From Kayaking to Paddleboarding: Orthopaedic Care and Injury Prevention for Water Sports Enthusiasts

There’s nothing like being out on the water—gliding across a glassy lake on a paddleboard, navigating a winding river in a kayak, or exploring the coastline by canoe. These summer pastimes aren’t just relaxing—they’re also great for your overall fitness, building upper body strength, balance, and cardiovascular health. But like any sport, water sports come with some orthopedic risks.

At Atlantic Orthopaedics & Sports Medicine, we see a range of water sports–related injuries every year, from overuse strains to acute trauma. The good news is that many are preventable with the right conditioning and technique—and very treatable if they do occur. Both Dr. Abigail Boduch and Dr. Andrew McMahon specialize in treating sports-related injuries and conditions, with a focus on reducing pain and getting patients back to the activities they love. Dr. McMahon has served the seacoast community as a Primary Care Sports Medicine provider and served as team physician for a number of local high school teams, while Dr. Boduch is an orthopedic surgeon (and paddle board enthusiast) who specializes in the treatment of tendon, ligament, and cartilage injuries, as well as trauma care focused on fractures of the extremities. Dr. Tyler Welch is an orthopedic surgeon and partner at Atlantic Orthopaedics who also specializes in Sports Medicine, with a focus on Arthroscopy of the knee, shoulder, and hip

Whether you’re an experienced athlete or just getting started with water sports, here’s what to watch for, how to avoid common injuries, and how we can help if something goes wrong.

Common Water Sports Injuries (and How to Prevent Them)

1. Rotator Cuff Strains and Tears
Shoulder pain is one of the most common complaints among kayakers and paddleboarders. Repeated overhead paddling motions, especially without proper technique or warm-up, can strain or even tear the rotator cuff—the group of muscles and tendons that stabilize your shoulder joint. Atlantic Orthopaedics partner Dr. Mayo Noerdlinger specializes in injuries of the shoulder, encouraging his patients to take an active role in their treatment. An advocate of opioid-sparing surgery, Dr. Noerdlinger uses novel pain-relieving treatment options to hasten the recovery process.

Prevention:

Warm up shoulders and arms before heading out

Use proper paddling technique—avoid overreaching or poor posture

Strengthen shoulder and upper back muscles with resistance exercises during the off-season

Treatment Options:

Rest, Ice, Compression, and Elevation (RICE) for minor strains

Physical Therapy to rebuild strength and improve flexibility

Corticosteroid Injections to reduce inflammation

Surgical repair in the case of full-thickness tears

2. Elbow Overuse Injuries (Including Tennis Elbow)
Holding a paddle for extended periods, especially with a tight grip or poor wrist alignment, can cause overuse injuries like tennis elbow (lateral epicondylitis), which involves inflammation of the tendons around the elbow. Hand and upper extremity surgeon Dr. Maximilian Meyer has years of expertise in treating both acute elbow injuries and chronic conditions. His philosophy centers on listening to and working together with patients to create individualized care plans – both surgical and non-surgical – that help you return to an active lifestyle as quickly as possible.

Prevention:

Avoid a death grip on the paddle—relax your hands

Strengthen forearm muscles with light weights or resistance bands

Mix up your activities to avoid repetitive strain

Treatment Options:

Rest and anti-inflammatories

Elbow braces or straps to relieve strain

Physical Therapy with eccentric strengthening exercises

Steroid or PRP injections for more stubborn cases

Elbow surgery in the event of serious injury

3. Foot and Ankle Injuries

From the sudden jolt of a fall from a jet ski to the subtle wear-and-tear of beach running, your feet and ankles take a beating during many popular water sports. These joints are crucial for balance, propulsion, and impact absorption—making them particularly vulnerable in fast-paced or high-impact environments like surfing, jet skiing, waterskiing, and beach volleyball. From ankle sprains to Achilles tendon tears to “Turf Toe” (a sprain of the big toe joint), ankle and foot injuries are some of the most common when it comes to water sports.

Prevention:

Warm up and stretch before getting on the water

Wear appropriate footwear (water shoes, board shoes, or sport-specific bindings)

Strengthen foot and ankle muscles with balance exercises, heel raises, and resistance band work

Be cautious on wet, slippery surfaces—many injuries happen on docks, boats, or shorelines

Treatment Options:

RICE (Rest, Ice, Compression, Elevation)

Ankle bracing or taping for support during recovery

Immobilization in a boot or cast

Physical therapy to restore strength and stability

Surgical repair in cases of severe ligament tears

4. Lower Back Pain and Muscle Strain
Poor posture, weak core muscles, or long hours kneeling or sitting can lead to lower back discomfort—especially for paddleboarders and kayakers. Water sports like wakeboarding and waterskiing can also result in muscle strain or injury. If you suffer from persistent lower back pain, there are non-surgical treatments that can help. Dr. Andrew Lehn is a board-certified interventional pain management provider uses spinal injections and other interventional and opioid-sparing treatments to alleviate back pain and get patients back to doing the activities they love.

Prevention:

Incorporate core exercises like planks, bridges, or Pilates into your regular routine

Sit tall while paddling and avoid slouching

Alternate between sitting, kneeling, or standing to give your back a break

Treatment Options:

Heat or ice, depending on the cause of pain

Physical Therapy focused on core strength and flexibility

Spinal Injections to alleviate pain

5. Wrist and Hand Injuries
Whether you’re gripping the throttle of a jet ski, maneuvering a sailboat, or paddling your way through a river, your hands and wrists are working hard. These small but essential joints are involved in nearly every water sport—and because of that, they’re also vulnerable to overuse, strain, and acute injury. If hand or wrist pain is persistent, worsening, or accompanied by numbness, weakness, or swelling, it’s important to get a proper diagnosis. Dr. H. Matthew Quitkin specializes in treating conditions of the hand and wrist, including fractures, tendon injuries, nerve compression syndromes (Carpal Tunnel and Cubital Tunnel), and overuse syndromes (Tendinitis, Tennis Elbow).

Prevention:

Adjust your grip—keep wrists neutral and avoid bending too far forward or back

Take breaks to shake out and stretch your hands

Use ergonomic paddles, grip pads, or sailing gloves

Treatment Options:

Wrist splints to reduce movement

Ice and anti-inflammatory medication

Corticosteroid injections for inflammation

Surgery for persistent carpal tunnel syndrome

6. Knee Pain and Meniscus Injuries
Jet skiing, surfing, and waterskiing can all place stress on your knees. The knees act as shock absorbers and stabilizers, constantly adjusting to shifts in motion and impact from waves, jumps, and turns. A rapid pivot, a forceful landing, or an unnatural twisting motion—such as falling while your foot is still anchored in a waterski or planted during a hard turn—can tear the meniscus. In some cases, these movements may also strain or injure surrounding ligaments, like the ACL (anterior cruciate ligament), or cause patellofemoral pain syndrome, which involves irritation under the kneecap. If pain or swelling in the knee persists, don’t ignore it. Early treatment can make a significant difference in recovery. Dr. Michael Morwood is an expert in treating knee conditions, including fractures and injuries due to trauma. And Dr. Akhil Sastry is an orthopedic surgeon specializing in partial and total knee replacement. Dr. Sastry was among the first 15 surgeons worldwide to perform a robotic-assisted total knee replacement and has since performed the surgery over 1,000 times.

Prevention:

Strengthen the muscles that support your knees—quads, hamstrings, and glutes

Practice proper landing mechanics, and use well-fitting equipment, including bindings or knee supports if needed.

Stretch hips and hamstrings to improve mobility and reduce strain

Treatment Options:

Rest and elevation for swelling

Targeted rehab exercises with a physical therapist

MRI evaluation for suspected structural injury

Arthroscopic surgery for severe meniscus tears

When to See a Specialist

Many water sports injuries start small—but they can become serious if they aren’t evaluated. If you experience persistent pain, numbness, swelling, or weakness after water sports, it’s time to check in with an orthopedic provider. Early diagnosis and treatment can keep minor issues from turning into long-term problems.

At Atlantic Orthopaedics & Sports Medicine, our entire team of doctors, physician assistants, and support staff are here to help get your body back in motion and feeling great so you can enjoy a pain-free summer season. From conservative treatments like physical therapy and injections to advanced surgical options, we’ll create a treatment plan tailored to your activity and goals.

Love the water? We’ll help you stay strong, safe, and ready for your next adventure. Schedule an appointment today.

Platelet-Rich Plasma (PRP) Injections Help the Body Heal Itself

What Are Platelet-Rich Plasma (PRP) Injections?

PRP injections are a treatment that separates the platelets in a patient’s own blood and uses them to promote healing. A small sample of blood is collected and placed in a centrifuge, a machine that spins at high speeds to separate the platelet-rich plasma from the other components, like red and white blood cells. Guided by ultrasound imaging to ensure accuracy and precision, the concentrated PRP is then injected directed into the affected area. The entire procedure takes about an hour.

Post-injection care may mean avoiding certain movements or activities for a period of time to optimize the healing process and minimize potential side effects. It’s normal for the injection site to become inflamed and may be quite painful for one to three days following treatment. The swelling and soreness are part of the healing process, and patients should avoid taking anti-inflammatory medication like Aspirin or ibuprofen, which can make the injection less effective.

What conditions do PRP injections treat?

PRP injections are frequently used to treat musculoskeletal injuries and orthopedic conditions like tendonitis, ligament sprains, bursitis, and partial rotator cuff tears, and tennis elbow. The injections can also be used to reduce joint pain, stiffness, and inflammation caused by arthritis.

How long will it take for me to see improvement?

Because the bioactive substances in the platelet-rich plasma need time to stimulate tissue repair and cellular regeneration, it can take a few weeks to start noticing the effects of PRP injections. Patients with musculoskeletal injuries like tendonitis or ligament sprains may experience improved functionality and pain relief quicker than patients with more severe or chronic conditions. Factors like age, overall health, and adherence to post-injection instructions all influence the speed of the healing process. It’s crucial to follow your doctor’s recommendations to maximize treatment benefits.

We recently sat down for a Q&A with our Sports Medicine provider and PRP expert, Dr. Andrew McMahon.

Q: In your own words, how does this procedure benefit your patients?
A: Platelet-rich plasma (PRP) therapy uses injections of a concentration of a patient’s own platelets to accelerate the healing of injured tendons, ligaments, muscles and joints. In this way, PRP injections use each individual patient’s own healing system to improve musculoskeletal problems.

Q: Who is a good candidate for a PRP Injection?
A:

Patients with overall good health
Patients with mild to moderate arthritis, partial tears, or chronic wear and tear injuries
Patients with decreased function due to pain, stiffness, or lack of mobility
Failure with more conservative treatment methods

It’s important to note that while PRP injections are generally considered safe, they may not be suitable for everyone. The treatment can’t be used if the tendon is torn completely and though PRP injections can address symptoms of arthritis, they can’t reverse pre-existing damage. The treatment’s efficacy and appropriateness depend on the specific condition being treated and individual patient factors. It’s important to consult with a specialist to evaluate whether PRP injections are appropriate for your specific needs.

Q: Where do you perform this procedure?
In our Portsmouth, NH office only, some of the surgeons use it intraoperatively.

Q: Do you have a recent patient success story you can share?
A: Recently, I have had a lot of success with PRP treating knee arthritis. Peter S. is a 68-year old gentleman who is very active in tennis/pickleball and is an avid skier. His moderate arthritis has given him a lot of stiffness and some pain which resulted in him cutting back on these activities at times, affecting his happiness and mental health. He had a consult for treatment options and we ultimately opted to inject PRP into both knees. Within 4 weeks, he had regained a significant amount of his function and he was able to play more tennis, and he successfully took a week long ski trip to Colorado.

Q: Anything else you’d like current or future patients to know about this procedure and how it would benefit them?
A: In the appropriate patient, PRP can offer a nice treatment option for patients with musculoskeletal problems who have failed conservative treatment options like PT, bracing, and cortisone injections. PRP can help heal soft tissue injuries (a torn tendon, for example), potentially avoiding surgical repair. PRP also provides patients with arthritis a treatment option that decreases pain and increases mobility and function. It typically lasts 2-3 times longer than cortisone injections and does not contribute to deterioration of the joint like a cortisone injection can.

Think PRP Injections may be right for you? Schedule a consultation with our specialist Dr. McMahon to learn more.

Pain Relief for Rotator Cuff Tears–Introducing the Stryker InSpace Balloon

What is a Rotator Cuff Tear?

The rotator cuff is a group of four tendons that surround and stabilize the shoulder joint, connecting the muscles of the upper arm to the shoulder blade. When a rotator cuff tear occurs–from acute trauma, repetitive stress, or degeneration over time–the tendon becomes separated from its attachment point on the bone. Rotator cuff tears are painful and cause weakness in the joint and limited shoulder mobility. Common symptoms of a tear include difficulty lifting your arm, a popping or crackling sensation in the shoulder, and pain both at rest and with movement.

Unfortunately, rotator cuff tears don’t heal on their own. If an untreated tear results in arthritis in the joint, patients often require shoulder replacement surgery, but for patients who still have shoulder function and haven’t developed arthritis, there is a less invasive treatment option called the Stryker InSpace Balloon.

What is the Stryker InSpace Balloon?

The Stryker InSpace Balloon is a medical device used to treat rotator cuff tears. It’s made of biocompatible material–a substance that can be implanted in the body and tolerated without damaging existing tissue. The balloon creates more space within the subacromial area–the space between the bone at the top of the shoulder and the ball of the shoulder–reducing compression and friction caused by the torn rotator cuff.

What’s involved in the procedure?

The Stryker InSpace Balloon is placed arthroscopically, using a small incision and the guidance of a camera to precisely place the deflated balloon in the subacromial space. The balloon is then inflated with a sterile saline solution, causing it to push the acromion away from the rotator cuff tendons. This reduces impingement on the injured tissues to restore function and alleviate pain.

The procedure is minimally invasive and performed on an outpatient basis. Recovery time varies, depending on the individual patient and the extent of the injury, and rehabilitation may include physical therapy to help restore strength and mobility in the shoulder.

How do I know if the Stryker InSpace Balloon can help me?

If you’re experiencing shoulder pain, or have been diagnosed with a rotator cuff tear, it’s important to consult with a shoulder specialist as soon as possible. The specialist will evaluate your injury and medical history, and may recommend the Stryker InSpace Balloon procedure as a treatment option.

Below is our Q&A with Dr. Noerdlinger, an orthopedic surgeon specializing in the shoulder. Dr. Noerdlinger is a partner at Atlantic Orthopaedics with extensive experience performing the Stryker InSpace Balloon procedure.

Q: In your own words, how does this procedure benefit your patients?
A: This is a pain relieving procedure.

Q: Who is a good candidate for the Stryker InSpace Balloon procedure?
A: The procedure is indicated for patients with irreparable rotator cuff tears, with good shoulder function and minimal to no arthritis.

Q: Where do you perform this procedure?
A: I perform the procedure at NECOS (New England Center for Orthopaedic Surgery) in Portsmouth, and York Hospital in Maine.

Q: Do you have a recent patient success story you can share?
A: I performed the Stryker InSpace Balloon procedure on a 67 year old man with years of pain and an unfixable rotator cuff tear. He described his shoulder as getting worse despite physical therapy and injections. He had pain with an active range of motion, and stated his shoulder was 30% normal. Four months after his February surgery, he described his pain as a 2 out of 10 on a daily basis and rated his shoulder as 60% normal.

I also treated a 73 year old female patient who came to me with pain from an irreparable rotator cuff tear. She described her shoulder as 40% normal before the procedure and 70% normal 3 months after her March 1st surgery.

Another patient, a 60 year old man with bilateral irreparable rotator cuff tears, had the balloon placed in his right shoulder on March 1st, and his shoulder improved from 20% normal to 65% normal in 6 weeks. He then underwent left shoulder balloon placement May 10th.

Q: Anything else you’d like current or future patients to know about this procedure and how it would benefit them?
A: The rotator cuff is the one structure that, when torn, causes the most pain and dysfunction in the shoulder. Rotator cuff tears do not heal, get bigger over time, become unfixable, and cause arthritis. Rotator cuff repair surgery is very successful and can restore normal, pain-free function.

If the rotator cuff is irreparable, the painful shoulder is often treated with a reverse shoulder replacement. For patients with unfixable, painful rotator cuff tears with little to no arthritis and good function, an InSpace balloon is a good option.

If you’re suffering from shoulder pain from a rotator cuff tear that hasn’t responded to treatments like injections or physical therapy, schedule an appointment to find out if the Stryker InSpace Balloon procedure is right for you.

What is Collagen Augmented Rotator Cuff Repair?

Rotator cuff injuries are one of the most common causes of shoulder pain, affecting more than 2 million Americans each year. If you have a partially torn rotator cuff that hasn’t responded to non-surgical treatment like physical therapy and cortisone injections, you may be a candidate for a procedure called Collagen Augmented Rotator Cuff Repair, performed by our shoulder specialist Dr. Noerdlinger.

What is the rotator cuff?
Shoulders are not singular joints, but rather a complex arrangement of bones, cartilage, ligaments, muscles, and tendons. The rotator cuff is made up of four muscles, connected by tendons, that originate from the shoulder blade (scapula) and attach to the upper arm bone (humerus) to form a cover, or “cuff.” The rotator cuff provides stability to the shoulder joint and helps the arm lift and rotate.

What causes a rotator cuff tear?
A rotator cuff tear happens when the tendons pull away from the bone. With a partial tear, the tendon remains attached to the bone and with a full tear it separates from the bone completely. Tears most commonly happen as a result of normal wear and tear due to aging, with people over 40 at greatest risk. A tear can also be caused by an acute injury like a fall, from repetitive shoulder movement from jobs like carpentry or painting, or from sports like tennis or rowing. Untreated, a rotator cuff tear can worsen over time and may lead to chronic shoulder pain and limited range of motion.

How do I know if I have a rotator cuff tear?
The most common symptom of a rotator cuff tear is pain. A tear can also cause weakness in the arm and shoulder, difficulty raising your arm or lifting something, and a clicking or popping sensation in the shoulder. You may also experience swelling or tenderness in the shoulder joint. If you think you have a rotator cuff tear, a doctor will need to perform a physical exam and may confirm your diagnosis with an x-ray, MRI, or ultrasound.

What is Collagen Augmented Rotator Cuff Repair?
Collagen augmented rotator cuff repair is a surgical technique that uses a collagen implant to reinforce the rotator cuff repair. The implant is made of a biologically derived material similar to the collagen found in human tissue. It’s designed to provide additional strength and support to the healing tendon, reducing the risk of re-tear. The postage-size collagen patches are absorbed by the body within about 6 months, and patients generally experience shorter recovery times than with conventional rotator cuff surgery.

We recently sat down with shoulder specialist Dr. Noerdlinger and asked him a few questions about this procedure.

Q: How does this procedure benefit your patients?
A: Collagen implants can lead to quicker recoveries. Adding collagen facilitates the biologic healing of torn tendons in certain situations. They are used in two situations:

To repair a partially torn rotator cuff tendon. In this scenario, the collagen is laid on top of the partially torn tendon. The implant blends in with the thinned rotator cuff tendon, thickens it and allows it to heal. Patients, with partial tears, do not need to wear a sling after surgery.
To augment a repaired shredded tendon that may not heal on its own, particularly in the setting of a revision rotator cuff tear when the tendon did not heal after the first surgery.

Q: Who is a good candidate for the Collagen Augmented Rotator Cuff Repair Procedure?
A: Not everyone is a candidate for this procedure. Patients with irreparable rotator tears would not qualify for this procedure. Also, patients with good tissue may not need to augment their repairs.

Q: Where do you perform the Collagen Augmented Rotator Cuff Repair procedure?
A: The procedure requires anesthesia and is performed arthroscopically at NECOS and York Hospital.

Q: Can you tell us about a success story?
A: I recently saw a 56 year old female with worsening constant shoulder pain since April 2022. I performed a Partial Rotator Cuff Repair with collagen implant in January of 2023. She was seen in early March of 2023 and reported to be doing well with minimal complaints of pain.

NOTE: Shoulder surgery has a long recovery and often people take 4-6 months before they feel great. Having an expert shoulder surgeon like Dr. Noerdlinger may help speed up recovery.