• Rib
• Stress fracture
• Ultrasound
• Rowing

Stress fractures are common injuries in endurance athletes, and are due to high-intensity, repetitive training activities.1 ,2 Although these fractures occur more frequently in weight-bearing bones, the ribs are a common site for non-weight-bearing stress fractures.3 Rib stress fractures are the most common type of stress fracture in rowers, with an incidence that has been reported as being between 6.1% and 12%.2–5 This relatively large range of estimated incidence rates is likely due to both under-reporting and underdiagnosis of rib stress fractures, as well as an overall lack of epidemiological studies on musculoskeletal injury rates in rowers.3 4 6 For these reasons, the burden of rib stress fractures is likely higher than the literature suggests.3 7 In fact, there is so little epidemiological data available that some recommendations suggest that focal rib pain in any elite rower should be regarded as a stress fracture until proven otherwise.8

Rib stress fractures are of great concern to elite-level rowers and their teams. Rib-related injuries account for the most time lost from training and competition, which can have a negative impact on the affected rower, and on crew members and coaches.3 6 8 Furthermore, because injuries can require up to 6–8 weeks of rest, a rib stress fracture can be a season-ending injury at the elite level.8 This is especially worrisome because a stress fracture that occurs during training for a major championship could prevent the injured athlete from competing altogether.3 Finally, elite level athletes may be more reluctant to abstain from training, and training despite a suspected rib stress fracture may lead to even more serious injury such as a displaced fracture and greater time lost from sport.8–10

Much like stress fractures in weight-bearing bones, rib stress fractures are thought to result from …