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The Paddling Shoulder

Injuries are a common occurrence in paddling sports such as canoeing, kayaking, rowing and dragon boating. When looking at the demands of paddling sports it is clear to see that the athlete has to perform the same paddling stroke again and again. Over the course of a race or training session, the number of strokes that the athlete is required to perform can quickly add up to the thousands.

The repetitive motion of paddling requires the body to generate a significant amount of force to propel the boat forward in the water. This force is generated and then transferred through the entire body, as the mechanics of the stroke requires the muscles and joints to work in a coordinated manner. With each stroke the paddler generates a force that is transmitted to the water through the paddle.

The resultant reaction force from the water is then transferred back through the paddle to the arms and the shoulders of the athlete, down the trunk, through the hips to the knees and foot and finally to the boat, causing the boat to be propelled forward. The repetitive forces associated with paddling can lead to injury in the forearm, should, back and hip.

Shoulder injuries are common, with the repeated paddling action leading to overuse injuries such as rotator-cuff tendinopathy humeral head subluxation.

The glenohumeral joint is an inherently unstable shallow ball and socket joint, often described as the equivalent of a golf ball and tee. Thus, effective shoulder function and stability require both static constraints (the glenohumeral ligaments, glenoid labrum, and capsule) and dynamic constraints (rotator cuff muscles and scapular stabilizing muscles). The rotator cuff muscles consist of the supraspinatus, subscapularis, infraspinatus and teres minor. Their tendons all attach into the humerus.


The most common rotator cuff injury seen in paddlers is tendinopthy. In rotator cuff tendinopathy, the tendons become swollen and hypercellular, the collagen matrix is disorganized and the tendon weaker, and there is an increase vasculature and nerve density.

Calcification may occur in any of the rotator cuff tendons but it is most often seen in the supraspinatus. Symptoms include pain with overhead activities, night pain, and tenderness over the supraspinatus tendon proximal to or at its insertion into the greater tuberosity of the humerus.

Humeral head subluxation

Instability may result from changes to passive structures such as ligaments, the capsule or the labrum. Or it can be caused by poor motor control of the rotator cuff muscles leading to a lack of dynamic stability. Humeral head subluxation seen in paddlers is an atraumatic type of abnormality caused by the repeated overhead activity. Shoulder dislocation is seen in 6% of paddlers.

If even a minor problem exists in the strength, flexibility, or coordination of just one muscle or joint, it will not only lead to a problem at that specific area, but it will also cause the body to move in an unwanted and inefficient manner in an effort to compensate for the problem. 

These alterations in body movements are referred to as “movement compensations”. Due to the high force repetitive movements associated with paddling, even minor movement problems will be greatly magnified and will prevent the paddler from properly generating and controlling the forces associated with each stroke.

When the athlete has adequate strength, flexibility and muscle balance along the entire kinetic chain the chances of injury are greatly reduced however, over time even minor imbalances can lead to major problems.

It is important to seek the advice of a physiotherapist to identify  movement compensations and correct muscle imbalances. We can design an individualized conditioning program focusing on balanced shoulder development.

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Specialist Rehab Group works with specialist physiotherapists and specialist rehab therapists who are highly trained, qualified, experienced and passionate to provide high level of expert care to our patients.

Areas of specialization

  • physiotherapy: back and neck (spine), sports, shoulder, hip, knee, ankle
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  • read more on our specializations here

All our therapists are fully insured and registered with Allied Health Professions Council (AHPC) and Traditional Chinese Medicine Board (TCM). See our entire team here by location and specialization.

Initially, our specialist physiotherapists will carry out a thorough assessment, helping them to select the most appropriate treatment to help you recover. They then provide expert treatment for your pain as well as prescribing specific exercises to reduce your risk of re-injury and giving you a long term solution.

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We are a wholly Singapore Private Limited group of licensed physiotherapists, hand therapists, podiatrists, chiropractors, sports massage therapists, clinical pilates practitioners and TCM physicians practicing in our scope of rehabilitation and its areas of specializations. As listed in our website are the list of services we provide our clients as referred by their medical doctors or by self referrals/word of mouth.

The range of rehabilitation results vary from patients to patients, depending on a variety of factors and reasons such as severity of condition, genetics, gender and age. However, we will still deliver the best evidence-based-practice of physiotherapy, hand therapy, TCM, sports training and deep tissue release therapy that we can deliver.

The information available on this site is for educational purposes only, if you need a full professional advise on physiotherapy, hand therapy and occupational therapy, please schedule an appointment with us by contacting our staff by Call/SMS/WhatsApp at xx, thanks!




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