Rowing with Ehlers-Danlos Syndrome: What You Should Know
If you are here, you probably have or know someone who has Ehlers-Danlos Syndrome and are looking for an exercise that is safe and okay to do. Ehlers-Danlos syndrome (EDS) is a group of genetic disorders that affect the connective tissues, which often leads to hypermobile (extra mobile) joints that are prone to partial or full dislocations. This can often lead to fear of movement, uncertainty, pain, fatigue, and more.1
First off, I am a Doctor of Physical Therapy, but everyone is unique and has different circumstances. So as my disclaimer, please check with your healthcare team, physios, MD’s, etc before deciding if your body is ready for rowing as an exercise. If you would like to connect, I’d be happy to do a one-on-one session, learn more about you, and help provide advice, but please note that this article is generalized information. You know your body better than I do, so please move forward at your own risk. Now that the disclaimer is out of the way… is rowing a good exercise for people with Ehlers-Danlos?
Is Rowing a Good Exercise for People with Ehlers-Danlos?
Quick Anser: It depends.
Long Answer: Keep reading.
Although there is limited research on this, exercise and strengthening have been shown to help people with Ehlers-Danlos improve confidence, decrease pain, decrease recurrent subluxations2, and more.1,3
There are no studies to date that I was able to find related to rowing specifically, which means based on you and your body, if you are comfortable, give it a try for a short amount of time.
Rowing is a low-impact, full-body exercise that offers a lot of advantages, especially for people with Ehlers-Danlos syndrome or other hypermobility disorders. Since you are strapped into the rowing machine at the feet, and your butt is on the seat, you have a couple of points of contact that are stationary making rowing a bit more comfortable to start as it takes balance and weights out of the equation. This can help the barrier of entry for trying or wanting to start exercises. Not only that, but because you are strapped in at the feet, you have less stress in weird angles on your joints. Your body moves back and forth in one direction, so there are no lateral or side to side movements, which changes which muscles you use a bit, but also means there is less your body has to control and less you have to think about when rowing. Since rowing is also a full-body workout, and you can see all the muscles used in these articles (upper body muscles used, lower body muscles used), you are working on strengthening a lot of muscles and joints, which can be very beneficial, and it does so with limited excessive overuse on one particular joint area.
Rowing is also great for cardiovascular strength and endurance. When used in conjunction with inspiratory muscle training, the two can compliment each other extremely well. In an article from the American Journal of Medical Genetics, it was shown that inspiratory muscle training can help improve functional exercise capacity and quality of life.4 This article is not specifically about inspiratory muscle training, but briefly, “it is a form of physical training that utilizes only the diaphragm and accessory respiratory muscles, particularly the sternocleidomastoid and intercostal muscles, to perform repeated inhalations against resistance, whereas expiration is unimpeded.”5 You can read more about it at this link.
The amount of intensity used when rowing can also be changed, but simply slowing down
and choosing not to exert more energy. You can go on a leisurely row for movement and cardiovascular endurance, or if you are feeling good you could do more effort, push harder, and get more of an exercise. You can adjust the workout to be what works for you, just like walking vs running. This video covers the basics of the numbers so you can learn a bit more about the power and how you know if you are exerting more.
Even though rowing has some great benefits, there are some things to keep in mind when rowing on the rowing machine.
Special Considerations When Rowing for People with Ehlers-Danlos Syndrome
Since joints are often effected, there are a couple of things to keep in mind when rowing to lower your chances of injury.
First, please pay attention to your technique. This blog post goes over the technique in more detail.
Second, there are some adjustments to technique that I would recommend specifically for people with Ehlers-Danlos syndrome or with other hypermobility disorders.
1 - When you are at the finish position, your legs are completely straight, and your leaning back slightly at the hips. In this position, it’s possible for your knees to go backwards a little bit. For you, I would not recommend straightening your knees out all the way. I would keep a slight bend in the knee, which might feel like a giant bend in the knee, depending on your own anatomy. I’d recommend setting up a recording device to the side of you, taking some strokes, and then looking at the recording. If it looks like you have a little bend in the knee, you are good. If you don’t bend it a bit more until you are able to see a little bend in the knee on the recording. This will decrease the chances of your knee going too far backwards and aggravating the joint. It also creates less stress on the quads, hamstrings, and calf muscles.
2 - Pay attention to where you are pulling to in the finish position when your legs are straight and your arms are coming in towards your body. We want to decrease the areas that could cause extra stress or torque on your joints. Keep your elbows by your side and your wrists in a neutral position. This will put less strain on the shoulder, elbows, and wrists. Here is a video demonstrating what to do with your arms.
3 - Now that you are pulling straight into your body with your arms, let’s talk about when you straighten your arms. Similar to your knees, I’d recommend keeping a slight bend in your elbows to decrease the strain there. Do the same thing as with the knees, record yourself, go look at it, and see if your elbows are completely straight, going backwards, or have a slight bend. Then adjust as needed.
Those are the main three adjustments that I would recommend, but again paying attention to your form will definitely help with some other things that could happen to cause some aggravation. However, I don’t want these to scare you away from rowing. Like I mentioned above, you can choose how intense your workout is.
Start small and easy.
Get on the rower, strap in, and don’t grab the handle. Just start sliding your butt slowly back and forth. Get comfortable with that movement. Then grab the handle. Now try just moving your arms without moving the seat. Pull the handle in towards your chest/stomach and then straighten your arms. Get comfortable with a slight bend in the elbows when the arms are straight, and a slight bend in the knees when your legs are straight.
Now start moving slowly back and forth with all the components. If you start moving faster back and forth, it requires more control and likely gets people more out of breath. It’s a bit like sprinting as if you were running. You are moving back and forth faster, so it takes energy to do that. When it comes to pushing with your legs, how much effort you push with your legs is how much power you are generating. Think of it like jumping, If you push a little with your legs you jump a tiny bit off the ground. If you push harder off the ground you will go higher off the ground. Same concept on the machine. Using the RPE or Rate of Perceived Exersion Scale can be helpful. This article goes over it in more detail.
Start rowing for 3-5 minutes. See how you feel. Do that for a few days, build up confidence, and see if you like it. Then slowly start adding on time. Then slowly start pushing more and exerting more energy. However, do it based on how you are feeling so you don’t cause a flare up. There are days I get on the rower, row for 30 minutes, and my pace is super slow because I just want to move. Then there are days I push myself. That’s completely okay and it’s nice that the rower is able to accommodate that choice.
In all, rowing can be a great workout for people with Ehlers-Danlos syndrome and other hypermobility disorders. Pay attention to your form, start small, and give those modifications I mentioned a try.
Don't Forget to Warm Up!
Rowing is a sport! It's important to remember you are doing activity. Research shows that doing warmups for people with Ehlers-Danlos syndrome can be helpful, even if just for 3-5 minutes. 2
There are tons of warmups you can do for rowing, here is a quick 8 minute off-the-rowing machine warmup you can do. It doesn't need to be long, just use the muscles you are going to be using when rowing (most of them) and get those muscles and joints ready to work for you after you've been sleeping or sitting. Wake them up gently, then jump on the rower and get rowing! If you feel this is too advanced or uncomfortable, reach out, I will make another warmup video just for y'all!
Please feel free to reach out if you want a one-on-one consult via zoom. I also offer form analysis reviews where you send a video of you rowing in and I send one back telling and showing you what I see and what to work on.
I wish you the best!
PS – I found an article from someone with Ehlers-Danlos who rows on the water if you want to check it out.
If anyone is looking for an easy gift for a rowing friend or looking to learn so much more about rowing, this is a great book to help you get started, Beginner's Guide to Indoor Rowing!
I hope that helps you out and found this information useful.
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1. Jane V. Simmonds, Anthony Herbland, Alan Hakim, Nelly Ninis, William Lever, Qasim Aziz & Mindy Cairns (2019) Exercise beliefs and behaviours of individuals with Joint Hypermobility syndrome/Ehlers–Danlos syndrome – hypermobility type, Disability and Rehabilitation, 41:4, 445-455, DOI: 10.1080/09638288.2017.1398278
2. Front. Rehabil. Sci., 08 November 2021 Sec. Rehabilitation for Musculoskeletal Conditions Volume 2 - 2021 | https://doi.org/10.3389/fresc.2021.769792
3. Stephanie Buryk-Iggers, Nimish Mittal, Daniel Santa Mina, Scott C. Adams, Marina Englesakis, Maxim Rachinsky, Laura Lopez-Hernandez, Laura Hussey, Laura McGillis, Lianne McLean, Camille Laflamme, Dmitry Rozenberg, Hance Clarke. Exercise and Rehabilitation in People With Ehlers-Danlos Syndrome: A Systematic Review. Archives of Rehabilitation Research and Clinical Translation. Volume 4, Issue 2, 2022, 100189, ISSN 2590-1095,https://doi.org/10.1016/j.arrct.2022.100189.
4. Reychler, G., De Backer, M.-M., Piraux, E., Poncin, W., & Caty, G. (2021). Physical therapy treatment of hypermobile Ehlers–Danlos syndrome: A systematic review. American Journal of Medical Genetics Part A, 185A: 2986–2994. https://doi.org/10.1002/ajmg.a.62393
5. Craighead DH, Freeberg KA, McCarty NP, Seals DR. Time-efficient, high-resistance inspiratory muscle strength training for cardiovascular aging. Exp Gerontol. 2021 Oct 15;154:1