South Florida's waterways, beaches, and flat-water paddling conditions make stand-up paddleboarding and kayaking two of the region's fastest-growing sports. Both activities demand significant shoulder, core, and wrist endurance — and overuse injuries are common when paddlers escalate volume without adequate preparation. Dr. Ezra Miller, PT, DPT provides in-home return-to-water PT for paddlers across Boca Raton, Delray Beach, and Pompano Beach.
Common Paddleboarding & Kayaking Injuries
- Shoulder rotator cuff tendinopathy — the paddle stroke demands high rotator cuff endurance through thousands of repetitions per session
- Wrist tendinopathy / De Quervain's tenosynovitis — paddle grip and wrist torque during power strokes
- Lower back pain — sustained forward trunk lean and rotational demands, especially on SUP in choppy water
- Lateral epicondylitis (kayaker's elbow) — grip-intensive paddle strokes load the forearm extensors
- Neck pain — sustained cervical extension while scanning ahead on open water
- Balance-related ankle injuries — falls from SUP, especially in choppier conditions
SUP vs. Kayak: Different Mechanics, Different Injuries
Stand-up paddleboarding demands single-blade alternating strokes with full trunk rotation — a more symmetric, higher-rotation movement than kayaking's double-blade stroke. SUP also requires constant dynamic balance, adding lower extremity and core demands that kayaking does not. The most distinctive SUP injury is lower back pain from the combination of sustained trunk lean and rotation.
Kayaker's elbow — similar to tennis elbow but driven by grip-intense paddle strokes — is the most distinctive kayaking injury. It responds well to a targeted eccentric wrist extensor loading program combined with paddle grip technique assessment.
Return-to-Paddle Protocol
Phase 1: Rest & Acute Care (Weeks 1–2)
Offload the primary structure. Thoracic and shoulder mobility assessment. Core stability baseline: paddling demands significant anti-rotation endurance. Initiate gentle mobility work.
Phase 2: Strength & Endurance (Weeks 2–5)
Rotator cuff endurance training (high-rep, low-load). Core anti-rotation: Pallof press, landmine rotation. Wrist extensor eccentric loading for lateral epicondylitis. Hip and glute endurance for SUP balance demands.
Phase 3: Return to Water (Weeks 4–8)
Short flat-water sessions first. Gradual distance and time progression. Technique assessment: catch angle, exit point, trunk rotation mechanics.
Frequently Asked Questions
Can I still paddle in flat water during recovery?
In many cases, light flat-water paddling with reduced distance and intensity is appropriate after the acute phase. Choppy water and longer tours are reintroduced later. Dr. Ezra will prescribe specific guidelines.
Is paddleboarding safe with lower back problems?
With proper instruction and progressive conditioning, yes. SUP is actually excellent for core strength and balance. The key is ensuring adequate core endurance before long sessions and using correct paddle length and grip technique.
Ready to Return to Paddleboarding & Kayaking?
Dr. Ezra Miller comes to you — Boca Raton, Delray Beach, Pompano Beach and surrounding South Florida. No waiting rooms. No generic programs. Just expert, one-on-one return-to-sport PT designed around your body and your game.
Call (954) 901-7211 Book a Free Consult