row2k Features
Collegiate Coaches Corner
Injury Prevention Part 1 - Overuse Injuries
June 23, 2020
Erik Dresser, row2k.com

2019 Dartmouth Lights

Following the cancellation of the 2020 spring racing season, row2k solicited the collegiate coaching community to engage in a variety of high-level topics within the profession. We submitted over sixty questions across a dozen topics and thank the coaches and staffs that found time to contribute their thoughts during this stressful time.

This week we focus on the topic of Injury Prevention with the first of two questions:

WHAT DOES YOUR PROGRAM DO TO MITIGATE THE IMPACT OF RIB INJURIES?

TREVOR MICHELSON - DARTMOUTH LIGHTWEIGHT MEN
The best way to mitigate rib injuries are to not have them in the first place! We have developed a “pre-hab” circuit that focuses on lengthening, strengthening, and balancing the muscles surrounding the rib cage. These include the cross-abs to work the obliques and trunk rotation, push-ups to strengthen the chest and shoulders, and band pull-a-parts at a variety of angles to focus on scapula strength and mobility. We try to implement these exercises three times a week when we are on the water and incorporate them into our strength training circuits throughout the winter.

While avoidance of rib injury is ideal, it is not always the case. Rib injuries can occur from a large increase in training volume, repeated strokes on the erg or boat with a particularly heavy load, or from a lack of proper recovery. When one of our athletes starts to have rib pain, we shut them down right away. A small niggle in your rib can be a sign of a stress fracture to come.

We have them spend a few days out of the boat and off the erg to see if the pain goes away. If caught early, a stress fracture can usually be avoided. However, the “no pain-no gain” mantra can get the best of many a student-athlete. Pushing through slight rib pain can lead to a stress fracture, keeping athletes away from rowing for six to eight weeks. If this is the case, do not fear. Many rowers have been relegated to the bike, and through disciplined training, have come back to rowing fitter than they left!


HEATHER BARNEY - TRINITY WOMEN
We have been fortunate to have relatively few rib injuries over the years. One big thing that I think has helped us with that is getting a decent amount of our steady state gains off the erg through running and other cross-training. We also include targeted strength training exercises to enhance scapular stability in our lifting program and encourage proper recovery habits from nutrition to sleep to mobility practices. We pay close attention to gearing and technique as well; when we have had rib issues, it’s often been due to technical issues and usually a rower trying to increase her stroke length in unproductive ways, so we definitely keep an eye out for that.


CAM BROWN - ORANGE COAST MEN
Fortunately, our program has had very little prevalence of rib injuries – or back injuries - over the past several seasons. There are quite a few potential causes of rib injuries: poor technique, overloading the gearing through the drive, muscle imbalance, incorrect muscle recruitment. We consciously include several strategies in order to help the athletes stay healthy. From the first week of the season every athlete – novice or returning – we focus on correct posture and muscle recruitment to reinforce correct muscle memory.

It’s become a cliché, but it is essential and must be well understood to be effective – strong core, and good flexibility around the hips and torso! It’s not enough to know what good core exercises are, I think you need a strong understanding of WHY the core is important and HOW to use it – the core is the foundation to all movement and posture, it is how the kinetic chain stays connected. It is the first step of injury prevention. I believe the core include the hips, torso, and shoulder joints. These are the areas of the body with most range of motion and movement and so this where you will find the majority of overuse injuries due to muscle imbalance.

Orange Coast Men racing at 2019 WIRA
Orange Coast Men racing at 2019 WIRA

Once you have a strong sense of why the Core is important, and how the Core works – and assuming you have decent core strength – the next important step is to ensure you can relax the neck and relax the muscles that aren’t needed. One of the biggest natural errors I see in athletes is tension in the neck and super tight trapezius muscles. If your shoulders are raised during the drive – if your upper trap muscles are overactive – you aren’t going to be able to engage the strong muscles of the back. This will give you slow splits, it will also put excess strain on your torso and ribs – and possibly lead to rib issues. About 1000 times a day, I will tell my athletes to “show me your neck”. Relax the upper trap muscles and allow the strong back muscles to engage.

There also needs to be adequate muscle activation in the chest and torso muscles. Too much ‘hang’ and suspension through the torso will strain the ribs – the torso stabilizing muscles must be active to hold the skeleton together and not allow too much strain occur in one area. This chest strength is often overlooked in rowing as it is not generally considered important. There is no need to Bench Press 300 pounds – just regular pushups several times a week is an excellent starting point. Pushups are underrated.

Especially early in the season and for younger athletes, ensure the gearing of the oar is set to a moderate load and don’t encourage too much power from the athletes. Increasing the power and load will lead to increased stress through the kinetic chain – if the athlete is not prepared for it, it will cause an exaggeration of incorrect muscle use and ultimately place more stress on the ribs. This is where the first few weeks of a season are so critical. We all know how hard it is to break poor technical habits, and if we start the season too aggressively with increased power work – it can often start these issues, which won’t become a major problem until later in the Fall/ early Spring.


ERIC GEHRKE - GEORGE WASHINGTON MEN
We work very intentionally as coaches to mix up land training, listen closely to the athletes’ comments about their bodies and soreness, and ask for feedback from trusted oarsmen one or two days after changing rigs. On top of everything also engaging our athletes daily about their prehab and rehab as 24-hour athletes, not just 2-hour athletes.


JENN LANGZETTEL - DUQUESNE WOMEN
We work a slow transition into the year and are mindful of the load on the women at any given time.


KEMP SAVAGE - EASTERN MICHIGAN WOMEN
To prevent rib injuries, we do a lot of unilateral lifting in the weight-room limited by the strength of the weak side. We also switch sides once or twice a week when sweep rowing. We also limit the number of strokes we row in each cycle of a drill, stopping early on the slide increases the force on the seat to dangerous levels and should limited with rowing full slide to reduce the load on the ribs and back.


ALICEA STRODEL - MINNESOTA WOMEN
There are a few things that we are implementing to encourage rib health. 1. We make sure we are rigged appropriately. 2. Our dynamic warm-up includes mobility exercises to open up the thoracic region before training. 3. Pull-ups


BART THOMPSON - ADRIAN
We primarily train on dynamic ergs. We do less volume on the erg than most teams, and when we do ramp up the volume during a given week we are cognizant not to do too much volume in back-to-back sessions; we try to space out erging sessions by putting lifts, yoga, or cycling in between the erging sessions.


HAVE YOU SEEN ANY INCREASES IN OTHER OVERUSE INJURIES RECENTLY AND HOW HAVE YOU RESPONDED?

KEMP SAVAGE - EASTERN MICHIGAN WOMEN
We have seen an increase in concussions from outside athletic activities, and now have added more running and proprioception work to help our athletes with their reflexes and response to uneven surfaces.


HEATHER BARNEY - TRINITY WOMEN
The main “new” injury I’ve seen in recent years has been a significant increase in hip labral tears. I’ve been told that this injury seems “new” in the past five to ten years largely because of advances in imaging technology; in the past it might have shown up as complaints of general hip pain with no specific diagnosis. It’s a frustrating injury because to the best of my understanding, it’s something that some rowers are just prone to as a result of preexisting abnormalities in their hip structure, but you don’t really know who’s got that issue until they’ve been training consistently and at a decently high level for a period of a year or two and start experiencing pain.

We’re definitely pretty cautious around hip pain as a result. The main solutions seem to be surgical – fixing the tear and then literally shaving down the roughness that was rubbing in the ball and socket joint - and then trying to minimize deep compression as much as possible – obviously not something you can do in the boat, but maybe limiting depth of compression in the weight room and fewer strokes on the erg. From a recruiting perspective, it’s on the back of my mind especially when I’m talking with juniors who haven’t hit that “threshold” of training yet where you’d have an indication that this is something they might be prone to. It’s a tough injury – I’ve seen rowers manage it, but I’ve also seen it end some careers.


JENN LANGZETTEL - DUQUESNE WOMEN
We have seen an increase in labral tears on the last couple years. We are working to remain diligent in a smooth transition to the work load, especially as freshmen, each year. We have also had large discussions with the women about advocating for themselves when there is a concern over pain that could be a major issue or turn into a major issue. We would prefer a woman out for a day or two for analysis than out for months or a year because she was concerned about taking one day off to see the athletic trainer.


BART THOMPSON - ADRIAN
No, we’ve generally seen our overuse injuries stay constant.


ERIC GEHRKE - GEORGE WASHINGTON MEN
I have seen an increase in overuse injuries based around what I consider to be too much emphasis on volume without proper physical prehab, dynamic movement prep, rehab, and rest. Also, I have noticed injuries around trying to use the same stiffness and length of equipment across genders.

I have responded by being very specific about when we choose to maximize volume versus when we stay in more maintainable volume ranges, while also keeping time in our practice frame for dynamic movement and core. We also do our best to listen to the feedback from the athletes as a whole. Rigging and equipment-wise, I did my best to not push the athlete’s bodies too far just because I heard someone else is rigged that heavy or hard.


TREVOR MICHELSON - DARTMOUTH LIGHTWEIGHT MEN
The biggest overuse injury we have seen on our squad is in the lower back. Similar to our mitigation of rib injuries, we have an equally important pre-hab circuit for low back pain. Most lower back pain seems to be associated with hamstring, psoas, piriformis, glute, and quadricep weakness and tightness. Our circuit includes hamstring curls and glute raises done on Swiss exercise balls to build strength, and a lot of stretching of the hips and hamstrings.


CAM BROWN - ORANGE COAST MEN
Lower back and rib injuries are certainly the most talked about injuries in rowing – but I have noticed a significant number of knee and finger problems also. When an athlete complains of knee pain, particularly at the Catch position – the first thing I will check is their foot height in the boat or on the erg. If their feet are too low, it will often cause over-compress through the knees and this will lead to injury in the joint. The knee must not go past vertical at the Catch. A coach must be careful though – if you raise the feet too high for the athlete you may fix the issue of over-compression, but could then increase the stress on the lower back instead.

This is where hip flexibility, particularly in the hamstrings is so critical. I will often tell my athletes that if they don’t have adequate flexibility it will be physically impossible to reach the correct catch position and posture. A correct catch position demands flexibility in the hamstrings and glutes, hip flexors, calf muscles, and back.

Several times each season I will also have an athlete complain about finger pain – usually after erging. An athlete must have a relaxed grip on the handle, but not too relaxed. If the fingers hang off the handle like a hook, and there is no grip strength being used – all of the force of each stroke is going through finger joints. Over time it will cause pain and injury. The athlete does not need to ‘strangle’ the handle, but they must still engage their forearm muscles as they “hang”. Using the thumb to gently wrap around the bottom of the handle is usually a good starting point for this.

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Comments

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Slidewinder
06/24/2020  5:04:52 PM
Except for the toss away reference to finger pain experienced by some on the rowing ergometer, there is no reference to the chronic wrist pain suffered by many erg users. Search the archives on the C2 Forum. Many have complained of this. It is always dismissed by others as the result of "poor technique". Apparently it is taboo to point out what should be obvious to anyone with eyes: this wrist injury is caused by the forced angulation of the wrist at the completion of the stroke, and this is caused by the standard, single-piece, rigid handle. The handle is a human/machine interface. At any such interface the machine should adapt to the natural movement of the user, not the user to the machine, as is the case with the standard handle.



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