Written by Zita Sham, Principal Physiotherapist, and Yuna Zhuang, Principal Hand Occupational Therapist, at Phoenix Rehab. Clinically reviewed by Louise Yow, Principal Physiotherapist & Director, AHPC A1300363H; hand, wrist and elbow sections by Nigel Chua, Principal Hand Occupational Therapist & Director, AHPC A1300362Z. Last reviewed 12 October 2026.
In a study of Singapore university dragon boaters, the lower back, the shoulder and the wrist made up about six in ten injuries, and just over half were from overuse.1 The back takes the reach and twist of every stroke, the shoulder takes the catch, and the wrist takes the grip and, in kayaking, the turn of a feathered blade.
Most of the paddlers we see are in dragon boat crews: corporate teams, community clubs, and university and school crews, training two or three times a week on the water at Kallang, Bedok Reservoir or MacRitchie, and more in the months before a regatta. Kayakers, outrigger and stand-up paddlers tend to come in after a long weekend paddle. Rowers come from clubs and, more and more, from the rowing machine at the gym.
Dragon boat is a one-sided sport. You sit on the same side for a season, reach forward, twist toward the water and pull, at 80 to 90 strokes a minute.1 The back and the shoulder repeat that thousands of times a week. They adapt, as long as the load comes up slower than the enthusiasm.
So the injuries split two ways. Most build over weeks. The lower back that stiffens on the drive home after training. The shoulder that aches reaching back for the seatbelt. The forearm that creaks when you wring out a towel. A few arrive in one moment: a paddle clash at a race start that catches a finger, or a slip on a wet pontoon onto the hand.
Elbow, forearm, wrist, hand and finger injuries on this page are seen by our hand therapy team. Everything else, including the back, the shoulder, the ribs and the knees, is seen by our physiotherapy team.
The movements, and what they load
| Movement | What it loads | What it most often irritates |
|---|---|---|
| Dragon boat reach and catch: twist toward the water, bottom arm reaching forward, top arm driving down | Lower back, both shoulders | Low back strain, rotator cuff, pinching at the top of the shoulder |
| Dragon boat pull and exit: the bottom hand pulling back, the trunk untwisting | Forearm, elbow and wrist of the bottom arm, the ribs and the side of the trunk | Golfer’s elbow, wrist pain on the little-finger side, rib muscle strain |
| Kayak stroke with a feathered blade | The wrist and thumb tendons of the control hand, which turns the shaft every stroke | Intersection syndrome, De Quervain’s, tennis elbow |
| Single-blade canoe and outrigger, one side for long stretches | Shoulder, neck and upper back | Rotator cuff, neck pain, pain between the shoulder blades |
| Stand-up paddle: standing, reaching and balancing | Lower back, shoulders, ankles | Low back strain, shoulder pain, ankle sprain stepping on and off the board |
| Rowing and the rowing machine: legs, then body, then arms | Knees, lower back, ribs | Kneecap pain, low back strain, and in heavy training, rib stress fracture |
Every paddling injury, by body part
Start from where it hurts. Rows with a link go to the page that covers that injury in full.
| Where | Injury | How paddling usually causes it |
|---|---|---|
| Neck | Neck pain and stiffness | The head held up over a rounded upper back for a long paddle |
| Upper back | Pain between the shoulder blades (rhomboid pain) | Pulling through the stroke on one side, hour after hour |
| Shoulder | Rotator cuff tendon pain | The top arm driving down and the bottom arm reaching far forward at the catch |
| Shoulder | Pinching pain at the top of the shoulder (subacromial pain) | Reaching high and far forward, stroke after stroke |
| Shoulder | Front of shoulder pain (biceps tendon) | The bottom arm pulling the blade back through the water |
| Elbow | Tennis elbow (outer elbow tendon pain) | A tight grip on the shaft, with the wrist cocking back |
| Elbow | Golfer’s elbow (inner elbow tendon pain) | The bottom hand pulling hard through the water |
| Forearm and wrist | Intersection syndrome (painful, creaking forearm above the wrist on the thumb side) | The control wrist turning a feathered kayak blade every stroke |
| Wrist and thumb | De Quervain’s (tendon pain at the base of the thumb) | Gripping and turning the shaft with the thumb wrapped around it |
| Wrist | TFCC injury (the cartilage on the little-finger side of the wrist) | The bottom wrist bending toward the little finger as it pulls, or a fall onto the hand |
| Wrist | Wrist fracture (distal radius) | A slip on a wet pontoon or jetty onto an outstretched hand |
| Hand and finger | Finger sprain or dislocation | A paddle clash with the paddler beside you, or a finger caught on the side of the boat |
| Hand and finger | Finger or hand bone fracture | A paddle clash at a race start |
| Ribs | Rib muscle strain (intercostal strain) | Hard rotation through the stroke, especially in race starts |
| Ribs | Rib stress fracture (a doctor first) | High training volume in rowing and on the rowing machine |
| Abdomen | Side or abdominal muscle strain | The trunk twisting and pulling hard on one side |
| Lower back | Low back strain | The forward reach and twist of every stroke, on the same side all season |
| Lower back | Disc-related back pain, sometimes with leg pain | The back rounding under load at the catch, in a boat or on a rowing machine |
| Hip | Hip flexor strain | Hips held bent for a long paddle, and pulling up the slide to the catch in rowing |
| Knee | Pain around the kneecap (patellofemoral pain) | The knee bending fully at the catch on every rowing stroke |
| Ankle | Ankle sprain | Stepping off a moving boat or board onto a pontoon |
The common ones, in more depth
The dragon boat back
The lower back was the most commonly injured area in the Singapore varsity study, at about one injury in five.1 The stroke is a forward bend and a twist toward the water, then a pull back and an untwist, over and over on one side.1 Across every area in that study, the most common type of injury was a muscle or tendon strain.1
It shows up as stiffness getting out of the car after training, or an ache on one side of the lower back by the last piece. We look at how much of the reach comes from the hips and how much from the lower back, and time how long the trunk muscles hold on each side. Paddling volume comes down first. Then the trunk is trained to take the reach and the twist again, in steps. Back pain that travels down the leg with numbness or weakness is a doctor first, listed below.
The paddling shoulder
The shoulder came second, also at about one injury in five.1 At the catch, the top arm drives the blade down from above the head while the bottom arm reaches as far forward as it can. The study authors link that overhead pressing of the top arm to shoulder injury.1
The pattern is an ache at the front or side of the shoulder, worse reaching up or lying on that side at night, and a warm-up that keeps getting longer. We test rotation strength against the other shoulder, overhead reach, and how the shoulder blade moves through the catch position. Paddling volume is cut back, the shoulder is strengthened in the positions the stroke uses, and race pieces come back last.
The kayaker’s wrist: intersection syndrome and De Quervain’s
Most kayak blades are feathered, set at an angle to each other, so the control hand turns the shaft on every stroke. That repeated turn and grip is the pattern we see behind intersection syndrome: pain, swelling and sometimes a creak you can feel on the back of the forearm, a few centimeters above the wrist on the thumb side, where two groups of tendons cross.
De Quervain’s is a different spot: pain at the base of the thumb, on the side of the wrist, worse gripping the shaft with the thumb wrapped around it or lifting a kettle. We find the exact tendon, measure grip and pinch strength on both hands, and test the thumb tendons against resistance. A hand therapist cuts the load first and may make a splint to rest the tendons, then builds the grip back up. Other treatment options are a decision for your doctor.
Elbow, grip and blisters
Holding a paddle for 90 minutes is a lot of grip. Tennis elbow in paddlers usually goes with a tight grip and a wrist that cocks back; golfer’s elbow goes with the bottom hand pulling hard through the water. It hurts lifting the kettle, turning a door handle, shaking hands. Tendons rarely settle on rest alone. They settle on load they can tolerate, built up in steps.
Blisters on the palm and fingers are common early in a season and usually settle as the skin toughens. Keep them clean and covered. A blister that turns red, hot and swollen needs a doctor.
Rowers and the rowing machine
A rowing stroke is legs, then body, then arms. The knees bend fully at the catch, so pain around the kneecap is common. The lower back takes the load when it rounds at the catch, or when the pull starts with the back instead of the legs, which is easy to slip into on a rowing machine as you tire.
Rib stress fracture is a recognized rowing injury, linked to high training volume.2 It usually starts as pain at the side or back of the chest that is worse with a deep breath, a cough or rolling over in bed. That needs a doctor first, who decides on imaging. Physiotherapy comes in once the doctor has confirmed what it is.
Return on tests, not dates
Pain going away is the first sign, not the last. These are the checks we use before full training and racing:
- Lower back: trunk holds on each side close to each other, and a full training paddle without pain the next morning.
- Shoulder: rotation strength against the other side, and full overhead reach without pain.
- Elbow, wrist and thumb: grip and pinch strength close to the other hand, and the tendon tests without pain.
- Knees and rowing: a single-leg squat compared with the other leg, and a full rowing piece without pain around the kneecap.
- Ribs: your doctor’s clearance first, then paddling or rowing volume built back in steps, with breathing and rotation free of pain.
Then volume comes back in steps: a shorter paddle at steady pace, then full training, then race starts and race pieces last.
Is this normal?
Sore shoulders, back and forearms on both sides after the first trainings of a season, easing over two or three days, are usual. So are blisters early on. A stiff lower back the morning after a long paddle that loosens as you move is common, and is a reason to adjust the load, not to panic. Pain on one side, at one spot, that is there at the start of the next training, that creaks at the wrist, or that gets worse week by week is worth getting checked.
When to see a doctor first
- Call 995 for anyone who becomes confused, stops making sense or collapses after training in the heat; for chest pain, or severe breathlessness, on or off the water.
- Emergency department now if a wrist or finger is visibly out of shape after a fall or a paddle clash, or a hand or finger is cold, white or numb.
- Doctor the same day for rib or chest wall pain that gets worse with deep breaths, coughing or rolling over, during or after a block of heavy training; a pop at the front of the elbow with weakness turning the palm up; or a blister or cut on the hand that becomes red, hot and swollen, with red streaks or fever.
- Doctor soon if a wrist stays painful at the base of the thumb after a fall, even if it looked normal; back pain comes with pain, numbness or weakness down the leg; or numbness in the fingers wakes you at night.
Numbness around the groin or saddle area, or a change in bladder or bowel control, is an emergency department today. Capsize drills and water safety sit with your club and are outside this page.
Questions people ask
What is the most common dragon boat injury?
In a study of Singapore university dragon boaters, the lower back was the most commonly injured area, at about 22% of injuries, followed by the shoulder at 21% and the wrist at 17%. Just over half of the injuries came from overuse, and the most common type was a muscle or tendon strain.
Why does my shoulder hurt after dragon boat training?
Dragon boat shoulder pain is usually the rotator cuff, or a pinching at the top of the shoulder, from reaching far forward and driving the blade down at the catch, on the same side for a whole season. It is managed by adjusting paddling volume and building rotation strength back up in steps.
Why does my forearm creak when I kayak?
A painful, swollen forearm that creaks a few centimeters above the wrist on the thumb side is often intersection syndrome, where two groups of wrist and thumb tendons cross. In kayakers, a feathered blade turns the control wrist on every stroke. A hand therapist assesses it and adjusts load, splinting and grip.
Can a rowing machine hurt your back?
A rowing machine can strain the lower back when the back rounds at the catch, or the pull starts with the back instead of the legs, especially when volume rises quickly. The order is legs, then body, then arms. Back pain with numbness or weakness down the leg needs a doctor first.
Where are you with this right now?
1. It is settling on its own
If the back is easier each week since you cut the extra trainings, or the wrist creaks less with every paddle, you are on the right road. Bring the volume back in steps, one more training a week at a time. You do not need us for this, and we would rather say so.
2. It has stopped improving
The shoulder still aches every time you reach back for the seatbelt, three months after the regatta. You have asked to switch sides in the boat. You strap the wrist for every training and the creak is back by the second piece, or you sit out the race starts and tell the crew you are saving yourself. That pattern is usually a strength and load problem, and rest alone rarely changes it. It is worth measuring. If it has been months, the Stalled Recovery Review is three visits over three weeks with the same therapist.
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3. You have had surgery, or you have a date
A wrist fracture held with a plate, a De Quervain’s release, a shoulder repair or a lumbar microdiscectomy each has a shape, with protected weeks before you are back in the boat. See the Lumbar Microdiscectomy Recovery Program, hand therapy after surgery, physiotherapy after surgery and the recovery programs. All of it runs on the four stages of The Phoenix Recovery Protocol.
Next step
Find out which stage you are in
Pain is the first thing to leave. Strength is the last thing trained back, and most people go back in the boat before that part is done. One Assessment and Treatment is a single 45-minute appointment at $230, nett, no GST. Your therapist finds what is limiting your reach, your stroke or your grip, treats it in the same appointment, and you leave with your current stage and a written plan.
Prefer to phone? Each of our five clinics has its own number on the clinics page. No referral needed to book.
Related reading
Sources
- Mukherjee S, Leong HF, Chen S, Foo YXW, Pek HK. Injuries in competitive dragon boating. Orthop J Sports Med. 2014;2(11):2325967114554550.
- McDonnell LK, Hume PA, Nolte V. Rib stress fractures among rowers: definition, epidemiology, mechanisms, risk factors and effectiveness of injury prevention strategies. Sports Med. 2011;41(11):883-901.
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