Rower’s Knee Pain and How to Treat it Properly

Rowing places repeated load through the knees. When timing, strength, or recovery fall slightly out of balance, that load can start to irritate the joint. We see this regularly at Perfect Balance. Competitive athletes. Club rowers. Recreational gym users using the erg. The pattern is similar: pain at the front or side of the knee that builds over sessions and starts to affect performance.

Rower’s knee is not a single diagnosis. It’s how many describe knee pain that starts during or after time on the water or erg. Calming pain helps, but correcting the overload is what truly counts. When we address the cause, not just the symptom, recovery becomes clearer and more sustainable.

Understanding rower’s knee

The term “rower’s knee” commonly refers to anterior knee pain linked to repetitive knee flexion and extension under load. From a professional standpoint, it may involve:

• Patellofemoral pain syndrome

• Iliotibial band irritation

• Patellar tendon overload

• Meniscal irritation in some cases

The stroke pattern depends on strength, timing, and smooth control. When hip control, ankle mobility, or core stability are lacking, the knee can absorb more force than it should. Over time, this repetitive strain can irritate cartilage surfaces, tendons, or surrounding soft tissue.

We prioritise correcting mechanics before treating the knee locally. Often the source is not just the joint itself, but how force is travelling through the body.Unravelling the Causes of Rower’s Knee

The primary culprit behind rower’s knee is the repetitive strain and pressure placed on the knee joint during rowing. This strain can lead to inflammation and damage to various parts of the knee, including the cartilage, ligaments, and tendons. Other contributing factors to rower’s knee include:

• Poor rowing technique: Incorrect form can place additional stress on the knees, leading to injuries.

• Overtraining: Rowing too frequently or for too long without adequate rest can lead to overuse injuries.

• Lack of flexibility: Tight muscles can pull on the knee joint, causing pain and inflammation.

• Muscle imbalances: Weak or imbalanced muscles can lead to improper knee alignment, which can cause pain and injury.

Why rowers develop knee pain

Repetition is not the enemy. Poorly managed repetition is.

The most common contributing factors we see include:

Technique breakdown

Proper stroke mechanics start with hip extension and coordinated leg transfer. When athletes collapse through the knees at the catch, drive too early with the upper body, or lose pelvic control, excessive stress can develop around the patella or lateral knee structures.

A straightforward video review comparing efficient and inefficient technique often makes the issue obvious. Subtle differences in knee tracking, foot positioning, or seat timing can significantly alter joint load.

Training load errors

Sudden training changes can push tissues beyond tolerance. Load can strengthen the knee, provided it’s increased gradually.

Reduced flexibility

Tight quadriceps, hip flexors, hamstrings, or calves can alter joint mechanics. Limited ankle dorsiflexion, in particular, changes how force transfers during the drive phase.

Muscle imbalance

Weak hip abductors, underactive gluteal muscles, or poor core stability can reduce pelvic control. The knee then compensates. Over time, that compensation becomes pain.

This is why simply resting the knee without addressing strength and control often leads to recurrence.

How we treat rower’s knee

Treatment depends on the specific diagnosis and severity, but the principles remain consistent. Calm irritation. Restore control. Rebuild strength. Correct movement.

1. Relative rest and load modification

Complete inactivity is rarely necessary. Instead, we adjust the training load. This may involve reducing stroke rate, lowering resistance, shortening session length, or temporarily replacing rowing with cross training.

Applying cold therapy post-training may limit irritation. Ten to fifteen minutes of icing can assist in reducing acute reactivity.

2. Physiotherapy-led rehabilitation

Physiotherapy forms the foundation of treatment. At Perfect Balance, assessment includes:

• Detailed movement analysis

• Hip and ankle mobility testing

• Strength profiling

• Functional rowing-specific assessment where appropriate

Recovery work typically includes:

• Glute activation drills

• Inner quadriceps (kneecap stabilising) strengthening

• Controlled single-leg loading

• Progressive compound strength work

• Core and lumbar stabilisation

Where helpful, video feedback of rowing technique is integrated into the plan. Seeing how your knees track during the catch or drive can make correction more intuitive.

3. Pain management strategies

Short-term use of over-the-counter anti-inflammatory medication may be appropriate for some individuals, but this should be discussed with a pharmacist or GP.

In cases where inflammation persists despite structured rehabilitation, a GP or sports physician may consider options such as prescription anti-inflammatories or corticosteroid injections. They are applied selectively in inflammatory conditions, not general overuse.

4. Advanced treatment options

In persistent cases, adjunct therapies such as shockwave therapy or targeted soft tissue techniques may be considered depending on the underlying structure involved.

Surgery is uncommon and generally reserved for significant structural damage such as unstable meniscal tears or advanced cartilage injury.

At Perfect Balance, surgery is always considered the final option when structured conservative care has been exhausted.Additional Insights: Avoiding Rowing Machine Knee Pain

Improper usage of rowing machines can result in knee pain, despite their popularity as a training and fitness tool. To help you steer clear of knee discomfort when utilising a rowing machine, here are some additional pointers:

• Proper Setup: Ensure the rowing machine is set up correctly for your body size and strength. The footrests should be adjusted so that your knees are slightly lower than your hips when you’re seated. The resistance should be set at a level that challenges you but doesn’t strain your knees.

• Correct Technique: Use the correct rowing technique to avoid unnecessary strain on your knees. The power in rowing should come from your legs and hips, not your upper body. Your knees should be straight when you pull the handle towards your body and bent when you extend your arms and slide forward.

• Gradual Progression: Increase the intensity and duration of your workouts gradually. Sudden increases can lead to overuse injuries.

• Strength Training: Strengthening the muscles around your knees can help protect them from injury. Incorporate exercises like squats, lunges, and leg presses into your workout routine.

• Stretching: Regular stretching can help maintain flexibility and prevent injuries. Focus on stretching your hamstrings, quadriceps, and hip flexors.

Preventing rower’s knee before it starts

Prevention is not about doing more. It is about doing the right things consistently.

Warm up properly

Gradually elevating heart rate before mobility work primes the body. Slowing down progressively after exercise restores normal blood flow.

Refine technique

Small technical adjustments can significantly reduce knee stress. If pain keeps returning, reviewing footage of your stroke with a coach or clinician is worthwhile.

Build strength outside the boat

Rowing is repetitive. Strength training builds resilience.

Key exercises include:

• Squats and deadlifts for lower limb strength

• Single-leg work for pelvic control

• Hip thrusts for glute activation

• Core stability drills such as planks and anti-rotation exercises

Strength work supports the knee indirectly by improving hip and trunk control.

Maintain flexibility

Regular stretching of hip flexors, quadriceps, hamstrings, and calves supports joint alignment. Stiff hips commonly contribute to kneecap pain but are often missed.

Manage load intelligently

Rapid load progression is a frequent driver of irritation. Gradual progression protects long-term performance.

Avoiding rowing machine knee pain

Erg training introduces its own challenges.

Ensure:

• Foot straps are positioned so knees track comfortably without excessive inward collapse

• The damper setting matches your training level rather than defaulting to maximum resistance

• You drive through the legs first, then hips, then arms

• You return in the reverse order with control

If knees are fully locking aggressively at the finish or collapsing inward at the catch, mechanical strain increases.

A short technique review often corrects this quickly.

When to seek professional assessment

If knee pain persists beyond a few weeks, worsens with training, or begins to interfere with daily life, it is time for assessment.

Addressing the issue early reduces the risk of long-term irritation. Most rowers who address the issue early return to full training with stronger mechanics than before.

At Perfect Balance, we assess the whole movement system, not just the painful joint. Our team approach means physiotherapists, osteopaths, sports therapists, and rehabilitation specialists work together where needed. The goal is clarity from the first session and a structured pathway back to confident rowing.

Rower’s knee treatment is available at Perfect Balance clinics in Cambridge, Hatfield, St Albans, Moorgate, Richmond, and Lord’s Cricket Ground.

If knee pain is affecting your training or performance, you can book an assessment with the Perfect Balance team to identify the cause and build a clear, progressive recovery plan.