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ISEH consultant Dr Rick Seah gives his insight into the Olympic Sport of Canoe Slalom and its assoicated musculoskeletal injuries among elite paddlers:

"Canoe Slalom (also known as “white water canoeing”) first featured at the summer Olympics in 1972. Athletes compete to navigate a canoe or kayak through a 300m course of hanging gates in whitewater rapids, striving to achieve the quickest time possible. Time penalties are added when a gate is missed or accidentally touched, so paddlers have to aim for precision as well as speed.

In the UK, the term “canoeing” is often used generically to cover paddling in either a kayak or canoe. There are some key differences between both activities- these pertain to seating position and the paddles used. In a canoe, an athlete kneels whereas in a kayak, they sit with knees extended. To the spectator, this is not always obvious as the athlete’s legs are out of view in both canoes and kayaks. For a canoe, an athlete will use a paddle with just one straight flat blade whereas in a kayak, athletes will use a paddle with twin curved blades (i.e. one blade attached to each end).

In the United Kingdom, British Canoeing is the National Governing Body and umbrella organisation for all paddlers. This includes the other canoeing discipline in the Olympics- Canoe Sprint (or “flat water canoeing” as it occurs on calm water such as lakes).  

Recent Achievements

British Canoe Slalom has medalled at every summer Olympics since 2004. At London 2012, Great Britain won gold and silver in the men’s C2 canoe slalom final. More recently, British Canoeing hosted the 2015 ICF Canoe Slalom World Championships at Lee Valley White Water Centre in east London where double Olympic medalist David Florence won his third World Championship title in the men’s C1 event.  

Musculoskeletal Injuries

Common sites of injury among elite paddlers include the shoulders, elbows, forearms and wrists. Many are overuse injuries sustained in training, as opposed to acute injuries due to trauma (abrasions, grazes and contusions) that are commoner in the recreational paddler.

Shoulder injuries can arise from subacromial impingement and rotator cuff tendinopathy. Humeral head subluxation is also not uncommon, with a figure of up to 1 in 20 elite white water paddlers suffering a shoulder dislocation in some surveys.

Elbow injuries are mostly of an overuse nature too. These tend to occur in the more dominant/ active forearm, which makes contact between paddle and fast flowing water. Insertional tendinopathies have been noted to the distal triceps, distal biceps, common flexor and extensor origins. Tenosynovitis affecting the forearm and wrists also occur for similar reasons. Subtle changes to paddling technique and training load can be a very effective part of the rehabilitation process.

Back problems in the thoracic and lumbar spine are also noted in competitive paddlers. This may be due to a combination of high mechanical demands to both areas from repeated spinal rotation and flexion with load and/ or less than perfect posture. Hypermobility in the spine may also contribute. Problems range from recurrent soft tissue muscular spasm to pars injuries, facet joint inflammation and prolapsed lumbar intervertebral discs.

Other anatomical sites affected by the high forces generated during white water paddling include the ribcage where rib stress fractures can occur, sometimes at more than one site.

The lower limbs are not largely involved in the act of paddling, apart from muscles acting synergistically with the trunk to maintain posture and aid force generation. Injuries to this region are therefore much rarer but can still occur. In the canoeist who has to repeatedly kneel to paddle, hip impingement syndromes can occur, as can anterior knee pain and infrapatellar bursitis.

Knowledge of an athlete’s discipline and training patterns, along with close discussion with the treating therapist (often physiotherapist) and feedback from the support staff, are vital clues to what the underlying problem is likely to be. Access to the investigative tools of X-rays, ultrasonography and high-resolution magnetic resonance imaging (MRI) - such as those available at ISEH - are very helpful and ensure that the diagnosis can be confirmed in a prompt fashion."