The Current State of Surf Injuries
*Thank you to DonJoy Performance for supporting this coverage of the science behind surfing’s progression in the lead up to surfing’s Olympic debut. DonJoy provides elite injury protection and prevention for surf athletes.
Team USA Olympic surfer John John Florence is on the road to recovery after a knee injury sustained during the World Surf League’s Australian leg. In an Instagram post, he reports that a surgical procedure will give him the opportunity to compete sooner than expected. He is on track to make an exciting Olympic surfing debut in late July.
Team USA’s Kolohe Andino has also been intensely focused on his physical therapy after a high ankle sprain sidelined him just before the World Surf League’s Newcastle event.
Both men are spending the next two-and-a-half months healing and rehabbing to ensure they are full strength for surfing’s Olympic debut this summer.
Injuries like theirs are increasingly common and getting more attention under the Olympic spotlight.
According to research conducted by USA Surfing medical director Kevyn Dean, WSL medical director Dr. Warren Kramer and orthopedic surgeon Dr. Eric Hohn, knee and ankle injuries are the most common injuries among the world’s most elite surfers.
The researchers are seeking to gain a better understanding of the kind of injuries occurring and what’s being done to prevent and address them.
“We wanted to find out — are surfing injuries on the rise, or are we just becoming more aware of them as a result of increased access to information through social networking and our desire to stack our fantasy teams?” asked Dean.
Dean, Kramer and Hohn have been tracking the recoveries of many professional, and recreational surfers after injury, and reports that surfing injuries requiring time out of the water are increasing.
It’s true that surfers are performing bigger, riskier maneuvers as the sport progresses, but going bigger doesn’t account for much of the increased injuries. In fact, the majority of injuries presenting to medical professionals continue to be a result of everyday surfing, in mediocre waves, attempting non-aggressive maneuvers.
To learn more about the types of emerging injuries, Dean, Kramer and Hohn collected and analyzed the injuries treated to date in an attempt to define injury patterns in this group.
Common injuries, treatment and prevention
The research found five top areas injured along with the typical mechanisms reported. Although there are many elements that make up proper movement, the most common are addressed, with suggestions for ways surfers can protect themselves.
Knee Injuries: 29 percent
Knee injuries were the most common, and like the hip, the most commonly involved side, was the back leg. In the knee the structure injured the most (46 percent) was the medial collateral ligament (MCL). The knee is the largest hinge joint in the body, and it flexes and extends forwards and back. It is not intended to bend from side to side. As such, surfers driving off their dominant back leg place undo stress upon the MCL by forcing their knee sideways down to the board.
Treatment: An easy approach for this is to encourage a slight outward placement of the heel. This allows the knee to drop toward the stringer of the board more in true flexion and extension (forward and back), and less in abduction and adduction (side to side).
Ankle Injuries: 22 percent
71 percent of the ankle injuries in this study were sprains and 52 percent involved the syndesmosis (a high ankle sprain). This type of injury occurs when the top of the foot is driven up forcefully toward the tibia or when the foot is twisted side ways under the ankle. This often occurs when landing hard during an air or floater.
Treatment: Increasing dorsiflexion range of motion (raising the toes toward the shin) allows the ankle to move into those ranges with greater ease and less resistance.
Shoulder Injuries: 19 percent
52 percent of the shoulder injuries involved joint instability. For surfers, when the shoulder joint is forced beyond its anatomical limits during activities such as grabbing the water to stall, or the arm gets stuck in the water during a fall, instability often results.
Treatment: Strengthening the rotator cuff is a simple solution. The function of the four muscles around the shoulder that make up the rotator cuff is to keep the head of the humerus centered in the joint. Often shoulder strengthening focuses the major muscles around the joint; the deltoid, latissumus dorsi, and the pectoralis. These are not the rotator cuff, and as such do not function to keep the ball centered in the socket. The following exercises will strengthen the rotator cuff, and improve the stability of the joint.
Hip injuries: 11 percent
67 percent of the hip injuries in this study involved damage to the labrum in the joint. The labrum is a soft tissue inside the hip that lines the edge of the socket encircling the round head of the femur. Impingement on the labrum can occur when the leg is brought forward, allowed to move across midline, and rotated in-ward. This is the same position found in a typical surf stance.
Treatment: To address this common injury the joint configuration for each athlete is assessed. Understanding the orientation (the positioning) of the hip socket and identifying any abnormalities in the shape of the head and neck of the femur is critical. When potential for pinching the labrum is possible, a “knock kneed” stance should be avoided.
Back injuries: 10 percent
The majority of back injuries (37.5 percent) are lumbar sprains. Lumbar sprains occur when the low back is forced into positions beyond its anatomical limits. Although typical core stability can help we want to focus on anatomical limitations that are put in place by recurring surf movements. Surfing is a unilateral sport, where a surfer has a consistent stance comprised of one foot forward, while the body is rotated slightly toward the front leg. A trunk rotation asymmetry often occurs. When the trunk is forced to rotate against the asymmetry, low back sprains result.
PREVENTION
There is a noted increase in surf injuries, both for the competitive athlete, and the recreational surfer. Identifying the reasons behind this increase, what is being done to address it, and the results of those efforts will benefit all involved in the sport.
“Surfers should work with trainers and physical therapists who watch them surf or at least watch film of them surfing, so they can see and understand the movement patterns unique to each surfers,” Dean said. “Our goal in identifying commonalities is to start a conversation and raise awareness about which injuries are on the rise and why.”
Strength training
Strength training is important for improving performance and preventing injury, but it should always be accompanied by attention to movement patterns. Moving correctly, avoiding positions that put surfers at risk, and staying within anatomical limitations are foundational keys to athletic training.
“This is overlooked far too often,” Dean warns. “Yes, physical conditioning increases power allowing an athlete to push harder, however, building strength on top of poor movement puts an athlete in compromised positions with increased force. Traumatic breakdown becomes inevitable. Strength is important, but proper movement as a foundation is imperative for preventing injury.”
Overuse
Overuse is another emerging culprit. Wave pools allowing for more repetitions in compromised positions lead to injury. Surfers have always logged many hours, but the repetition in close succession is increasing with the rise of wave pools.
Recovery
Due to COVID-19, World Surf League competition schedules and surf travel were put on pause for most of 2020. The shutdown gave many surfers a newfound appreciation for the importance of rest and recovery. Surfers taking part in USA Surfing’s 2020 Olympic Training Camp at BSR Surf Resort in Waco, Texas took advantage of the newly installed recovery room, complete with ice baths, infrared saunas, Normatec and Hyperice tools to reduce inflammation and rehab bodies that get worked in the wave pool.
USA Surfing medical director Kevyn Dean, MSPT, OCS spoke to surfers about the role recovery and rehab efforts play in keeping surf athletes strong and healthy. He shared emerging findings about how surfing injuries take place and how to address and prevent them.
For many, the increased down time led to more rest, more attention to film review and technique, equipment tweaks and smarter training — all having the potential to reduce injuries.
As the WSL Championship Tour continues this month, Dean, Kramer, and Hohn will continue to watch performances and injuries carefully.
As the science of surfing performance advances, more will be known about prevention and rehabbing these common injuries so that surfers can stay in the water doing what they love.
- Thank you to DonJoy Performance for supporting this coverage of the science behind surfing’s progression in the lead up to surfing’s Olympic debut.
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