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Fly Fishing First Aid and Prevention

Fly Fishing is fun but a study of fly fishers shows lots of back pain, elbow pain, and shoulder pain. Something is wrong.

From On The Fly, January 2013.

By Richard Oldenski MD

Fly-fishing is fun. As Suncoast Fly Fisher Carl Hanson said: " It's the most fun you can have standing up". But do you ever have pain while fishing or afterward? Have you ever had to stop fishing or miss an outing because of pain? If you did, you are not alone. I searched the medical journals for studies on fly fishing injuries, and learned that many fly fishermen experience pain that may be due to their casting technique, the type of equipment they use, or the species of fish they catch. Dr. Keith Berends MD, an orthopedic surgeon at Duke University, did an Internet based survey of 131 fly fishermen. Fifty-nine percent of those surveyed had experienced back pain. Saltwater fishermen had the most shoulder and elbow pain (31%), while trout fishermen had the most wrist pain (31%). Dr. Berends collaborated with Stephen Hisey, a physical therapist, to publish Fit to Fish: How to Tackle Angling Injuries, a book on treating and preventing fly-fishing injuries. To read a review of this book go to

Dr. Timothy McCue MD et al. at the University of Montana did a survey of 292 FFF certified fly-casting instructors to determine how frequently overuse injuries occurred in this group and whether there is an association between pain and casting style and equipment. 74% of the respondents reported some pain in the wrist, elbow or shoulder; but only 25% reported moderate to severe pain. Pain was in the shoulder in 50%, in the elbow 39% and the wrist 36%. The pain most often lasted a few hours or a few days, but 5% indicated that the pain lasted all year and 2% missed work because of the pain.

Moderate to severe pain was more frequent in saltwater fishermen. Although overuse injuries occurred frequently in this group, they were self limited and not very severe. Overhead casting was associated with less wrist and elbow pain than with sidearm or elliptical casting. Those who used multiple casting styles had less elbow pain than those who use mostly one method. Pain was more frequent in those who cast with a haul, used shooting heads, or added weight to sinking flies.

As for fly-casting grip styles, no relationship was found between different grip styles and wrist or elbow pain. Moderate to severe shoulder pain, however, was more frequent in those using the forefinger on top grip.

These surveys show that overuse injuries occur frequently in fly fishers, and although they suggest that these injuries are associated with casting styles, types of equipment and type of fishing, they do not establish a cause and effect relationship. Dr. McCue, an avid fly fisherman, has brought together a group of experts in kinesiology, physics, medicine and fly casting to establish the Fly Casting Institute to research the biomechanical/medical aspects of fly casting. Using high tech video and infrared cameras and computers, they are researching every aspect of fly-casting to determine what is the "healthiest" way to cast. They hold casting clinics where you can have your cast scientifically analyzed and possibly learn how to avoid injuries. Go to for more information. To read Dr. McCue's original study go to

Overuse injuries are caused by too many uninterrupted repetitions of a motion, unnatural or awkward motions, overexertion, incorrect posture, or muscle fatigue. These activities stress our ligaments, tendons, joints, muscles, and peripheral nerves and can cause temporary or permanent damage. But not all of the injuries sustained by fly fishers are caused by repetitive motion. You could strain your muscles or tendons while landing a big fish like a large snook or a 120-pound tarpon. You could sprain your back hoisting your kayak onto your truck, or you could sprain your ankle by stepping in a hole on your way to the river. There are many ways for the unwary fisherman to be injured. Future articles in this series will cover the treatment and prevention of sprains, strains, and overuse injuries of specific joints. Hopefully, this information will help us recover quickly from our injuries and spend more time on the water.

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