SUP & Your Shoulders

Jeff Orr, MD

Lake Tahoe is a SUP, standup paddleboard, paradise — 72 miles of gorgeous shoreline ringed with snowcapped peaks — an outdoor excursion good for body and soul.

Paddling is an excellent workout, targeting not only your core muscles, but also muscles throughout your entire body. Your arm, shoulder, and back muscles engage when you paddle through the water, while your leg muscles work to maintain your balance.

Like any sport or workout, there are some musculoskeletal risks related to SUP including shoulder impingement, lower back strain, and elbow pain.

Shoulder impingement occurs when inflamed/ swollen tissue gets caught in the shoulder joint leading to stiffness and pain, and is often related to repetitive rotation of the shoulder like paddling. Shoulder impingement is a common injury among swimmers, surfers, kayakers, and paddleboarders.

To help avoid shoulder impingement while paddling:

  • warmup and cooldown with dynamic shoulder mobility exercises. It’s important to target both the internal and external rotation muscles.
  • paddling in conditions appropriate for your ability helps develop the strength, balance, and flexibility needed to help avoid injury.
  • shorten the length of your paddle, lowering your top arm and reducing force on your shoulder and spine (note you may need to try a few lengths, as a paddle that is too short can strain your back).
  • pay attention to your paddle technique: keep your top hand below eye level and your top elbow below shoulder level — the lower your top arm, the less stress on your rotator cuff. Keep your bottom arm straight to force your paddle power from your core, not your shoulder.
  • keep a loose grip to avoid straining your wrists and arms while paddling.

Importantly, if you experience shoulder pain, rest and take an extended break from paddleboarding or other shoulder-intensive activities.

If you have shoulder impingement, you may find it difficult reaching behind your back or extending your arms over your head. You may also experience general shoulder weakness or a constant pain in your arm that may get worse at night.

An orthopedic physician can diagnose shoulder impingement with a physical exam and potential medical imaging, such an MRI, to rule out serious injury. Common treatments include anti-inflammatories and physical therapy to help improve your range of motion and paddling mechanics.

Jumping on a paddleboard is an excellent way to experience Lake Tahoe and get in an enjoyable workout — keep an eye on your form, paddle technique, shoulder mechanics to continue your paddle sessions well into the summer.

Dr. Jeff Orr is an orthopedic specialist seeing patients at the Barton Center for Orthopedics & Wellness in South Lake Tahoe, CA and the Tahoe Orthopedics and Sports Medicine offices in Carson City and Round Hill, NV. Learn more at or by calling 530.543.5554.

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