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.