Clinical issues in rowing

Most rowing biomechanical and physiological research has been performed on rowing machines (‘ergometers’) on which rowers can closely mimic the movement of the rowing stroke. There has been less research on boats in water. Most rowing injuries are due to overuse/overload or poor mechanics. Lower back pain, wrist tendon disorders and rib stress fractures are the most common injuries reported. There has been a well-documented increase in the incidence of these injuries since the 1991 introduction of the hatchet ‘big’ blades.

Lightweight rowing, where athletes compete within defined weight limits, shares many of the problems associated with other weight-controlled sports. The Sports Medicine Commission has been concerned about weight control practices and produced a position statement “Weight Loss by Lightweight Rowers and Coxswains.”1 A tragic heat stroke death of a young lightweight rower using inappropriate weight loss techniques2 (running alone in the forest wearing layers of non-breathable sportswear in hot weather) reinforced the recommendations of the position statement and resulted in improvements in the education, monitoring and enforcement of these regulations. Recently, as an addendum to this position statement, intravenous rehydration of athletes post ‘weigh in’ has been banned at all FISA events. Since the first position statement above, the Medical Commission has produced a number of other position statements available to all on the World Rowing (FISA) website.

Rowing medical organisation and the fight against doping

As a member of the Olympic Family, FISA adheres to the IOC Medical Code and has also introduced additional policies aimed at protecting the health of all rowing athletes. In 2013, based on the recommendation of the Sports Medicine Commission, the FISA Extraordinary Congress mandated that each member federation have a designated medical officer. Correspondence for medical and antidoping matters between FISA and the member federations are now conducted through this medical officer to ensure that medical ethics, confidentiality and accepted medical standards are respected for the athletes.

The team doctors are now required to provide details of their qualifications and certify that they are familiar with FISA Medical Rules, The IOC Medical Code and The WADA Code.

The Congress has also adopted the IOC's guidelines regarding gender re-assignment and hyperandrogenism. In cases requiring determination of eligibility, FISA will refer to and abide by the International Olympic Committee guidelines.

In 2011, collaborating closely with the International Cycling Union (‘UCI’), FISA initiated the ‘No Needles’ Policy and has incorporated this policy into the FISA rules. The ‘No Needles Policy’ prohibits the use of injections during competition without medical justification and medical certification. This policy was implemented in early 2011 and was presented to the IOC later that year. The IOC adopted it for the London 2012 Olympics and this policy was updated by IOC for the Sochi 2014 Winter Olympic Games. The policy is available in the Medical Section of the FISA website.

Mandatory pre-competition health screening

FISA introduced mandatory pre-competition health screening in 2013. This screening follows the IOC's protocol and widely accepted sports medicine recommendations and includes three elements:

1. A medical questionnaire on the athlete's personal and family medical history (now provided on the FISA website in 14 languages);

2. A clinical examination;

3. An ECG.

Any additional testing or clinical investigations are then based on the results of the three-part health screen. All rowers entered in the 2014 World Rowing Junior Championships were required to have completed this screening in 2014. In 2015, all rowers entering the World Rowing Championships, World Rowing Under 23 Championships and the World Rowing Junior Championships will be required to have undertaken the mandatory screening. Data are being compiled on the results of this initial screening. In a report from the Australian Federation,3 the first year after introduction of this screening, up to 14% of athletes screened have required further investigation in the form of an echocardiogram. Only 1.6% (3 of 185) athletes required further follow-up after this with a specialist Cardiologist and 2 of 185 (1%) were diagnosed with a condition that was potentially fatal. The FISA Sports Medicine Commission is presently implementing surveillance to assess the true rate of these abnormalities in elite rowers.

Although there have been relatively few doping violations in rowing (27 positive cases dealt with by FISA over the past 10 years), FISA has historically adopted tough rules against doping in sport. In 1983, FISA was the first International Federation to conduct out of competition doping controls. The FISA Congress voted in 1989 to impose a mandatory life ban for any doping offence and, in 1991, FISA introduced an ‘athlete commitment’ form to be signed by all rowers competing in the World Championships in which all athletes, among other things, accept to undergo any and all types of antidoping testing. FISA also started blood sampling in 2001. In 2003, the FISA Congress adopted the World Anti-Doping Code with a maximum ban of 2 years for the first offence.

FISA was one of the first federations to use biotechnology in the fight against doping in 20074; the haematological passport was introduced in 2010 and FISA has conducted more than 1600 haematological passport tests since its introduction.

The health and safety of all athletes participating in rowing is of utmost importance to FISA and the member federations. It is with this principle that FISA will continue to implement new initiatives and support research that helps ensure the safety and long-term health of all rowers. We trust that you will find this Rowing theme issue of BJSM helpful in caring for rowers in your practice. We look forward to seeing you at future sports medicine-related conferences and workshops.