Education: Shoulder Injury Prevention For Kayakers (How Not To Become One Of Dr. Green's Wilderness Medicine Stories)by Dr. Lee Green, Chair of Family Medicine (University of Alberta) and AWA Paddler at Large Shoulder injuries are probably the most common season-ending injuries for whitewater kayakers. There are quite a few ways to injure the complex shoulder joint, but two account for the vast majority of cases. Those are rotator cuff tears and shoulder dislocations.
Shoulder dislocations are the more common of the two. I have reduced shoulder dislocations on the river four times so far in my 11 years of paddling, and I don't even get that many river days a year (to my considerable chagrin). Dislocations happen when the rounded head of the humerus, the upper arm bone, gets pulled forward out of the shallow dish-shaped spot it belongs in, and gets stuck under the front rim of that dish. (It's possible for it to come out the back also but generally only in a high-velocity impact such as a motorcycle crash.)
The best way to prevent shoulder dislocations is to stick to good paddling technique. Keep your elbows in the "paddlers's box," don't extend your arm on a high brace, and never brace upstream in a hole. If these techniques aren't familiar to you, just ask any experienced boater. She or he will be happy to show you. Actually doing them properly on the river takes some attention, and building good habits takes repetition.
Even skilled paddlers can let their guard down for a moment, or get caught just the wrong way. That's what happened to my highly skilled friend on the Pacuare River in Costa Rica: a rock in a very forceful Class IV rapid snagged his paddle at the instant he started to sweep out to roll. So dislocations can't always be prevented, but good technique will certainly make them much less likely.
Shoulder dislocations are trouble, and take many weeks to heal. Rotator cuff injuries are worse: they can take years to heal, and for old geezers like me can spell the permanent end of surfing or even paddling anything above Class II. That's why I place such a high premium on avoiding them.
The rotator cuff is the ring of tough fibrous tendon that holds the head of the humerus in that shallow dish where it belongs. It's formed from the tendons of four muscles in the shoulder. (If you're curious, they're supraspinatus, infraspinatus, teres minor, and subscapularis.) The way to prevent rotator cuff injuries, in addition to the good technique that prevents dislocations, is "pre-habilitation."
That means essentially the exercises you would do to rehab an injured rotator cuff, but before you need them. Strengthen and work-harden the tendons, and they hold up a lot better – especially as you age. So here are the exercises I do to protect my 60+ year old shoulders.
The first three are done standing. They are abduction (Fig 1), overhead raises (Fig 2), and flexion (Fig 3). The remaining two are external (Fig 4) and internal (Fig 5) rotation, which I do with free weights lying on my side. Some people like to use elastic bands instead for these. All the exercises are done alternating, not both arms simultaneously, to permit a bit of recovery time between reps on each side. 10 to 15 reps for each arm are sufficient. |
