully grown.
Only one point, take them seriously, especially when rowing on polluted water. Infected blisters are very painful, can stay a long time in healing and markedly decrease the performance of a rower. An awful lot of force goes through the hands of an oarsman. Look after them.
Constant tiredness, irritability, trouble sleeping, training performance decreasing, decreased appetite, loss of weight, etc, are all signs of over training. These signs are seldom recognized by athletes themselves; so it is important for every coach, to look out for these things and care about their athletes. It is particularly important for young athletes, whose motivation for the sport long-term can be severely damaged. With the increasing prevalence of diseases like Chronic Fatigue Syndrome, it is important to realize the long-term effects, that over training can have. Give your athletes regular rest times and make it their responsibility to rest. Make clear and sure, that this time is set aside just to rest and recover, both physically and mentally. You will get rewarded for it with increased enthusiasm, better performance and healthier athletes.
Internet / Joern Grosskopf , 2002