Rowing, kayaking and paddleboarding load the shoulders, the upper back and the ribs through thousands of repeated strokes. In rowers, the condition to know about is a rib stress fracture: a pinpoint sore spot on the side or back of the ribs that hurts with deep breaths, often after a jump in training volume. Kayakers and paddleboarders more often develop shoulder impingement or rotator cuff irritation from strokes with the top hand held high. Upper back strain is common in all three.
Key takeaways
- Rib stress fracture: one of the more common injuries in competitive rowing, linked to sudden increases in training volume or intensity.
- Breathing pain: rib pain that is worse with deep breaths, coughing or rolling over in bed should be assessed rather than trained through.
- Paddlers’ shoulders: a top hand held above head height for many strokes loads the rotator cuff.
- Load: gradual increases in distance or time, and power from the legs and trunk rather than the arms, reduce the load on the shoulders and ribs.
Common problems by body part
- Ribs (rowing): a rib stress fracture usually sits on the side or back of the chest, around the middle ribs. It builds over days to weeks from an ache during the drive into sharp pain with deep breaths, coughing, sneezing or lying on that side. One spot on the rib is tender to touch. It tends to follow a sudden rise in volume, long sessions on the rowing machine, or a change of boat, rigging or oar. Low energy intake for the amount of training raises the risk.
- Rib joints: rib joint pain sits right next to the spine, often starts suddenly with a twist or a catch, and is sharp with breathing or turning. It is not usually tender along the rib itself.
- Shoulder (kayak and paddleboard): pain at the front or outer side of the shoulder, worse reaching overhead, from strokes with the top hand high and far from the body. This is shoulder impingement or rotator cuff irritation.
- Shoulder dislocation (kayak): a high brace or roll with the arm above the head and pulled back can force the shoulder out, especially in white water. Recovery is covered in dislocated shoulder recovery.
- Upper back: an ache between or beside the shoulder blades after long sessions, from the muscles that pull the shoulder blades back at the finish of each stroke. This is usually upper back strain, which eases with gentle movement and does not leave a pinpoint sore spot on a rib.
Early warning signs
- Chest wall pain that outlasts the session: especially if it is in the same spot each time.
- Pain with a deep breath or cough: a sign to stop and get assessed rather than reduce and continue.
- Shoulder ache when the top hand passes head height: the earliest sign of rotator cuff overload in paddlers.
- Upper back pain into the next day: recovery is not keeping up.
Load and technique changes
- Gradual increases: add no more than about 10 percent to weekly time or distance, and avoid raising volume and intensity in the same week.
- Watch the risky weeks: the start of a training block, a move to long machine sessions in winter, or a new boat, rigging or oar.
- Fuel the training: eating enough for your training load supports bone health. A doctor or sports dietitian can help if weight is a focus.
- Power from the trunk: in a kayak, rotate the torso to drive the stroke and keep the top hand at about forehead height. On a paddleboard, a paddle length that keeps the top hand near head height reduces overhead reaching.
- Keep the elbows low when bracing: a low brace with the elbows below the shoulders protects the shoulder better than a high brace.
- Strengthen: rotator cuff and shoulder blade strengthening two to three times a week, built over 6 to 12 weeks.
A sore spot on a rib that hurts when you breathe deeply is a reason to stop rowing and get it checked, not to row through it.
Keep going or ease back
- Muscle ache that settles by the next day: keep training at a lower volume for 1 to 2 weeks, then build back gradually.
- Shoulder pain during paddling: shorten sessions, keep the top hand lower, and see a physical therapist if it is not easing within 2 weeks.
- Suspected rib stress fracture: stop rowing and see a doctor. Plain X-rays are often normal early, so a scan may be needed. Rowing usually stops for about 4 to 6 weeks, and a full return often takes 6 to 12 weeks. Cross-training that does not hurt, such as cycling, is often allowed. Your doctor’s plan comes first.
- Returning: start with short, light sessions and add time before intensity. A returning sore spot means stepping back.
Where else this could be coming from
- Breathing-related back pain: upper back pain when breathing covers the other causes, from rib joints and muscles to the lungs, and the signs that need urgent care.
- Rotator cuff: rotator cuff tendinopathy gives pain at the outer upper arm when lifting, and does not hurt with breathing.
- Heart: left-sided chest, shoulder or upper arm pain during exertion that comes with breathlessness or sweating needs urgent care. Left shoulder pain: heart or shoulder? explains what tends to set them apart.
- Forearm and wrist: pain in the elbow, wrist or hand from gripping the oar or paddle is a separate problem from the shoulder.
Call your local emergency number or go to the emergency department if
- Chest pain with exertion: chest pain, pressure or tightness, especially spreading to the arm, neck or jaw, or with breathlessness, sweating or nausea.
- Sudden breathlessness: sudden sharp chest pain with breathlessness, or coughing up blood.
- Shoulder out of place: a shoulder that looks deformed and cannot move after a capsize, brace or fall.
See a doctor today if
- Rib pain with fever: chest or rib pain with a fever, or a cough bringing up colored phlegm.
- Rib pain after an impact: rib pain after a fall or collision that is getting worse, or makes breathing hard.
- New breathlessness: breathlessness at rest that was not there before.
Get it checked soon if
- A sore spot on a rib: pain on breathing or coughing, with one tender spot on a rib, that has built up with training.
- Repeat stress injuries or missed periods: more than one stress fracture, or periods that have become irregular or stopped during heavy training.
- Shoulder that feels loose: after a brace or capsize, even if it went back in by itself.
More on this area: neck and shoulder pain by job and sport.
Pain with breathing is a reason to stop and get checked before building back slowly.
Written by Louise Yow, Neck & Shoulder Physio.