Overuse Injury Care in Stand Up Paddle Boarding

For most of us stand up paddle boarding is a very safe sport for fun, fitness and competition. Excluding surf style stand up paddle boarding, acute traumatic injuries are rare. Overuse injuries to the shoulder, elbow and low back are more common. For those involved in seasonal competition, these injuries often present at two points in the race season- early on in the year as the paddler increases training volume/intensity and later in the year as competitions are more frequent.

There are a few factors that can lead to or be associated with overuse injuries. In most cases the athlete simply increased the training intensity or volume too fast for their current fitness level. Equipment factors might include board size, paddle length, paddle stiffness or blade size/shape. Other factors might include a prior history of injury, poor sleep, stressful lifestyle and poor nutrition.

If you are experiencing pain with paddling it is important to listen to your body, especially early in the season. Simply taking a few days off from paddling may be all that is necessary to calm down an injured area. During this time of relative rest the athlete can participate in activities that do not cause the pain. For example, if your shoulder or elbow is sore, you may be able to run, bike or do the elliptical. Core work could be continued. On the other hand, if your low back is sore the bike, swimming or the elliptical may be possible activities. Specific therapeutic exercises for the injured area may be added.

Certain scenarios in paddle boarding can be very stressful to the body. Paddling into a strong wind or current come to mind. If you are dealing with an overuse injury it would be best to avoid these conditions or minimize your exposure to these conditions. As most of us in the northern hemisphere enter warmer months it is important to stay hydrated. Dehydration is a tremendous stress to the body. While dehydration may not directly cause injuries, the associated stress to the body can impair healing and recovery. Inadequate sleep or a poor sleep cycle may be associated with poor healing and recovery as well. Nutrition plans high in anti-oxidants can help with the stress of exercise and training on the body. Appropriate carbohydrate levels are necessary to maintain energy and avoid fatigue during training. Adequate lean protein is important to rebuild tissue after training. Healthy fats are important to athletes as well as an energy source for endurance activities. Healthy fats also assist with certain vitamin absorption and have anti-inflammatory properties.

There are some equipment factors worth discussing in relation to overuse injuries. The current trend of narrow boards is potentially beneficial in that moving a narrow board through the water is less taxing on your body. That said, if you are on a board too narrow for your abilities you may fatigue faster due to poor balance and then be prone to an injury. There has also been a trend to shorten paddle length. This will likely result in less overuse shoulder injuries. Shorter paddles do require a slight technique modification in which there is more bending at the low back/waist to allow the paddle to get buried in the water early in the stroke. This along with a faster cadence could lead to some strain in the low back. Therefore, core strength and hamstring flexibility is critical. Paddle shaft bend characteristics and paddle blade size/shape are important. For example, a shaft that is less stiff and blade that is smaller or less grippy in the water could be less stressful to your body and thus be less prone to cause an injury (or allow you to paddle during a rehab process without re-aggravating the issue).

Basic recommendations if you start experiencing pain with paddling include the following: First you might look back and ask yourself “what did I do differently with my training?” If you can identify a training modification associated with the injury simply adjusting that may be all that is needed. Initially overuse injuries are associated with some localized inflammation. Applying a cool compress after training for 15-20 minutes may be helpful. Anti-inflammatory medications (i.e. Advil or Aleve) or supplements (i.e. Turmeric, tart cherry juice) are considerations. If relative rest and basic modifications/treatments do not help the problem it is best to see a health care provider with Sports Medicine experience. Often simple interventions with physical therapy type exercises can help the problem. Discussing the issue with a paddle coach is a good idea as well. Experienced coaches can look at paddle technique and equipment particulars that might be contributing to the problem. If the pain lingers past 2-3 months it can be much more challenging to treat. These chronic injuries may require more time off from sport, advanced physical therapy or interventions to help stimulate blood flow to the area to assist with healing.

Paddling of any type is an excellent fitness activity. Simple guidelines can go a long way in terms of injury prevention. Train smart, listen to your body and seek medical advice for persistent pain. Good luck, stay healthy and happy paddling!

John P. Batson, MD, FACSM

Interventional Spine Care
Adult & Pediatric Sports Medicine
Pain Medicine

Lowcountry Spine & Sport, LLC
300 New River Pkwy, Suite 37
Hardeeville, SC  29927