Elbow and wrist pain in rowers - Why?

Lateral Epicondylitis (Tennis Elbow) & Extensor Tenosynovitis of the Wrist

Lateral Epicondylitis and extensor tenosynovitis are a common overuse forearm and wrist injuries in rowers. They generally manifest early in the season when there is a return to high-intensity rowing on the water and in relatively cold weather.

What is lateral epicondylitis?

Lateral epicondylitis (also known as tennis elbow) is characterised by lateral elbow and upper forearm pain and tenderness. It is a condition where there is damage, with subsequent inflammation and degeneration of the forearm extensor muscles and tendon at its bony attachment to the outer elbow. These group of muscles at the back of the forearm act to extend the wrist and fingers.

What is extensor tenosynovitis?

Wrist extensor tenosynovitis associated with pain, swelling, and crepitus with motion of the involved tendons in the wrist and hand. It is a relatively common overuse condition which may affect one or more wrist tendons.

What causes these injuries?

During contraction of the wrist or forearm muscles, tension is placed through the tendons. When this tension is excessive due to too much repetition or high force, damage to the tendons may occur. Wrist tendonitis is a condition whereby there is damage, with subsequent inflammation and degeneration to one or more of the wrist tendons where lateral epicondylitis occurs because of damage to the extensor tendon near its attachment to the lateral epicondyle of the elbow. These conditions are usually due to gradual wear and tear associated with overuse.

Why are these conditions common in a rower?

During the rowing stroke, the oar blade is removed from the water at the finish, it then rotates parallel to the water and is rerotated back perpendicular at the catch prior to its placement into the water. This feathering motion is different for the sculler and sweep rowers. The sweep rowers use 1 hand to rotate (feather) the oar, while the sculling rowers have to use both hands.

The sweep grip position: the inside hand feathers (rotates) the oar parallel and perpendicular to the water. The outside hand is kept in a neutral position with the fingers cupped around the handle. The outside arm is only used to pull the oar toward the rower, it does not rotate the oar. This constant motion with the inside hand may lead to the development of these injuries.

The sculling grip: The ideal technique to feather two oars simultaneously is using the fingers only and keeping the wrists in a neutral position (this takes time to master!). In preparation for the catch the lower fingers should extend while the upper part of the fingers stay flexed to keep hold of the oar. At the finish the elbows should extend slightly, lifting the blade out of the water, and fingers flex to feather the blade. These injuries can occur with this repetitive movement or, more commonly, if the wrist flexion and extension is used to feather the blade, which is commonly seen in novice rowers.

What can I do in my rowing program to prevent these?

The key to prevention of extensor tenosynovitis is:

  • Stretching

  • forearm muscles regularly before and after training.

  • Keep the wrist and forearm warm on cold training days.

  • Keeping the hand and wrist warm by using long sleeves that protect the hand and wrist while rowing outdoors.

  • Rowing technique: feathering

  • Focusing on your feathering technique and using the least amount of wrist flexion and extension as possible for economical movement.

What do I do if I have these injuries?

Initially treatment involves rest, forearm stretches and in some cases physical therapy, including massage, dry needling and taping may be required. Occasionally the use of a cock-up wrist splint while rowing can help or a specialty elbow brace and anti-inflammatory medication. Conservative physiotherapy management can generally provide relief in 2 to 3 weeks.

Are you having trouble with your wrist or forearm?

See Alex to be fully assessed, and to find out what you specifically need to do to overcome your symptoms. You can book online here