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Rib stress fracture (RSF) is one of the most hotly debated and least understood of all rowing injuries. It has recently been stated that ‘the pathology and prevention of rib stress fractures will be one of the most useful areas of research in rowing injuries’.1 There is a pressing need for more quality research of RSF aetiology and epidemiology that will inform effective prevention strategies. The current ‘best practice’ management of RSF is principally based on clinical experience and expert opinions from the 20th century.2–4 This is likely due to few major advances within the field of stress fracture healing. Current management strategies, therefore, focus mainly on fitness maintenance and a graded return to rowing.
As previously described2 ,3 a pain-dependent approach is taken, involving a period of complete rest until breathing deeply remains pain free, a period of non-rowing exercise—that is, stationary bicycling and lower extremity strength training—and, eventually, a gradual return …