How to avoid knee pain in rowers

Patellofemoral pain (Knee pain)

Patello-femoral pain usually develops as an overuse injury with complaints of front knee pain with rowing and quad-strengthening training activities.

What is patello-femoral pain?

Patellofemoral pain usually involves a gradual onset of pain in or around the kneecap. Pain with ascending and descending stairs, swelling, crepitus, and/or a clicking sensation during the rowing stroke may be present.

Patellofemoral pain, is mainly due to the kneecap not tracking smoothly through the groove it runs in at the front of the knee. Instead of the patella running in the centre of the groove the it runs over towards the outer side of the groove. This results in pain and premature wear at the patellofemoral joint.

What causes this injury?

Abnormalities of the muscles around the knee may result in the kneecap not tracking smoothly. For example, tightness of the outside thigh muscles (which pull the kneecap outwards) is often accompanied by weakness of the inner thigh muscle. This results in the kneecap being pulled towards the outside of the leg.

Other biomechanics factors of the hip and foot may also contribute to the malalignment of the kneecap. These factors can include poor foot posture, decreased knee control as well as knock knees or bow legs. When poor biomechanics are repeated with each stroke or gym program, that repeatedly may contribute to malalignment of the patella and patellofemoral pain.

Patellofemoral pain syndrome is more common during adolescence, because the long bones are growing faster than the muscles, tendons and ligaments, putting abnormal stresses on the joints. Active children who do not stretch the appropriate muscles are predisposed to patellar malalignment.

Why is this injury common in a rower?

Rowing involves loading of the patellofemoral joint. In addition, the training activities designed to increase the strength of the quadriceps mechanism, including stair running and squat jumps, cause significant patella pressure. Of particular note in the rowing population is the presence of tight quadriceps, hip flexors, and the ITB.

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

  • Stretching

  • Important to focus on stretching the quadriceps, hip flexors, and the ITB post training and racing to prevent patella malalignment.

  • Rowing technique

  • When you are rowing, make sure your knee is bending in line with your second toe to ensure ideal knee biomechanics.

  • Gym Program

  • Complete elements of the gym program mimicking on the ideal knee tracking position needed in the boat (make sure your knee is positioned over your second toe)

  • Boat set up: foot stretcher

  • Modifications in the position of the foot stretcher can alter the patellofemoral mechanics.

  • A decrease in the knee flexion angle at the catch and, thus, a decrease in patella compression can be achieved by raising the height of the foot stretcher.

  • Boat set up: shoes

  • This can addressed by changing the rotation of the toe-in or toe-out position of the shoes.

  • If your have ‘bow legs’ or ‘knock knees’, they may also be contributing to you developing PFJ pain.

  • Boat set up: front and back stops

  • An extreme strategy would also be to place front or back stops on the track of the sliding seat of the shell or ergometer to limit the arc for knee flexion or extension.

What do I do if I have patellofemoral knee pain?

Current research suggests that physiotherapy intervention is a very effective short and long-term solution for patellofemoral pain.

The aim of treatment is to reduce pain and inflammation in the short-term and correct the cause of the patella malalignment to prevent it returning in the long-term.