Shoulder Pain and Kayakfishing
By George DeFranca, DC

Kayakfishing, although fun, is associated with its share of injuries, usually those of a chronic nature. The word ‘chronic’ essentially pertains to longstanding pain due to a prior injury, repetitive motion, and/or overuse. Although acute injuries do occur, they are often due to trauma and consist of cuts, abrasions, sprains and strains. Ten percent of these acute injuries include fractures and are usually associated with surf zone entries or white water kayaking. It is interesting to note that the second most common reason for water-sport related deaths are due to canoe and kayaking injuries.(1) The vast majority of these deaths are preventable. Even though 98% of people that canoe or kayak carry a PFD, 75% of recorded fatalities happened among people not wearing one.(1,2) Amongst canoeing fatalities, 25% were attributable to alcohol use. The vast majority of deaths involving canoeists and kayakers were associated with inexperience, hazardous water, weather, or a combination thereof. Therefore, our creed as kayakfishermen should be “be prepared, be safe, be smart”. I would also add, know your limits and play within them. Paddle wear must be geared toward possible emersion. Therefore, dress for the water temperatures. Our website stresses the 50/50 rule where water and air temperatures should add up to 100 to be considered safe to be on the water. You must always wear your PFD.

Characteristically, 25-40% of kayak injuries are chronic and involve the upper extremity, specifically the shoulder and wrist. (3,4) The joint most at risk for injury is the shoulder due to its excessive mobility and inherent lack of stability. As with anything else, improper technique is the cause of most chronic injuries, especially as it pertains to paddling. In addition surfing a kayak, either on purpose or by being in the wrong place at the wrong time, will put the shoulder in vulnerable positions that can readily injure it, ie., a high brace position. Paddling techniques that use excessive wrist motion can cause wrist tendonitis and elbow pain. To prevent this strain, paddles that have little or no offset or with paddle shafts that are bent have been made to prevent this strain, however, there are no studies that show these changes are effective in reducing these injuries.

Problems inherent in kayak paddling that can injure the shoulder are its repetitive nature, the placement of the shoulder in a biomechanically vulnerable position when the hand crosses the midline, and the forces and leverage applied via the paddle to the upper extremity. The arm is also placed in a vulnerable position when it is allowed to pass the hip on the stroke-arm side. A beginner’s inexperience can get him or herself into trouble due to inadequate paddling technique or poor judgement of the marine environment. It can be quite demanding and potentially dangerous to misjudge the direction and strength of the current, wind, tide, or surf. Any seasoned kayakfisherman prepares for these things before heading out to his favorite fishing spot. Letting someone else know of your plans and estimated return are also recommended and you should contact them if these plans change.

Any repetitive motion places soft tissues and joints at risk for strain and pain, especially if the motion is performed at or near the joint’s end range. Correct paddling is technique driven and for our purposes does not need to be a high demand activity. Extreme kayaking and competitive paddling are different situations. However, paddling like crazy to get to a distant flock of birds circling over and diving into a blitz can be just as demanding for a kayakfisherman. Most of the time, steady easy strokes are readily tolerated especially if performed correctly.

When paddling, the power from the power stroke should come from the trunk, legs, and larger muscles of the body versus the arms, forearms, and wrists. In a prior article on this website, Lower Back Pain and Kayaking, this is discussed but will be reviewed below.

Understanding some basic principles of shoulder biomechanics will give us a deeper understanding of injury mechanics. Whenever the upper arm is rotated inward (internal rotation), elevated, and/or brought across or toward the midline, there is a natural tendency for the rotator cuff muscles to become ‘impinged’ or pressed up against a hard ligament structure in the shoulder joint. The rotator cuff is a thin tendinous sleeve that encircles the ‘ball’ of the ball and socket shoulder joint. Four small muscles insert into it and make up this cuff or sleeve. Since these muscles are associated with rotational forces in various planes, it is called the rotator cuff. Internal rotation of the shoulder occurs during many daily activities. For example, if you hold your arm outstretched in front of you and rotate your arm inward so that your thumb faces downward and your palm faces outward, you have internally rotated your shoulder joint. The same thing happens when you bring your paddle across the midline with your non-stroke arm hand held high. Not only are you bringing your arm across the midline, but your palm is facing downward, and the shoulder is elevated. This is a perfect recipe for impingement of the rotator cuff muscles: elevation, internal rotation, and bringing the arm across the midline (adduction). However, when you are paddling hard, the result is internal rotation of the shoulder joint under power. In addition, the inappropriate overexertion of the non-stroke or non-power arm will tend to drive the shoulder joint into a vigorous impingement of the rotator cuff. If this is done repetitively, rotator cuff injury will result. This is especially so if you are 35 years old or older, an age when the incidence of rotator cuff degeneration increases.

Paddling Technique
Paddling can be broken down into four basic phases– the catch, power, exit, and recovery phases. Paying attention to the purpose of each phase will make a difference to your paddling time on the water. Some basics are to sit up straight, use the larger muscles of your body as the engine (legs, torso/abdominals, latissimus dorsi or ‘lats’), do not over-rotate your trunk, and try to push with your non-stroke arm. Visualize yourself trying to pull the yak past the paddle, not pulling the paddle blade through the water past the yak. In addition, visualize two planes that transect the body. (See Figure 1). One divides the body down the centerline yielding equal in right and left halves (sagittal plane). The other cuts through the shoulders from side to side, dividing the body into front and rear halves (frontal plane). It essentially puts the shoulders on the same line. To avoid straining your shoulders when paddling, neither hand should cross the midline or go behind the plane of the shoulders. See Figure 1 for explanation but essentially, your hands should operate within a “box” defined by the above two planes.

The Catch. Basically you need to stick the whole paddle in the water close to the kayak and keep it vertical and perpendicular to the direction of pull.

To start the stroke the trunk is rotated at the hips toward the stroke side so as to reach the paddle blade forward. The paddle blade should enter the water without a splash and dip into the water so that it is close to the kayak and as far forward as comfortable. If you are making a lot of noise with paddle splashing or gurgling, you are wasting energy and alerting fish in the area that you are nearby. Do not bend your back to reach forward but hinge at your hips, keeping your lower back as straight as possible. The blade should be positioned at a right angle to the line of pull, biting into as much water as your forward body lean will comfortably allow. The arm is straight and ready for the power stroke, however trunk rotation in the power stroke should not start before the paddle is fully set in the water.

Power Stroke. In a nutshell, you want to essentially turn or rotate your trunk slightly toward your paddle as it is pulled rearward, thus imparting more energy and power to your stroke using large muscles. Try not to pull your stroke hand past your hip. Also, push with your non-stroke hand.

Using your legs is critical in this phase to take pressure off of the shoulders in creating power during this phase. The same leg on the side of the stroke-arm straightens as it pushes into the foot-well allowing you to push your butte and pelvis backward on that side, thus initiating a trunk rotation from your seat. The trunk should not flex or rock back and forth, but rotate while being held upright. Try holding your abdominal muscles tight, as if trying to slightly brace for a punch to the belly. This stabilizes the spine. The opposite knee bends slightly as a result of you pushing your other foot into the foot-well. The energy from this trunk rotation movement is transferred to the paddle via the latissimus dorsi muscle or ‘lats’, a large arm muscle that goes from your upper arm to your lower back. Meanwhile the arm is kept relatively straight allowing the trunk rotation to be transferred to the paddle. This is the ‘power’ part of the stroke. In addition, the non-power arm is pushing forward as the paddle is powered backwards by the stroke-arm. This allows the paddle to pivot between the two hands. The non-stroke arm pushes the paddle from in front of the face out to full elbow extension. However, try not to let the hand of the non-power arm cross the midline. The paddle blade should be kept as vertical as possible from the time it is in front of the body until it is at the level of your hip, while the ‘boat is pulled past the paddle’. Remember, keep your hand in front of the “shoulder line” by removing the paddle when it gets to your hip. At the end of the power stroke the elbow will be bent slightly as the blade approaches the hip.

The Exit or “Lift”
The paddle blade is quickly lifted out of the water as the stroke hand comes level with the hip (“shoulder line”) and not passed it. The outer edge of the blade is lifted out of the water first so that water is not splashed or lifted. The boats momentum will slow if the blade is slowly lifted out of the water.

Recovery or “Reversal”
Both blades are out of the water and the paddle is being prepared for the next stroke. The trunk is already rotated at the hips towards the side of the next stroke by virtue of having gone through a power stroke on the opposite side. The back must be straight and not allowed to slump. After the stroke hand lifts the blade out of the water, good form manifests in the paddle shaft being horizontal at about shoulder or eye level, and the forward arm is straightened, getting ready for the next catch.

Injury Prevention
The best injury prevention strategy is to use proper technique. The most common fault is the use of excessive wrist, elbow, and arm effort during paddling. Another fault is to reach to far for the catch and to pull to hard and far during you power stroke. In addition, a deconditioned (out of shape) shoulder is a recipe for failure. Stretching and strengthening exercises can go a long way to prevent shoulder injuries. In addition to simple stretching exercises and conditioning, special attention should be paid to balanced shoulder development. The US Canoe and Kayak Federation (5) suggests backwards paddling as an effective training technique, with warm-up and cool-down regimens including up to 10 minutes of back paddling.


Stretches
There are many great stretches for paddling but I will share with you the ones I use. I target the torso and spine, hips, and shoulders. Because of the amount of sitting inherent in kayaking, I stretch the lower spine and hips. The rotator cuff muscles and shoulder capsule (a ligament) are also stretched. It takes all of 5 minutes to do and makes a big difference. In addition, I will periodically stop on long paddles, get out and stretch again, especially the lower back.

Spine: Standing backward bending, 5-10 times (Figure 2). Stand with hands on your lower back and backward bend, keeping your head level and focused on an object in front of you. Repeat 10 times. This may cause discomfort in the lower back while you are doing it. It pain is caused that travels into the butte or leg, stop.



Hips: Three point stretch, 30 seconds in each position (Figure 3-5 ) #1: Sit with spine straight, pull knee to same shoulder and hold for 30 seconds. #2. Cross your leg, push knee to floor gently and hold 30 seconds. #3, With leg crossed as in #2, pull you knee to the opposite shoulder and hold for 30 seconds.







Shoulders:
Posterior cuff stretch (internal rotation) (Figure 6) Difficult to do but very effective stretch. Place the back of you bent wrist on the side of your hip. Reach around with your other hand and grasp behind your elbow and pull it forward. Hold for 30-6- seconds. Repeat on the other side.



Arm pull across front (Figure 7) Grasp your elbow and pull it across your chest. Hold for 30-60 seconds.



Posterior Capsule Stretch (Figure 8). This stretches the ligaments in the back of the shoulder joint. You can do this lying as shown or leaning up against a wall or even a tree! Your arm is 90 degree elevated from your body and your elbow is flexed to 90 degrees. With your opposite, hold above the wrist and press your arm down and hold for 30 seconds. Repeat.



Side stretch (Figure 9) Stretches the tissues between your shoulder and hips on the side of the trunk. Raise your elbow up near your ear, grasp with other hand and pull your trunk into a side bending stretch. Hold for 10 seconds and repeat 3 times on each side.




Strengthening
The main muscle group to strengthen consists mostly of the small rotator cuff muscles. In addition, the latissimus dorsi, deltoid, and serratus anterior muscles should be trained. However for this article, we will discuss simple exercises for the rotator cuff muscles.

Lateral rotation: (Figure 10) Lie on your side, bend your arm 90 degrees at the elbow, and press a rolled towel against your side with your upper arm to stabilize your shoulder joint. While keeping your elbow pressed into your side, slowly raise a light weight (5 or even 3 pounds to start) as far as you can without rolling or leaning your trunk backward or cheating. It should take you 5-10 seconds to raise the weight, AND another 5-10 seconds to lower it. Yes it is very slow but for a reason. Repeat until the muscle fatigues and you can’t do another rep. (usually 8-10 per set). Perform 2-3 sets.



Lateral Raise: (Figure 11) This simple exercise has been shown to maximally recruit activity from two important rotator cuff muscles (supraspinatus and infraspinatus). Lie on your side, keep your arm straight at the elbow. Slowly raise a light weight until the arm reaches a 45 degree angle with your trunk. It should take you 10 seconds to raise, and another 10 seconds to lower. Repeat until fatigued. Perform 2-3 sets.



References:
1. USCG. Boating Accident Report Database (BARD) 1996-2002. United States Coast
Guard.
2. Association AC. Critical Judgment II. Understanding and Preventing Canoe and
Kayak fatalities. American Canoe Association. www.acanet.org, 1996-2002.
3. Fiore DC, Houston JD. Injuries in whitewater kayaking. Br J Sports Med.
2001;35:235–241.
4. Schoen RG, Stano MJ. Year 2000 whitewater injury survey. Wilderness Enviro
Med. 2002;13:119–124. [PubMed Citation]
5. www.usacanoekayak.org

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