Mar 22, 2013

Rowing and Ribs - Case Study pt 2 [Writing Injuries]

 Disclaimer: This is not to be taken as medical advice, simply as a story that can be used to add realism to future fiction.

The second rower went all out and wrote a complete guest post for me. She’s had so many rib injuries she red-shirted the year– not rowing for the team at all – because she was always injured and couldn’t compete. If you forgot why rowing is so hard on the ribs, it’s how the athlete performs a stroke as discussed last time.

I would just like to thank these two ladies for answering all my questions, and want to say congratulations for being Big 10 champions in 2011. Despite one of your rowers being ejected from the boat during a race.

A Ribcage Story
In September I started the season rowing starboard and about three weeks into the season, I began having pain on my left side. At first it was soreness and discomfort associated only with rowing, but then it hurt to breathe and it was hard to find a comfortable position for sleeping. The pain was right on the band of my sports bra, which made certain outfits painful too. About the time it hurt to move my left arm at all I went to the trainer and explained my pain. I took two days off from rowing and erging (rowing on a machine) and felt some relief. I went back to rowing and the pain came back.

After an x-ray and a bone scan, the team doctors determined that I had a stress fracture of rib 7 and that rib 6 had been broken or stressed previously and healed already. (Rib 6 broke last spring when I picked up my backpack a little too aggressively and in addition, was standing on the strap. I heard and felt the crack, but upon telling the athletic trainer received no care at that time. It was probably three weeks before I was back to normal. This injury happened at the end of the season and we were tapering; workouts were short and easy.)

Back to September- after the official diagnosis, I was shut down completely. I was only allowed to do things that didn’t make my ribs hurt or hurt worse than it did to breathe. This meant I could run and bike at first. As I healed I was able to start lifting with my lower body only, then once I was pain free completely for two days I was allowed to start erging in small increments. 10 minutes one day, if that was pain free I could do 20 minutes two days later etc. When I could erg full time I started to add upper body lifting again. I ran between 5 and 9 miles every morning while the team rowed on the water and biked while they lifted or erged in the afternoons. I was given rehab exercises, but they generally made me sorer so I did not do them often. Also, I heated before and iced after every work out. Before Thanksgiving, 6 weeks after being shut down initially, I did my first 6k test of the season and almost qualified for Miami (OSU training camp). I was completely pain free and doing full workouts. The team was on the erg full time by that point. After Thanksgiving I passed my 6k and went to Miami, trained the whole week pain free.

Winter quarter was mostly pain free, but towards the sixth or seventh week the same ribs started to bother me during practice. It was the same kind of pain as the fall, but it came and went much more frequently. During one long work out, for example, my ribs hurt on one stroke and I’d wonder if I should stop erging, but then the next stroke was okay again. After a week or so of this I told the trainer and she shut me down for a day to let my ribs calm down. When I continued to be sore, the doctors ordered another x-ray and bone scan.

The tests showed the same two ribs had been broken, but there was a twist! The trainer was going over the results with me, but then asked if I had any pain in my back. I had been having pain in my back, but it was normal after so much time on the erg, and it was happening on both sides. She told me that she had to ask because the scans showed something weird in my eleventh rib, a floating rib.

The periosteum (tissues that surrounds the bones) was tearing off of the bone and it should have been really uncomfortable – aka, my muscle was ripping off of a rib that I didn’t even know was a problem!

After about a week or alternate workouts I got back on the erg and finished the quarter problem free. I used ice and heat and added e-stim treatments: for twenty minutes two or three days a week I wore electrodes over the broken ribs and endured electric stimulation to the area. This was supposed to help stimulate blood flow and thus healing. I do believe that stim was helpful. I also was given Ionto, a medicated version of stim. It was like stim, but the electric impulses helped send steroids to the affected area to help the healing process. This was also helpful.

Spring quarter. We had been on the water a handful of times before spring break, but we saw a gigantic increase in volume that week. I was switched to port from starboard to try to spare the ribs on my left side. After 3 days, nine practices on port I started feeling that familiar pain on my right side. I have taken physiology and health and spent enough time with the training staff that I knew it was my serratus anterior (the muscle on the upper side of the chest) that hurt. I was in stroke seat of the first four and we were doing a set of four race pieces.

During the second race there was a stroke that felt fine and then the next stroke I knew I was in trouble. The affected area grew and by the end of the third race I could no longer connect my lower body to the oar handle because there was no contracting of my core muscles. Being a rower, I did not want to stop before the job was done, so I switched places with our 2 seat (a different position on the boat) thinking this would allow us to row better.

It made no difference which seat I was in, we lost the race and by the end I couldn’t straighten my back or move my right arm. This is tricky because I am right handed. In the fall I had to take care not to open doors or lift things with my left hand, but again, being right handed, this was easy. I went to see the trainer immediately and was shut down again for three days.

I woke up the morning after feeling worse than I had the first day of ribs round 2. The pain had spread from my serratus to cover the entire length of my ribs. From where I had been hurt in the Fall, just the other side of my ribcage, to the back along the same rib. I was allowed to run and bike, but developed a flimsy theory that running actually made my rib worse and that I shouldn’t have been allowed to run in the Fall. I eased back into exercise with the same general rules as the Fall. Heat before, ice after, don’t do anything that hurts or hurts worse.

The healing process was more painful emotionally than physically as this time, I was biking and swimming while my teammates competed and drew closer and closer to the Big Ten Championships. I was recently given a new set of rehab exercises that actually seem to be helping. I am sore after, but that’s more because I haven’t lifted anything with my upper body basically all year. In the Fall when I said that rehab made me sore it hurt my ribs specifically, this rehab makes the surrounding muscle groups sore instead.

I recently returned to rowing full time and have been pain free throughout the transition. I still heat before and ice after. I had blood drawn to see if there was an answer there to why I had so many broken ribs. The doctors found me to be vitamin D deficient and I now take a supplement. I don’t completely believe that vitamin D broke my ribs, this is Ohio and it was early spring when I had the blood drawn, everyone in Ohio is vitamin D deficient! This time around I was probably ready to start rowing again about 6 weeks after the initial injury, same as the Fall.

So here’s a summary of what I have learned about ribs/prevention/treatment this year. 

In any kind of training, but especially at the elite level and above there is the problem of the Weak Third Week. This means that for whatever reason, during the third week of each training cycle, the skeleton is weak and most susceptible to stress fractures and breaks. In the Fall we had been rowing three weeks exactly when I started to hurt, and in the Spring we had been transitioning from the erg to the water for about three weeks when I got hurt again. To prevent injuries it is important to ease up during this third week. Easing up is not something that our team does, and as a result, there have been many broken ribs this year. The rowing itself caused all of my injuries, I was always rowing when I noticed the pain the first time. Moe specifically within rowing, it was the intercostal muscles, the serratus anterior and other muscle groups that act on the ribs that just pulled my bones in opposite directions too much and caused the breaks to begin.

Any one else want to share a story about getting injured while playing a varsity sport?

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