Surfing/Injuries

Injury Modifications

5 injury guides

Guidelines for safely modifying workouts when dealing with common injuries. Always consult a healthcare professional for specific medical advice.

Concussion Drowning

Head injuries in surfing can occur from contact with your own board, other surfers' boards, the ocean floor (reef/sand), or underwater impact during wipeouts. The unique danger in surfing is that a head injury can lead to drowning if the surfer becomes unconscious or disoriented in the water. This is a safety-critical awareness document.

Warning Signs

  • ⚠Any symptom of concussion
  • ⚠Persistent coughing after hold-down
  • ⚠Feeling unusually tired
  • ⚠Difficulty thinking clearly

Red Flags - Seek Immediate Care

  • ●Loss of consciousness - EXIT WATER IMMEDIATELY, seek medical care
  • ●Person floating face down - EMERGENCY RESCUE, call 911
  • ●Repeated vomiting - may indicate significant head injury, ER
  • ●Worsening headache - possible brain bleed, ER
  • ●One pupil larger than other - BRAIN EMERGENCY, call 911
  • ●Cannot be awakened - BRAIN EMERGENCY, call 911
  • ●Difficulty breathing after being held under - may develop delayed pulmonary edema, seek care
  • ●Blue lips or altered consciousness - MEDICAL EMERGENCY
  • ●Seizure - MEDICAL EMERGENCY

When to Seek Professional Care

  • →Any loss of consciousness
  • →Concussion symptoms
  • →Significant water inhalation
  • →Confusion or disorientation after head injury
  • →Any red flag symptoms
  • →Persistent symptoms after near-drowning

Contraindicated Movements

Continuing to surf after any head injurySurfing alone if history of head injuryBig waves without proper safety measuresShallow reef without helmet

Ear Infections

Ear problems are extremely common in surfers. Two main conditions: 1. Otitis Externa (Swimmer's Ear): Infection of the ear canal from water exposure. Causes pain, itching, and sometimes drainage. 2. Exostosis (Surfer's Ear): Bony growths in the ear canal from cold water and wind exposure. Develops over years and can trap water, increasing infection risk. Cold water surfers are at particular risk for exostosis.

Warning Signs

  • ⚠Pain worsening despite treatment
  • ⚠Swelling spreading to face
  • ⚠Fever
  • ⚠Hearing getting worse
  • ⚠Drainage changing character

Red Flags - Seek Immediate Care

  • ●Swelling/redness spreading to face or neck - SPREADING INFECTION, urgent care
  • ●Fever with ear infection - may need oral antibiotics, see doctor same day
  • ●Severe pain uncontrolled by medication - may need ear wick or stronger treatment
  • ●Diabetes + ear infection - MALIGNANT OTITIS RISK, needs urgent evaluation
  • ●Black or bloody drainage - concerning for more serious infection
  • ●Facial weakness (inability to move face muscles) - nerve involvement, ER visit

When to Seek Professional Care

  • →Moderate to severe ear pain
  • →Drainage from ear
  • →Fever with ear symptoms
  • →Hearing loss
  • →Symptoms not improving with home care
  • →Recurrent ear infections
  • →Concern for exostosis (chronic water trapping)

General Principles

  • •Dry ears after every surf session
  • •Prevention is easier than treatment
  • •Ear plugs are essential for cold water surfers
  • •Don't put objects in ear canal (Q-tips can worsen problems)
  • •Exostosis is preventable with ear plugs

Recommended Exercises

Any land-based training

sets × reps

Maintain fitness while ear heals

Swimming (if ears dry after)

sets × reps

Pool swimming with plugs may be okay once infection clear

Lacerations Reef

Lacerations are common in surfing from contact with fins, the board, reef, and rocks. Reef cuts are particularly problematic due to infection risk from marine organisms and coral debris embedded in wounds. Tropical reef cuts heal notoriously slowly and are prone to infection. Proper wound care is essential to prevent complications.

Warning Signs

  • ⚠Wound not healing after 1 week
  • ⚠Increasing pain after first 2 days
  • ⚠Any signs of infection
  • ⚠Numbness or weakness near wound

Red Flags - Seek Immediate Care

  • ●Red streaks spreading from wound - INFECTION SPREADING, seek care immediately
  • ●Fever with wound infection - SYSTEMIC INFECTION, urgent care
  • ●Wound has foul smell - SIGNIFICANT INFECTION, medical care
  • ●Significant bleeding that won't stop - may need sutures, apply pressure, seek care
  • ●Visible bone, tendon, or deep structures - ER for evaluation and repair
  • ●Human or animal bite wound - high infection risk, needs antibiotics
  • ●Numbness distal to wound - nerve damage possible

When to Seek Professional Care

  • →Deep wounds that may need sutures
  • →Wounds that won't stop bleeding
  • →Visible deep structures
  • →Any signs of infection
  • →Wounds that aren't healing
  • →Tetanus not up to date (>5 years)

General Principles

  • •Reef cuts heal slowly - be patient
  • •Infection is common with marine wounds
  • •Thorough cleaning is more important than closure
  • •Don't surf with open wounds (infection risk)
  • •Tetanus should be up to date for surfers

Recommended Exercises

Upper body training (if lower body wound)

sets × reps

Maintain fitness while healing

Lower body training (if upper body wound)

sets × reps

Maintain fitness while healing

Core work (usually possible)

sets × reps

Maintain surf fitness

Lower Back

Lower back pain is common in surfers due to the sustained hyperextension position during paddling. Lying prone on the board with the back arched to lift the head creates significant lumbar extension loading. Pop-ups also load the spine as you transition from prone to standing. Duck diving involves repetitive flexion and extension cycles.

Warning Signs

  • ⚠Radiating leg pain
  • ⚠Numbness or tingling in legs
  • ⚠Weakness in legs
  • ⚠Pain worsening despite rest
  • ⚠Difficulty with bowel or bladder

Red Flags - Seek Immediate Care

  • ●Saddle numbness (groin, inner thighs) - CAUDA EQUINA EMERGENCY, ER immediately
  • ●Bladder or bowel dysfunction with back pain - ER immediately
  • ●Bilateral leg weakness - ER immediately
  • ●Progressive numbness or weakness in legs
  • ●Severe pain after specific incident (possible disc herniation)

When to Seek Professional Care

  • →Any red flag symptoms
  • →Radiating leg pain
  • →No improvement after 2-4 weeks of rest
  • →Pain affecting daily activities significantly

General Principles

  • •Core stability is protective against back pain in surfers
  • •Hip flexibility reduces compensatory lumbar motion
  • •Paddling position can be modified to reduce extension
  • •Cross-training helps balance the extension-dominant surf position
  • •Bodyboarding is easier on the back than shortboarding

Recommended Exercises

Core stability (planks, bird dogs)

3 sets × reps

Stabilizes spine during paddling

Hip flexor stretching

3 sets × reps

Tight hip flexors increase lumbar extension

Glute bridges

3 sets × 15 reps

Counteracts hip flexor tightness

Cat-cow stretches

3 sets × 10 reps

Restores spine mobility

Swimming (freestyle, breaststroke)

sets × reps

Cross-training that reduces extension bias

Thoracic extension mobilization

3 sets × 10 reps

Better thoracic mobility reduces lumbar compensation

Shoulder Paddling

Shoulder problems are the most common overuse injury in surfers, with paddling accounting for 45-55% of total surf time. The repetitive overhead pulling motion, combined with the prone paddling position, creates significant stress on the rotator cuff and surrounding structures. Common conditions: - Rotator cuff tendinopathy: Overuse of supraspinatus and other cuff muscles - Shoulder impingement: Compression of structures in subacromial space - Biceps tendinopathy: From repetitive paddle stroke

Warning Signs

  • ⚠Pain increasing during session
  • ⚠Weakness developing
  • ⚠Night pain
  • ⚠Clicking or catching
  • ⚠Unable to reach overhead

Red Flags - Seek Immediate Care

  • ●Sudden weakness with inability to lift arm (rotator cuff tear) - seek evaluation
  • ●Shoulder dislocation or deformity - seek immediate care
  • ●Numbness or tingling down arm
  • ●Significant weakness in specific movements

When to Seek Professional Care

  • →Any red flag symptoms
  • →No improvement after 4-6 weeks of modification
  • →Significant weakness
  • →Pain affecting daily activities
  • →History of shoulder instability or dislocation

General Principles

  • •Paddle technique matters - high elbow catch reduces impingement
  • •Rotator cuff and scapular strength are protective
  • •Surfing a smaller board = more paddling = more shoulder stress
  • •Warm up before paddling out
  • •Cross-train with swimming to improve paddle fitness

Contraindicated Movements

Long paddle-outs when symptomaticOverhead stretching while inflamedAggressive duck diving (uses significant shoulder force)Surfing spots requiring long paddles when injured

Recommended Exercises

External rotation with band

3 sets × 15 reps

Strengthens rotator cuff to counteract internal rotation dominance from paddling

Y-T-W raises (prone)

3 sets × 10 reps

Strengthens lower trapezius and rotator cuff in prone position

Scapular push-ups

3 sets × 15 reps

Serratus anterior strength for scapular stability

Rows (cable or band)

3 sets × 15 reps

Strengthens posterior shoulder and scapular retractors

Face pulls

3 sets × 15 reps

External rotator and posterior shoulder strengthening

Thoracic spine mobility

2 sets × 10 reps

Better thoracic mobility reduces shoulder compensation