The popularity of stand-up paddle boarding (SUP), which originated in Hawaii, is growing at an impressive rate. Participation has increased from 1.1 million in 2010 to 2.8 million in 2014 in just the United States.1 A cross between paddle-based sports and surfing, SUP has joined the ranks as a fun and family-friendly sport for anyone who enjoys being out on the water. It also carries the benefit of being a complete workout that you can participate in on any body of water. However, SUP carries risk of injury if rules are not followed correctly.

Balance and core strength are key for remaining upright on your board, as is upper body strength to maneuver the board. Significant improvements in balance, core strength, and quality of life have been found in those who participate in this activity.2, 3 As with any sport, the benefits are maximized when riders use proper equipment and adhere to regulations.

The United States Coast Guard has provided general guidelines for SUP participants, intended to maximize safety. Standard items for this activity include:

  • Whistle to call for help if needed
  • Leash to tether you to your paddle board
  • Proper clothing – The US Coast Guard recommends wearing a wet suit, if the water temperature is below 70 degrees
  • Sun protection, including water resistant sunscreen with a high enough SPF for maximum protection

Some items are time or location-dependent, such as a light on your board if you intend to be out after sunset and a personal flotation device (PFD) if you are paddling outside a designated swimming or surfing area. The latter regulation was implemented in 2008 when paddle boards were officially classified as vessels, devices capable of being used as a means of transportation on water, but only while being used in an area not designated for swimming, surfing, or bathing.4

Weather is also an important risk factor to take into account, with wind playing a major role in the ability to paddle and stay upright on the board. For a smoother time on the water, prepare by checking wind speed and direction in advance.

While life-threatening injuries are rare, fifteen paddle boarders died in 2016, as reported by the U.S. Coast Guard. The risk of injury with SUP rises for older participants and those who ride competitively, with the repetitive motions increasing the possibility of sustaining an upper body injury.1 A 2017 study on the epidemiology of paddle boarding injuries corroborated the relationship between parts of the body used most frequently while paddle boarding and injury type. Researchers found the most frequently injured body location to be the shoulder/upper arm, along with the most common injury type occurring in the muscle/tendon.1 The mechanism behind the most frequently reported injuries was endurance paddling, indicating that most paddle boarding injuries are a result of competitive SUP or training to compete. Recreational riders, when adhering to safety rules and regulations and being aware of their own strength and capabilities, have a lower risk of sustaining injuries.5

To prevent injury, riders should warm-up before participating, not overexert their muscles, and maintain proper paddle boarding posture.1 Correct SUP posture is described as positioning your feet centered and hip-width distance apart on the board and keeping your toes pointed forward, with your knees slightly bent, and back straight. Poor paddling techniques, including improper sweeping and trunk rotation, may also contribute to injury, but further studies on the biomechanics of SUP are necessary to confirm this.

Keeping safety in mind, stand-up paddle boarding is a fun water sport for people of all ages to enjoy. Preparation is key and goes a long way, as it does with any sport.


1. Furness, J., Olorunnife, O., Schram, B., Climstein, M., & Hing, W. Epidemiology of injuries in stand-up paddle boarding. Orthopaedic Journal of Sports Medicine. 2017. June; 5(6):1-9.

2. Schram, B., Hing, W., & Climstein, M. The physiological, musculoskeletal and psychological effects of stand up paddle boarding. BMC Sports Science, Medicine and Rehabilitation. 2016. Oct; 8(32):1-9.

3. Schram, B., Hing, W., & Climstein, M. Profiling the Sport of Stand-Up Paddle Boarding. Journal of Sports Sciences. 2016. 34(10):937-44.

4. United States Coast Guard. Vessel Determinations. U.S. Coast Guard’s Boating Safety Division. 2018. Retrieved from

5. Waydia, S.-E., Woodacre, T. Paddle-boarding: Fun, New Sport or an Accident Waiting to Happen? Trauma Monthly. 2016. Mar; 21(3):1-5.