What Back and Knee Pain Fishing Feels Like: What Should You Watch This Week?

An angler has been poling a flats skiff off Sugarloaf Key all morning, quiet except for the push of the pole and the light slap of water on the hull. Then one cast changes the feel of the day. The low back tightens first, and a knee starts complaining each time the stance shifts on the deck.

Back and knee pain during fishing usually means the day’s repeated strain has started to catch up with you. Jason Pirozzolo, DO, a sports medicine physician, keeps the advice practical. "Split cooler contents and get help with heavy anchors, equipment or catch," he says. Pain that settles with a few simple changes is often handled one way, while pain that keeps running your day deserves a closer look.

What is going on inside

Most of the time, this kind of pain means irritated joints, muscles, or tendons have been asked to work past their usual limit. In the back, chronic low back pain, meaning back pain that keeps coming back or lasts over time, has been linked with lifting and carrying loads. A 2023 systematic review found moderate evidence for that link.

The knee can tell a similar story. A 2020 systematic review found that work with lifting, kneeling, climbing, squatting, and standing was associated with higher odds of knee osteoarthritis, meaning wear in the joint that can bring aching, swelling, and stiffness. These studies show links, but they do not prove that one person’s fishing day caused arthritis.

Why a fishing day can set it off

Fishing puts your back and knees to work in small repeated ways, not just one big lift. On a moving boat, your body keeps making little corrections to stay balanced. A 2024 maritime review found substantial physical strain during heavy work on moving vessels, including extra effort to compensate for vessel movement.

That fits the moment on the skiff when the back grabs during a cast or the knee starts to ache while you keep shifting your feet. Gear matters too. A 2023 systematic review found moderate evidence linking lifting and carrying loads with chronic low back pain, while a Cochrane review found that lifting instruction by itself did not prevent back pain better than no intervention or other approaches. "When practical, handle heavy equipment while the boat is steadier," Dr. Pirozzolo says. "Store frequently used gear where it is easy to reach."

What to do this week at home

The first goal this week is to lower the load and keep the body moving. For long lasting low back pain, a 2021 Cochrane review of 249 trials found that exercise probably reduces pain compared with no treatment, usual care, or placebo, and the average improvement was large enough to matter to patients. For knee osteoarthritis, a 2024 Cochrane review found exercise may reduce pain compared with no treatment, usual care, or limited education.

• Keep walking or doing light exercise every day this week, unless the pain rises while you do it.
• Use ice or heat for 15 to 20 minutes at a time, a few times a day, if one clearly feels better.
• Reduce deep squatting, kneeling, repeated tower climbs, and heavy lifting until the pain calms down.
• Try cushioned insoles for standing comfort during long days on deck if your shoes allow them.

A 2018 systematic review found moderate evidence that cushioning materials such as cushioned shoe insoles reduced discomfort and fatigue in workers who stood for long periods. Dr. Pirozzolo puts that into boat terms. "Try cushioned insoles or a secured anti-fatigue mat for standing comfort." For readers with knee osteoarthritis who are overweight, a 2013 JAMA trial found that dietary weight loss combined with exercise reduced knee pain more than either one alone after 18 months.

The next step is simple. If the same back pull or knee ache is still changing how you cast, stand, or step by the end of the week, get it checked. "Keep exercising between trips," Dr. Pirozzolo says, returning to that same morning off Sugarloaf Key with one clear next move instead of just pushing through.

If the pain is still changing the way you move on the boat by the end of the week, have it checked and make a plan that fits the way you fish. Contact Key West Concierge Orthopedics.

Questions About Back and Knee Pain From Fishing

Is this just normal soreness from a long day on the water?

Sometimes it is, especially when it eases over the next few days with lighter activity and less load. When it keeps changing how you stand, cast, or step, it is worth being seen.

Does better lifting technique fix back pain by itself?

Not usually. Research on workers found that lifting instruction alone did not prevent back pain better than other approaches or no intervention.

What can make standing on the boat easier?

Cushioned insoles can help some people during long periods of standing. The main idea is to lower the steady load on your back and knees while they calm down.

Sources

• Jahn A et al. Occupational mechanical exposures as risk factor for chronic low-back pain: a systematic review and meta-analysis. Scand J Work Environ Health. 2023.
• Wang X et al. Occupational Risk in Knee Osteoarthritis: A Systematic Review and Meta-Analysis of Observational Studies. Arthritis Care Res (Hoboken). 2020.
• Belz L et al. A systematic review on the impact of ship movements on lower back among maritime workers. Int Marit Health. 2024.
• Verbeek JH et al. Manual material handling advice and assistive devices for preventing and treating back pain in workers. Cochrane Database Syst Rev. 2011.
• Hayden JA et al. Exercise therapy for chronic low back pain. Cochrane Database Syst Rev. 2021.
• Lawford BJ et al. Exercise for osteoarthritis of the knee. Cochrane Database Syst Rev. 2024.
• Speed G et al. The effect of cushioning materials on musculoskeletal discomfort and fatigue during prolonged standing at work: A systematic review. Appl Ergon. 2018.
• Messier SP et al. Effects of intensive diet and exercise on knee joint loads, inflammation, and clinical outcomes among overweight and obese adults with knee osteoarthritis: the IDEA randomized clinical trial. JAMA. 2013.