One Paddler’s Achilles

On a calm July afternoon, Patrick Simard set out to paddle alone near his home in Victoria. Patrick is a skilled kayaker who likes to paddle for fitness. He has a good roll and has experience paddling and rolling a kayak in surf. He has taken a number of courses and clinics to keep abreast of effective paddling techniques and good judgment for sea-kayak touring, and over the past year, he’s concentrated on developing his offside roll.
His plan was to launch from Cattle Point and cross Baynes Channel to paddle out to Strongtide and Chatham Islands. The air temperature was about 70˚F, but the water was in the mid-50s, so under his PFD and spray skirt, he wore a 3mm wetsuit. The arms of the suit chafe a little, but Patrick puts up with it knowing that the sleeves of his suit will keep him warmer in the cold British Columbia water than a sleeveless Farmer John suit would in cold water.
The wind was calm, and the sea was smooth. Visibility was more than a mile through light overcast. The marine forecast was for continued calm weather throughout the day. The flood tide, pushing eastward from the Pacific Ocean and through the Strait of Juan de Fuca at a speed of two knots, accelerated as it curled around the southern tip of Vancouver Island. The tidal stream at Baynes Channel, well-known for its strong currents, would be running at about four knots at its peak.
Patrick launched from Cattle Point at 2:30 and headed along the Vancouver Island shore, then across Baynes Channel to Strongtide and Chatham Islands. The crossing was uneventful, and Patrick had only to make a small ferry angle to compensate for the current. After a short time exploring the shores of the islands, Patrick headed back across Baynes Channel. The tide was now flooding near its predicted maximum of four knots, and Patrick had adjusted his course to the west to make a good ferry angle that would set him on a course back toward Cattle Point.
A sea-going tug crossed Patrick’s path, and he set up to surf its wake. The waves were only two feet tall and didn’t provide much of a ride. Patrick was relaxed and unconcerned about the tug’s wake. After it had passed, he noticed a larger wake closing in on him from a different direction. Three feet tall with a breaking crest, this wake promised a better ride. The tidal current probably contributed to the wave’s steep slopes and slightly breaking crest. The source of the wake was a mystery—possibly a large freighter out in the shipping lane.
Before Patrick had time to set up for surfing, the wake hit him broadside on his right. Patrick let the crest pass beneath the kayak, but the back side of the wave was surprisingly steep. Patrick began to capsize down into the trough and prepared to high-brace into the trough as the kayak slid down the back of the wave. He had to reach well down with his paddle to reach the water. He capsized only far enough to dip his shoulder in the water; his brace kept him at the surface but didn’t right the kayak. After a quick sculling stroke to hold him at the surface, he put additional effort into a second attempt to high brace, but he lost his grip of the paddle from his right hand and capsized fully. Something had happened to his right arm. He released the spray deck and exited his kayak. He emerged and held onto his kayak with his left hand. His paddle was floating nearby, and as he reached for it, he realized that he had dislocated his right shoulder.
While in the water, he assessed his situation: He could see the tug that had made the smaller wake heading away. A sailboat, the only other vessel in the area, was also heading away from him. Although his right shoulder was badly injured, it wasn’t very painful for the first few minutes; however, with the joint between his upper arm and shoulder now distorted, his arm and hand were weak and unresponsive.
He tried to keep his injured limb very still—he held onto the boat with his left hand and held the paddle with his weakened right hand. The flooding tide was pushing Patrick out of Baynes Channel into the open waters of Haro Strait. He drifted in the current for about 15 minutes before he saw a sailboat under power approaching him from the northwest. With only one good arm, it was very difficult to hold onto the kayak and raise his paddle above the surface to signal for help, but fortunately the sailboat responded to his signal and altered course toward him. By the time the sailboat reached him, Patrick had drifted a mile or more from where he had capsized and was approaching the much-less-traveled waters bordering Haro Strait.
The skipper of the sailboat put a boarding ladder over the side, and Patrick passed over his kayak’s bow line and began the difficult task of getting up on the first step of the ladder. He had been in the water for 30 minutes but was still comfortably warm, and although he was seriously disabled, he was not in excessive pain. With Patrick and his kayak aboard, the sailboat skipper headed to shore for the emergency medical treatment that Patrick needed.
Patrick felt cold and began to shake. The pain of the dislocation increased rapidly, and his hand had grown numb. The sailboat’s small motor struggled to make progress against the current. It took another half hour before they made it to a marina in Oak Bay. At the dock, Patrick’s kayak was locked up securely before his rescuer drove him to a nearby hospital.

Lessons Learned
When we are close to home and out for an afternoon of paddling, the familiar surroundings tend to lower our perception of risk, especially if we know that emergency rescue services are readily available. Patrick had often paddled to the Chatham Islands, and for him there was nothing unusual about paddling alone across that busy channel in a current running up to four knots. This section of the Victoria shoreline is a popular area for experienced local paddlers to practice their skills, and many make the crossing of the channel to the Discovery Islands. While the area is considered by many to be the local playground, it has also been the scene of a number of kayaking accidents.
Patrick now feels that he was lulled into a false sense of security by the familiar and seemingly benign circumstances and was not sufficiently alert at the time the breaking wave arrived. He recalls being very relaxed at the time he capsized and believes that his nonchalant response to the approach of the wake resulted in a poorly executed high brace and the subsequent disabling injury.
To his credit, he had reduced the risk of cold-water immersion by wearing a wetsuit. He had also taken several kayaking courses and had practiced his skills to the point of feeling prepared to perform a self-rescue if it became necessary to do so. His training contributed to his ability to remain calm throughout his capsize and wet exit, but he was unprepared for the injury to his arm and the obstacle it created in getting back in his kayak.
Many of us train and practice to be stronger, more skillful kayakers, but fail to consider the possibility that we may be incapacitated to some degree by injury, illness or exhaustion. We regularly make a risk assessment before we depart the beach based on weather reports and tide tables, on the gear we have with us and on an assumption of normal health and fitness. Chronic or traumatic injuries to a wrist, elbow or shoulder are infrequent but common to sea kayaking. The possibility of injury should be taken into account in our training and in our assessment of risk.

Coping with Injury
It’s common to practice bracing and rescue skills in rough sea conditions, but generally we don’t practice techniques to perform self-rescues while simulating injury or other impairment. The training regimens among Greenland kayakers include a long tradition of preparing for the possibility of injury or entanglement while hunting. To recover from incidents similar to Patrick’s, they developed rolls that kayakers could do with one arm. While the variety of Greenland rolls may not be possible to perform with contemporary kayaks and euro-paddles, practicing wet exits and reentries using just one arm could provide valuable insight into coping with an injury. It would be best to learn to deploy a paddle-float or stirrup with one hand in a practice session when you’re not in a survival situation. It’s also very important that paddlers have the mental preparation and decision-making capacity to make the most of these special techniques at the time they’re needed. 

Practicing Mental Preparedness
Capsizing into the trough of a steep wave is not uncommon. A sudden high-brace into a deep trough can place a great deal of stress on the shoulders. After a failed brace or roll, the paddler’s shoulders are again at risk, as a second attempt to high brace is often aggressive and forceful and done from an awkward position. If you find yourself faced with a situation that requires a difficult high brace, allowing yourself to capsize and roll back up can be a more controlled and safer response. Patrick thinks he could have avoided the injury by not struggling to high-brace. He feels certain that relaxing, allowing himself to capsize, then rolling up would have been a simple, easy and successful alternative. Frequent practice of rolling and bracing in a wide variety of paddling conditions will help you stay relaxed and confident and better able to set up and execute a safe and controlled roll, with elbows low and close to the torso.
Physical skills are only useful when mental control is present. Practicing the mental skills that allow us to assess situations, choose plans of action and implement our best bracing, rolling, wet-exits and reentries when we need them. Practice sessions that simulate injuries, distractions, changing circumstances and limited performance times provide an excellent way to develop the mental agility necessary for effective rescues under difficult circumstances. Frequent practice will help us make assessments and decisions quickly even while under considerable stress.
Patrick had practiced wet-exits and reentries but had not prepared himself to respond to an unexpected injury. After his capsize in Baynes Channel, he didn’t think to use the pig-tail tow-line he was wearing to secure himself to his kayak, leaving his uninjured arm to raise the paddle or reach into the kayak for emergency equipment. Just as it is with physical skills we practice, the mental techniques we practice diligently will be the ones we have available at the time of unexpected circumstances.
It took three months of rest and rehabilitation before Patrick’s shoulder was strong enough for him to paddle a sea kayak. He is now paddling again, but he takes his local waters more seriously now and carries flares and a marine VHF radio.

The shoulder joint is formed by the junction of three bones: the collarbone (clavicle), the shoulder blade (scapula) and the upper-arm bone (humerus). The rotator cuff is the name given to the group of muscles and tendons that form a cuff that holds the head of the humerus in the glenoid fossa, a shallow socket in the scapula.
The structure of the shoulder joint provides an extraordinary range of motion. The only contact between the bones of the shoulder and those of the torso of the skeleton is at the joint between the clavicle and the top of the sternum, so the integrity of the shoulder joint comes almost entirely from the muscles that surround it. By allowing a wider range of motion than any other joint in the body, the shoulder is less stable than other joints, and two types of shoulder injuries are infrequent but well-known among paddlers.
Shoulder dislocations occur when there is an injury to the joint between the humerus and scapula. Shoulder separations occur when there is an injury to the joint between the clavicle and the acromion, an extension of the scapula. When a shoulder traumatically dislocates, the top of the humerus is usually displaced below and forward of its usual position in the glenoid fossa (anterior dislocation). In far fewer cases, and unlikely in paddling-related injuries, the top of the humerus is displaced to a position behind the shoulder blade (posterior dislocation).
Typically, the significant pain of a dislocation starts about five minutes after the incident. The pain starts as a dull throb and gets progressively worse. Soon after the trauma, the muscles become tight and hold the shoulder in its injured position. The muscles begin to spasm, and the victim will not find any comfortable position for the arm. Without treatment, the pain can become overwhelming, leading to debilitating shock, if not unconsciousness. 

Treating Dislocations
Occasionally an injury to the shoulder may only temporarily dislocate the humerus and allow it to return to its original position within the shoulder joint. In this case, a supportive sling will serve to minimize discomfort and prevent further injury until medical help is available. If the humerus remains out of position, there are potentially very serious complications when treating the injury. The pain and the damage will grow progressively worse, and emergency medical assistance should be obtained as quickly as possible.
A hospital or appropriate clinic will choose the best of several procedures to relocate the humerus into its shoulder socket. As with setting a broken bone, the patient will be well-medicated to relieve pain and relax the tense and spasmed muscles. Advanced wilderness first-aid courses may cover field treatment of a dislocated shoulder, but believe me, I have witnessed four anterior shoulder dislocations, and all of the victims were in severe pain. Any field treatment would have been overwhelming and excruciating for everyone involved. Typically, victims cradle their injured arm and aren’t inclined to let any non-medical person move them. Some padding and a sling to support the arm in its existing position are likely the safest—and maybe the only—options available prior to transporting the injured paddler to a medical facility.
A long process of healing and rehabilitation begins after the dislocation is treated. The patient might be paddling again in three months, and it may take up to a full year to regain normal strength and a full range of movement. The shoulder may never be quite the same again. Patients who have sustained a shoulder dislocation can develop chronic instability and often suffer recurring dislocations. It may be necessary for surgery to tighten up and/or repair torn ligaments. 

Causes and Prevention
The shoulder is most stable when the elbows are positioned well below the shoulder and are well bent. The shoulder is unstable and prone to traumatic injury when the elbows are near or above the level of the shoulder. The shoulder is most vulnerable to dislocation when the elbow is at, or above shoulder level with the elbow behind the shoulder and the arm externally rotated (palm rolled to face upward). The leverage on the arm the possibility of dislocation is further increased when the arm is extended with a straight elbow.
Imagine driving your car with your left hand on the steering wheel and your left elbow by your side. Your right arm is extended and your right hand is hooked over the top of the passenger seat; your left shoulder is in a safe position—your right shoulder is not.
In a high brace, the wrists are above the elbows. Contrary to what the name of the brace suggests, the working blade should remain as low possible, and the hands shouldn’t be much above the shoulders. The forearm closest to the working blade should remain near 90 degrees to the paddle shaft, and the elbows should be well bent and near the torso. In a low brace, the same rules for the arms and elbows apply, but the wrists are below the elbows. The very common tendency in either brace is to extend the arm closest to the working blade. That only reduces grip strength and places the shoulder in an unstable and weakened position.
The remarkable range of motion in a shoulder provides us with the ability to manipulate a paddle and control a sea kayak. Deprived of that joint’s supple strength, our independent progress comes to a stop. We should all pay heed to our shoulders and routinely practice the best exercise and paddling techniques to keep our shoulders safe and strong.


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