by Dirk Kokmeyer, PT, DPT, PhD
As a physical therapist, my passion is diagnosing and treating pain in the shoulder joint. In fact, I spent several years conducting research on the two most commonly torn rotator cuff tendons.
My other passion, on my days off, is fly fishing – an activity I started when I lived in the mountains of Colorado before moving to Maine and opening an office in Augusta.
So, you can imagine my enthusiasm when a fellow angler comes to me with shoulder issues. Considering that roughly 23% of individuals between the ages of 50 and 70 experience rotator cuff injuries, it’s not uncommon. Over the past 25 years in physical therapy, I’ve worked with countless anglers who share one common goal: getting back on the water to fish.
Casting a Fly is a Whole-Body Process
Fly casting gracefully requires a complex and calculated set of maneuvers, not just from the arm, but from the entire body.
Biomechanically, force generation begins at the foot, and travels upward through the trunk, to the shoulder blade, and then down the arm.
When these forces are properly synched with the action of the rod, an angler can propel a line with precision and impressive distance.
Injuries Common
The shoulder is the most common area of upper extremity pain among fly fishermen.
This is especially true when an angler is fishing with heavier gear (such as striper fishing off the Maine coast), using a haul technique (single or double), using a sidearm or elliptical cast, or using a palm-out grip (finger on top) versus a V-grip or thumb-on-top hand position.
Most Complex Joint in the Human Body?
This outcome is not surprising, given the complicated mechanics of the shoulder joint. In fact, the shoulder joint is arguably the most complex joint in the body.
The ball-and-socket architecture of the shoulder joint allows for a greater range of motion than other joints. To ensure stability, power, and seamless motion of the arm during a cast, the rotator cuff muscles draw the ball in the socket so that the ball can rotate in any direction without being pulled out of joint.
The shoulder blade houses the socket part of the joint and the rotator cuff muscles, but more important, it guides the position of the shoulder joint through an elaborate coupling of muscle activity. Pain, whether from an injury or overuse, can inhibit muscle activity, and therefore, throw off the movement pattern necessary to present a fly where it was intended to be.
Most of the shoulder injuries reported in medical studies are diagnosed as rotator cuff tendonitis. Considering the risk factors mentioned above, we can reach some conclusions.
Perfect “Recipe” for Pain
First, the palm-out grip (hand on top) is characteristic of a longer cast where more power is needed. This grip also places the shoulder joint closer to what we call the 90/90 position (the elbow at shoulder level and pointing to the side).
Adding a haul does the same, but also increases the force on the shoulder joint – namely, the rotator cuff and shoulder blade muscles. A side arm cast further amplifies load demand by increasing the lever arm on the shoulder.
Lastly, much like holding a light weight with an extended arm, heavier gear with a long lever arm exponentially increases the force applied to the rotator cuff. These elements in combination create a perfect recipe for rotator cuff issues.
Prevention
Prevention can be addressed in many ways. First, it’s important to understand body mechanics in fly casting. Good body posture, utilizing a stable base support (not always possible), good trunk bracing (yes, that dreaded word – the core), and keeping the shoulder blade and rotator cuff muscles strong and controlled, can lead to a well-positioned shoulder joint free from potential break-down.
Second, while the risk factors mentioned above do not illustrate “the wrong way” to cast a line, like pitch counts in Little League, they may offer a means of decreasing risk. On average, anglers report 200 casts per day when fishing. Taking into consideration that the weight of a complete 6wt – 10 wt setup ranges between 10-18 oz (0.3-1.1 lbs), the torque placed on the rotator cuff can range between 8-30 lbs. – not terribly heavy, but it will feel like 100 lbs. after 200 repetitions.
Preparation and Prevention
During the off-season, I recommend a simple shoulder program that will help to maintain strength of the rotator cuff and shoulder blade muscles.
During the season, don’t overload the shoulder. Every bit of activity using your arm equals load. Overloading the joint causes injury, and these injuries usually come on gradually.
If you develop shoulder pain, the most effective initial treatment is to shut it down for a day (or more, if necessary). Persistent and debilitating pain should be checked out by a professional – someone who can pinpoint the affected area and offer an appropriate treatment plan.
Protect your shoulder, and save your casting arm for the long haul.
The author is founder of Forza Physical Therapy, in Augusta
