## 4 Discussion
The incidence of lower back injuries was 31.8-34.7%, followed by knee injuries (12.6-19.6%) and arm/wrist injuries (15.2%) among male rowing athletes [3; 4; 13]. For female rowing athletes, the incidence of lower back injuries was 29.9-33.3%, followed by the shoulder (25.9%) and knee (16.9-17.6%) [3; 4; 13]. The results of this study are consistent with previous studies. Back flexion and extension during rowing is similar to incomplete hard pulling, and athletes need to continuously push the oars with the force of the lower back, which causes great stress on the back muscles and intervertebral disks. At the same time, during leg extension and contraction, knee flexion and extension cause significant load on the knee joint, and women are more prone to patellofemoral injuries due to their anatomical structure. The repetitive nature of the rowing maneuver puts the rower's lower back and knee joints at a higher risk of injury [14]. This study found a higher incidence of injuries in female rowing athletes than in male rowing athletes. Anatomical, biomechanical, and hormonal differences between females and males might contribute to this result. Firstly, anatomically and biomechanically, females generally exhibit greater joint laxity, and the alignment angles of the femur and tibia differ from those of males, reducing knee joint stability during exercise and increasing the risk of injury [15]. Additionally, rowing involves unique kinematic and kinetic characteristics, with energy being transferred from the lower limbs through the upper limbs to the oar. This specific biomechanical pattern further exacerbates the injury risk for females due to the lack of knee joint stability. As a result, female rowing athletes face a higher likelihood of injury. Secondly, hormonal influences also play a role. Female athletes with irregular or absent menstruation are at a significantly higher risk of musculoskeletal injuries. Studies have shown that women with irregular menstrual cycles are more prone to injury during high-intensity training, possibly due to fluctuating hormone levels that impair muscle and joint function [16]. Furthermore, other studies suggest that elevated estrogen levels during ovulation can increase joint laxity, making women more susceptible to skeletal asymmetry, which might further raise the risk of injury [17]. Therefore, training programs should incorporate targeted preventive strategies, strengthen injury surveillance in female athletes, and ensure timely rehabilitation to prevent injury exacerbation, thereby addressing the heightened injury susceptibility during training sessions. This study demonstrated that injury incidence in rowing athletes was significantly positively associated with BMI (OR: 3.63, 95% CI: 1.33-9.95; \(p\) = 0.012), aligning with previous findings on BMI-sports injury correlations. A retrospective study of international elite adolescent rowers revealed that injured athletes had significantly greater height and body weight compared to non-injured athletes [3]. Furthermore, the existing literature suggests that elevated BMI values may increase lower extremity injury risk through dual mechanisms. First, excessive BMI substantially elevates knee joint loading, leading to cartilage damage and degenerative meniscal tears [18; 19]; second, athletes with higher BMI require greater force control during dynamic movements, where lower limb ligamentsmay exceed stability thresholds under such loads, thereby increasing non-contact sprain risks [20,21]. The injury patterns observed in rowing athletes in this study may reflect similar biomechanical pathways. The repetitive lower limb drive and combined trunk flexion-rotation in rowing strokes--a characteristic of this cyclic sport--likely induce cumulative joint stress in individuals with high BMI, ultimately resulting in musculoskeletal injuries.