To explain what a bone stress injury is, it is important to first understand how bone cells work.
Bone cells are constantly remodelling. We have osteoblasts which build the bone (think osteoBlasts, B for Build), then osteoclasts which resorb bone (think of a recycling factory). This process is important as it allows the new bone to be stronger!
Exercise stimulates this process to occur, which is a good thing. Think of it as your body laying down concrete, and in response to exercise, it lays down… thicker concrete!
This process takes time to occur, so if we rapidly increase the amount of exercise/training we are performing, then we are stimulating the effects of the osteoclasts (the cells that resorb bone), where as the osteoblasts can only work so fast. This can lead to weakening of the bone if there is inadequate recovery time and if this continues, a fracture or break may form in the bone.
The analogy I was taught (credit to Kellie Wilkie and Larissa Trease – Rowing Australia Legends), was imagine Bob the Builder who is laying down new, stronger bone (osteoblasts), then we have Pacman (osteoclasts) who can go into overdrive and rapidly eat away at the bone if we do not allow for suitable recovery.
Adequate nutrition and vitamin D are important – eating enough across the day is also vital. Vitamin D assists with the absorption of calcium which helps the bone to be strong and flexible. The stronger the bone, the less likely it is to break and the more forces it can withstand.
So how can we avoid it?
Ensuring that training is increased gradually, particularly after a break and with adequate sleep will help keep the scale in balance. Rowing camps are a big source of these injuries to the ribs (in addition to lower backs!) because they are usually held after a break, amongst a huge training block. Eating nutritiously and getting a safe amount of sunlight (vitamin D) can be helpful. Weight training will also improve the strength of the bone. The good news is that these injuries are quite rare amongst adolescents rowers.
Stress fractures can occur throughout the body, with rib stress fractures being almost unique amongst rowers, but can also occur (but not limited to) in the lower back, wrists, hips and feet.
How do you know if you have a rib stress fracture?
There are few ways to know for sure without consulting with a health professional experienced in rowing. If you are experiencing rib pain (particularly a hand width below the armpit) then stop rowing immediately until you can get it assessed.
These are the signs and symptoms of a potential rib stress injury:
- Pain on deep breath
- Pain on coughing/sneezing
- Pain opening/closing doors
- Pain with push ups
- Pain with sit ups
- Pain with rolling over in bed
- Pain sleeping on the affected side
A rib stress injury (pre-fracture) is generally a 4-6 week recovery, where as a stress fracture is a 10-12 week recovery (sometimes longer). You would prefer to be vigilant with these injuries than vague!
In my opinion, unless under the care of a very experienced practitioner, a sports physician should be involved in the management of these injures to explore contributing factors such as lifestyle, diet and other medical causes including changes with menstruation in females.
As always, if you have any questions on rib stress injuries, please do not hesitate to contact me on Instagram @therowingphysio
Matt
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