SUP is 'sup

What do golfers and stand up paddlers have in common? Not very much. And no, I’m not trying to make a joke at the expense of SUP-ers. The answer is: elbow pain.

I have been seeing an explosion in the number of medial elbow pain cases over the past few months. All of these patients are stand up paddlers and nearly every one of them is new to the sport. There are a lot of areas I would expect to be the “weakest link” in a SUP-er. What surprises me is that, as of yet, the ONLY SUP-related injury I am treating is medial epicondylitis, or “golfer’s elbow”.

There is some debate about the etiology of golfer’s elbow: is it the repeated and high velocity concentric contraction of the forearm flexor group during the mid phase of the swing or the ever so slight but real eccentric contraction of the forearm flexors as the club head strikes the ball? I’ll let the researchers sort that one out. I have tough enough a time getting the ball to go through the windmill, under the mushroom and come out of the waterfall to land next to the hole! :P

With SUP, the flexion motion of the forearm muscles (the extrinsic flexor muscles of the hand/wrist plus the pronator teres and quadratus) is much more powerful than in golf, but much slower as well. This probably removes the eccentric model. This is important because eccentric-type contraction injuries (in my experience) are much more acute and cause significantly more inflammation (think soccer player rupturing a hamstring as her knee extends beneath her) when compared to concentric-type injuries (think cyclist NOT stretching his hamstrings over thousands of miles of training). This puts the typical SUP-er in an overuse category of muscle injury (cumulative trauma disorder) rather than a one-time traumatic injury.

So what, you ask? I went through the hundreds of hours of post-graduate courses to learn Active Release Technique®, which is intended to treat exactly this type of injury. While ART® works fantastically well, the best course of action is to avoid the injury in the first place.

Well, how do you avoid CTD problems? Deal with them before they become a problem (duh!!). If you’re a SUP-er and you are asymptomatic (no pain, no numbness, no weakness) start stretching the forearm ASAP. Even though we’re discussing a flexor problem, I would recommend stretching the wrist and elbow extensors, as well. As for strength exercises, the act of paddling gives the flexors enough of a workout already. So focus on strengthening the wrist extensors, supinator and elbow extensors (triceps and anconeus).

There’s no guarantee that you won’t become injured, but at least no one will mistake you for a golfer.