Physical Therapy Question about Paddling

I know that somewhere out there is a physical therapist who is a paddler and may be able to provide some insight here for me since this problem is caused by kayaking I believe. Ironic to me how paddling can knee problems that seems to be the case with me. I ask the question here because I am not sure that my therapist can envision exactly what kind of strain that kayaking puts on the lower body, and because quite frankly I am not getting really good care at the place where I am forced to go.

I paddle a lot.

About 8 months ago or so I started having some pain in my outer knee. I started going to therapy and they said the pain was from my IT band pulling on the attachment at the knee.

I have been going to therapy for 7 months now and still am having problems.

The PT first said this was from my torso being rotated (which I believe is due to paddling and pulling harder on one side than the other when paddling which I had noticed I do).

We got that problem reasonably solved but the problem continued.

Now we have discovered that I have issues with the hip rotator and the small muscles that control this. They are chronically knotted up and seem to be getting worse. Rotating my hip hurts my hip and in turn hurts my knee.

I have noticed that this is particularly bad when sitting in a kayak in the frog leg position. Getting in and out really bothers it, pushing on the foot pedals when paddling hard bothers it, and rolling the boat when I have to pull with my knee really bothers it.

My conclusion is that this is somehow caused by paddling and being in this position for long periods of time. I also wonder if carrying a heavy sea kayaking on one shoulder for extended periods of time (leaning to the other side to compensate) has something to do with it as well.

We just started with dry needling. I think that seems to be helping a bit.

Any thoughts, advice, etc? On what to do or on how to better describe this to my therapist so that she can help me better?



Have you had any imaging?

What’s dry needling?

If you’re asking how to describe what you do kayaking that could cause/worsen your condition, I’d sit down with him/her at a computer and check out videos of the kind of paddling you do. Plenty of them on You Tube.


the best therapy is time
Everyone has gone down the knee and elbow pain route at some time or another and In my personal opinion, the best healer is your body. I have found that not doing the things that irritate it is best. Also, it takes quite a while for it to heal like 7 months or more. You don’t have to stop paddling but need to maybe switch paddles, try another boat and go with way less force.

Also in my opinion, physical therapists have their place but they can do a lot of irritating of the body with too much “therapy”. No therapy, no pay check. I know quite a few people who just quit going to “therapy” and their bodies healed fine with rest from using the injured area. I have a kayaker friend who suffered from a bad elbow for years. He now paddles a stand up board and all his elbow problems have vanished. If he starts kayaking, it comes back.

I agree - time if the best healer.
I was on the verge of having significant back surgery years ago. I was an avid golfer at the time. I decided that before having surgery I would quit golf for a year. Six months later my back pain was gone. Completely gone. It has never returned. So, now I paddle lot more. No surgery required. So my feeling is before you do anything drastic give the paddling rest and see if it solves your problem. Then maybe ease back in to paddling with your improved technique and awareness and see what happens.

If they can take a look at your back. I have a slight twist in my spine and it causes problems with my hip so that could be it, not a big deal, they just do a correction on me once a week, and I haven’t gone in awhile and I’ve been fine. Another thing in your day to day life how you stand affects your knees. I never knew this but we aren’t supposed to lock them, they’re always supposed to be slightly bent. Good luck!

Rest and a straighter leg
Inflammation, which it sounds like is involved, only goes away by stopping the damaging activity. That said, you may want to check around with the racers to see what they have to say about the advantages of a more straight and less froggy hip to knee angle. It may be that this kind of problem is part of the reason they tend to paddle with everything in a straighter line than many other paddlers.

Padding and a cart?
I have twisted knees and ankles hauling boats over uneven /slick terrain causing nearly every significant kayak related injury I have ever had. I now have a c-tug and use it religiously. Sure it is a slight pain to tear it down and re-pack it, and it does bang around if I do not put towels around it, but it keeps my bird legs from getting torn up.

If the frog leg position is hurting you, maybe try some temporary padding in the knee area of your boat. You may lose a little leverage with straighter legs, but it might be worth a try in my opinion.

All I Can Add…
I had tendon inflammation issues years ago and went to the sports orthopedic guy. He emphasized a long, slow, easy warm up before pushing hard. It works. I routinely ease into a competitive bike ride with a half hour of easy spin. No knee pain for the most part. On those rare occasions when I have pain I hit the ice and ibuprofen. It goes away. Also… tweak your position now and again. Does it help with less knee bend? Does it help with some padding here? Those things you might have to learn by trial and error.

My experience is that sports doctors don’t recommend rest. Ice, ibuprofen, and a very sensible warm up.

yes. good advise
Do this with your current PT. If you’ve completely lost confidence with them, find a sports-oriented PT, it made all the difference in the world in my case.

Surprising. Knee issues from kayak
paddling seem not to be common in the ww kayak community. Most ww kayakers, myself included, are way over toward the froggie leg orientation.

I would want you to be in your kayak on dry land and fake paddling while your therapist watches, and you report when the pain occurs.

The straight leg position was somewhat forced on me in one of my kayaks, and while I adapted to it, it compromised my control of the boat.

I would have thought that lateral pain at the knee might be from damage to lateral collateral ligaments, just as my medial pain is from MRI confirmed damage to the medial collateral ligaments.

The “frogleg” position is all about stability and not efficient torso rotation. Look at any race-oriented kayak or surfski; they employ an angled footplate (60 angle is fairly common), with feet and knees close together. This position is much more comfortable for your hip capsule, and allows stronger rotation, but you do lose stability.

Variation is key. I have modified my touring kayaks to allow either a “race position” or “frogleg” position depending on conditions. A foam bulkhead works, or you can buy a footplate from ONNO that adapts to yakima rails.

Tight hip capsules are pretty common among people who paddle a lot. I reached a point a few years ago where it hurt just to sit in a car for several hours. My local PT suggested massage and some specific stretches that worked wonders for me. My favorite hip stretches are:

Of course, your condition might very well be completely different, which is why a good PT will tailor your treatment to YOU, and is why all internet advice (including mine) should be viewed with a healthy skepticism.

Greg Stamer

I stop
I confess to skepticism about what the medical community “knows” about many things, but of course the internet community may be worse. I do believe in intense internet research on medical studies and authoritative websites.

I have had a variety of pains in my lower back, knees, shins, elbows and shoulders over the years. Nothing permanently debilitating or crippling.

I follow my own subjective believe that: if it is medically established or logically compelling that activity X is causing the pain, I stop doing activity X and rest the parts of the body involved – often for many, many months until the pain goes away. So far this has worked in all cases, sometimes supplemented by glucosomine-chondroitin formulations, fish oils, and limited ibuprofen.

Isn’t the position you favor more about
use of leg extension in the stroke? I can’t think of any reason why the frogleg position would inhibit my torso rotation, if one means by that rotation of the torso above the pelvis. Pelvis stays stationary, torso rotates.

If the legs are in a more vertical plane, then torso rotation could be augmented by pelvis rotation, as the legs extend or flex. But I had not ever thought of pelvis rotation as part of torso rotation. Not even many years ago, when “The Twist” was in vogue.

For performance kayaking torso rotation doesn’t stop at the pelvis. With a strong leg drive, rotation goes all the way down to your butt in the seat; your stroke-side hip rotates backward, while your opposite hip moves forward. This is so important that some racers even go so far as to wax their seat or sit on a plastic bag (to reduce friction) or even use a “swivel seat” that is specifically designed to rotate freely to enhance the effect.

Greg Stamer

All good points…

– Last Updated: Aug-12-13 6:28 AM EST –

Yes, these are all good points. As to the advice to rest, I have to admit that when this first started I thought it was from mountain biking which I did stop.

When I then was told that it was from the rotational issue I figured that kayaking with a more balanced stroke might actually help the rotational problem. I think it might have.

At this point you all are probably right that maybe stopping paddling for a while may be beneficial, but I just can't do it right now. Living an hour for only two more years is a unique opportunity for me that I can't let go. Maybe I will take some time off this winter and concentrate more on mountain biking, but in the meantime I am going to avoid the "rest" option, although admittedly it may be the best option as many of you have pointed out.

As far as choosing another therapist--that's where I have a problem. Being in the Army I have to go to the Army therapist and in this case I feel that I am not getting good care which is why I have to ask in other places. I actually have considered paying for medical coverage through my wife's work just so that I can go to a civilian PT. The one my wife sees is actually quite good and better than the Army one which she initially went to as well.

To answer the question above---dry needling is a technique where they take a very long need and stick into chronically knotted muscles. It causes the muscle to fire and then "reset" Not super pleasant but seems to be helping a bit.

I will try paddling with a straighter leg position. That is good advice. Unfortunately though it will not work for paddling in the surf which is what I really like to do, but is an option for touring.

Although this problem is frustrating, I find it quite interesting. Who would have thought that padding could cause a knee problem. This has actually taught me a lot about the importance of having BALANCED and correct forward paddling technique. I had somewhat always noticed that I paddled harder on my dominate side. Well years of doing that will cause an inbalance in your body which can have all sorts of negative effects. The body is an interesting system.

As to my back, which was asked above, yes I do have a back issue. I explained that to the PT but she has not considered that as a cause. I have spondiolysthesis in my L5 which is a hairline crack in in the flanges of the vertebrae. Maybe I need to push them to take another xray to see if that has worsened.

I am going to check out that bulkhead from Onno. That sounds like a great thing for me in my touring boat. And as to carts--totally agree. For years I just carried my boat solo (even a loaded boat). Although strength is not a limiting factor for doing so, my knees and back are. I now swallow my pride and maximize the use of a cart when needed. A smart choice.

I appreciate all the responses! I never thought I would get this many.


Yeah, rowing with sliding seats started
with oarsmen greasing their shorts, so they could slide on varnished wood. Seats with wheel on tracks came later.

But what you describe is pelvis rotation driven by the legs. Torso rotation occurs above the pelvis. And ww paddlers get more than enough torso rotation without using leg drive. I leave leg drive and pelvis rotation to Greg Barton and the like. I don’t think ww kayakers could loosen their outfitting enough to use leg drive without losing the control they need over the boat.

i may have mentioned that one of my kayaks somewhat forced knees-up position. My control over the boat was definitely not what it has been in later kayaks with splayed legs positioning.

From a No-Rest-er

– Last Updated: Aug-12-13 12:59 PM EST –

Until your pain subsides, try this. A general practitioner (former Air Force doc) told me to do this:

Take 3 ibuprofen before your workout.

Ice on the area that's in pain after the workout.

Take 3 ibuprofen 6 hours after the first dose.

Again; the sports orthopedic guy: LONG, EASY WARM UP before pushing hard.

Good luck.

Edit: Having a bad hip, I think I'm qualified to predict this: If you carry your kayak on your right shoulder it will aggravate your left hip and left knee and vice versa. Don't do that.

That'll be $700. Pay on your way out.

Apples and Oranges
I agree that WW is a different animal. In WW you give up some rotation and speed for control, stability and manueverability. My WW and surf kayaks are a much tighter fit than my sea kayaks and race kayaks.

The OP specificially mentioned carrying a sea kayak. Leg drive and rotation starting down at the sit bones is commonly taught for sea kayaking to racing. It’s not just for “Greg Barton” and elite racers, although the amount of rotation depends on a number of factors and sea kayakers often don’t rotate as strongly as racers. Also, the swivel-seats I am discussing are for performance kayaks and Olympic K1 kayaks, they rotate like sitting on a turntable and are completely different than sliding seats for rowing. They would be useless for WW, or course.

Not all kayaks and activities allow the rotation I am discussing, but it is great if your kayak and paddling conditions permit it. For example, sea kayaking often has periods of calm when you can adopt a feet together, knees together, “racing style” stroke for quickly covering the miles (albeit with reduced stability). At other times, when you are getting bounced around or need to enter the surf zone you can then drop into a “froglegged” position when you need the stability and control more than raw speed.

I’m a fan of having variation. I have been in my sea kayak for more than 28 hours straight and often getting out and stretching on shore is not an option, it helps greatly to be able to adopt different positions in the cockpit for comfort and to avoid injury.

Don’t take NSAIDS prophylacticly
BTW, you will get some well meaning responses. Unfortunately we are not all up on the latest research. Sometimes we remember what was recommended at the time but who knows, maybe that was 20 years ago…

So prophylactic use of NSAIDS is not recommended.

Personally I try to avoid medications as much as possible.

I would recommend checking in with a local acupuncturist. To find a good one, check with a teaching school nearest to you to get a good recommendation. Acupuncture worked for me for shoulders/ mid back issues that couldn’t be touched by loads of PT and massage. An orthopedic surgeon was the one who originally suggested trying acupuncture.

Good luck in your healing search!

how is your boat padded out?
Do your pads lock your knees and thus legs into a frogleg position?

I have a foam masik with four notches cut into it, mounted to the underside of the deck. The notches let me lock into the boat in frogleg position, or in “legs together” position.

I have to almost constantly be moving my legs to avoid knee stiffness.