Keeping Healthy – Preventing Injury

The Casting Connection

November 2026

By Capt. Scott Swartz

Scott Swartz founded the Atlanta Fly Fishing School, which began in 1999. It is the largest such operation in the Southeast and the only Trout Unlimited “Gold Endorsed” school in the United States. His Florida Fly Fishing Schools started in 2008, helping anglers learn to successfully fly fish in saltwater.

Fly line casts appear fluid and are mesmerizing to watch. It looks relaxing…and it can be. But it can also be tough – not a contact sport tough, but a repetitive motion kind of tough.

One of my early introductions to fly fishing was through a patient who came with shoulder pain. His case history revealed a week of fly fishing at Yellowstone.

Repetitive motion injuries from fly casting happen more than most imagine.¹

Instructors teach grips, stance, and casting movements. We also need to teach good ergonomics. As a chiropractor I am biased, but if the goal is comfortable, efficient casting with less shoulder/elbow/wrist/hand fatigue, then think good ergonomics.

An understanding of anatomy allows us to help anglers stay in the game. Rotator cuff tears, “tennis elbow” tendonitis, arthritis, wrist pain and even joint replacements benefit from thoughtful ergonomic adaptations.

Let’s start with the rod and work our way up.

GRIP: It is natural when learning to hold on tight. We have seen plenty of hot spots and even a few blisters from the “death grip.” Hold the cork just firmly enough to control the rod.

WRIST: The smallest muscles in the arm should not do all the work. Excessive wrist motion is fatiguing and causes poor loops. The analogy of hammering a nail into a wall in front of you describes the best use of the wrist. It is involved, but not the primary driver. The bigger arm muscles do most of the work, and the smaller wrist muscles finish the job.

Elbow: Keep it relaxed and close but not locked against your side. Try not to hold it high and away like throwing a ball. Also, do not hold the elbow stationary, but allow it to glide forward and back. If you keep the elbow locked in one position you cast with only the forearm and wrist and none of the larger arm muscles. However, if you have shoulder issues, locking the elbow to your side can isolate the shoulder after injury, surgery or to avoid pain.

Shoulder: Keep the shoulder dropped and relaxed. Unless you are wading deep or sitting low there is no reason to lift the shoulder. Lifting the shoulder uses neck muscles that do not help the cast.

Casting is a sequence: Think, “start big – finish little.” Begin casting with the shoulder and upper arm. Bring in the elbow and forearm next, then finish with the wrist just prior to a stop.

Pain: Researchers found higher rates of pain with heavier gear and elliptical casting. It is hard to avoid needing bigger sticks for bigger fish, but we can often minimize elliptical casts that rotate the shoulder outward.

Changing the angle can help relief stress during a long day of casting. Photo courtesy of St. Croix Rods.

Pro Tip: If you experience discomfort, change casting styles throughout the day. This reduces effects of repetitive motion by changing stresses on specific tendons, ligaments and joints. It can be as easy as going slightly sidearm, changing your grip, or changing elbow positions. Do not let discomfort take away your joy of fly fishing. In most cases there are solutions to keep you in the game.

¹.The National Institutes of Health, National Library of Medicine October 2020 article entitled “Upper Extremity Pain and Overuse Injuries in Fly-Fishing: A North American Cross-Sectional Survey and Implications for Injury Prevention” can be found by clicking here.

Send your questions or comments for Scott to: info@atlantaflyfishingschool.com