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Rowers Knee Pain Treatment


According to a study by Hosea and Hannafin that analysed injury patterns in rowers from Harvard and Ruthgers universities over three years, knee injuries were the most commonly occurring injury in rowers. The knee pain is usually felt under the kneecap, which is known as patellofemoral pain, or on the outside of the knee due to irritation of the IT band. While the structure causing the pain in these injuries may vary, the underlying causes of these injuries tend to be quite similar. IT Band injuries and patellofemoral pain can often be traced back to the athletes’ ability, or lack of ability, to maintain control of hip and knee alignment when loading the legs.

Knee injuries in rowers

There are two main technical faults that can lead to knee injuries in rowers. The first is seen in people who are new to steering or those who are steering particularly bendy courses. The second technical fault is in rowers who excessively spread their legs at the catch. This can place an increased force on the outside of the knees as well as shifting the load on the kneecap from the part of the joint that’s designed to take it to a part that’s not.

Cross-training, mainly running, can also lead to knee injuries in rowers. Rowers are not designed to be good at activities like stadium steps and running, especially heavyweights. Large shifts in loading are among the most common causes of injuries. Injuries in the weights room are also common among rowers, with poor technique and/or sacrificing technique to beat a friend being the most common reasons.

Preventing knee injuries

To prevent knee injuries, avoid peaks in cross-training, and build up slowly. Work on hip and hamstring flexibility and lift weights that challenge you, but not so much that they sacrifice technique. Additionally, try some single-leg training like pistol squats and RDLs to help with hip and knee control.

There are several key things that rowers can do in the gym to help avoid knee injuries:


  1. Avoid sacrificing technique for heavier weights: Poor technique is a common cause of knee injuries in the weight room, so it’s important to prioritize good form over lifting heavier weights.
  2. Work on hip and hamstring flexibility: Tight hips and hamstrings can contribute to knee pain in rowers, so it’s important to stretch these areas regularly and incorporate exercises that improve flexibility.
  3. Do single-leg training: Exercises like pistol squats and Romanian deadlifts (RDLs) can help improve hip and knee control, which can reduce the risk of knee injuries.
  4. Avoid excessive cross-training: High-impact activities like running and stadium steps can be hard on the knees, especially for heavier rowers who may not be well adapted to these types of exercises. Gradually building up the intensity of cross-training activities or choosing lower-impact options like cycling can help reduce the risk of knee injuries.


Specific Exercises for Rowers Knee

Activation Exercises

The key areas to look to activate are the following


  1. Glute Medius
  2. Glute Maximus
  3. VMO
  4. Lower back extensors
  5. Rotator Cuff

Here’s how to activate each of these areas

Activation exercises are typically performed using lower intensity and lower resistance to stimulate the targeted muscle(s) and improve their neuromuscular activation. Therefore, higher repetitions and sets are often used to achieve this goal.

For activation exercises, it’s recommended to perform 2-3 sets of 10-20 repetitions per exercise. The tempo should be slow and controlled, with a focus on the mind-muscle connection and feeling the targeted muscle working throughout the movement.

A general tempo guideline for activation exercises is to use a 2-3 second eccentric (lowering) phase, a 1-2 second isometric (pause) phase, and a 2-3 second concentric (lifting) phase. This tempo can be adjusted based on the specific exercise and individual needs, but the focus should always be on maintaining control and feeling the muscle working.

Glute Medius

A common glute medius activation exercise is the side-lying leg lift. To perform this exercise, lie on your side with your legs straight and your head resting on your lower arm. Engage your core muscles and lift your top leg a few inches off the bottom leg, keeping your foot flexed and your toes pointing forward. Hold for a few seconds, then lower the leg back down. Repeat for several repetitions on one side before switching to the other side.

Another variation of this exercise is the clamshell exercise, which involves lying on your side with your knees bent and your feet together. Keeping your feet touching, lift your top knee while keeping your feet in contact with each other. Hold for a few seconds, then lower the knee back down. Repeat for several repetitions on one side before switching to the other side.

Both of these exercises target the glute medius muscle, which is located on the side of the hip and helps to stabilize the pelvis during movement. By strengthening the glute medius, you can improve your hip and knee alignment, reduce the risk of injury, and enhance your overall performance in activities such as running, jumping, and squatting.

Glute Maximus

A glute maximus activation exercise is the hip thrust. This exercise targets the largest muscle in the glutes, the gluteus maximus, which is responsible for hip extension and external rotation. To perform a hip thrust:


  1. Begin seated on the ground with your back against a bench or stable object.
  2. Place a resistance band just above your knees, and position a barbell across your lap, with your feet flat on the ground.
  3. Drive through your feet and lift your hips up, squeezing your glutes at the top of the movement.
  4. Slowly lower your hips back down to the ground, keeping tension on your glutes and hamstrings.
  5. Repeat for the desired number of reps.


The hip thrust can also be modified to increase the difficulty of the exercise, such as by using a heavier weight or adding a pause at the top of the movement. This exercise is a great way to strengthen and activate the gluteus maximus, which can help improve athletic performance and reduce the risk of injury.

Vastus Medialis Obliquus

The vastus medialis obliquus (VMO) is a muscle located on the inner part of the thigh that is important for knee stabilization and proper tracking of the kneecap. Here are some VMO activation exercises:


  1. Terminal Knee Extension (TKE) – TKE is a common VMO activation exercise that involves straightening the knee from a bent position while keeping tension on the band. This can be done with a resistance band tied around a sturdy object, with the other end looped around the ankle.
  2. Short Arc Quad – This exercise involves lifting the lower leg while the knee is resting on a rolled-up towel. This exercise helps isolate the quadriceps muscles, including the VMO.
  3. Isometric Wall Sit – This exercise involves sitting against a wall with the knees bent at a 90-degree angle, and holding this position for a set amount of time. This exercise can help strengthen the quadriceps muscles, including the VMO.
  4. Leg Press with Toes Turned Inward – This exercise involves using a leg press machine and turning the toes inward while pressing the weight away. This movement helps engage the VMO by forcing the knee to track inward.


When performing VMO activation exercises, it is generally recommended to do 2-3 sets of 10-15 reps with a slow and controlled tempo. A tempo of 2-3 seconds on the concentric (lifting) phase and 3-4 seconds on the eccentric (lowering) phase can be effective for VMO activation. It is also important to use a weight or resistance that allows for proper form and activation of the VMO, rather than using too much weight and compensating with other muscles.

Lumbar Spine Extensors

The lumbar spine extensors are a group of muscles that help extend and stabilize the lower back. Here are some activation exercises for the lumbar spine extensors:


  1. Bird Dog: Begin on your hands and knees with your wrists under your shoulders and your knees under your hips. Slowly raise your right arm and left leg until they are parallel to the ground. Hold for a few seconds, then lower and repeat on the opposite side. Aim for 2-3 sets of 10-12 reps.
  2. Superman: Lie face down with your arms and legs extended. Slowly lift your arms, chest, and legs off the ground as high as you can while squeezing your lower back muscles. Hold for a few seconds, then lower and repeat for 2-3 sets of 10-12 reps.
  3. Bridging: Lie on your back with your knees bent and feet flat on the ground. Slowly lift your hips off the ground as high as you can while squeezing your glutes and lower back muscles. Hold for a few seconds, then lower and repeat for 2-3 sets of 10-12 reps.
  4. Prone Press Up: Lie face down with your hands placed under your shoulders. Push up through your arms, lifting your upper body off the ground while keeping your hips and legs on the ground. Hold for a few seconds, then lower and repeat for 2-3 sets of 10-12 reps.


When performing these exercises, focus on using your lower back muscles to initiate the movement rather than relying on momentum or other muscles to do the work. Additionally, aim for a controlled tempo with a 2-3 second hold at the top of each movement to fully activate the lumbar spine extensors.

Rotator Cuff

Rotator cuff activation exercises are designed to strengthen and activate the muscles that make up the rotator cuff, which is located in the shoulder joint. These exercises are important for maintaining shoulder health and preventing injuries.

Here are some examples of rotator cuff activation exercises:


  1. External rotation with a resistance band:
  • Attach a resistance band to a stable object at elbow height.
  • Hold the band with your affected arm and stand with your side facing the anchor point.
  • Keep your elbow bent at a 90-degree angle and your upper arm close to your body.
  • Rotate your forearm away from your body, keeping your elbow at your side.
  • Slowly return to the starting position.
  • Aim for 3 sets of 10-12 reps on each arm.
  1. Prone horizontal abduction:
  • Lie face down on a bench or stability ball with your arms hanging straight down toward the floor.
  • Slowly lift your arms up and out to the side, keeping your thumbs pointing upward.
  • Pause for a second at the top of the movement.
  • Slowly lower your arms back down to the starting position.
  • Aim for 3 sets of 10-12 reps.


  1. Y-T-W-L exercise:
  • Lie face down on a bench or stability ball with your arms hanging straight down toward the floor.
  • Lift your arms up and out to form a Y shape, with your thumbs pointing up.
  • Hold for a few seconds, then move your arms into a T shape, with your palms facing down.
  • Hold for a few seconds, then move your arms into a W shape, with your elbows bent and your palms facing up.
  • Hold for a few seconds, then move your arms into an L shape, with your elbows bent at 90 degrees and your forearms pointing straight down.
  • Aim for 2-3 sets of 8-10 reps.


Remember to use a lightweight or resistance band for these exercises, as they are meant to activate and strengthen the rotator cuff muscles, not to be a high-intensity workout.

Flexibility exercises

There are many exercises that can help improve hip mobility and flexibility. Here are some examples:


  1. Butterfly stretch: Sit on the floor with the soles of your feet together, knees out to the sides. Gently push your knees down towards the floor using your elbows, feeling a stretch in your inner thighs.
  2. Hip flexor stretch: Kneel on one knee with the other foot in front, knee bent at a 90-degree angle. Keeping your torso upright, gently push your hips forward until you feel a stretch in the front of your hip.
  3. Pigeon pose: Start in a downward dog position, then bring one knee towards your hands and lower your hips to the floor. Extend your other leg behind you and stretch your arms out in front. You should feel a stretch in your hip and glutes.
  4. Lizard pose: Begin in a low lunge with your hands on the floor. Lower your forearms to the floor inside your front foot, then lower your chest towards the ground. You should feel a stretch in your hip flexors and inner thighs.
  5. Frog pose: Start on all fours with your knees wide apart and toes pointing outwards. Slowly lower your hips towards the ground, keeping your chest and head lifted. You should feel a stretch in your inner thighs and hips.


It’s important to stretch both sides of the body equally and hold each stretch for 30 seconds to a minute. Additionally, incorporating mobility exercises like leg swings and hip circles can also help improve hip flexibility.

Strength Exercises

Rowing is a physically demanding sport that requires a combination of strength, power, and endurance. Here are some strength exercises that can benefit rowers:


  1. Deadlifts: Deadlifts are a compound exercise that targets multiple muscle groups, including the glutes, hamstrings, and lower back. This exercise can help improve overall strength and power in the legs and lower back, which are critical for rowing.
  2. Squats: Squats are another compound exercise that target the lower body, including the quads, hamstrings, and glutes. They can help improve leg strength and power, which can translate to better rowing performance.
  3. Pull-ups: Pull-ups are a great upper body strength exercise that can help improve rowing performance. They target the back, shoulders, and arms, which are all important muscle groups used during the rowing stroke.
  4. Bench press: Bench press is a classic upper body strength exercise that targets the chest, shoulders, and triceps. This exercise can help improve pushing power, which is important during the drive phase of the rowing stroke.
  5. Rows: Rows are an excellent exercise for targeting the back muscles, including the lats, rhomboids, and traps. They can help improve posture and pulling power during the rowing stroke.
  6. Planks: Planks are a core strengthening exercise that can help improve overall stability and balance, which is important for maintaining proper rowing form and technique.


It’s crucial to remember that strength training alone isn’t enough for rowers. It’s essential to balance it with cardiovascular and flexibility exercises. Moreover, prioritizing proper form and technique is crucial to avoid injury.

While focusing on improving activation, strength, and flexibility, it’s crucial to understand where your body currently stands. Relying solely on generic advice from the internet, including this article, will only take you so far. To achieve optimal results, it’s best to seek personalized and specific guidance.

Why not schedule an appointment with the team at Perfect Balance Clinic to see how we can help you reach your personal best?


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