Clinical features:
(1) The athlete develops acute chest pain while rowing.
(2) The fractures most commonly affect the 5th through 9th ribs along the anterolateral to posterolateral aspects (from the anterior to posterior axillary lines). Usually 1 but occasionally multiple ribs may show a fracture.
(3) The fracture or a callus may be seen on chest X-ray (least sensitive), bone scan or MRI.
(4) The rower may have a history of a previous rib fracture.
Risk factors are associated with overuse:
(1) vigorous exercise with a high load per stroke
(2) vigorous long-distance rowing
(3) significant increase in the intensity of the training program
(4) rowing technique with high reach, pull through and layback
Prevention involves reducing the force on the ribs exerted by the serratus anterior and/or external oblique muscles
(1) changing rowing technique to reduce reach, pull-through and layback
(2) reducing the length of the lever arm
(3) rowing at a higher stroke rate
