Rafter's Elbow

Rafter’s elbow often manifests as a combination of possible injuries from the repetitive stress of paddling. Lateral and medial epicondylitis more commonly called Tennis elbow and golfers elbow respectively, are conditions characterized by pain and inflammation in the tendons that attach to a bony bump on the outside and inside of the elbow. The repetitive motion of paddling can put stress on the tendons that attach to the lateral or medial epicondyle.

How do I know if I have Rafter’s Elbow?

Paddlers may experience pain and inflammation in the elbow, which can make it difficult to hold and control the paddle. The condition can also affect their stroke technique, which can lead to decreased power and endurance. The pain is typically worse with gripping or lifting objects, and may radiate down the forearm. This pain can also irritate the bicep tendon and manifest itself as shoulder pain that travels all the way to your pectoral muscle. Given the wide range of paddle strokes that rafters use, we tend to end up with injuries to one of both of these tendons.

All outdoor athletes are at risk of overuse injuries due to the nature of their sports, which often involve repetitive motions and long training sessions, but it can be especially bad in commercial raft guides. Tendons which are required to continuously move heavy loads of clients in commercial rafts can easily be strained. During the height of a commercial rafting season or on a long multi day trips an injury like this early in the core season or early in the trip may not be particularly noticeable. Alternatively busy work schedules of back-to-back river days will put a great deal of stress on forearm tendons and there may not be adequate time for rest and recovery.

Treatment options

It's important for paddlers focus on proper technique and to have adequate warm-up and cool-down time, as well as proper equipment sized to your body. You should also be mindful of your training schedule and not to overdo it, and if you experience pain or discomfort, it's important for you to seek medical attention as early intervention can help prevent the condition from becoming more severe.

According to the Hospital for Special Surgery: “In patients whose symptoms are not severe, an orthopedic surgeon may advise a "wait-and-see" approach. These patients are also advised to modify their activities, reducing or stopping altogether any activity that aggravates the condition.

For all patients, use of over-the-counter anti-inflammatory drugs such as ibuprofen and the application of ice can also reduce pain. Physical therapy may also provide some relief by strengthening surrounding muscles. Although strengthening the wrist using weights is advocated by some therapists, this particular exercise may aggravate the patient’s pain.”

Equipment and Form Evaluation

In tennis they evaluate and change equipment and rafting is no different. Evaluating equipment is one important part of developing a treatment plan for this type of repetitive stress injury. You want to get equipment that is properly sized to you especially focusing on your paddle. Paddles are the main interaction between the boat and the water so you want to make sure the size of the paddle is correct for you so you are not over reaching or straining to get your stroke in. Similarly paddles that are too long will prevent you from having proper form and body dynamics causing more strain. Swing weight is another consideration a well. Having a light paddle can help alleviate some of the strain in the shoulder as you are moving less weight repetitively all day. Finally, having a stiffer paddle will increase paddle power requiring fewer strokes, but a softer paddle may help to cushion the impact and put less strain on your wrist as you are moving from stoke to stroke. There are other possible equipment evaluation concerns like thwart spacing and shoe stickiness which can help with having better form.

Good form is another critical component as it will help you achieve a better transfer of power throughout your strokes thus requiring less stress on particular joints and particularly the forearm tendons. Good body position like avoiding hunching, proper foot positioning, and proper follow through with each stroke will help you achieve better form. If you need some more help with good form, check out our beginner rafting series below:

 Paddlers with rafter’s elbow may find it difficult to paddle for long periods of time, which can limit their ability to participate in consecutive boating days or working as commercial guides. The pain and inflammation can also make it difficult to perform other activities of daily living, such as lifting or carrying objects, which can lead to decreased quality of life.

In addition to physical limitations, rafter’s elbow can also cause psychological stress, as athletes may become frustrated with their inability to perform at their usual level, and may worry about the impact on their career.