( Article written by Suzie Cooney, CPT for Naish International ) Direct link, click here.

Stand up paddling is no doubt taking the world by storm, and while you don’t need to be in the greatest shape to paddle, you’ll soon discover the benefits. As you begin to improve your technique, experiment with new gear and maybe decide to enter a race or wave competition, it’s a good idea to learn how to train in a balanced way to prevent injury so that you can enjoy paddling even more and stay on the water.

As the sport continues to evolve, and as a trainer who specializes in educating people how to paddle stronger and better improve their performance, I’d like to share with you first an overview of some of the known complaints and injuries that I’m seeing and helping people manage. I’ll also share with you many training strategies designed to help you better approach your SUP training in a balanced manor as a way to avoid injuries.

This article is part one of a two-part series that will illustrate a more in-depth review of the anatomy and how your muscles function while you paddle and how injuries might occur. Part two will be the actual exercises and training approach I recommend to help recover from some of these injuries and/or avoid them.

I’ve also gathered some helpful insight from one of our Naish Team Riders, Karen Wrenn, on how she trains to help her better perform. In addition, I’ll be highlighting another paddler, Kevin Vangritis from North Carolina and new racing competitor and long distance paddler, with his personal story and struggle with a unique injury and how he’s managed to come back on the water.

Common SUP Injuries

Overuse injuries and strains from SUP are common and include mostly the muscles of the shoulder and/or rotator cuff muscles, the knee joint, foot and ankle and low back. It’s good to have a knowledge base of the anatomy and function of each group so you can better adapt your SUP training to avoid these injuries. There may be more to mention, but in my practice and I too have experienced things such as a nagging bicep tendonitis issue in my right arm and on occasion after long distances over 20 miles, my traps (trapezius) have cramped a bit and my feet have fallen asleep.

photos by Simone Reddingius

Injuries that are more common where there are waves are fin lacerations to the extremities and face, paddle handles giving bloody noses (mine), and leash wrap-arounds I call them, that can cause sprains to fingers and other body parts from wrapping around you after a heavy wave wipe out. Also, as these boards are much heavier than surfboards for example, if you get hit in the head you could suffer a good blow or even a concussion. In addition, some super heavy hold downs at some of the bigger breaks can wreck havoc on your back and lower extremities.

Shoulder and Rotator Cuff Injuries:

Stand up paddling works a lot of muscles and is well known for being a great core workout. It also requires a lot of work from the stabilizers of the shoulder girdle. The paddle stroke is a combination of medial rotation and abduction (of the top hand). The deeper rotator cuff muscles included are the supraspinatus, subscapularis, infraspinatus and the teres minor. This requires the work of the subscapularis, latissimus dorsi, pec. minor, pec. major, and teres major along with deltoid and supraspinatus to lift the arm up. The bottom hand is mostly stabilizing to transfer the rotation of the trunk to the paddle the muscles used to stabilize are mainly latissimus dorsi rhomboids, triceps, and middle fibers of the traps.

One client complaint was that of a burning sensation radiating from his elbow up to his shoulder and down to his hand, and another, with numbness radiating down from his shoulder through his pinky finger.  These can be common nerve entrapment injuries with chronic tension and overuse of certain muscle groups.

Rhomboid & Trapeziums Strains:

The rhomboid muscles interact with and help support the shoulder blade. Your trapezius (also referred to as your “traps”) are the connective muscles from the neck to the head of the humerus or top of the shoulder, and are responsible for stabilizing your neck and shoulder while you paddle. These muscles require a great deal of endurance. This is also where we tend to hold our stress and the area that can fatigue and cramp up on long distance races. I often hear of muscle fatigue and recently of a tear of the rhomboid as described by Kevin Vangritis. Read more of his experience and how he recovered:

Kevin Vangritis is a friend of mine from North Carolina and is just getting into SUP racing. Over the summer, Kevin was training for a big 50+mile-long distance SUP crossing in Chicago (with Windy City Waterman and Matt Lennert). Prior to the race, he was helping a friend with an exercise and felt a pop near his right scapulae or shoulder blade. At the time, he thought that to simply take an anti-inflammatory and ice should do the trick.

I should note that Kevin is in amazing shape and has a very consistent, well planned and executed training and paddling routine, so this was a bit of a surprise. Kevin is also well versed in the field of sports orthopedics as he assists surgeons and medical teams and knows the anatomy which is also helpful when recovering from an injury.

He writes, “Over the next couple of days, I began to develop a large knot in my trap as well as radicular pain down my right arm into my hand, which was my major concern. This is a classic sign of a herniated cervical disc. The knot began to limit mobility in my neck. Our endurance paddle of crossing Lake Michigan was fast approaching, and I had to come up with a plan to get better. I completely stopped training both on the water and in the gym and continued using anti-inflammatories as well as heat. I showed up for the crossing on August 21st. We had very unfavorable conditions that day for the 50 plus mile paddle with 8-12 foot chop and 30 mph plus winds on Lake Michigan. We decided to go for it anyway without the support of our chase boats and Coast Guard. For four hours straight, we paddled hard against the wind and waves. We decided to call it a day due to safety concerns and knowing that the conditions were just too dangerous to continue without our support team in place.

After the paddle, there were a few large knots on my back that now involved my rhomboid on the right side. Upon returning home, I consulted a physician who diagnosed me with a torn trapezious and rhomboid. Apparently, this is a fairly common injury in this sport. He felt my best course of action would be seeing a sports medicine physical therapist. I spent the next six weeks in PT, attending two sessions each week. Each session, my regimen included a deep tissue massage, electric stimulation, heat therapy as well as cervical traction. I was given simple upper body exercises and stretching to do at home that kept my injured muscles isolated.  Each visit, we added a few new exercises to my routine.

I am 10 weeks out at this time and have just one small knot that still has not released itself and the radicular pain is 95% better. In the next week, I plan to try acupuncture therapy to try and release the one small knot. Since my injury, I paddled for the first time two weeks ago doing 2-3 mile paddles at a moderate pace. Although my weights are still a bit lighter than I normally use, I am slowly getting back to a more normal exercise routine. It is really important to listen to your body. I feel if I had not tried to push myself on Lake Michigan, my recovery would probably have been 3-6 weeks instead of the 10 plus weeks I have endured. Before the injury, I was enjoying a very successful year of racing and am now focused on and looking forward to being ready by spring to begin competing once again.”

Kevin will be on Maui this month and I’ll be checking him out in my training studio and on the water. We’ll be fine tuning him and making sure his training is in check and balanced. Thanks Kevin. Hang in there and keep up the good work!

Bicep Tendonitis:

Simply stated, this is where inflammation or tenderness occurs at the head or top of the bicep tendon due to weakness and overuse. I suffer from this sometimes after a downwind race or while I’m in intense training. This long, chord-like tendon connects the upper end of the biceps muscle to the bones in the shoulder. This muscle is responsible for extending your outward as you reach for the nose of your board with your paddle.

Since I’m right-handed, this is obviously my stronger paddling arm and tends to take most of the load. I often feel tingling, burning and soreness. Usually it is a result of weakness of the rotator cuff muscles. Icing helps me as well as good old rest.

I’ll discuss in more detail how to strengthen this area and the supportive muscles in the next article.

Knees:

The knees young and old can often take a beating, but SUP is probably quite mild on them compared to other high-impact sports like running, dirt biking or soccer. Sometimes old injuries from some of these pounding sports can show up when paddling. But for most, stand up paddling is incredibly gentle and great for the knees.

We all have our own unique paddling styles and types of conditions to manage that can also lead to imbalances of the joint and ligaments that stabilize the knee. For example, if faced with choppy, windy conditions where you are paddling long and hard from one side of your board, pressing down on the board rail in a funny angle can lend to knee irritation. This is especially taxing to the knee compartment if the tendons and supportive muscles and ligaments are weak and not trained properly.

The knee is the largest joint of the body and is compromised of many muscles, ligaments and tendons that help absorb twisting and shocks, and help brace the body for any abnormal consequences. Tears of the medial, lateral, anterior or posterior ligaments are common knee injuries. In wave paddling, I’ve seen a knee dislocate. This is rare, but happened when I saw a guy paddle into a big wave and all of a sudden his leg simply buckled. Later, I learned that his knee gave way completely due to an unstable knee cap (patella). It literally slid out of its natural groove.

Some folks have mentioned that the outer part of the knee, where the iliotibial band joins, can be sore and painful. Again we find that some of these larger muscles – that are used to taking a lot of the load as you unload the stroke and exit the blade at your feet – can be overstretched and are over active. This then can lead to extreme tightness and underactive inner thigh and adductor muscles.

Also, after multiple Maliko runs, I’ve discovered a twinge of inner knee discomfort on my back carving leg after being in a deep, surf stance position on big drops. Managing a 14ft board is very different, with a lot more property from the center of the board all the way back to the fin vs. a short board, requiring one to really utilize more force production on the knee of the carving leg.

Back:

The back is a really important component to stand up paddling for it also helps stabilize the core and is part of the core. It also helps release and control power and of course keeps you upright for all levels of paddling. Refer to my article: More on the Core for SUP here.

Here, we’ll talk about mainly the lower back since we’ve covered quite a bit on the upper part of the body. Having personally suffered extreme back injuries, SUP has actually really helped me!

The function of the lower back allows for flexibility forward and backward and doesn’t easily tolerate too much twisting.

Most people who paddle may experience low back discomfort usually caused by improper paddle length, poor paddling technique or from other muscle imbalances such as tight hamstrings and hip flexors and weak abdominal muscles, or a combination of all the above.

The spine itself or vertebral column contains the spinal cord and other nerves, along with sponge like discs that can be damaged or pinched in pretty severe wipeouts. Sometimes, no matter how well you train or how strong your core and low back are, things can just happen.

Now that you have a good understanding of the anatomy and how it functions while you paddle, you can learn to safely train to keep your body strong. Accidents, muscle strains, riderless boards torpedoing towards you in the lineup can certainly happen, therefore it’s important to know how to recognize something that may not be right or may even be really, really wrong.

Seeking qualified help is very important. I have an excellent medical team that I trust and go to when I myself or my clients or readers write in with questions. I also keep a well-stocked first aid kit in my truck at all times in case I need to wrap a strain or sprain, or at least help stabilize someone if needed.

Stand up paddling is easy and is typically easy on your body. Being very aware of your body, the muscles that you use when you paddle and being mindful of some possible injuries will simply make you a better paddler. Your body has a lot of moving parts, so in the next article I’m going to show all the cool exercises you can do for each muscle group I mentioned here, to help you potentially avoid injury, keep your body balanced and strong and keep all those part together and intact.

Also, don’t forget we’ll be posting Karen Wrenn’s training strategy too!

SUP wipe out photos by Simone Reddingius

Medical photos courtesy of webmd.com

Suzie Cooney, CPT Naish Team SUP Rider and Owner of Suzie Trains Maui

Follow Suzie on Facebook: SuzieTrainsMaui

Check out all of the new 2012 Naish SUP Boards!  Suzie rides the Hokua, Mana, Nalu & Glide for Maliko Runs.

Disclaimer

All the information presented in the SUP Fitness section of naishsurfing.com is for educational and resource purposes only. It is there to help you make informed decisions about your fitness training. It is not a substitute for, or an addition to, any advice given to you by your physician. Suzie Cooney, CPT, and Naish International strongly recommend that you consult your doctor and get medical approval before beginning any fitness and/or exercise program. You are solely responsible for the way information in SUP Fitness is perceived and utilized and you do so at your own risk. In no way will Suzie Cooney, Naish International or anyone associated with Naish International be held responsible for any injuries or problems that may occur due to the use of this website or the advice contained within.

Meet Clay Everline, MD. and get your own copy signed. He’s got a wealth of knowledge and experience and can often be seen on Oahu’s N. Shore as the doc on the beach who is ready for anything at all the big contests! He’s been my head doctor at my events and as a surfer he knows that sometimes even on the smallest of days, big things can happen. See you there!

When the big stuff goes down, are you ready? A SUP board can be very dangerous in small and big surf. Learn what to do if you get hurt, your fin slices you or someone blacks out from a board hitting them. Know right of way and how to prevent accidents on the water. These things  you must know if you want to charge in big and small surf! 

Introducing Clay Everline’s et al, Surf Health Handbook! I know Clay personally and think this is the most helpful, comprehensive book all stand up paddlers,

surfers and water sports enthusiasts should have in their car or on their book shelf. I worked with Clay on this book on the fitness aspect  ( see photos ) and he is spot on with the warm ups, exercises to help prevent injury and shares what to do if the worst goes down.  Also see all the great tips on how to prevent and manage injuries from SUP. Get it now!  Excellent work Clay!  Suzie

“Surf Survival”

The surfer’s health handbook

Skyhorse Publishing, Inc. NY, NY

Synopsis

Written by 3 hardcore surf docs, this book gives surfers the complete lowdown on surfing related medical problems; how to diagnose them, how to treat them, and how to prevent them.  With chapters devoted to first aid, fitness, dangerous marine animals, big wave surfing, overuse injuries, surf travel medicine and more, Surf Survival is a book no surfer should be without.  Surprisingly entertaining, and very comprehensive, over 300 pages of text and 200 illustrations and photographs describe in practical terms how to deal with the myriad of injuries and ailments that can afflict surfers.  From shoulder dislocations to surfer’s ear, fin cuts to first aid kits, this book is written for surfers who know that self-sufficiency is the name of the game. Don’t leave home without it.

Reviews

“This thorough, authoritative and oddly enjoyable book tells you not only how to treat surfing’s myriad ailments, but also how to prevent them. For that reason alone, it might be the most important piece of surf literature you ever buy. All that,plus lots of photos of gnarly injuries.”

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“I’ve read over 100 surfing-related books, but Surf Survival is the first one that I’ll carry with me on every surf trip. ”

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“Good medicine, and a fun read in the bargain. Read this book and surf until
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“Great book by great doctors. Doc Renneker is a Balls-to-da-Wall big wave surfer, too. What a great combo: smart and hard-core surfers who care deeply about people and their health!”

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Book can be purchased at major bookstores, and on-line at the link below.

http://www.amazon.com/gp/product/images/1616083182/ref=dp_image_z_0?ie=UTF8&n=283155&s=books

Clayton Everline, MD

Director: Ocean Sports Medicine

Work*Star Injury Recovery Centers

Board Certified Diplomate:

Sports Medicine

Internal Medicine

Fellow of the Academy of Wilderness Medicine

Clinical Assistant Professor: Department of Orthopaedic Surgery, Seton Hall University, School of Health and Medical Sciences and Department of Medicine, University of Hawaii John A. Burns School of Medicine

Certified Strength and Conditioning Specialist (CSCS)

Waves of Health 501c3:

Sports and Outreach Medicine

EverlineMD.com

TheWavesOfHealth.org

Co-author of Surf Survival

http://www.amazon.com/gp/product/images/1616083182/ref=dp_image_z_0?ie=UTF8&n=283155&s=books

Suzie

Iliotibial band (ITB) syndrome is an overuse problem that is often seen in bicyclists, runners, and long-distance walkers. Personally, it has been noted while Backcountry Skiing and Stand-Up Paddling (SUP). Many people ask me what causes pain on the outside of the knee just above the knee joint. It is ITB syndrome and it can be problematic. The discomfort may be so intense as to discourage you from participating in the often long and rewarding sessions of SUP and other endeavors. So what can be done about it?

Ice massage is one of the best initial therapies for ITB syndrome. Hold a cube of ice in a napkin and massage the inflamed area until the cube has melted. It could take up to 20 minutes. Do this 1-2 times daily. A Cho-Pat strap or similar compression tape may prevent overstretching and inflammation,  but ultimately it comes down to adjusting biomechanics and muscle balance. The following exercises should help as well:

• Iliotibial band stretch: Standing: Cross one leg in front of the other leg and bend down and touch your toes. You can move your hands across the floor toward the front leg and you will feel more stretch on the outside of your thigh on the other side. Hold this position for 15 to 30 seconds. Return to the starting position. Repeat 3 times. Reverse the positions of your legs and repeat.
• Iliotibial band stretch: Side-leaning: Stand sideways near a wall. Place one hand on the wall for support. Cross the leg farthest from the wall over the other leg, keeping the foot closest to the wall flat on the floor. Lean your hips into the wall. Hold the stretch for 15 seconds, repeat 3 times, and then switch legs and repeat the exercise another 3 times.
• Standing calf stretch: Facing a wall, put your hands against the wall at about eye level. Keep one leg back with the heel on the floor, and the other leg forward. Turn your back foot slightly inward (as if you were pigeon-toed) as you slowly lean into the wall until you feel a stretch in the back of your calf. Hold for 15 to 30 seconds. Repeat 3 times and then switch the position of your legs and repeat the exercise 3 times. Do this several times each day.
• Hamstring stretch on wall: Lie on your back with your buttocks close to a doorway, and extend your legs straight out in front of you along the floor. Raise one leg and rest it against the wall next to the door frame. Your other leg should extend through the doorway. You should feel a stretch in the back of your thigh. Hold this position for 15 to 30 seconds. Repeat 3 times and then switch legs and do the exercise again.
• Quadriceps stretch: Stand an arm’s length away from the wall with your injured leg farthest from the wall. Facing straight ahead, brace yourself by keeping one hand against the wall. With your other hand, grasp the ankle of your injured leg and pull your heel toward your buttocks. Don’t arch or twist your back. Keep your knees together. Hold this stretch for 15 to 30 seconds.
• Wall squat with a ball: Stand with your back, shoulders, and head against a wall and look straight ahead. Keep your shoulders relaxed and your feet 2 feet away from the wall and a shoulder’s width apart. Place a soccer or basketball-sized ball behind your back. Keeping your back upright, slowly squat down to a 45-degree angle. Your thighs will not yet be parallel to the floor. Hold this position for 10 seconds and then slowly slide back up the wall. Repeat 10 times. Build up to 3 sets of 10.
• Side-lying leg lift: Lying on your uninjured side, tighten the front thigh muscles on your top leg and lift that leg 8 to 10 inches away from the other leg. Keep the leg straight and lower slowly. Do 3 sets of 10.
• Knee stabilization: Wrap a piece of elastic tubing around the ankle of the uninjured leg. Tie a knot in the other end of the tubing and close it in a door.
  1. Stand facing the door on the leg without tubing and bend your knee slightly, keeping your thigh muscles tight. While maintaining this position, move the leg with the tubing straight back behind you. Do 3 sets of 10.
  2. Turn 90 degrees so the leg without tubing is closest to the door. Move the leg with tubing away from your body. Do 3 sets of 10.
  3. Turn 90 degrees again so your back is to the door. Move the leg with tubing straight out in front of you. Do 3 sets of 10.
  4. Turn your body 90 degrees again so the leg with tubing is closest to the door. Move the leg with tubing across your body. Do 3 sets of 10.

Hold onto a chair if you need help balancing. This exercise can be made even more challenging by standing on an Indo Board with Flo-cushion while you move the leg with tubing.

• Iliotibial band stretch: Side-bending: Cross one leg in front of the other leg and lean in the opposite direction from the front leg. Reach the arm on the side of the back leg over your head while you do this. Hold this position for 15 to 30 seconds. Return to the starting position. Repeat 3 times and then switch legs and repeat the exercise.  This exercise can be made even more challenging by standing on an Indo Board with the IndoFlo-cushion
• Clam exercise: Lie on your uninjured side with your hips and knees bent and feet together. Slowly raise your top leg toward the ceiling while keeping your heels touching each other. Hold for 2 seconds and lower slowly. Do 3 sets of 10 repetitions. This works the hip abductors that stabilize the iliotibial band.

Your doctor may also prescribe an anti-inflammatory. Piroxicam has been shown in the Sports Medicine literature to speed sprain and strain healing times, but there is still controversy. If you have any reservations, stick with the exercises and maintain good posture. Surgery is very rarely necessary. Should you have any questions, email me through my websites: www.everlinemd.com or www.boardsportsdoc.com. Be well!

Clayton Everline MD, DMO, CSCS
Board Certified in Sports Medicine and Internal Medicine
Clinical Assistant Professor of Orthopaedic Surgery
Seton Hall University School of Health and Medical Sciences
The Waves of Health (www.thewavesofhealth.org)