Surfer's Back Pain & Injuries

Surfing is popular with participants on coastlines throughout the world. At some stage, most surfers experience some degree of lower back pain or stiffness. A 2014 Australian study reporting it as the highest-ranking of surfing injuries at 23.3%. The most common form of lower back pain when surfing is characterised by tight muscles and a constant dull ache, and is most often caused by an over-arching lower back and a very stiff upper back. Unfortunately, many surfers are also plagued by back pain that hinders or terminates their participation in the sport.

The older surfers (age higher than 40) and more experienced surfers (more than 20 years of surfing) have higher relative risks of injuries, with the 35-55 age bracket being the most affected by lower back pain.
Common Causes of Back Pain in SurfersThe most common reasons for low back in surfers is due to one or more of the following:

1. Large amount of time spent in the prone position. 38.5% of chronic lower back injury were attributed to both prolonged paddling and lying on the surfboard, both of which involve lying prone.[
2. Prolonged extension of the lumbar with facet joints in a closed packed position (whilst paddling) increases the demands on the low back and may predispose it to chronic injury.
3. Inadequate extension in the thoracic and cervical spine increasing the demands of extension on the low back. The lower back is forced to do more extension than it would normally do.
4. Explosive turning, cutting, and twisting movements often combining the trunk movements of flexion and rotation combined, predispose the lower back to chronic injury.
5. Insufficient core stability (an integral part of surfing). The core is required to perform manoeuvres and to protect the body, especially the spine, from injury by stabilisation. Also an important function is to stabilise the trunk to enable precise movement of the extremities (needed in the completion of surfing maneuver.
6. Insufficient flexibility and strength of muscles in lower kinetic chain and spine.
7. Poor surfing technique eg in "pop up"; with paddling.

What would a Physical Therapist be looking for ? 
An objective assessment would include the following

Surfing position and "pop up" technique - look out for:

• hyperextension of the back
• stiff segments in the back
• poor flexibility/strength with "pop up"
• not engaging core muscle adequately (All these can contribute to a potential cause of the problem).
• Checking  movement in spine - looking for :
  • stiff or hypermobile joints
  • scoliosis; kyphosis
  • excessive lordosis, etc.

Muscle lengths and strength should be assessed in the major muscles involved in surfing.
These include:

• core muscles as involved in stabilising/supporting pelvis
• hip flexors
• thigh muscles

Physical Therapy treatment program will address  :

• highlighted tight or weak areas
• posture
• core stability & core strengthening

• faulty movement patterns
• deficits in flexibility, strength, and coordination.

 
Manual Therapy skills to improve the client's condition.
These skills include:

• Joint Mobilization 
• Foam roller techniques
• Soft tissue release
• Trigger point release
• Active Release Techniques
• Stretching including  contraction & relaxation, etc.

Stretches
Include some or all of the following stretches: 

• Hip flexors stretch (shown in image),
• Quadratus Lumborum stretch
• Erector Spinae stretch
• Latissimus Dorsi stretch
• Thoracic and or Lumbar rotation and extension stretches
• Gluteal muscles and any other relevant muscles found to be tight

Core muscle trainingPerform Core muscle training in the neutral position for functional tasks, as the neutral position is where you have the least amount of stress on lumbar spine and will help protect the back. Stability and endurance of the deep stabilizers of the lumbar spineThese will provide stability for the lumbar spine, critical for its performance and protection.ie deep abdominals, deep lumbar multifidus, and glutes. They provide stability and support to the lumbar spine throughout movement and provide important protection from the high forces placed on the body during surfing.

Surfing Technique Guidance 
​The PT will instruct on ways to lessen extension in paddling and "pop ups". eg learn to engage core before popping up, learn to arch whole spine when extending not just low back, instruct on need to loosen up body and back before and after surfing to maintain back health. Check that muscles have sufficient flexibility, strength and co-ordination for surfing postures. 

Conclusion: This blog highlights the lower back as a key region where chronic injuries occur in surfers. This can assist in reducing the occurrence of injury through appropriate assessment, treatment and the use of sports-specific strength training and conditioning.  Happy Surfing !