Paddleboarding Injuries and Safety: Life Jackets, Leashes and Cold Water

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It’s a glassy summer morning on the lake. You’re a mile out, the board gliding, the water so calm it looks like you could walk on it. Then a ski boat’s wake rolls through, your feet slide, and you’re in. Most of the time that’s the funniest moment of the day: you climb back on, laughing. But stand-up paddleboarding (SUP) has one serious risk that every paddler, from a kid on a rental board to a racer, needs to take seriously: drowning. This page covers it first, then the injuries that actually show up in paddlers’ bodies, from shoulders and backs to cold water and sunburn, and when to get help.

This page is general information, not medical advice. If you’re hurt, see a sports medicine doctor, physical therapist (PT) or certified athletic trainer (AT). For the bigger picture of the sport, start at our paddleboarding hub.

Drowning: the number that matters most

The U.S. Coast Guard’s Recreational Boating Statistics 2024 counts stand-up paddleboards as their own vessel type. In 2024 it recorded 29 deaths on paddleboards, and 26 of them (90%) were drownings. Of those 26 people who drowned, 24 were not wearing a life jacket. Paddleboards made up 5% of all recreational boating deaths that year, the highest share in the Coast Guard’s table going back to 2010. Paddlecraft overall (canoes, kayaks and SUPs) accounted for 143 deaths, 124 of them drownings.

Why does a “calm water” sport drown people? A fall is normal on a SUP. What turns it deadly is usually a combination: no life jacket on, the board drifting or blowing away, cold water that takes your breath, a leash snagged in a river, or a bump on the head. The fix for most of these is simple and cheap, and it starts with wearing the life jacket rather than strapping it to the deck.

Life jackets (PFDs): the rules and the reality

• A SUP is a vessel. The Coast Guard lists the paddleboard among craft it has determined to be vessels. Outside the narrow limits of a swimming, surfing or bathing area, that means carriage rules apply: a Coast Guard-approved life jacket for each person, a sound-producing device such as a whistle, and, between sunset and sunrise, a light (a flashlight meets this, per the Coast Guard Auxiliary).
• Kids under 13 wear one. Federal rules say children under 13 on a vessel that is underway must wear an appropriate Coast Guard-approved life jacket; where a state has its own child-wear rule, the state rule applies.
• Wear it, don’t stow it. The Oregon State Marine Board, after a run of paddleboard deaths, puts it bluntly: wear your life jacket at all times, because there isn’t time to put one on in an emergency. Tuck loose straps away so they can’t snag.
• Inflatable or foam. Many paddlers like a manual inflatable belt pack because it stays out of the way of the stroke. The Coast Guard does not recommend inflatables for children under 16 or for non-swimmers, and a manual one only works if you can pull the cord. On moving water or for kids, a foam vest is the simpler choice.

Two common choices: a foam paddling vest like the Onyx MoveVent Dynamic, cut with a big arm opening for paddling, and a manual inflatable belt pack like the Onyx M-16 for adult swimmers on flat water. Check the label for Coast Guard approval, size and weight range.

Leash entanglement on rivers

On a lake or in the ocean, a leash keeps your board, your biggest flotation device, attached to you when wind or waves try to take it away. On a river, the same ankle leash can kill. The Oregon State Marine Board has warned that paddlers who were otherwise well equipped have died when their leash snagged on brush or debris: the current pins the board or the leash, and the paddler can’t reach the ankle cuff. Its advice:

• Don’t use a standard ankle leash in moving water. Most aren’t designed to release quickly.
• Use a quick-release leash worn at the waist or attached to the life jacket, where both hands can reach the release. A jacket-mounted one is easier to grab.
• Wear a life jacket at all times on moving water.

Practice pulling the release on land and in calm water before you need it. The NRS Quick-Release SUP Leash is one example: its shackle lets you disconnect from the board, and it can clip to a rescue-style PFD. If you’re paddling whitewater, take a swiftwater course; the same entrapment hazards apply to kayakers.

Cold water

The National Weather Service treats any water at 70°F or colder as cold water, and many lakes stay below that well into summer even on hot days. A sudden plunge can trigger a gasp and rapid, uncontrolled breathing; the Coast Guard’s Boater’s Guide notes that sudden immersion can lead to cardiac arrest and other reactions that end in drowning. The NWS adds that within about 10 minutes you can lose muscle control, which makes climbing back onto a board much harder. Hypothermia comes later. In the Coast Guard’s 2024 data, 5 of the 13 injuries reported on paddleboards were hypothermia.

• Dress for the water temperature, not the air (NWS): a wetsuit or drysuit in spring, fall and on cold lakes.
• If you fall in: keep your life jacket on, keep your head out of the water, and get your breathing under control before you try anything. Then get back on the board quickly.
• Hypothermia signs (CDC): shivering, exhaustion, confusion, fumbling hands, slurred speech, drowsiness. Get the person somewhere warm, remove wet clothing and warm the core; a body temperature below 95°F is an emergency.

Falls onto the board and head knocks

In the first injury study of SUP paddlers (240 international paddlers, published in 2017), contact with your own board was the second most common cause of injury at 20%. A German-speaking survey of 438 paddlers in 2021 also found board and ground contact among the main causes, and the highest injury risk in whitewater and SUP surfing. Bruises, cuts, wrist and knee knocks, and the occasional blow to the head are the result.

• Fall away from the board, flat into the water rather than onto the deck or fin, and protect your head with your arms as you come up.
• Shallow water: kneel or lie on the board when it’s shallow or rocky. Many injuries happen at launch and landing.
• Concussion: the CDC’s HEADS UP message is “When in doubt, sit them out”. Anyone who may have a concussion leaves the water, stays out for the day and gets checked. On the water a concussion is extra dangerous, because a dazed paddler can drown. Call 911 for danger signs such as a worsening headache, repeated vomiting, slurred speech, weakness, seizures or increasing confusion.
• Cuts: fins and reefs cut. The CDC advises staying out of salt or brackish water with an open wound if you can, covering it with a waterproof bandage, and washing it with soap and clean water.

Shoulder, elbow and back strain

The everyday SUP injury isn’t dramatic. It’s the shoulder that aches after long paddles. In the 2017 study, the shoulder and upper arm accounted for 33% of injuries, the lower back 14% and the elbow and forearm 12%. Endurance paddling was the most common cause (35%), and the injury rate was 3.6 per 1,000 hours of paddling. Paddlers older than 46, racers, and people paddling more than about 4.8 hours a week were more likely to be hurt. A 2026 study of 330 competitive paddlers aged 8 to 67 again found the shoulder and lower back on top, with most injuries during the pull phase of the stroke, and higher rates in adults than in teens.

What helps, in general terms: build up distance gradually, use your hips and trunk rather than only your arms (a 2019 motion study found beginners used much more shoulder motion and less hip motion than experienced paddlers), get a paddle sized for you, and do some shoulder and core strength work on land. Our paddleboard training page has the details. Pain that lingers more than a few days, wakes you at night, or comes with weakness, numbness or a shoulder that feels loose deserves a visit to a sports medicine doctor or PT.

Sun, glare and heat

Out on the water you get the sun twice: from above and reflected off the surface. The American Academy of Dermatology recommends a broad-spectrum, water-resistant sunscreen of SPF 30 or higher, applied about 15 minutes before you go out and again every two hours and after swimming or sweating. A long-sleeve rash guard, a hat and sunglasses cut down how much sunscreen you need. The American Academy of Ophthalmology links pterygium (“surfer’s eye”) to UV, wind and dust, so UV-blocking sunglasses on a retainer strap matter on long paddles. A mineral sunscreen like Blue Lizard Sport SPF 50 (80 minutes water resistant) is a common pick. Heat illness is covered on our Paddle Day & Race Day page.

When to get help

• Call 911 right away: anyone pulled from the water who isn’t breathing normally, is confused or coughing hard; concussion danger signs; a possible neck injury (keep the person still); hypothermia with confusion or drowsiness.
• Within a day or two: a suspected concussion, a deep or dirty cut, a joint you can’t use normally, or a wound that turns red, hot and swollen.
• Soon: shoulder, elbow or back pain that keeps coming back, pain at night, or numbness and tingling down an arm or leg.

A sports medicine physician diagnoses and decides on imaging; a physical therapist guides rehab and the return to paddling; a certified athletic trainer is often the first person to see an injury at schools and events. For care after a long day, see paddleboarding recovery. Surfers face many of the same issues in bigger waves; see surfing injuries.

Paddleboarding safety and injuries: FAQs

Do I have to wear a life jacket on a paddleboard?

Outside swimming, surfing or bathing areas, the Coast Guard treats a SUP as a vessel, so you must carry a Coast Guard-approved life jacket, and children under 13 must wear one under federal rules (states can set their own child rules, and some require more). Wearing it is what saves lives: in 2024, 24 of the 26 people who drowned on paddleboards weren’t wearing one.

Should I wear a leash on a river?

Only a quick-release leash worn at the waist or attached to your life jacket, with the release where both hands can reach it. The Oregon State Marine Board warns that standard ankle leashes have snagged on debris in rivers and caused deaths. On lakes and in the ocean, a regular leash keeps your board with you.

What is the most common paddleboarding injury?

Shoulder and upper-arm injuries, followed by the lower back and elbow, mostly from long or hard paddling. In the first SUP injury study, the shoulder accounted for about a third of all injuries, and hitting your own board was the second most common cause.

Is an inflatable belt-pack life jacket OK for paddleboarding?

Many adult paddlers use a Coast Guard-approved manual belt pack on flat water. The Coast Guard doesn’t recommend inflatables for children under 16 or non-swimmers, and a manual one only inflates if you pull the cord, so a foam vest is the safer choice for kids, beginners and moving water.

How cold is too cold to paddleboard without a wetsuit?

The National Weather Service calls any water 70°F or below “cold water” and advises dressing for the water temperature, not the air. If you’re likely to fall in, a wetsuit or drysuit plus a life jacket is the standard advice for cold lakes and shoulder seasons.