Injuries during Sailing
by Dr Anthony Theodorides*, Consultant Trauma and Orthopaedic Knee Surgeon Athens, Greece
Sailing has been a mode of transportation for thousands of years and has been a recreational and competitive sport for hundreds of years. The sport of sailing covers a wide spectrum of boats and activities from recreational sailing on a lake to around the world ocean racing. The size and crew on a boat vary from single person 2.4m dinghy to the 23m America’s Cup boats which have a crew of 11. Injuries are dependent on the physical demands placed on the sailor, which in turn depends on the type of boat, crew position, and environmental conditions. Broadly speaking sailboats can be categorised into dinghies and keelboats. Dinghies require a sailor spend significant energy and time levering their body over the side of the boat (called hiking) to prevent it from capsizing whilst harnessing the wind to make the boat go faster. Keelboats on the other hand require the sailor to physically turn winches (called grinding) to pull in lines under tension.
Injuries in small boats
Injuries can be due to inadequate physical fitness, acute trauma or from overuse injuries. Many movements in sailing are sudden short powerful bursts which predisposes the sailor to injuries due to inadequate warm up. Hiking exerts large stresses to the knee and lumbar spine putting them at risk injury. In Laser sailing the hiking position is with a mainly extended knee which puts greater moment loads on the knee and lumbar spine but reduces the sheer forces on the knee. However, in Finn sailing the knee is more flexed thus reducing the moment loads on the knee and spine but increasing the sheer forces on the knee. The foot position whilst hiking alters the forces around the knee with an internal rotated position resulting in hypertrophy of the outer portion of the quadriceps muscle (vastus lateralis). This results in excessive forces on the patella pulling it towards the outside, which manifests in anterior knee pain and increased wear and tear of the cartilage behind the knee cap (patella). The overtraining of the front thigh muscles (quadriceps) relative to the back thigh muscles (hamstrings) leads to an imbalance of forces around the knee increasing the risk of tendinopathies and sheer forces on the cartilage.
Injuries in larger boats
Powerful rapid movements required in mainsheet handling puts the shoulder and arms at risk. Injuries whilst sailing are also caused because keeping proper form and posture whilst carrying out a task is difficult when speed is of the essence and is made worse as the boat is moving and having to balance on a constantly tilting floor as well as having to cope with the wind forces.
Handling of the sailing sheet needs care to avoid common hand injuries such as friction burns, fractures, and lacerations. Head injuries are common from the swinging boom either from unexpected change in wind direction, or poor communication between the crew. Therefore, awareness and improved communication helps prevent head injuries.
The majority of injuries whilst windsurfing (~75%) are acute secondary to impact with equipment. Around 20% of male competitive windsurfers report severe injuries such as knee ligament sprains and ruptures, shoulder dislocations, disc herniations in the spine and spine fractures. Chronic lower back pain occurs more commonly during low wind speeds due to a prolonged lordotic posture.
The most physically demanding position is the grinder whose role is to manually raise the sails by rapidly turning the winches. This is done in short powerful bursts placing great physical demands on the lumbar spine, shoulders, neck, elbow and forearms which are the areas most commonly injured. The most frequent type of injuries are ligament sprains and tendinopathies.
The most common method of injury whilst sailing is tripping and falling and so keeping your eyes open and your wits about you helps minimise the risk of fractures, bruises, falls (this could be over a step, a misplaced item, an open hatch or even falling overboard), and head injuries.
Whilst there are numerous injury prevention programmes with great effect there is limited evidence on how effective they are at preventing sailing injuries mainly due to the difficulty in carrying out such research when there are so many variables. Improving the ergonomics of the boat or using straps whilst hiking is another avenue to help reduce risk of injuries. Medical evidence for injury prevention whilst sailing points to incorporating exercises that focus on strength, power, cardiovascular fitness, core stability, weightlifting, balance and agility. Improving endurance has shown to greatly reduce injuries. Aerobic workouts should be varied and include running, swimming, cycling and rowing. Performing functional movements rather than exercises that isolate muscles aids in maintaining balance between agonists and antagonists which in turn helps minimise the risk of tendinopathies.
Improving the technique used to carry out high demand physical activities helps to reduce the risk of injury. For instance, neutral foot position whilst hiking, high amplitude low frequency pumping in windsurfing and use of the lower limbs to provide power whilst grinding. Sailors involved in competitions should have regular screening to assess for underlying pathologies, technique and performance and provide advice on injury prevention. The volume and intensity of training and competitions should be monitored to help prevent fatigue and manage recovery. Sailing should be avoided if fatigue sets in as the risk of injuries is markedly raised. Hydration and nutrition before and during a competition should be carefully checked as they are important factors to minimise fatigue and dehydration thereby preventing injuries.
Part of injury prevention is to analyse and correct an imbalance of muscle strength between the agonists and antagonists (i.e. the muscles located in front and behind a joint). Hikers are prone to hamstrings being markedly weaker in relation to their quadriceps which are firing all the time whilst hiking and grinders are prone to shoulder muscles at the back being considerably weaker compared to the front shoulder muscles. Emphasis should be placed on strengthening joint stabilisation muscles such as the rotator cuff muscles of the shoulder, the core, as well as exercises to help improve balance around the ankle and knee. Depending on the type of sailing being carried out, certain muscle groups which are prone to injury should be strengthened more for peak power as well as endurance. Strengthening of specific muscle groups should be carried out for the specific type of sailing demands being carried out: forearm strengthening is helpful for grinders and windsurfers, posterior shoulder muscles for big boat sailors, medial quadriceps and hamstrings for hiking sailors, whilst all sailors should carry out lower back, and core stability. Lower limb strengthening should not be ignored especially for windsurfers and grinders as power is generated there and helps increase force generation for activities like pumping, grinding and steering.
High UV light waterproof sunscreen protection should be used as well as protective clothing, hats, and sunglasses to help minimise risk of skin cancer. Slalom windsurfers can reduce the incidence of head injuries with protective head gear whilst all windsurfers are advised to wear non-slip shoe wear and wetsuits to protect from being stung by jellyfish. Lumbar supports can be worn by windsurfers to help protect from lower back injuries. Hand injuries are among the most common severely injured parts of the body and the use of high performance enduring sailing gloves helps protect them from cuts, friction burns and keeping them warm. Life jackets should be worn at all times whilst sailing. Unfortunately, they are an essential item that is often overlooked as death by drowning accounts for three quarters of all deaths by recreational sailors and around 80% of the sailors who drown were not wearing a life jacket.
Improving the ergonomics
Improving safety as well as equipment that simplify the activities whilst sailing are key components in reducing injuries. Windsurfers would benefit from a smoother and faster foot strap release. Increasing the friction of the steering wheel in large boat racing. The height of the pedestal, handle position, width and grip shape can all help reduce back, shoulder and forearm injuries in grinders. Better antiskid deck surface helps reduce risk of sliding and falling.
By taking the necessary precautions, improving levels of fitness, strength and endurance, incorporating proper technique, wearing sunscreen, life jackets, gloves and shoes the risk of acute and chronic injuries can be greatly reduced.