Shoulder Pain in Rowing

Whilst much of the focus in injury management and prevention for rowers is on the lower back, forearms, and knees (and ribs for the elite rowers), shoulder pain can also be an issue for a small cohort of 4-6% (Baugh & Kerr, 2016)(Wilson, Gissane, Gormley & Simms, 2008). Although this has not been my personal experience, shoulder pain in rowers has also been reported in one study to last from 1 year to a lifetime (Mohseni-Bandpei, Keshavarz, Minoonejhad, Mohsenifar & Shakeri, 2012). Those that have pain in this area might feel neglected through a lack of information about how to treat and prevent it but you won’t be ignored any longer! Let’s take a dive into the shoulder!

What kind of shoulder injuries can rowers experience?

• Non-specific shoulder pain – a growing body of evidence supports that medical imaging findings, similar to the lower back, may not be as conclusive at providing a diagnosis as previously thought, particularly when it comes to gradual shoulder pain. Irritation, inflammation or sensitisation of various structures in the shoulder can be the cause.
• Referred pain – pain from structures in the neck (nerves, muscles and joints) can cause pain in the shoulder. Occasionally the thoracic spine (upper back) muscles can also cause pain in this area.
• Dislocated Shoulder – usually from other activities such as weights or other sports
• Clavicle Stress Fracture – uncommon but have been reported in lightweight rowers (Noguchi, Chopp, Borgs & Dickerson, 2013)
• Osteoarthritis/Frozen Shoulder – not usually directly related to rowing. Fortunately rowing may be an activity that may not overly aggravate this condition.
• Other – e.g. serious pathology such as tumours or fractures.

What can you do for shoulder pain?

• Ice or Heat packs – ice if it is a traumatic injury (contact), heat or ice for all other types.
• Isometric Exercises for the shoulder muscles – isometrics are exercises where the muscle is working in a fixed position without moving through range (like in a wall squat). The beauty of this exercise type is that you can push as hard or as soft as you like according to pain. Keeping it pain free early on, a 1-2/10 on the pain scale is OK in most cases. 5×5 seconds 3-5x/day is what I will usually prescribe (little and often). These are great to encourage the muscles to work when things are particularly sore. You will want to avoid excessive rest as this will cause atrophy. Some options include:
  • Making a fist with your elbow at 90 degrees and gently pushing your hand into a wall, trying to use the muscles at the front of the shoulder (pec and deltoid)
  • Elbow at your side and gently push your elbow outwards against a wall
  • Standing with your back against a wall, elbow bent to 90 degrees and pushing your elbow backwards against the wall
• Train around the pain – if you are getting pain at 45 minutes into your 60 minute rowing/erg session, train for either a reduced duration or stagger your session so that you get a break e.g. 2x30mins. If a gym exercise is causing pain, reduce the amount of weight you are lifting temporarily. If it is still sore, then ask your coach/trainer if there is a suitable alternative you can try that is not painful. Ideally get advice from a physiotherapist. Too often, athletes are terrified of making an injury worse and so they end up doing nothing at all, which in my experience leads to a longer rehabilitation period, as you need to strengthen everything back up again.

Inadequate utilization of the shoulder during rowing can lead to forearm issues from my observation. This can be seen when a rower bends their elbows too early during the drive phase or brings the elbows up too high at the finish. This can be corrected with the following drill (requires a partner):

• Lying on your back with your arms up straight above you (knees bent with feet on the ground or legs out straight)
• Pull your shoulder-blades down to the ground (almost as though your are pulling it towards your spine – technically called ‘retraction’)
• With a partner, grab each other’s hands. Get your partner to gently pull your arm forward so that you can tense the muscles behind the shoulder to keep your shoulder-blade down against the ground.
• These are the same muscles we needed to hold the tension of the oar while driving the legs during the rowing stroke.

Reps – 3×20 2-3 sec holds

Whilst this is an awareness drill, it can be progressed to a banded row, incline row, bent over row and even a deadlift.

What to avoid or be careful of?

• If you have had a dislocated shoulder, take some caution when lifting and turning the boat on/off the water, particularly in windy conditions.
• Forunately for rowers, the likely reason for the shoulders being an uncommon injury, is that there is little overhead movement. The shoulder is a very mobile joint, but with increased mobility, comes increased demand for control and stability in different directions. It is quite common to have shoulder pain when moving the arms overhead.
• Shoulder press is a fantastic shoulder exercise but can be painful for many shoulder conditions in the early stages. Much like a deadlift for the lower back, that does not mean it should be avoided forever. Ensure your technique is appropriate and the weight is progressively increased. Most of the injuries in both of these exercises occur because we get carried away with unaccustomed weight or, increase the amount of sessions/reps/sets at an accelerated rate.

In my opinion, x-rays should not be routine for assessing a shoulder with gradual pain unless ruling a specific diagnosis in or out, such as a fracture (break in the bone) or frozen shoulder/osteoarthritis. MRI would have the same approach, but would be useful for evaluating a dislocated shoulder or stress fracture (uncommon in rowers).

How can it be prevented?

Like most rowing injuries, keeping a steady training load with gradual increases is the most effective way to prevent injuries.

A point of interest that may or may not apply to rowers was found in a recent study, where footballers that had niggles were 3-6.5x more likely to pick up an injury (Whalan, Lovell & Sampson, 2019). The key here is not to completely ignore injuries. Being proactive is effective!

Training in the gym may also be useful, focusing on exercises that engage the muscles at the back of the shoulder. Typically in rowing, our shoulder-blades do not go through a complete range of motion, particularly into retraction (pulling the shoulder-blades towards the spine/midline). As such, rowers can actually have weak rhomboid muscles despite the perception that they are performing lots of “rows”. Although anecdotal, this may also be the case with exercises such as bench pull, which is often performed at a high velocity. To offset this, a great exercise is the single arm bent over row, double arm bent over row, inverted bar row and cable row exercises.

Good shoulder function is helpful for neck pain, forearm pain and upper back pain – so it is important to train it! Don’t just focus on the legs. If you can’t hold the force through the handle in the shoulder, you are limiting the power through your legs!

Disclaimer: This advice is general only. For best results, see a Health Care Practitioner for individualised assessment and treatment of shoulder pain.

References

Baugh, C., & Kerr, Z. (2016). High School Rowing Injuries: National Athletic Treatment, Injury and Outcomes Network (NATION). Journal Of Athletic Training, 51(4), 317-320. doi: 10.4085/1062-6050-51.4.13.

Mohseni-Bandpei, M., Keshavarz, R., Minoonejhad, H., Mohsenifar, H., & Shakeri, H. (2012). Shoulder Pain in Iranian Elite Athletes: The Prevalence and Risk Factors. Journal Of Manipulative And Physiological Therapeutics, 35(7), 541-548. doi: 10.1016/j.jmpt.2012.07.011.

Noguchi, M., Chopp, J., Borgs, S., & Dickerson, C. (2013). Scapular orientation following repetitive prone rowing: Implications for potential subacromial impingement mechanisms. Journal Of Electromyography And Kinesiology, 23(6), 1356-1361. doi: 10.1016/j.jelekin.2013.08.007.

Whalan, M., Lovell, R., & Sampson, J. (2019). Do Niggles Matter? – Increased injury risk following physical complaints in football (soccer). Science And Medicine In Football, 4(3), 216-224. doi: 10.1080/24733938.2019.1705996.

Wilson, F., Gissane, C., Gormley, J., & Simms, C. (2008). A 12-month prospective cohort study of injury in international rowers. British Journal Of Sports Medicine, 44(3), 207-214. doi: 10.1136/bjsm.2008.048561.

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