July 23, 2001 COEUR D'ALENE, Idaho -- The sport of fly fishing conjures up images of a solitary angler, wading in a cool, pristine wilderness stream, using guile to entice an unsuspecting fish to bite on his hand-crafted fly.
While that image may seem idyllic and serene, a new study by a Duke University Medical Center orthopedic surgeon reveals a more pedestrian truth -- this Zen-like experience with nature often leads to the same maladies experienced by much more competitive sportsmen such as golfers and tennis and baseball players.
While the nature of these sporting pursuits is quite different, common to all is that participants use repetitive arm motions and spend the bulk of their time standing. And just as interestingly, the remedies for the fly fishermen are the same -- staying in good general shape, paying attention to technique and using the right equipment.
The study, which was conducted by avid fly fisherman Dr. Keith Berend, chief orthopedic resident at Duke, looked at the health and fishing habits of 131 fly fishermen and found that 69 percent reported lower back pain, up to a quarter reported pain in their hands and wrist, shoulders and knees, and 18 percent reported elbow pain.
"The sport of fly fishing is growing in popularity, and this study was an attempt to get a better handle on the types of maladies we are seeing more often in orthopedic clinics," Berend said. "The results demonstrate that these maladies seem to mirror those seen in other, more studied recreational activities."
Berend prepared the results of his analysis for presentation Thursday (July 19) at the annual meeting of the Southern Orthopedic Association.
Not only is this study believed to be the first to look at the aches and pains specific to fly fishermen, the results substantiate the use of the Internet as a valid tool for gathering data for analysis, Berend said.
For his study, Berend posted a notice on the top 10 Web sites frequented by fly fishing enthusiasts that he was conducting a study of physical ailments of fly fishers. During the one-month period of the study, 89 anglers requested and completed the detailed questionnaire about their health status and fishing habits.
As a control, Berend went to a monthly meeting of the North Carolina chapter of Trout Unlimited, and asked those fishermen in attendance to complete the same questionnaire. Forty-two members did so. Statistically, there was little difference between the two groups in terms of age or prevalence of the different ailments, leading Berend to conclude that the information collected via the Internet and e-mail was indeed a representative sampling of fly fishermen.
"I was surprised to learn that there was no correlation between the numbers of days per year the people fished and the pain they suffered," Berend said in an interview. "Also, there didn't seem to be a correlation between age and physical complaints."
For shoulder, elbow and wrist pain, the repetitive motion involved in maintaining the fly far from the fisherman and keeping it active to mimic a live insect or bait, leads to complaints that are similar to ailments experienced by tennis and baseball players.
"Simply put, repetitive motions in general can cause problems," Berend said. "It is even worse if this repetitive motion -- whether during fishing or tennis -- occurs intensely and sporadically, much like the typical weekend warrior who is only active on weekends. Staying in shape on a continual basis should help reduce the level of these pains."
The back and leg pains experienced by the fishermen stem from a number of factors, Berend explained. Many fly fishermen stand on rocky and uneven surfaces in fast-moving waters while they fish, which can cause stresses on the leg and lower back over long periods of time. Also, since the fishermen typically stand in the middle of a stream, they carry much of their gear in or on vests for easy access.
"Some fishermen load their vests with too much weight to save trips back to the shore, while others wear vests that do not equally distribute the weight across the body," he said. "In these cases, I would recommend switching to the newer, better designed vests and not carrying so much weight."
The method used for casting, or presenting, the bait to the fish can also create pains in the shoulder, he continued. The fisherman typically uses the pole to gather the energy necessary to propel the bait a great distance. Just as in pitching a baseball, improper technique can lead to shoulder pain, Berend said.
The study found that saltwater fishermen, who typically use heavier equipment, had much higher rates of shoulder and elbow pain, than their freshwater counterparts.
While he plans further studies to look at the actual mechanics of casting, Berend believes that improper casting technique, possibly coupled with the actual properties of the rod itself, can lead to the shoulder pain.
"We are planning to conduct detailed electromyographic studies of the shoulder muscles, as well as three-dimensional biomedical analysis of technique, to better understand the actual mechanics of the cast," Berend said. "With that knowledge, we hope to be able to come up with strategies to prevent or reduce pain and increase performance, like we have done for other sports."
These studies will be conducted in the Michael W. Krzyzewski Human Performance Lab at Duke.
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