Whitewater rafting and kayaking are growing exponentially in popularity, with almost 10 million rafters and 2 to 3 million kayakers, yet little has been published concerning the safety or hazards of these activities. This article reviews the demographics of such injuries and the types of injuries commonly encountered. Fortunately, fatalities are uncommon in these activities, with rafting and kayaking fatalities occurring at a rate of 0.55 and 2.9 per 100000 user days, respectively. Injury rates for kayaking and rafting are 3 to 6 and 0.26 to 2.1 per 100000 boating days, respectively. Acute injuries in kayaking are usually due to the transferred force of the water on the upper extremity, most often the shoulder, or the impact on an object while "swimming." Acute rafting injuries are more often due to contact with another rafter's paddle or other equipment; the next most common injury is the rafter hitting an object while "swimming." Chronic injuries are very uncommon in rafting but account for 25% to 40% of all kayaking injuries and are most often either shoulder or wrist complaints.