9 Common White Water Rafting injuries (Prevention & Treatment)

The 9 injuries white water rafting brings most often: bruises, cuts and abrasions, wrist and ankle sprains, muscle strains and fractures.

A hard flip can dislocate a shoulder or cause a concussion, and cold water adds hypothermia, with drowning covered as the rare worst case and prevention pointers for each.

Injury Rates and Numbers

The figures below come from injury surveillance data and peer reviewed studies. Each row names the population it was measured in, because rates from elite athletes and from recreational players are not comparable.

Finding	Measured in	Source
Commercial whitewater rafting had an overall injury incidence of 0.263 per 1,000 rafters across three West Virginia rivers, based on 200 reported injuries.	commercial whitewater rafting participants on West Virginia rivers, 1995 to 1997	Whisman, Hollenhorst, Injuries in commercial whitewater rafting, Clinical Journal of Sport Medicine
The face was the most commonly injured body part in commercial whitewater rafting, making up 33.3 percent of injuries, including the eye at 12.1 percent.	commercial whitewater rafting participants on West Virginia rivers, 1995 to 1997	Whisman, Hollenhorst, Injuries in commercial whitewater rafting, Clinical Journal of Sport Medicine
Lacerations were the most common commercial whitewater rafting injury type at 32.5 percent, followed by sprains or strains at 23.2 percent.	commercial whitewater rafting participants on West Virginia rivers, 1995 to 1997	Whisman, Hollenhorst, Injuries in commercial whitewater rafting, Clinical Journal of Sport Medicine
Musculoskeletal injuries made up 47.4 percent of whitewater rafting injuries on the New and Gauley rivers, including sprains or strains at 21.1 percent.	commercial whitewater rafting participants, New and Gauley rivers, West Virginia, 2005 to 2010	Attarian, Siderelis, Injuries in commercial whitewater rafting on the New and Gauley rivers of West Virginia, Wilderness and Environmental Medicine
A rafting passenger was more likely to be injured while still inside the raft, with a probability of 0.55, than after being ejected into the river, at 0.39.	commercial whitewater rafting participants, New and Gauley rivers, West Virginia, 2005 to 2010	Attarian, Siderelis, Injuries in commercial whitewater rafting on the New and Gauley rivers of West Virginia, Wilderness and Environmental Medicine

Overview

Injury	Body area	Typical time out
Bruises and contusions	Whole body	3 days to 2 weeks, deep ones 4 to 8
Cuts and abrasions	Skin, hands and shins	2 days to 3 weeks
Sprains (wrist, ankle)	Ankle and wrist	1 to 8 weeks, 3 months if grade 3
Strains (muscle)	Shoulder, trunk and forearm	1 to 8 weeks, 3 months if repaired
Fractures	Face, hand and lower leg	6 weeks to 6 months
Dislocations (shoulder)	Shoulder	6 to 12 weeks, 4 to 6 months post-op
Concussions	Head	2 weeks to over a month
Hypothermia	Whole body	Hours to days, weeks if severe
Drowning (rare)	Airway and lungs	1 to 2 days, weeks if lungs affected
Lower Back Strain and Facet Joint Irritation	Lower back	Days to 8 weeks
Corneal Abrasion and Blunt Eye Injury	Eye	1 to 3 days, weeks if blunt trauma

Bruises and contusions

A contusion is crushed muscle tissue and small blood vessels under intact skin, most often over the thigh, hip, forearm or the sitting bones. In rafting they come from the raft slamming down in a hole, from a knee or elbow striking the tube or thwart, from a swinging paddle shaft, and from being pressed against rock during a swim. Repeated hard landings on a hard seat or tube also bruise the soft tissue over the tailbone and sit bones, which is why a sore backside after a long trip is so common.

Symptoms

• A dull, deep ache that is worse when you press on the spot.
• Discoloration that appears over hours and shifts from red to purple to yellow.
• Stiffness in the nearby joint because the muscle guards against stretch.
• Swelling and warmth over the area for the first day or two.
• Sitting, climbing stairs or lifting the leg hurts more than resting.

How serious it is: A mild contusion stays superficial, hurts to touch and keeps almost full range of motion. A severe one involves the muscle belly, limits the joint to less than half its normal movement and stays tense and hard, which needs a check for a large bleed inside the muscle.

Typical time out: Three days to two weeks for a light bruise, four to eight weeks for a deep thigh contusion that limits knee bend, longer if a hematoma forms inside the muscle or if calcification develops in the healing tissue.

See a doctor if: See a doctor if the area becomes tight, tensely swollen and increasingly painful rather than easing, or if you lose feeling or normal movement below the bruise, which can point to bleeding under pressure.

What helps

• Move the joint gently within a pain-free range from the first day so the muscle does not stiffen.
• Short cooling in the first hours for pain relief, ten to fifteen minutes at a time, not as a fixed daily program.
• Load the limb again as soon as walking or paddling is tolerable, increasing a little each day.
• A padded seat pad or a wetsuit with a reinforced seat cuts repeat bruising of the tailbone area.
• Get imaging if a firm lump persists past three weeks or if the muscle stays hard and painful.

Cuts and abrasions

These are breaks in the skin and the layer of fat beneath it, caused by shearing against a rough surface or a sharp edge. On a river the usual sources are barnacled or fractured rock during a swim, the metal footbrace and frame, a foot slipping on a rocky put-in, and the D-rings and cam straps on the raft. Hands take rope burn from the throw bag and blisters from the paddle shaft, while shins and knees scrape against the tube and the rocks in shallow water.

Symptoms

• Immediate stinging pain that is sharpest right at the wound edge.
• Bleeding that slows within minutes under direct pressure.
• Grit or sand visibly embedded in a scraped area.
• Skin flap, gaping edges or a wound that keeps reopening when you move the joint.
• Rising pain, spreading redness and a hot feel after a day or more, which suggests infection.

How serious it is: A superficial abrasion involves only the outer skin layers and heals without a scar. A laceration through the full thickness of the skin, one that gapes at rest, crosses a joint or exposes fat or tendon, needs closure within hours.

Typical time out: Two to seven days for a graze that you can cover, one to three weeks for a sutured laceration until the wound tolerates immersion, longer if the cut crosses a knuckle or if infection sets in and needs antibiotics.

See a doctor if: Get medical care if the wound gapes, will not stop bleeding after ten minutes of firm pressure, contains debris you cannot flush out, or if red streaks, fever or throbbing pain appear over the following days.

What helps

• Irrigate generously with clean drinking water or saline under pressure, since dilution matters more than any antiseptic.
• Remove grit early, because particles left in the skin cause tattooing and infection.
• Cover with a moist, non-stick dressing rather than letting a scab dry out in the sun.
• Keep the dressing waterproof on the water and change it as soon as it is soaked, since river water is not clean.
• Check your tetanus status and see a clinician for any cut from a puncturing object or with visible fat or tendon.

Sprains (wrist, ankle)

A sprain is an overstretch or tear of the ligaments that hold a joint together. At the ankle it is usually the anterior talofibular ligament on the outer side, wrenched when the foot rolls inward on wet rock at the put-in or catches under a thwart as the raft drops. At the wrist it is usually the scapholunate or the ulnar-side ligaments, loaded when you catch yourself with an outstretched hand or when the paddle blade is grabbed by an eddy and torques the shaft against a locked wrist.

Symptoms

• A sharp pain at the moment of the twist, often with a pop.
• Swelling around the joint within the first hour.
• Bruising that tracks down toward the toes or into the palm over a day or two.
• The joint feels loose or unreliable when you put weight or push through it.
• Pain when you press directly over the ligament, not over the bone.

How serious it is: Grade 1 is a stretch with pain but a stable joint, grade 2 a partial tear with looseness and marked swelling, grade 3 a complete rupture with obvious instability. Tenderness directly over the bone at the ankle, or in the hollow at the base of the thumb at the wrist, raises the question of a fracture instead.

Typical time out: One to three weeks for a grade 1 ankle sprain, four to eight weeks for grade 2, three months or more for a grade 3 or for a wrist ligament tear treated surgically. Wrist sprains often take longer than expected because paddling loads the joint on every stroke.

See a doctor if: See a doctor if you cannot take four steps on the ankle, if the joint is visibly deformed, or if the pain sits over the bone rather than the soft tissue, since those point to a fracture.

What helps

• Load the joint early within pain limits, since protected weight bearing heals a sprain faster than immobilizing it.
• Balance work on one leg, progressing to unstable surfaces, cuts the risk of the next ankle sprain roughly in half.
• A lace-up brace or taping for the first weeks back on the river and on the walk-in over rock.
• Grip strength and forearm rotation work for a wrist sprain, plus a looser grip on the paddle shaft.
• Imaging if bone tenderness, an inability to bear weight, or persistent instability after six weeks.

Strains (muscle)

A strain is a tear at the junction where muscle fibers meet tendon, caused by force applied while the muscle is lengthening. Rafting loads the latissimus dorsi and posterior shoulder on the catch of each stroke, the obliques and quadratus lumborum during the trunk rotation that drives the blade, and the forearm flexors that grip the shaft. A sudden grab of the blade by fast water, or a hard brace stroke to keep the raft upright, is the classic moment of tearing.

Symptoms

• A sudden pulling or tearing sensation during a stroke.
• Pain that returns when you contract the muscle against resistance.
• A tender, sometimes palpable dent or knot along the muscle.
• Stiffness and soreness that peak the next morning.
• Weakness on that side, so the stroke feels uneven.

How serious it is: Grade 1 is a minor fiber tear with pain but near-normal strength, grade 2 a partial tear with clear weakness and bruising, grade 3 a complete rupture with a visible gap and loss of function. A palpable gap or a muscle that bunches up when you contract it needs surgical assessment.

Typical time out: One to three weeks for a grade 1 strain, three to eight weeks for grade 2, three months or more after repair of a complete tear. Trunk and shoulder strains often drag on because every paddle stroke reloads the same tissue.

See a doctor if: Get it checked if you felt a distinct pop with immediate loss of strength, if there is a visible dent or bulge in the muscle, or if the limb becomes numb.

What helps

• Start gentle pain-free contractions within the first days, since prolonged rest weakens the healing scar.
• Progressive strengthening through the full lengthened range, which is the part of the muscle that fails.
• Build paddling volume back in steps rather than returning straight to a full day on the water.
• Fix the technique cause: rotate the trunk instead of pulling with the arm alone, and keep the top hand low.
• Get an assessment if there is no improvement after two to three weeks or if strength does not come back.

Fractures

A fracture is a break in the continuity of a bone, from direct impact or from a twisting force the bone cannot absorb. In rafting the common patterns are nose and cheekbone fractures from a paddle blade or a fellow rafter’s helmet inside the boat, finger and hand fractures from a hand trapped between paddle and frame, rib fractures from landing on the tube or a rock, and ankle or lower leg fractures when a foot lodges between rocks during a swim. The face is exposed because it is the one area a helmet leaves partly open.

Symptoms

• Immediate, severe pain focused on one point of bone.
• You cannot use the limb or put weight through it.
• Visible deformity, angulation or shortening.
• Rapid swelling and bruising over the bone.
• A grinding or grating feeling when the part is moved.

How serious it is: An undisplaced crack in a stable bone may only need protection, while a displaced, angulated or open fracture, or one involving a joint surface, requires reduction and often fixation. An open fracture, with skin broken over the break, is an emergency because of the infection risk from river water.

Typical time out: Six to eight weeks for a simple undisplaced fracture to unite, three to six months before full loading after a lower leg or ankle fracture, and longer if surgery, joint involvement or delayed healing is part of the picture.

See a doctor if: Treat any deformity, inability to bear weight or use the limb, numbness, a cold or pale hand or foot, or bone visible in a wound as a reason to stop and get emergency care.

What helps

• Splint the limb in the position you find it, including the joint above and below, before any evacuation.
• Cover an open fracture with a clean dressing and treat it as an emergency, since river water contaminates the bone.
• Follow the loading plan you are given, because controlled weight bearing stimulates bone healing.
• Rehabilitate the neighboring joints and muscles during immobilization so you do not lose them.
• Return to the river only once the bone tolerates an unexpected impact, not just everyday movement.

Dislocations (shoulder)

A dislocation is the head of the upper arm bone leaving the shallow socket of the shoulder blade, usually forward and downward, tearing the labrum and stretching the capsule as it goes. It happens in rafting when the arm is caught high and behind the body: a high brace stroke against strong water, a hand still on the paddle when the raft flips, or an arm grabbed by a rescuer during a swim. Once the labrum is torn, the joint is more likely to go out again.

Symptoms

• Severe pain with the arm held stiffly away from the body.
• A squared-off shoulder shape with a hollow under the outer edge.
• You cannot bring the arm across your chest.
• Numbness or pins and needles over the outer upper arm.
• A sense that the joint slips or is about to slip when the arm is raised and turned outward.

How serious it is: A first-time full dislocation needs professional reduction and imaging. Repeat dislocations and subluxations, where the joint partly slips and goes back on its own, indicate structural damage, and the younger the person at the first event, the higher the chance of recurrence.

Typical time out: Six to twelve weeks for a first dislocation managed without surgery before contact with fast water, four to six months after stabilization surgery, with earlier return carrying a clear risk of it happening again.

See a doctor if: Go to an emergency department the same day for any suspected dislocation, and go immediately if the hand is numb, cold or pulseless.

What helps

• Support the arm in the position of most comfort and get it reduced by trained hands rather than pulling on it yourself.
• Strengthen the rotator cuff and the muscles that hold the shoulder blade down and back once pain allows.
• Train control in the vulnerable overhead and outward-rotated position rather than avoiding it forever.
• Keep the top hand below shoulder height on paddle strokes and avoid one-armed high braces.
• Discuss surgical stabilization if the joint has dislocated more than once or gives way in daily life.

Concussions

A concussion is a disturbance of brain function after a force transmitted to the head, without structural damage visible on standard scans. On the river it comes from a paddle blade swung by the person behind you, from your head striking rock in shallow water during a swim, and from the whiplash of a raft dropping into a hole. Losing consciousness is not required and happens in only a minority of cases.

Symptoms

• Headache and a pressure feeling in the head after the impact.
• Feeling dazed, slowed down or as if in a fog.
• Dizziness, nausea or trouble with balance.
• Sensitivity to light and noise.
• Trouble remembering the moments just before or after the hit.

How serious it is: Grading systems are no longer used, since the deciding factor is how symptoms behave over the following days. Warning features that separate a concussion from something more serious are a headache that keeps worsening, repeated vomiting, seizures, weakness in a limb or increasing drowsiness.

Typical time out: Most adults are symptom-free within two weeks and return to the water in stages after that, but a minority take a month or more, and anyone who returns while still symptomatic risks a longer recovery. On a river the deciding point is that you must be reliable in cold water before you go back.

See a doctor if: Get emergency care for any loss of consciousness, a seizure, repeated vomiting, worsening confusion or headache, unequal pupils, weakness or slurred speech.

What helps

• End the trip for that person, since a second impact while still symptomatic is the real danger.
• Take it easy for the first two days, then return to light activity that does not clearly worsen symptoms rather than lying in a dark room.
• Build back in stages: walking, then light aerobic work, then flatwater paddling, then rapids.
• Have a clinician assess anyone whose symptoms are not improving after ten to fourteen days.
• Address neck pain and dizziness with targeted therapy, since both often drive persistent symptoms.

Hypothermia

Hypothermia is a fall in core body temperature below roughly 95 degrees Fahrenheit, because heat is lost faster than the body makes it. Water pulls heat from the skin far faster than air of the same temperature, so a swim in snowmelt, a wet paddler sitting in wind, or a long day of spray on a cool river all drive core temperature down. Shivering and paddling create heat only for a while, and once glycogen runs low that defense fails.

Symptoms

• Uncontrollable shivering that you cannot suppress.
• Clumsy hands, so you fumble buckles and cannot hold the paddle properly.
• Slurred or mumbled speech and slow answers.
• Poor judgment and irritability, often noticed by others before you notice it yourself.
• Shivering stopping while the person remains confused, which is a bad sign rather than a good one.

How serious it is: Mild hypothermia means the person is shivering and still alert, and this reverses with shelter, dry layers and warm sweet drinks. Moderate to severe means shivering has stopped, consciousness is reduced and the person must be handled gently, kept horizontal and evacuated, because rough movement can trigger a dangerous heart rhythm.

Typical time out: Hours to a day off the water after a mild episode once the person is warm, alert and eating normally, and several days to weeks after a severe episode treated in hospital. Cold sensitivity often lingers for a season, so the next cold day feels worse than it should.

See a doctor if: Call for help if shivering stops while the person stays confused, if they cannot walk or answer simple questions, or if consciousness is reduced.

What helps

• Get them out of wind and wet clothing and into dry insulation, including a hat and something under them on the ground.
• Wrap in a windproof and waterproof layer, since evaporation from wet skin keeps the cooling going.
• Give warm sweet drinks and food to a fully alert person, and no alcohol.
• Add heat to the trunk rather than rubbing the limbs, which pushes cold blood back to the core.
• Handle a severely cold person gently and keep them horizontal while arranging evacuation.

Drowning (rare)

Drowning is respiratory impairment from being submerged or immersed in liquid, and on a river it usually begins with entrapment rather than with poor swimming. The specific dangers are a foot caught between rocks in current, being pinned under a strainer or against an undercut rock, being recirculated in a hydraulic below a ledge, and the involuntary gasp that cold water triggers on first immersion. Even a strong swimmer cannot fight a current that holds them in place.

Symptoms

• Struggling to keep the head above water with no ability to call out.
• Repeated coughing and choking after coming out of the water.
• Breathlessness, wheeze or chest tightness in the hours afterward.
• Voice changes, foam at the mouth or blue lips.
• Confusion or unusual drowsiness after a swim, which can reflect low oxygen.

How serious it is: The range runs from a swim with a few mouthfuls of water and a cough that settles, through a rescue with persistent cough and breathlessness that needs observation, to unresponsiveness with no breathing, which requires immediate rescue breaths and CPR. Anyone who needed rescuing and keeps coughing must be assessed.

Typical time out: A day or two after a swim with a brief cough that fully settles, several days to weeks of medical follow-up when breathing problems develop, and much longer if oxygen deprivation caused organ or brain injury. Many people also need time before they are willing to face the same water again.

See a doctor if: Get emergency care for anyone who needed to be rescued and still coughs, is short of breath, has a changed voice or is not behaving normally, even if they seem fine at first.

What helps

• Rescue without becoming a second casualty: reach, throw a bag or use a boat before you swim to anyone.
• Start rescue breaths first in a drowning arrest, since the problem is lack of oxygen rather than the heart.
• Learn and practice the defensive swim position and aggressive swimming across current, not against it.
• Never stand up in moving water above knee depth, because foot entrapment is the classic fatal mistake.
• Carry and know how to use a throw bag, and take a swiftwater rescue course if you paddle regularly.

Lower Back Strain and Facet Joint Irritation

Rafting puts you in a seated position with the hips lower than the knees, feet braced and the lumbar spine held in a rounded, loaded posture for hours, while every stroke rotates the trunk against that load. The result is strain of the erector spinae and quadratus lumborum, irritation of the small facet joints at the back of the spine, and compression of the discs. The hard landings when the raft drops off a wave add repeated axial jolts through the same segments.

Symptoms

• A deep ache across the lower back that builds through the day on the water.
• Stiffness and difficulty straightening up when you first stand out of the raft.
• Pain on rotating or leaning back, more than on bending forward.
• One-sided muscle tightness on the side you rotate toward most.
• Soreness that eases with walking and returns as soon as you sit again.

How serious it is: A simple muscular strain is sore, moves reasonably well and settles within days. Pain that shoots below the knee, with numbness, tingling or weakness in the leg, points to nerve involvement and is a different problem that needs assessment.

Typical time out: A few days to two weeks for a straightforward strain, four to eight weeks when the facet joints stay irritated and the back has to be rebuilt, and considerably longer where a disc is involved or where the pain has been present for months already.

See a doctor if: Seek care urgently for numbness in the groin or saddle area, loss of bladder or bowel control, or progressive leg weakness, and see a clinician for pain that wakes you at night in one position regardless of movement.

What helps

• Sit higher on a thwart or a foam pad so the hips are above the knees and the lower back is not held rounded.
• Get out and walk at every eddy and scout stop, since the trouble comes from sustained position more than from effort.
• Build trunk endurance rather than doing sit-ups: side planks, dead bugs and hip hinge work carry over to paddling.
• Rotate through the hips and mid-back on the stroke so the lower back is not the segment doing the twisting.
• Keep moving during a flare, since staying active is more effective than bed rest, and see a physical therapist if it recurs each trip.

Corneal Abrasion and Blunt Eye Injury

The cornea is the clear front surface of the eye, and it scratches easily when grit carried in spray or a fingertip drags across it. In rafting the eye is also open to direct blunt impact from a paddle blade or shaft, from a rope, or from an elbow inside a crowded raft, since a standard helmet does not cover it. A blunt strike can bruise the tissues around the eye, bleed into the front chamber of the eye or fracture the thin floor of the socket.

Symptoms

• A sharp feeling that something is stuck in the eye, which does not go away with blinking.
• Streaming tears and difficulty keeping the eye open in daylight.
• Blurred vision or a halo around lights.
• Redness and pain that worsens with eye movement after a direct hit.
• Seeing floaters, flashes or a shadow across part of your vision.

How serious it is: A simple corneal abrasion is intensely painful but heals over a day or two with no lasting effect. Blood pooling in front of the iris, a pupil that is no longer round, double vision, or reduced vision after blunt trauma indicates a serious injury that needs same-day ophthalmology assessment.

Typical time out: One to three days off the water for an uncomplicated corneal abrasion, one to two weeks after a significant blunt injury with bleeding inside the eye, and several weeks or more if the socket is fractured or the retina is involved.

See a doctor if: Get seen the same day for any loss or blurring of vision, blood visible in the eye, an irregular pupil, double vision, or a suspicion that something has penetrated the eye.

What helps

• Flush the eye with clean water or saline rather than rubbing it, since rubbing drags the particle across the cornea.
• Remove contact lenses and leave them out until the eye is comfortable and clear.
• Shield a blunt-injured eye with a rigid cup rather than a pad, and do not press on it.
• Wear retained sunglasses or goggles on strap, since UV off the water also burns the corneal surface.
• See an eye clinician for anything that has not settled within forty eight hours or that affects vision at any point.

First Aid for Soft Tissue Injuries: PEACE and LOVE

Sports medicine has moved on from RICE. The current guidance, published in the British Journal of Sports Medicine in 2019, splits care into the first days after the injury and everything that follows.

PEACE, the first two to three days

• Protect: unload the area and limit movement that hurts, but only briefly.
• Elevate: keep the limb above heart level when you can.
• Avoid anti-inflammatories: they may blunt the healing you need.
• Compress: a bandage or taping limits swelling.
• Educate: your body heals this on its own; passive treatments rarely speed it up.

LOVE, from day three onward

• Load: return to movement as pain allows, early loading builds tissue.
• Optimism: expectations shape recovery more than most people assume.
• Vascularization: easy cardio that does not hurt brings blood to the area.
• Exercise: restore strength, mobility and balance before returning to play.

Ice still helps with pain in the first hours. What changed is the evidence that long icing and routine anti-inflammatory drugs slow tissue repair.

How to Lower Your Risk in White Water Rafting

• Match the river to the group, not to ambition. Class and water level change week to week, and most trouble starts when the run is above the weakest paddler’s skill.
• Wear a properly fitted whitewater helmet and a snug life jacket, and check the jacket fit by having someone pull up on the shoulders while you stand. The face is the most exposed area on a raft, so a helmet with a brim and good side coverage earns its place.
• Learn the paddle discipline that prevents most in-boat injuries: top hand capped over the T-grip, blade kept low and in front, and no wild swinging when the raft lurches. Passengers are more likely to be hurt inside the raft than after being thrown out of it.
• Practice the swim before you need it: feet up and downstream in the defensive position, aggressive swimming to shore, and never standing up in moving water above knee depth.
• Dress for the water temperature rather than the air. A wetsuit or drysuit with a wind layer prevents both hypothermia and the cold shock gasp that starts many drownings.
• Build paddling-specific fitness before the season: trunk rotation endurance, grip and forearm work, and shoulder blade control, so the muscles that fail on the last rapid of the day are not already exhausted.

When to Stop and Get Medical Help

Most of the injuries on this page are treated at home. These signs are not.

• Any suspected fracture: visible deformity, an inability to bear weight or use the limb, or bone tenderness that does not ease.
• A head impact followed by loss of consciousness, a seizure, repeated vomiting, worsening headache or increasing confusion.
• Numbness, tingling, weakness or a cold, pale, pulseless hand or foot below an injury.
• A joint that will not move or is locked in an unnatural position, including a shoulder held stiffly away from the body.
• Loss of vision, blood visible inside the eye, an irregular pupil or double vision after a blow to the face.
• Anyone who needed to be rescued from the water and is still coughing, breathless, confused or unusually drowsy, and anyone whose shivering has stopped while they remain confused.

Sources

• Whisman, Hollenhorst, Injuries in commercial whitewater rafting, Clinical Journal of Sport Medicine
• Attarian, Siderelis, Injuries in commercial whitewater rafting on the New and Gauley rivers of West Virginia, Wilderness and Environmental Medicine

This article is general information, not medical advice. If you are hurt, a doctor or physiotherapist who can examine you is worth more than any web page. Last reviewed: August 2026.

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