Humans have used canoes and kayaks for transport, hunting and fishing for centuries. But the origins of the modern sporting discipline lie with a British barrister, John MacGregor, who after studying ancient kayaks, designed a his own version, and then went on to found the Royal Canoe Club in 1866. Canoe regattas started a year later and the sport gained full Olympic status in 1936(1). As with many non-traditional sports and extreme activities, the popularity of canoeing, both competitively and for recreation, has been increasing rapidly. A survey in 2000 put the numbers of paddlers in Britain at almost two million(2); and while most of them take to the water in inland rivers (86%), the sea, lakes and reservoirs, canals and artificial white-water sites are also used. With so many different types of location it is not surprising that canoe and kayak styles vary widely, with at least 11 variations from flatwater canoeing and kayak touring, to surf kayaking and white-water rafting, reflecting the wide spectrum of usage, from relaxing recreation to extreme sport.
The canoeist kneels to paddle, while the kayak user paddles sitting down. The kayak paddle has a curved blade on either end; the canoe paddle has a flat blade on only one end of the shaft. Slalom competition-standard canoes, unlike regular ones, are decked to keep water out of the boat. A slalom boat is a shorter and wider craft than a sprint canoe to give it greater manoeuvrability. The long, narrow sprint boat is fast but less stable. As with other fringe sports, increased participation brings with it greater hazard and injury risk, and with canoeing there are some fairly straightforward inherent dangers to being in a relatively unstable craft in moving water which is often fast-flowing and cold, in sometimes unpredictable environments. It is, therefore, not surprising that there is a high number not only of acute and chronic injuries, but also of fatalities.
There is very little in the way of injury data for this sport and nothing that differentiates between recreational and sports-related injury rates or types. One recent study gives an overall risk of injury from canoeing and kayaking as 4.5 injuries for every 1,000 days paddled and compares this with estimated rates for Alpine skiing, cross country skiing and windsurfing of 3.2, less than 1 and 1 respectively(3). Among competitive athletes, it seems that more than half of all injuries happen during training, with 40% during recreation and 4% during competition(4). The most common injury sites are the upper limb (shoulder, wrist/hand and elbow/forearm). Injuries to the back are also common, and these tend to limit activity the longest(5). Table 1 below shows the most common injuries sustained by a group of athletes during competitive whitewater paddling for Olympic trials(4).
|Type of Injury
|Chronic muscular pain||14%|
The studies by Schoen et al and Krupnick et al also suggest there is a sharp difference between pro and amateur paddlers, with more than two-thirds of injuries among athletes being chronic or recurrent. This is a reversal of the picture for all canoeists, among whom twothirds of injuries are acute. The difference may reflect the more experienced, safer, but more intensive activity undertaken by athletes.
Acute injuries are commonly the result of direct trauma, the most frequent being cuts, contusions and abrasions as well as various sprains and strains. Between them, cuts and sprains account for two-thirds of acute injuries; 1 in 10 involves broken bones(3,4). Head and facial injuries are not uncommon and can be serious or even fatal.
Paddling involves a repetitive movement of the upper body and if done for long enough it can lead to an overuse injury. The strain, much of it derived from the initial contact between the paddle and the water, is concentrated on the shoulder, elbow and lower back. Commonly reported chronic injuries are tenosynovitis (tendon inflammation) and chronic sprains/strains, usually of the forearm and wrist(3). Canoe marathons run from 11km to 160km in distance and one study showed that almost one in four athletes involved in these long distance events developed tenosynovitis of the forearm(6); while the incidence was higher in the dominant hand, it was not dependent on the type of canoe or angle of the paddle blades. The risk decreased among those who paddled more than 100km a week for eight weeks prior to the competition. Other factors predisposing tenosynovitis were hyperextension of the wrist during the pushing phase of the stroke and environmental conditions, including high winds and fast-flowing waters(6).
Shoulder injuries are common (especially in Canadian canoe style, where a single-bladed paddle is used just on one side(5)), with the repeated paddling action leading to overuse injuries such as humeral head subluxation, rotator-cuff tendinitis and subacromial impingement. Shoulder dislocation is seen in about 6% of paddlers(3). It is essential therefore that in addition to simple stretching exercises and conditioning, these athletes pay particular attention to balanced shoulder development. The US Canoe and Kayak Federation(7) suggests backwards paddling as an effective training technique, with warm-up and cool-down regimens including up to 10 minutes of back paddling. Canoeists have to maintain the same position in their small craft for long periods while they paddle, submitting their backs to significant
shear forces. In one study 15-25% of competitive canoeists reported lowback pain, the highest incidence being among the Canadian canoe style group(5). Indeed, in the same study more than half of the canoeists complained of some kind of back problem. Mainly this was caused by muscular or ligamentous strain, but spondylolysis was seen and in one series 36 out of 42 canoeists had prolapsed discs. Men tend to be affected more by acute injury to the back; women suffer more with chronic problems(3). Maintaining a strong back is therefore essential in this sport.
Water-borne infections are another relevant health risk not commonly encountered by sports physicians. For instance, in one study giardiasis (an infectious diarrhoeal disease usually transmitted through oralfaecal contact and by contaminated water) was diagnosed in 14% of US paddlers, compared to a background level of 4%(3). Leptospirosis and its more severe form, Weil’s disease, are canoeing infection hazards, too. Infected rats’ urine in the water is often the agent of transmission. The disease is characterised by jaundice, fever, headaches, muscle aches, rashes and enlargement of the liver and spleen. Although in most cases the disease is mild and treatable with antibiotics, it sometimes leads to septicaemia, organ damage and even death. It is, therefore, paramount that paddlers minimise this risk, by learning the infective risk of the waters they take to, which varies not only from country to country, but also from area to area, depending in part on the rate of water flow. In one study, infections of enterovirus and coliform among canoeists using two nearby sites reflected the different levels of bacterial contamination in the lowland and upland waters(8). Sea-water paddlers can also be at risk of infection from sewage contamination and there are numerous anecdotal reports of significant problems with jellyfish.
In the US, canoeing and kayaking rank consistently second only to motor boating in contributing to water-sport related deaths(9) One study found that 1 in 10 competitive paddlers had had a near-drowning event during their careers(6). And the evidence suggests that most fatalities are preventable. Two US accident studies found that although 98% of all canoeists and kayakers carried a personal flotation device (lifejacket) with them, 75% of all fatalities occurred among people not wearing a PFD(9,10). Alcohol use was cited as a factor in 25% of canoeing deaths, and most fatalities involved some combination of inexperience, hazardous water or weather(9,10). The American Canoe Association has produced a safety publication(10) with tips for canoeists emphasising the importance of wearing PFDs, minimising movement in the vessel, avoiding extremes of weather (and therefore the chance of hypothermia), not getting drunk and using appropriate safety equipment (eg sun hat when touring, hard hat when white-water rafting).
Most minor injuries should not need medical input. Minor sprains, bruises and muskuloskeletal aches need only a period of rest for recovery; for most minor cuts and abrasions the key is to clean and disinfect these thoroughly before dressing them. Medical help should be sought for more significant acute injuries and those that are becoming chronic or recurrent. Among more substantial injuries, dislocated shoulders need to be treated urgently, not only because of the associated pain, but more importantly to minimise the possible damaging consequences to ligaments and nerves. Surgery (because of fracture, dislocation or other) is required in 13% of acute paddling-related shoulder injuries(3). Chronic shoulder problems may well need MRI or CT scans to pinpoint the problem.