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Imaging of rib stress fractures in elite rowers: the promise of ultrasound?
  1. Alexandra T Roston1,
  2. Mike Wilkinson2,
  3. Bruce B Forster3,4
  1. 1 University of Alberta, Edmonton, Alberta, Canada
  2. 2 Allan Macgavin Sports Medicine Centre, UBC Hospital Centre for Brain Health, Vancouver, British Columbia, Canada
  3. 3 Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
  4. 4 Department of Radiology, UBC Hospital, Vancouver, British Columbia, Canada
  1. Correspondence to Alexandra T Roston, University of Alberta, Walter C Mackenzie Health Sciences Centre, 8440 112 St. NW, Edmonton, Alberta, T6G 2R7 Canada; roston{at}

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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 …

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  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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