Overuse Injuries in Fly Fishing: Recognition and Injury Prevention

Seth L. Sherman, MD, Taylor Ray, BS, and Mark F. Sherman, MD

Fly fishing is increasing in popularity amongst ‘die hard’ enthusiasts and recreational anglers. Fly fishermen often learn the casting motion early in childhood and they continue to enjoy the sport throughout their lifetime.1 A recent survey performed by the U.S. Fish and Wildlife Service found that 34 million anglers fish 16 or more days a year, equal to 16% of the U.S. population greater than 16 years old.1,2

Despite common misconceptions, fly fishing should be considered a “throwing” sport. Fly casting requires a complex and coordinated set of body motions to accurately and efficiently land the fly (or artificial bait) in the vicinity of a willing adversary (i.e., a hungry fish). The combination of high velocity, repetitive, overhand movement common to fly-casting predisposes the angler to injury similar to other overhead athletes (i.e., baseball players). In fact, fly fishing is unique in that it requires fluid throwing motion in both a forwards and backwards direction. This increases stress on various parts of the body and puts anglers at risk for overuse injury.1,2

Researchers at Montana State University performed a survey of 292 fly-fishing instructors. In total, 50% reported shoulder pain, 39% reported elbow pain, and 36% reported wrist pain, while 74% reported pain in at least one of these locations (i.e., shoulder, elbow or wrist).2 Those who fish for heavy saltwater fish (i.e., tarpon) have a higher prevalence of severe pain after casting when compared to fresh water angling (i.e., trout). This makes intuitive sense in that casting for tarpon involves periodic long casts with heavier flies and equipment. In fact, 31% of those who fish for heavy saltwater fish reported moderate-to-severe pain after casting as compared to 19% of those who have not, a significant difference.2

Montana State researchers also conducted a biomechanical study of the fly fishing motion that compared amateurs to expert casters. Those who fished 10 days a year or less showed a significantly higher wrist velocity than shoulder or elbow velocities, while more experienced fishers exhibited a much higher shoulder velocity.3 These interesting results help us to understand the development of common overuse injuries in the sport. Amateurs with relative poor form may overload at the wrist causing a common form of tendonitis (i.e., Dequervain’s tenosynovitis). Experts more commonly experience injuries to the shoulder (i.e., rotator cuff) or elbow (i.e., tennis elbow) following years of repetitive casting.2,4

Similar to other sports, there are important considerations to improve fly fishing performance and to reduce injury risk. Appropriate equipment should be obtained at licensed fly fishing outfitters. Beginners should consider learning proper technique at a designated fly fishing school or by hiring a licensed fly fishing guide. Proper casting technique combined with postural stability are critical to maximize success and minimize injury. Other factors such as rod and line balance, casting method, and grip style may also help mitigate risk.1

Proven injury prevention techniques include maintaining overall fitness and hydration, stretching and strengthening of the shoulder and forearm, maintaining core strength, and balance.1 A pre-fishing warm-up program and scheduled breaks may reduce risk. Importantly, anglers must listen to their bodies. PAIN IS NOT GAIN—please consult a healthcare professional if you experience pain while fly fishing and it is limiting your enjoyment of the sport.

Tight Lines!


  1. Mitchell T. Gone Fishing: Overuse injuries in fly fishing. 2017. Available at: http://www.working-well.org/articles/pdf/Fishing.pdf Accessed April 29, 2019.
  2. McCue TJ, Guse CE, Dempsey RL. Upper extremity pain seen with fly-casting technique: a survey of fly-casting instructors. Wilderness Environ Med. 2004;15:267-273.
  3. Allen JR, O’Keefe KB, McCue TJ, Borger JJ, Hahn ME. Upper extremity kinematic trends of fly-casting: establishing the effects of line length. Sports Biomech. 2008;7:38-53.
  4. Hartwick J. Fly fishing and shoulder pain. 2010. Available at: https://www.reboundsportspt.com/fly-fishing-and-shoulder-pain/ Accessed April 29, 2019.