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COEUR D'ALENE, Idaho -- The sport of fly fishing conjures up
images of a solitary angler, wading in a cool, pristine
wilderness stream, using guile to entice an unsuspecting fish
to bite on his hand-crafted fly.

While that image may seem idyllic and serene, a new study by
a Duke University Medical Center orthopedic surgeon reveals a
more pedestrian truth -- this Zen-like experience with nature
often leads to the same maladies experienced by much more
competitive sportsmen such as golfers and tennis and baseball
players.

While the nature of these sporting pursuits is quite
different, common to all is that participants use repetitive
arm motions and spend the bulk of their time standing. And just
as interestingly, the remedies for the fly fishermen are the
same -- staying in good general shape, paying attention to
technique and using the right equipment.

The study, which was conducted by avid fly fisherman Dr.
Keith Berend, chief orthopedic resident at Duke, looked at the
health and fishing habits of 131 fly fishermen and found that
69 percent reported lower back pain, up to a quarter reported
pain in their hands and wrist, shoulders and knees, and 18
percent reported elbow pain.

"The sport of fly fishing is growing in popularity, and this
study was an attempt to get a better handle on the types of
maladies we are seeing more often in orthopedic clinics,"
Berend said. "The results demonstrate that these maladies seem
to mirror those seen in other, more studied recreational
activities."

Berend prepared the results of his analysis for presentation
Thursday (July 19) at the annual meeting of the Southern
Orthopedic Association.

Not only is this study believed to be the first to look at
the aches and pains specific to fly fishermen, the results
substantiate the use of the Internet as a valid tool for
gathering data for analysis, Berend said.

For his study, Berend posted a notice on the top 10 Web
sites frequented by fly fishing enthusiasts that he was
conducting a study of physical ailments of fly fishers. During
the one-month period of the study, 89 anglers requested and
completed the detailed questionnaire about their health status
and fishing habits.

As a control, Berend went to a monthly meeting of the North
Carolina chapter of Trout Unlimited, and asked those fishermen
in attendance to complete the same questionnaire. Forty-two
members did so. Statistically, there was little difference
between the two groups in terms of age or prevalence of the
different ailments, leading Berend to conclude that the
information collected via the Internet and e-mail was indeed a
representative sampling of fly fishermen.

"I was surprised to learn that there was no correlation
between the numbers of days per year the people fished and the
pain they suffered," Berend said in an interview. "Also, there
didn't seem to be a correlation between age and physical
complaints."

For shoulder, elbow and wrist pain, the repetitive motion
involved in maintaining the fly far from the fisherman and
keeping it active to mimic a live insect or bait, leads to
complaints that are similar to ailments experienced by tennis
and baseball players.

"Simply put, repetitive motions in general can cause
problems," Berend said. "It is even worse if this repetitive
motion -- whether during fishing or tennis -- occurs intensely
and sporadically, much like the typical weekend warrior who is
only active on weekends. Staying in shape on a continual basis
should help reduce the level of these pains."

The back and leg pains experienced by the fishermen stem
from a number of factors, Berend explained. Many fly fishermen
stand on rocky and uneven surfaces in fast-moving waters while
they fish, which can cause stresses on the leg and lower back
over long periods of time. Also, since the fishermen typically
stand in the middle of a stream, they carry much of their gear
in or on vests for easy access.

"Some fishermen load their vests with too much weight to
save trips back to the shore, while others wear vests that do
not equally distribute the weight across the body," he said.
"In these cases, I would recommend switching to the newer,
better designed vests and not carrying so much weight."

The method used for casting, or presenting, the bait to the
fish can also create pains in the shoulder, he continued. The
fisherman typically uses the pole to gather the energy
necessary to propel the bait a great distance. Just as in
pitching a baseball, improper technique can lead to shoulder
pain, Berend said.

The study found that saltwater fishermen, who typically use
heavier equipment, had much higher rates of shoulder and elbow
pain, than their freshwater counterparts.

While he plans further studies to look at the actual
mechanics of casting, Berend believes that improper casting
technique, possibly coupled with the actual properties of the
rod itself, can lead to the shoulder pain.

"We are planning to conduct detailed electromyographic
studies of the shoulder muscles, as well as three-dimensional
biomedical analysis of technique, to better understand the
actual mechanics of the cast," Berend said. "With that
knowledge, we hope to be able to come up with strategies to
prevent or reduce pain and increase performance, like we have
done for other sports."

These studies will be conducted in the Michael W. Krzyzewski
Human Performance Lab at Duke.