On-water and dry-land training programs for sprint canoeists and kayakers are physically demanding. Musculoskeletal injuries particularly to the shoulder, thoracic, and scapula regions are common. Overtraining can lead to muscle imbalances, glenohumeral and scapular kinematic dysfunctions, soft-tissue damage, and pain. Preventive programs are required. However, objective research-based evidence for sprint canoe- and kayak-specific preventive programming is lacking. This study will discuss common injuries sustained by paddlers, the mechanisms of these injuries, treatment and prevention approaches, and practical applications highlighting the need for coaches, clinicians, and strength and conditioning professionals to take a proactive approach in addressing high-risk injury factors. For a video abstract of this article, see Supplemental Digital Content 1, http://links.lww.com/SCJ/A275.