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

Abstract

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