Back and Knee Pain Fishing Without Surgery: Can It Be Treated Without Surgery?

An angler drifts the reef edge off Big Pine Key and watches the bait fall through clear water. A fish takes it on the way down, the rod loads fast, and the body braces against the roll before the line even comes tight. In that instant, the low back can grab or a knee can answer with a sharp ache that changes the rest of the day.

Yes. Many cases of back and knee pain from fishing can be treated without surgery, especially when the pain starts after a hard pull, a long day of standing, or repeated lifting. Jason Pirozzolo, DO, a sports medicine physician, tells patients, "Ask for a program that includes strengthening appropriate to your diagnosis and current ability."

The pain usually comes from strain, overload, or wear

The most common problems here are a low back strain, meaning an irritated muscle or tendon, and knee osteoarthritis, meaning wear in the joint that can make it sore and stiff. A painful flare can also come from patellofemoral pain syndrome, meaning pain around the kneecap, after long periods of bending and standing. In a 2016 survey in the Journal of Occupational Medicine and Toxicology, 37% of 270 Danish fishermen reported low back pain that lasted at least 30 days in the past year.

Fishing loads the body in a few ways at once. A 2024 review in International Maritime Health found substantial physical strain during heavy work on moving vessels, including extra effort to compensate for vessel movement. A 2023 systematic review in the Scandinavian Journal of Work, Environment and Health found moderate evidence linking occupational lifting and carrying loads with chronic low back pain, while a 2020 systematic review in Arthritis Care and Research linked kneeling, squatting, climbing, standing, and lifting with higher odds of knee osteoarthritis than sedentary work. These observational findings establish associations, rather than proving that a particular worker's activities caused arthritis.

If your pain started when you braced against that sudden strike, a low back strain is often the most likely problem. If your knee has been aching on and off and feels worse after repeated squatting, climbing, or long hours on deck, joint wear or kneecap pain moves higher on the list.

What to do this week at home

The first week is usually about calming the flare and keeping safe movement going. Resting completely often leaves the back or knee stiffer, so most people do better with lighter activity, short walks, and simple exercise that does not sharply raise pain. Dr. Pirozzolo says, "Keep exercising between trips."

1. For the next few days, cut back on heavy lifting and hard twisting until basic walking, sitting, and stairs feel easier.
2. Do short exercise sessions once or twice a day, using movements that match your diagnosis and current ability, until the pain settles.
3. Split cooler contents and get help with heavy anchors, equipment or catch until lifting no longer brings the pain right back.
4. When practical, handle heavy equipment while the boat is steadier until you can pull and carry without a flare.
5. Try cushioned insoles or a secured anti-fatigue mat during long periods of standing until deck time feels less tiring.

That return to the reef edge matters. When pain spikes with one hard pull, the problem is often overload from that moment. When it builds over many trips, repeated lifting, kneeling, squatting, and standing usually matter more than any single cast or drop. A 2011 Cochrane review found that lifting instruction by itself did not prevent back pain better than no intervention or other approaches, so the plan usually works best when movement and strengthening are part of it.

Recovery depends on what is irritated and what you keep asking it to do

A simple back or knee flare often starts to ease over days to a few weeks, but a longer pattern can take several weeks or months. The range changes with the structure involved, how much stiffness or swelling you have, and whether you keep loading it the same way. Chronic low back pain and knee arthritis usually need a longer stretch of steady work than a fresh strain does.

For the back, a 2021 Cochrane review found that exercise probably reduces chronic nonspecific low back pain compared with no treatment, usual care, or placebo. That same review found the average pain reduction 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, and a 2013 JAMA trial found that in older adults with overweight or obesity and knee osteoarthritis, dietary weight loss combined with exercise reduced knee pain more than either approach alone after 18 months.

Small changes in how you fish can help the area calm down while you keep moving. Dr. Pirozzolo says, "Reduce unnecessary kneeling, deep squatting and repeated tower climbs." He also tells some people, "Store frequently used gear where it is easy to reach."

Most back and knee pain from fishing can be managed without surgery, but the right plan depends on whether you are dealing with a fresh strain, a longer back problem, or knee joint wear. As the boat drifts and another bait drops, your next step is not to wait for the next bad pull to make the choice. Dr. Pirozzolo puts it simply: "Ask for a program that includes strengthening appropriate to your diagnosis and current ability."

If the same back or knee pain is still limiting you after this week, have it checked and get a plan you can use on your next trip. To be seen, contact Key West Concierge Orthopedics.

Questions About Back and Knee Pain From Fishing

When is surgery less likely for fishing related back or knee pain?

Surgery is less likely when the pain fits a strain, an overuse flare, or arthritis that still responds to exercise, activity changes, and load changes over time.

Should you stop fishing completely while it heals?

Not always. Many people do better by cutting back the heaviest lifts, twisting, kneeling, or long standing while staying active in ways that do not sharply worsen pain.

What if the pain keeps coming back after trips?

That usually means the load pattern needs attention, not just rest. A focused exam and a strengthening plan can help match the treatment to the part of the back or knee that is being irritated.

Sources

• Berg-Beckhoff G et al. Prevalence and predictors of musculoskeletal pain among Danish fishermen - results from a cross-sectional survey. J Occup Med Toxicol. 2016.
• Belz L et al. A systematic review on the impact of ship movements on lower back among maritime workers. Int Marit Health. 2024.
• 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.
• 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.
• 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.