Pain when casting

Walter & Group.........

Let's start with a note from John Bilotta:

Gordy,

 

I am glad we are discussing this topic because I think arm pain is also an issue that some students suffer from but they are sometimes reluctant to talk about.

 

 From my experience some students, particularly in a group, are often reluctant to discuss or I have not probably asked them enough health-related questions before teaching a class.  Recently I been raising the issue about hand/wrist/arm shoulder pain as side-bar of my beginning discussion about types of grips we can use in casting. The advice below was very helpful.

 

Thanks

John Bilott

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John

New casters and CCI (not MCCI) candidates are, in my experience, especially prone to get hand and wrist pain for the simple reason that they tend to grip the rod handle throughout the entire cast rather than relaxing a bit when not rapidly accelerating to a stop.

Gordy

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Gary Eaton has taken great pains to come up with a very detailed note on this subject :-

Gordy,

 As a trained Physical Medicine and Rehabilitation physician also Board Certified in Pain Medicine, I had every casting student with pain I could accommodate for many years. I wrote a few pieces for Paul Arden's web site a few years ago  - not geared to the instructor, per se.(links http://www.sexyloops.com/articles/rice.shtml  http://www.sexyloops.com/articles/howhurt.shtml 

http://www.sexyloops.com/articles/carpal.shtml )

This issue became a major topic at an advanced casting half day session with Tim Rajeff three weeks ago. Here are some elements of that exchange.

 

All motion change is grounded at one's center-of-gravity (center-of-mass). When standing it is midway along a line through the top of one's hips (femur/greater trochanter, for anatomists). If you sit to cast, that changes. Contorted stances may also change the precise location. When one attempts to initiate  or change movement contrary to what is going on there, a bigger force is required. More force, more speed, more repetitions without recovery time and more drastic changes in rate increase potential for injury. The body part at least optimal position or with the smallest mass presents as with higher vulnerability. Parts with highest mobility (joints) and their attachments serve as "weakest links" to fatigue, overload and repetitive strain. Sites of previous injury, especially if poorly rehabilitated, tend to be sentinel of new increases in force leading to re-injury or aggravation of prior sites.

 

Physiologic structures with better blood supply (muscles over ligaments) tend to recover easier from less than catastrophic injuries. Less vascular structures tend to take longer and recover less completely (lateral epicondylitis aka "tennis elbow" being a particularly enduring symptom). From this it seems logical to act for prevention and focus on 1) increasing injury resistance in joints and their attachments 2) moderation of force, duration, speed, and aggressivity of activity and 3) provide biomechanically less risky casting styles and style corrections.

 

Tim asked what modifications or recommendations I had for conditioning exercises for him after he shared his routine exercises. Reserving my comments to a general nature I suggested-

1) increase hand and wrist strength with a "roll-up" devise. A closet dowel 1.25 inches in diameter taped with a cushioning tread such as used on tennis racket handles or sticky back foam insulation. Roll-up and roll back down under very controlled pace a 2.5 to 5.0 pound weight on a rope. rest the wrist on the knee and perform one up and down rep with palms up, one with palms down, one with one palm up and one palm down, then opposite palm up and down. Repeat with the first knuckle (MCP) held against the top of the knee.

2) increase elbow and shoulder stability and control with very slow paced push-ups and bar-dips (pushing up and lowering from a chair with solid arm rests).

NOTE - I suggested no conditioning exercises with the arm raised or with the shoulder in an extremely abducted position.

 

I differentiated conditioning as not with the device (fly rod) and training as that activity performed while operating the actual tool. Along the lines of training I suggest - a heavier line weight and longer amount of line with a stiffer rod or higher line weighted rod as a strength building option BUT only for a limited number or repetitions. To reduce risk of injury go up only one or two line weights at a time and limit the length of line carried and duration of activity very severely - pain equals injury in training. Pain after conditioning may be acceptable as long there is no increase in pain with the training. If something is sore at the beginning of a training session and increases with the activity - do not proceed.

 

If building a skill such accuracy or presentation casts, increasing refinement with a lighter line and rod outfit may allow longer skill-building sessions with less chance of injury. One can overdo anything so this is not a guarantee of injury-free training.

 

From a researchers seminal work on muscle strength and decline, I recalled that it takes working a muscle to the point of fatigue once daily for six weeks to double the strength and that completely immobilizing a muscle allows decline of one percent approximately every 3 days. Daily training is not essential to prevent loss of strength. A week off, or more, may put you at risk of injury if you are too aggressive on your first few days of return to training.

 

Regarding "tennis elbow" - back cast stops with the wrist not in neutral position, especially with the reel turned away from the caster, is my pet peeve and commonly observed source of lateral elbow pain. Likewise sidearm casters are at more risk for this injury than when casting more overhead.

 

 

The following summarises some basic principles. I submitted it to another study group a few years ago -

There is tremendous specialized strength & essential general conditioning involved in casting a fly.
Generally, the intuitive truth is also practically true.

Heavier gear, longer lines, presence of wind, larger fly profile etc. require more strength to control than lighter, smaller, shorter versions. I submitted an article on these very issues to sexyloops for publication a couple of months ago but it has not been returned for edit. So, I will recap here.
Initiation of movement after the pause and initiation of stop after maximizing momentum require the greatest muscle strength. The highest requirements from my clinical & instructor observation appear to be in the trunk and hand/forearm of the rod hand. Second tier strength also fall on the rod side including anterior (front) and superior (top) of the shoulder & the upper arm into the elbow. No surprises there, I hope.

The stop originates primarily at the center of gravity (think behind and below your belly button) and spreads both toward your knees and toward your neck. The resistance of ongoing momentum comes largely from hand grip strength from the forearm acting to stabilize the rod. (screw driver work, grip ball, and putting 2 to 5 pounds on a rope attached to a closet dowel and wind-it-up and down under slow control - good hand strength exercises).

The strengthening of the center of gravity includes controlling whole body by initiating motion and maintaining control. The popular "Swiss ball" and other "core-strengthening" work should be the first focus. Stuff like sit ups, leg lifts, squats, and martial arts typically provide development of this core.

It generally takes 6 weeks of daily working a muscle to exhaustion to double strength. It generally decreases strength to immobilize a muscle and there is a formula for the rate that really is not an issue unless you're in a fracture cast.

RECOVERY RATES -
Age creates a slower recovery rate from exhaustive conditioning or injury. Other things that slow the recovery rate are smoking, nutritional deficiency, re-injury, inadequate healing time. Things that may enhance recovery are aerobic fitness, adequate rest, nutrition and blood flow, stretching and proper warm-up and warm-down.

INJURY PREVENTION -
Avoid maximum performance for prolonged periods.

Build-up to the heavier, longer, & faster demand equipment and techniques.

Slow down - rapid repetition results in more fatigue, less control and a more likely adverse biomechanical demand that leads to significant injury (see recovery rate).

A PLAN -
Stretch when warm.
Don't start without a warm up.
Stay fit in every way. Walking and running to elevate heart rate (Search for "Talk Test" for a practical guideline) is the simplest aerobic method.
Plan way ahead - 10 weeks minimum before your salt water trip introduce the 7 weight and be ready to get the nine weight involved in 3 or 4 weeks.
Go Slow - if you develop a pain that does not recover by the next day, back-off a little or skip the rod work and go for a longer walk that day.
The best training is with the actual device but that doesn't mean it's complete training.

Use a larger rod grip - it requires less grip power - I like a Full Wells for this reason.
Use a lighter rod - I like companies that offer a full line of rods- The greater costs seem to follow the lighter weight but, I tolerate the lighter units for a longer time.
Use a shorter carry and longer shoot - easier to control the momentum.
Avoid longer levers for longer line carry - the 10-foot rod has a moment-arm and much greater swing-weight than the eight and a half of the same weight and line designation.

(Caveat is that for a much lighter line weight, the lever advantage of the longer rod may require less effort.)
Accept your limits - I have a few extra bone pieces in my casting shoulder. I will not be competitive in a five-weight contest & choose a nine weight over 10 or 11 on the flats.

I hope this is useful to you. I will be glad to answer specific questions. Gary Eaton

Regarding Seated Casting

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You make an excellent point. Jack LaLanne <http://www.jacklalanne.com/,> , the fitness guru, told me one time that changing your entire routine every six weeks was essential to balancing joint forces as an injury avoidance mechanism. The seated casting recommendation fits that same challenge.

HALF THE AVAILABLE STRENGTH -
One reduces their power base by half when going from standing to sitting for the cast. The legs and pelvis probably account for close to 50% of the muscle mass and energy consumption of standing casting at the stop and start around RSP. I use the same theory doing "half rod" drills; no more than half as long, less than half the distance.

TRY NOT TO HURT YOUR STUDENTS -
A very important caution is to go to a lighter line weight and shorter cast distance when making this transition (stand -> sit) to prevent overload injury. I would also caution that reducing the time that one is performing seated casting is important to reduce fatigue related biomechanical failures.
The glycogen (sugars = energy) storage of a muscle is related to it's mass. The above-the-diaphragm muscles are generally much smaller than those below the diaphragm (base of the rib cage). Therefore, they fatigue faster and develop lower energy with lower available oxygen faster. When they shift to this less aerobic (more anaerobic) energy source, sustained activity becomes more time limited. The slightly more acidic products (lactic acid) of anaerobic metabolism also create a less favorable internal environment for connective tissue recovery, especially tendons and ligaments. The longer anaerobic activity is sustained, the greater the risk of tissue damage, generally speaking.

HOW LONG A BREAK -
A second caution for all instructors is that upper body & arm repetition, aerobic activity causes greater increases in blood pressure than whole body activity over the same time. This could be an issue if your student has known heart or blood vessel disease, including high blood pressure or stroke. My instructor rule-of-thumb is to break for twice as long as we worked before starting another activity. This gives me time to demonstrate, describe theory and technique and discuss application of techniques to real fishing situations. If you need a longer break, try practicing tying knots, demonstrating different rod actions or go through your fly box, watch a video, etc. Give your students permission to take their own break if they feel fatigue, pain or less control.

DECIDING WHEN TO BREAK -
When I see students stop casting and shake their arm, stretch, or move the rod out of their casting hand, I start looking for a reason to have everyone stop. I have students put their rods down during this phase so they can pay attention and truly rest their grips. This is easy but, a better method is to watch for the casting loops to deteriorate. I like this better because a shorter break is involved and they have fewer repetitions with bad mechanics and less reinforcement of incorrect "muscle memory".

(An ounce of prevention is worth a pound of cure).

RESUMING CASTING AFTER A LONG BREAK -
Start short and slow for a few casts then, start the new activity.
Stretching is much more effective at preventing injury if done in a sustained fashion after warming-up. As an example-

"That video was a pretty good clip, I think. Everyone try to get 7 perfect loops at 35 feet then set your rod down." "Great! Gary, you can stop now. Good Effort!"

"Some of those loops were perfect and everyone is improving."
"Let's stretch together. Put you casting hand behind your head, grab your casting hand with your line hand and apply a little pressure toward you line hand side and breath in and out for ten full breaths."
"Great! Now go the other way."
"Good! Now press your fingertips together and make your palms touch bring them over your head, point your fingertips back and then bring your thumbs slowly down the middle of your face to your belt and back up to your chin." "Good! Pick up your rods and let's do something new." - Resume the lesson. Maybe seated?
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(To A specific member)
You have very good sense and rational approach. This just gives rationale to your method. As I said in my first post on this subject - the intuitive truth is also practically true. It is very practical not to take students into discomfort, if you want repeat business or recommendations for your services.

Group classes give you some authority to keep everyone paced properly. I greatly enjoy giving individual lessons and that is what I provide over 90% of the time.

The dynamicindividual student often makes very specific demands.

If they are type A, have a trip looming or are a little impulsive; there can be trouble.

For this reason and to give breaks, I have some favored video clips to have them watch. I stop them to tie on a new piece of yarn and sometimes that knot takes 4 or 5 minutes.

I have even "accidentally" clipped the leader to force appropriate rest.

I often appear without a rod so I can "borrow" my student's gear to show a skill (another enforced break).

I may have them try it with a rod carrying "more visible" line (orange, chartreuse or white, for example). It takes a few minutes to rig the reel spool & re-string the rod.

I have never had anyone go away saying they learned less than "a lot". I never had anyone tell me they didn't have some fun or find something to laugh about. I think people are wonderfully special and become more interesting as they learn to fly fish.

That is pretty long for now-

 

Gary

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As an orthopaedic sugeon, I find your advice sterling !  Often, we've had patients upon whom we were almost ready to recommend elbow, wrist or shoulder surgery when our more conservative methods such as some you outlined above plus time served well allowing us to avoid operation.

Most of these "injuries" are not from one incident or even a moderate number of repetitions, but are inflammatory or sprain patterns from rapid, repetitive, or too forceful applications of power ..... or a combination.  Even when rotator shoulder cuff tears occur, we find they usually are of varying severity and are "atretic" tears which means a sort of wearing out and fraying of the tendons.  Few represent tendons / cuffs or muscular attachments which are literally ripped asunder ..... so most do not require surgical repair.

All this is getting closer and closer to Ally Gowans' concept of efficient fly castinng being best performed according to ergonomic principles.  (Do it as easily as you can using methods which don't overtax your muscles.)

These messages should take plenty of time to study and "digest".  For that reason, I'll wait to come in with another detailed message from Guy Manning on the relationship between painful arms and casting style.

Gordy