title: Rib stress fractures among rowers: a systematic review on return to sports, risk factors and prevention.
abstract: BACKGROUND
  Rib stress fractures (RSFs) are injuries frequently sustained by elite rowers with an injury rate of 8-16% over the course of a rowing career, resulting in negative effects on training and performance. For clinical management, the aim of this review was to describe time to return to sports, summarize potentially preventive measures and appraise the evidence on risk factors.
  
  
  METHODS
  A search strategy was performed in PubMed, SportDiscus, Web of Science and Embase till June 1st 2015. All studies were graded on their quality.
  
  
  RESULTS
  The search resulted in 124 studies, of which 17 were included: Ten reported on return to sports, 17 reported on risk factors and nine on preventive measures. For return to sports, nine studies mentioned a loss of training of 4-6 weeks. The shortest period was one week and the longest 16 weeks. For risk factors, insufficient or conflicting evidence was found for changes in the training program, incorrect rowing technique, female gender, low bone mineral density, inadequate equipment, and training type. For prevention, gradual changes in the training program, alertness on the part of coaches and clinicians, and supplementation of diet and hormones are suggested as effective measures. However, no effect studies have been found.
  
  
  CONCLUSIONS
  The main outcome of this review on RSFs is that little evidence is available on return to sports, risk factors and preventive measures. Coaches and clinicians should carefully guide and assist rowers suffering from RSFs in off training and in the subsequent training period to regain their pre-injury level.
authors.affiliation: Coronel Institute of Occupational Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands - p.p.kuijer@amc.nl.
authors.forename: Philip N
authors.initials: PN
authors.lastname: D'Ailly
authors.forename: Judith K
authors.initials: JK
authors.lastname: Sluiter
authors.forename: Paul P
authors.initials: PP
authors.lastname: Kuijer
mesh_terms: D005260:Female; D015775:Fractures, Stress; D006801:Humans; D008297:Male; D000068958:Return to Sport; D012272:Ribs / Q000293:injuries*; D012307:Risk Factors; D013177:Sports