Rib Bone Stress Injuries

Oxford celebrates winning the women’s race REUTERS/Andrew Boyers.

The International Delphi consensus highlights increasing recognition of bone stress injuries⁽¹⁾. Rib BSIs may not be on many clinicians’ radars compared with the more familiar lower limb stress injuries encountered in runners. However, they may be particularly prevalent in sports with repetitive upper limb and thoracic motion- most notably in rowing but also found in baseball, cricket fast bowling, tennis, swimming and golf^(2,3).

Although the majority of published research has been conducted in rowing, the underlying principles of rib BSI, including diagnosis, risk-factor identification, load management and rehabilitation, are applicable across athletes participating in repetitive overhead and rotational sports.

Bone stress injuries can be career-ending in elite sports and require an athlete to take significant time off to recover. During this time, overall global deconditioning can have a huge impact on the return to sport, too. Athletes may be required to rest for 8-10 weeks^(4,5). Physiotherapists are critical in identifying the early warning signs and creating management plans that facilitate recovery and mitigate further deconditioning. 

Epidemiology 

There is limited evidence comparing the epidemiology of rib BSIs within certain sports. Most of the available evidence is centered on rowers, with a 2011 review by authors in New Zealand stating that, at the time, epidemiology showed 8.1-16.4% in elite rowers, 2% in university level, and 1% in juniors⁽⁵⁾. Aside from rowing, the remaining literature consists of case reports and small retrospective series, limiting the ability to estimate incidence, prevalence, and recurrence. Consequently, the true epidemiological burden of rib BSIs in overhead and rotational sports remains unknown.

While epidemiology is poorly understood, the anatomical location of rib BSIs varies markedly across sports (see figure 1).

“The simplest trigger is an increase in load...”