Although fly casting can cause injury to most parts of the body, not surprisingly, the casting arm is particularly vulnerable.  And it’s the elbow that seems to bear the brunt, if the frequency of tennis elbow amongst fly casters is anything to go by.

What causes tennis elbow?

Let’s get rid of one popular misconception straight away.  Although the pain of tennis elbow is felt at the elbow, curiously the condition has nothing whatsoever to do with elbow overuse or malfunction.  The sole cause is excessive or strenuous gripping – the dreaded TIGHT GRIP!  I’m sure a detailed anatomical dissertation is not appropriate here but, for anyone curious or doubtful, the following paragraph hopefully will help to explain things…….or you could just trust me on this one and move on!

To fully appreciate how tennis elbow develops, it is necessary to understand the part played by the forearm muscles.  These muscles, with tendons at each end, connect the inner side of the elbow to the front of the wrist (flexor muscles) and also the outer side of the elbow to the back of the wrist (extensor muscles).  One of the jobs of these two opposing muscle groups is to automatically stabilise the wrist joint during the act of gripping.  It’s easy to confirm this by making a fist and using the other hand to feel the tense forearm muscles bracing the wrist; note that the harder one grips, the more the forearm muscles contract.  With excessive or strenuous gripping something eventually has to give and usually it is the tendons at their attachments to the elbow.  The result is pain and inflammation either at the inner side of the elbow if the strain has fallen on the flexor muscle tendon (golfer’s elbow), or at the outer side if the extensor muscle tendon has been affected (tennis elbow).  Because of the particular mechanics involved, fly-casters are more likely to suffer tennis elbow than golfer’s elbow.

When does a firm grip become a tight grip?

So, we accept that tennis elbow is caused by too tight a grip.  But when does a correct firm grip become a harmful tight grip?  Some advise that the rod be regarded as a delicate instrument, not a garden tool.  Mike Marshall suggests the correct grip is like holding a tube of toothpaste with the cap off – squeeze too hard and you’ll make a mess of things!  One thing’s for sure – if the knuckles go white, the grip’s too tight!

How do I know I’ve got tennis elbow?

Gripping (sometimes in severe cases even just holding say a cup of tea) will cause pain at the outer side of the elbow and this spot will be tender when pressed.  Another test for tennis elbow is to hold the arm out straight then attempt to bend the wrist backwards against resistance; this will provoke pain at the outer side of the elbow.  Consult a doctor if there is any doubt about the diagnosis or if symptoms persist despite appropriate treatment.

How do I treat tennis elbow?

Painkillers such as paracetamol or non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen may be helpful.  Ideally, any activity that provokes the elbow pain should be avoided until symptoms completely settle.  However, since this could make fly rods redundant for quite some time, it may be possible to continue casting or fishing by employing some of the preventative measures discussed below.  Other lines of treatment include physiotherapy involving ultrasound, friction massage or manipulation.  The most effective treatment by far, albeit possibly quite painful for a day or two after, is a steroid injection into the tender spot at the elbow; this should be repeated after two weeks if symptoms persist.  Incidentally, I have never been a fan of tennis elbow appliances, although admittedly some sufferers swear by them.

Left untreated, tennis elbow tends to get better by itself within one to two years.

How do I prevent tennis elbow?

The aim of prevention is to avoid excessive or strenuous gripping and that’s the basis for the following suggested measures.  I realise that some are simply a matter of common sense or very much in the category of preaching to the converted, but for the sake of completeness l would ask you to bear with me.

Measures relating to tackle

Let’s consider rods first of all.  The longer and heavier the rod, the tighter the grip has to be to control the increased leverage on the wrist.  So changing to a shorter, lighter outfit (say a 9ft 5 or 6 wt) might be worth considering.  Similarly, a rod with a progressive rather than a stiff action would be preferable.  A rod handle that is too thin will be difficult to grip and thus need to be held more tightly.  Mike Marshall recommends a handle of between 7/8” and 1” in diameter at the centre.  For the average hand this should ensure there is a gap between the finger tips and the palm when holding the rod handle with the thumb on top; if not the handle is too thin and needs to be taped up.  Mike also points out that the reverse half wells design needs a tighter grip to stop the hand slipping up the rod, so he therefore favours a full wells which avoids this problem.

Considerations about the reel balancing the rod are outweighed by the importance of minimising the overall weight of the outfit.  Choose the lightest possible reel, consistent with storing the line and sufficient backing.  An up-locking reel seat is preferable since the closer the reel is to the wrist fulcrum during casting, the less strain there will be.  For a right-handed angler, the reel should be set for left-handed winding.  This avoids having to change hands when playing a fish and ensures that the stronger hand is always holding the rod.

With regard to fly line ratings, bear in mind that both under-loading and over-loading the rod will involve more effort by the caster and that the inevitable consequence of increased effort is a tighter grip.  Extremely long-bellied WF lines (so-called “extra distance lines”) offer incredible potential for experienced casters.  However, they are more physically demanding and are not to be recommended for more modest achievers.  To maximise the benefits of the shorter, lighter rod mentioned above, a short (9 - 10 yards) shooting head might be worth considering.  Compared to a standard WF line set up, casting such a shooting head requires very little effort.   Intermediate lines should pose no problems when roll cast to the surface but sinking lines are probably best avoided because of the extra effort required to lift them from the water.

Measures relating to casting

The most mechanically efficient grip is one which controls the rod effectively with minimal gripping effort.  Of the many different grips suggested, the thumb-on-top is probably the most popular.  In efficiency terms it seems to demand the least effort, particularly when stopping the rod on the back cast which of course has to be done effectively in order to avoid “wrist cocking”. 

The longer the casting stroke, the easier it is to make the cast.  A short stroke may be all that is required for a short cast but using the same short stroke for a longer cast will require much more concentrated effort and therefore a tighter grip.

As we know, the more line that can be aerialised, the greater the distance potential.  However, regardless of line profile, struggling to false cast more line than can be comfortably handled is counterproductive.

Casting with a straight-arm action, that is with the elbow straight, is bad practice since apart from any casting implications, it requires the rod to be held more tightly.

If tennis elbow is an issue, engaging in tournament distance casting is probably asking for trouble bearing in mind the specialised tackle used and the greater rod loading involved.  With normal fishing tackle, seeking modest distances with minimal effort is preferable to striving for the horizon every time.

Even with suitable tackle and good casting technique, problems can still arise as a result of prolonged or excessive casting.  So it makes sense to keep false casting to a minimum and casting sessions brief, albeit frequent.

Measures relating to fishing

When a fish takes, some tightening of the grip is necessary, but striking with a huge heave (and possibly several running paces backwards – or is that just me?!) should be avoided.  

Never play a fish, particularly a big one, with the elbow straight and always have the rod butt supported by the forearm.  

A prolonged fight is potentially harmful, in tennis elbow terms, and lowering the rod angle nearer to the horizontal will certainly put greater pressure on the fish and subdue it more quickly.  However, unfortunately this demands a much tighter grip and therefore could actually be counterproductive.

Are exercises worthwhile?

Stronger extensor muscles will undoubtedly protect the more vulnerable extensor muscle tendon.  So, exercises may be worth considering, provided they are graduated and do not provoke tennis elbow symptoms - and that the newfound strength is not used to grip the rod even harder!  Specialised equipment is available from most sports shops but simple exercises such as squeezing a small rubber ball would suffice.

Parting shot

With its tendency to recur if the causative factors are not removed or modified, tennis elbow can be a troublesome condition for fly fisherman.  Because of the site of the pain, attention in terms of prevention is often focussed wrongly on the elbow.

So, ………whatever it takes, SLACKEN THAT GRIP and save the elbow!

I would like to thank Vernon for writing this for us. I have suffered from Tennis Elbow and can confirm not only the pain involved but also the sheer frustration of having to wash your face one handed. Heed the warning, if it hurts let it heal.

Mike H

It is with much sadness that I have to record the recent passing of long standing Member, Albert Horne from West Sussex, after a short illness. Due to difficulties with travel he has not attended Meetings recently, however, he will not be forgtten as he is the one with the walking stick in the pictures on the website home page. 

Albert was a great example of casting keeping us going, since he reached the age of 89 years and was fishing up to 2010 and fly tying until 2011 - a great angling ‘innings’. In fact he learned his craft from the famous Lionel Sweet at the age of 7 and, later, greatly enjoyed teaching many anglers as a member of  many fishing-related organisations. From personal experience I know just how keen he was about casting and his knowledge was deep - he will be missed in angling and casting circles.

Albert is survived by daughters Jackie and Elaine and our thoughts reach out to them.