Prevalence of Orthopaedic Maladies in People Who Flyfish: An Internet-Based Survey

Keith Robert Berend, MD

Disclosures

J South Orthop Assoc. 2001;10(4) 

In This Article

Discussion

Multiple reports exist about back, elbow, shoulder, wrist and knee pain in various groups of athletes such as golfers, tennis players, cyclists, and even canoeists. To date, no report exists on the prevalence of orthopaedic conditions in people who flyfish. Trout Unlimited, the International Women Fly Fishers organization, and the Federation of Fly Fishers boast a combined membership of more than 125,000 people.19-21 This epidemiologic group as a whole is a large one, and the scope of their orthopaedic problems is not insignificant. In fact, 64% of the 131 people surveyed who participate in flyfishing had seen an orthopaedist, chiropractor, or general medical doctor for orthopaedic problems. Of these, 35 had had surgery.

In this study, low back pain or "stooper's back" was reported in 59% of respondents. Several people surveyed commented that carrying a heavy flyfishing vest and wading in strong current caused or exacerbated their symptoms. The prevalence of low back pain in athletes reported in the literature ranges from 38% of male professional tennis players to as high as 85% of male gymnasts.11,14 Up to 66% of people in one study reported at least one episode of low back pain in their lifetime, and 50% had an episode during the year preceding the study.22 A second study reports a slightly higher total incidence of 79% and concludes that no difference in back pain characteristics are seen across socioeconomic groups or occupational posture, but the 1-year prevalence of low back pain (69%) has been associated with long periods of standing.10,23,24 This concept is supported by comments provided by some particpants in the current study. Standing, wading in strong currents, and walking on slippery, uneven rocky surfaces may increase the amount of back pain seen in people who flyfish. Warmwater flyfishing, which frequently includes the use of a float tube or belly-boat, had the lowest prevalence of low back pain at 47%. In contrast, trout fishing, which involves wading in rocky streams had a slightly higher rate at 59%. Saltwater fishing, which can include wading the shoreline or standing on a rocking and swaying boat, had the highest prevalence at 65% of people surveyed. Interestingly, the use of lumbar support devices (23% of people with back pain in this study) has been shown to have no influence on the incidence of low back pain. However, their use does reduce the number of days with low back pain per month.25 Overall, the type of flyfishing does not statistically correlate with the rate of low back pain, but certain suggestions can be drawn, as mentioned.

No correlation was noted between age and frequency of fishing with the prevalence of shoulder pain. There was a trend toward more shoulder pain (31%) in the people who mostly flyfish in saltwater (versus 24% for freshwater and 18% for warmwater). Compared with other types of flyfishing, saltwater flyfishing involves the use of heavier equipment, and weightier flies, and typically produces bigger, harder-fighting fish. For this reason, one could postulate that the use of heavier gear and fighting bigger fish could predispose this group to "caster's shoulder." The overall prevalence in this study was 24%, which is considerably less than that reported in a study of athletes whose sport demanded vigorous overhead activities. Of 372 respondents, 44% had shoulder problems. The rate of shoulder pain was highest in volley ball players and swimmers, and less in those who participate in basketball and tennis.26 It can be suggested that shoulder girdle strengthening should be a part of any avid angler's activities, both in and out of the fishing seasons.

Elbow pain is another frequent problem encountered in the athletic population. Multitudes of studies have investigated the role of technique, conditioning, and equipment in the etiology and therapy for elbow pain in the athlete.3-9 More than 50% of athletes who use overhead arm motions are said to have lateral epicondylitis or tennis elbow.6 Technique of the racquet stroke has been repeatedly emphasized as a causative or curative factor in lateral epicondylitis. The same may be true of flyfishing. As with shoulder pain, there was a higher rate of elbow pain in the anglers who primarily saltwater flyfish (30%), more than twice that of warmwater fishermen (12%), and almost twice the rate seen in freshwater anglers (16%). Again, heavier, stiffer equipment and longer casts requiring the "double-haul" may be to blame. Proper grip size and rod action combined with conditioning, stretching, and strengthening may reduce the occurrence of elbow pain in those who enjoy flyfishing.

Wrist pain was the second most common complaint after low back pain in this population of flyfishing enthusiasts. Twenty-six percent of respondents reported wrist or hand pain associated with flyfishing. Interestingly, anglers who primarily saltwater flyfish had the lowest rate at only 12%. In contrast, 31% of people who mostly freshwater flyfish had hand and wrist pain. The casting techniques used in trout fishing involve more delicate presentations, requiring more wrist motion and frequently less shoulder and elbow effort. No correlation was noted between the occurrence of wrist and hand pain and the age of the angler or frequency of flyfishing. DeQuervain's tenosynovitis and wrist intersection syndrome are reported to be frequent problems in racquet sports.4 A similar mechanism of repetitive flexion-extension, and ulnar-radial deviation may be involved in the etiology of wrist pain in both racquet sports and flyfishing. This is especially true in coldwater flyfishing with the lighter weight rods and more delicate presentations requiring more wrist motion and less elbow and shoulder effort.

Of the people surveyed, 23% complained of leg pain, most frequently in the knee. Leg symptoms, including foot and ankle, knee, and hip pain, were a nonspecific finding in the present study. The prevalence of knee pain is 54% in competitive athletes and has been associated with years of jogging and competitive gymnastics and negatively correlated with weekly hours of tennis.27 While primary fishing type did not correlate with the occurrence of leg pain, people who participated in warmwater fishing, even occasionally, had a significantly lower rate of leg pain than those who never flyfish in warmwater (P = .04). Leg pain was reported by 12% of people who mostly warmwater flyfish, 23% of those who primarily coldwater flyfish, and 31% of those who saltwater flyfish. This may again be related to equipment and technique. Warmwater fishing is done primarily from a sitting position in a boat, float tube, or belly boat, versus freshwater wading and standing to cast or shoreline wading in saltwater. These various conditions may account for the prevalence rates of leg pain observed in this study, but it appears that the rate of leg and knee pain in this group of anglers is no higher than that observed in other recreational sports.18,27

The current study is the first to use the Internet as a means of collecting medical data for use in research studies. As a control against possible confounders to the use of an E-mail survey solicited on the Internet, members of a local flyfishing club were also surveyed. The two groups were well matched in terms of age (mean age of 50 in the Club group and 47 in the E-mail group) and sex (95% and 92% male, respectively). While the demographics of the two groups were similar, some differences were observed. The reported frequency of flyfishing was much higher in the E-mail group (75 days per year versus 30 days per year; P = .0003). The much higher number of professional guides who answered the E-mail questionnaire likely explains this. Furthermore, in the region of the country where the Club survey was done, flyfishing is not easily accessible. The closest coldwater and saltwater fishing opportunities lie more than 4 hours away. This would also help to explain the higher proportion of people in the Club group who participate in warmwater flyfishing (P = .03), which is the only locally accessible flyfishing opportunity. There were also significantly more people in the Club group who reported participating in coldwater flyfishing (although at a lower frequency) than in the E-mail group. The obvious explanation for this difference is that the Club group participants were attending a monthly meeting of a national trout flyfishing organization. When taken into account together in a multifactorial regression analysis, no significant differences were observed between the two study groups in terms of prevalence or location of pain.

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