Upper extremity pain seen with fly-casting technique: a survey of fly-casting instructors

Upper Extremity Pain and Overuse Injuries in Fly-Fishing: A North American Cross-Sectional Survey and Implications for Injury Prevention

Background:

Fly-fishing requires rhythmic, coordinated movements to successfully cast a fly line. Previous studies have shown that the biomechanical demands of fly-casting may cause some individuals to develop upper extremity pain or injuries.

Purpose:

To report the rates, trends, and contributing factors of upper extremity pain and overuse injuries in a sample of North American recreational fly-fishers.

Study Design:

Descriptive epidemiology study.

Methods:

Participants were reached via 3 popular online fly-fishing forums in April 2019. Each consenting North American participant over 18 years of age was given a link to a unique survey that recorded his or her demographic and orthopaedic histories, fly-fishing experience, equipment, casting techniques, upper extremity pain after fly-fishing, and chronic outcomes.

Results:

The 162 fly-fishers included were 63.3 (± 11.5) years of age, and 95.1% were men. In total, 59 (36.4%) reported experiencing upper extremity pain immediately after fly-fishing. Pain was rated a 4.0 (interquartile range, 3.0-6.0) on a 10-point Likert scale, commonly lasting less than 1 day (45.0%) or between 1 day and 1 week (45.0%). The majority (62.7%) reported not needing to see a medical provider for their pain/soreness. Those who did most commonly received diagnoses of elbow or rotator cuff tendinitis. Pain/soreness was associated with casting in an elliptical/sidearm fashion, compared with overhead or 2-handed casting (P = .006) using a weighted line or added weight (split-shot, weighted heads, etc) (P = .034) and with grip styles where the hand was pronated compared with being in a more neutral position (P = .046). The mean shortened version of the Disabilities of the Arm, Shoulder and Hand score was 10.8 (± 11.5). Higher scores were associated with a history of self-reported upper extremity orthopaedic injuries (B = 6.059 [95% CI, 2.476-9.642]; SE, 1.814; P = .001) and having had surgery for these injuries (B = 8.484 [95% CI, 4.454-12.513]; SE, 0.314; P < .001).

Conclusion:

In this sample of recreational fly-fishers, no aspects of fly-fishing were associated with long-term upper extremity disability, and only a little more than a third reported having transient pain immediately after fishing. Casting style, using weighted lines or added weight, and grip style were all associated with pain. These are modifiable risk factors that can be adjusted to reduce the risk of upper extremity pain immediately after fly-fishing.

Wrist pain: a systematic review of prevalence and risk factors- what is the role of occupation and activity?

OBJECTIVE

To evaluate the prevalence and risk factors of wrist pain.

METHODS

Systematic review.

DATA SOURCES

The MEDLINE and EMBASE via OVID, CINAHL and SPORTDiscus via EBSCO databases were searched from database inception to 9th March 2018. Specific criteria were used to define inclusion and exclusion. Data was extracted independently by a pair of reviewers.

RESULTS

In total 32 cross sectional studies were identified for inclusion (1 with a longitudinal component). The median prevalence of wrist pain in the general population and non-manual workers within the short term (within last week) was 6 and 4.2% within the medium term (> 1 week and within a year). The median prevalence of wrist pain in physically demanding occupations and sports people was 10% within the short term and 24% within the medium term. Non-modifiable factors associated with wrist pain included increased age (1 study in adults and 3 studies in children/adolescents) and female sex (2 studies). Modifiable risk factors included high job physical strain (2 studies), high job psychological strain (1 study), abnormal physeal morphology in children/adolescents (2 studies), high frequency impact tool use (1 study) and effort reward imbalance (1 study).

CONCLUSIONS

Wrist pain is highly prevalent in groups who partake in physically demanding activities from day to day such as manual labourers and sportspeople. It is less prevalent in the general population and non-manual workers, although there is a relative lack of research in the general population.

TRIAL REGISTRATION

The review protocol was registered with PROSPERO under the registration number CRD42018090834.

LEVEL OF EVIDENCE

1 (Prognostic study).

Upper extremity kinematic trends of fly-casting: establishing the effects of line length

Fly-fishing is a popular form of recreation. Recent evidence has associated overhand fly-casting movements with upper extremity pain. However, little research exists on the motions and coordination common to fly-casting. The aim of this study was to establish upper extremity kinematic trends of fly-casting while casting greater line lengths. It was hypothesized that kinematic casting parameters would increase and time between peak angular velocities would decrease with greater line length. Eighteen males participated in the study. Three-dimensional motion capture was conducted to calculate shoulder, elbow, and wrist kinematics during casting conditions of 6.1, 12.2, 18.3, and 24.4 m of line. Multiple analyses of variance were used to assess the condition effect of line length on the kinematic variables (P = 0.05). Overall, total range of movement increased with increasing length of line cast. Peak angular velocity exhibited a proximal-to-distal trend: peak shoulder internal rotation followed by elbow extension, then wrist ulnar deviation. Time between peak shoulder and elbow angular velocities increased significantly as line length increased. Our findings indicate that specific changes in total range of movement accommodate the demands of casting greater lengths of line. Also, joint velocity coordination patterns of fly-casting appear to follow a proximal-to-distal pattern. These findings represent an initial foundation for connections between kinematics and upper extremity pain reported by fly-fisherman.