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Rib stress injuries in the 2012–2016 (Rio) Olympiad: a cohort study of 151 Australian Rowing Team athletes for 88 773 athlete days
  1. Rachel Harris1,
  2. Larissa Trease1,2,
  3. Kellie Wilkie3,
  4. Michael Drew4,5
  1. 1 Orthopaedics ACT, Woden, Australian Capital Territory, Australia
  2. 2 Centre for Health Care in Remote and Extreme Environments, School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
  3. 3 Bodysystem Physiotherapy, Hobart, Tasmania, Australia
  4. 4 Department of Physiotherapy, Australian Institute of Sport, Canberra, Australian Capital Territory, Australia
  5. 5 Australian Collaboration for Research into Injury in Sport and its Prevention (ACRISP), Federation University Australia, Ballarat, Victoria, Australia
  1. Correspondence to Dr Rachel Harris, TRIGG, WA 6954, Australia; admin{at}


Aim To describe the demographics, frequency, location, imaging modality and clinician-identified factors of rib stress injury in a cohort of elite rowers over the Rio Olympiad (2012–2016).

Methods Analysis of prospectively recorded medical records for the Australian Rowing Team in 2013–2015 and the combined Australian Rowing Team and Olympic Shadow Squad in 2016, examining all rib stress injuries.

Results 19 rib stress injuries (12 reactions and 7 fractures) were identified among a cohort of 151 athletes and included 12 female and 7 male cases, 11 open weight, 8 lightweight, 12 scull and 7 sweep cases. The most common locations of injury identified by imaging, were the mid-axillary line and rib 6. Period prevalence varied from 4% to 15.4% and incidence ranged from 0.27 to 0.13 per 1000 athlete days. There were no significant differences in prevalence by sex, sweep versus scull or weight class. There was a statistically significant increase in incidence in the pre-Olympic year (2015, p<0.001). MRI was the most commonly used modality for diagnosis. Stress fracture resulted in median 69 (IQR 56–157) and bone stress reaction resulted in 57 (IQR 45–78) days lost to full on water training.

Conclusions In our 4-year report of rib stress injury in elite rowing athletes, period prevalence was consistent with previous reports and time lost (median ~10 weeks) was greater than previously published literature. Rib stress injury limits training and performance in elite rowers and MRI should be considered as a first line investigation.

  • rowing
  • athlete
  • injury prevention
  • injury
  • stress fracture

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  • Twitter @DrRachelHarris, @DrLarissaTrease, @KellieWilkie, @_mickdrew

  • Contributors RH, LT and KW were involved in the original design, data collection, interpretation of the statistics and drafting and approving the manuscript. LT and KW were responsible for collected data from 2012–2016. MD undertook all statistical analyses and was involved in the interpretation of the statistics and drafting and approving the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement statement Rowers in the Australian Rowing Team were not involved in the development of the research questions or study design and the collection of this data did not demand any additional time or intervention burden for them. All members of the rowing community, including Australian Rowing Team athletes will benefit from the increased understanding of rib stress injuries in the sport and results of this study will be disseminated through the Australian Rowing Team medical staff to current athletes.

  • Patient consent for publication Not required.

  • Ethics approval Ethics approval was obtained from the Australian Institute of Sport Human Ethics Committee, Approval Number 20180403.

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

  • Data availability statement No data are available. No data are available.