Thoracic and lumbar injuries can dramatically affect a rower's performance and lead to time lost from practice and competition. Even though the number of injuries encountered by elite and competitive rowers appears to have increased over the past 20 years, rowing-specific research has been very limited in its scope and ability to guide practitioners caring for these athletes. Specifically, case reports relating to rib stress fractures abound, yet very few controlled studies discuss the mechanisms of injury and appropriate management of thoracic injuries. We believe that the identification and treatment of kinetic chain abnormalities in areas distant to the site of injury, such as the lower extremities, pelvis, and lumbar spine, should be an integral part of thoracic injury evaluation and treatment. Simultaneous evaluation of training regimen and equipment is also crucial to the management of rowers suffering from thoracic injuries.