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- 1 Introduction
- 2 Common Causes of Back Pain in Surfers
- 3 Subjective Assessment
- 4 Objective Assessment
- 5 Physiotherapy Treatment
- 6 References
IntroductionSurfing 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 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.
NB - This page describes and evaluates the common forms of surfers back. If assessment reveals any eg.red flags, spinal masqueraders, suspected spinal fracture be sure to liaise with appropriate medics and investigate as needed.
Common Causes of Back Pain in SurfersThe most common reasons for low back in surfers is due to one or more of the following:
- Large amount of time spent in the prone position. Furness et al (2012) finding that 38.5% chronic lower back injury were attributed to both prolonged paddling and lying on the surf board, both of which involve lying prone.
- 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.
- 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).
- Explosive turning, cutting, and twisting movements often combining the trunk movements of flexion and rotation combined, predispose the lower back to chronic injury.
- 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 manoeuvres).
- Insufficient flexibility and strength of muscles in lower kinetic chain and spine.
- Poor surfing technique eg in "pop up"; with paddling.
Questions to ask include:
- Past back problems?
- Any accidents falling off board?
- Check for any red flags i.e recent malignancy, unremitting pain, weight loss etc.
- Is it chronic, sub-acute or acute?
- Recent changes in surfing regime
- What type of work do they do, as this may predispose to back pain
- How long does it take for pain to come on?
- Is it only with certain movements or manoeuvres?
- Inquire if they have ever had surfing lessons or technique coaching.
Include at a minimum 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).
- Check movement in spine - looking for :
- stiff or hyper mobile 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
- quadratus lumborum
- erector spinae
- Neurodynamic tests:
A good treatment program will address the correction of :
- highlighted tight or weak areas
- faulty movement patterns
- deficits in flexibility, strength, and coordination.
Manual TherapyAs a physical therapist you have lots of good Manual Therapy skills to improve the client's condition. These skills include:
- Maitland mobilisations,
- Foam roller techniques (see attached picture),
- Soft tissue release
- Trigger point release
- Kaltenborn techniques
- Active Release Techniques
- Stretching including PNF, contract relax, etc.
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 training
Perform 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 spine
These 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
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. Rehabilitate as needed.
NB seek out surfing coaches if required
This page highlights the lower back as a key region where chronic injuries occur in surfers. This page can assist in reducing the occurrence of injury through appropriate assessment, treatment and the use of sports-specific strength training and conditioning. Happy Surfing
Additional ViewingThis video gives tips on ways to lessen facet joint irritation when surfing
This video gives some technique guidance to lessen the load on the low back
- Furness J, Hing W, Abbott A Walsh J Sheppard JM, Climstein M. Retrospective Analysis of Chronic Injuries in Recreational and Competitive Surfers: Injury Location, Type, and Mechanism. International Journal of Aquatic Research and Education. 2014:Vol 8:No 3; Article 6. (last accessed 19 September 2019)
- Hammer RL, Loubert PV. Alternative pop-up for surfers with low back pain. North American journal of sports physical therapy: NAJSPT. 2010 Feb;5(1):15. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2953347/ (last accessed 15.9.2019)
- Bazanella, N.V., Garrett, J.G.Z.D.A., Gomes, A.R.S., Novack, L.F., Osiecki, R. and Korelo, R.I.G., 2016. Association between low back pain and functional/kinetic aspects of surfers: disability, function, flexibility, range of motion and angle of the thoracic and lumbar spine. Fisioterapia e Pesquisa, 23(4), pp.394-401. Available from: http://www.scielo.br/scielo.php?pid=S1809-29502016000400394&script=sci_arttext&tlng=en#B3 (last accessed 16.9.2019)
- Liisa Airaksinen THE ROLE OF CORE STABILITY IN SURFING Melbourne, Australia. Bachelor Degree Program in Physiotherapy May 2013 Available from: https://www.theseus.fi/bitstream/handle/10024/63501/Airaksinen_Liisa.pdf?sequence=1&isAllowed=y (last accessed 16.9.2019)
- Surfline The straw that broke the surfer's back Available from: https://www.surfline.com/surf-news/tim-brown--team-offer-advice-on-back-injuries-in-surfing_38952/ (last accessed 16.9.2016)
- Santa Cruz Spine and Sport Low back and neck pain from surfing - Dr. Justin McLeod- Spine & Sport Available from: https://www.youtube.com/watch?v=3Q2F_-iA8ps (last accessed 17.9.2019)
- Kelly Starrett Low Back Pain and Better Surfing | Feat. Kelly Starrett | Ep. 328 | MobilityWOD Available from :https://www.youtube.com/watch?v=IvrG1nOn_ZA (last accessed 17.9.2019)