Article

How To Rehab a Surf Injury

Dr. Tim Brown on preventing, and healing, a worn rotator cuff

| posted on August 21, 2012

Damien Hobgood, one of the many victims of a damaged shoulder--an injury often caused by too many perfect barrels. Photo: Joli

A lifetime spent in the lineup doesn’t come without a price. Whether it’s a bum knee, a nagging ankle injury, or the all-too-fickle rotator cuff, if you surf long enough, your body will eventually begin to wear down. To keep you in the lineup and injury-free, we tapped the shoulder of Dr. Tim Brown, the co-medical director of the ASP and founder of IntelliSkin, for the ins and outs of treating one of surfing’s most commonly injured areas: the rotator cuff.

By in large, most rotator cuff injuries occur from paddling improperly. As surfers, we have very developed shoulder muscles. Believe it or not, that’s actually throwing off our body’s alignment, which is what can lead to the injury in the first place. When we paddle, we have a tendency to stroke and then pull our arms inward and toward our body. Repeating that motion for years will actually alter the natural alignment of our shoulders. Over time, you’ll gradually wear down your rotator cuff and eventually be in a lot of pain.

The key to preventing a shoulder injury—like most injuries in surfing—is keeping your body and joints in proper alignment. Think of your rotator cuff as a wheel on a bike. If your wheel is out of alignment, it’ll begin rubbing up against the fork of your bike. At first, it might not be that big of a deal, but over time, that wear and tear will make riding your bike harder and harder until one day, you physically just can’t do it anymore. Now compare that to a tire that’s in perfect alignment. That bike will ride forever—or at least until you don’t want to ride anymore. The key to preventing a rotator cuff injury is all about alignment.

Rotator cuff injuries are actually pretty common in a lot of sports, so we’ve gotten pretty good at treating them. You’ll see a lot of these types of injuries in baseball players as well, and it goes back to that motion of swinging your shoulder over your body and forcing your arm out of alignment. When we treat the injury, we approach more than just the rotator cuff; we look at the whole body and try and strengthen other parts as well to keep everything aligned. We’ll put a lot of focus on strengthening your core and getting you into a proper posture. That’s a huge part of the rehab. Let’s say you surf every day for an hour or two. You’re constantly pulling your shoulders forward in the water and over time, if you’re not actively working to correct it, your shoulders and posture will begin mimicking what you’re doing in the water on land. What you do for those one or two hours in the lineup will actually end up affecting you all day. You’ll get stuck in that pose. If we can fix your posture, we can help fix the injury as well, and hopefully prevent more injuries in the future.

When we’re trying to heal the specific parts of the shoulder in a rotator cuff injury, it’s important to focus on mobility in the area and work on opening up your chest and the muscles underneath your shoulders. It’s all connected. For a lot of surfers, the front of our shoulders are very over used, while the back is not. So you should focus on working on strengthening and opening up the muscles that surround the shoulder to take some of the stress off the injured area. The good news is that, if the injury isn’t too severe, you can typically see a significant amount of recovery in four to eight weeks. Obviously, the younger you are and the healthier you are, the quicker the recovery.

What’s the worst injury you’ve encountered from surfing? Let us know in the comments section below.

  • malcolm nicholson-smith

    Hi, I’m 39 and have been surfing for about 30 years, I am fit and healthy ( apart from a little bit of a spread going on). I recently noticed that when I come out of the water that my right arm was feeling pretty pumped, now I just put this down to having just excercising it and thought nothing of it. Had a great sesh in the water last tuesday and again my arm was feeling “tight”, I asked my wife and best mate if my arm looked big, to which they fell about laughing! but on closer inspection they said that my right arm was actually considerably larger than my left. After some discussion that evening it was decided that I should pay a visit to my G.P., who was puzzled by this and referred me to the local hospital, where after blood tests and a chest xray , which all came back clear, I finally managed to get an ultrasound scan done 2 days later (with the help of a friend who works in the hospital) and they found a blood clot in my armpit. We measured my arm and my right bicep was 3 inches bigger than the left and pretty veiny. I now face 3 months on anti coagulating drugs and some time out of the water. I was wandering if paddling could be a contributing factor to this clot and if there are any other surfers out there who have suffered similar symptoms? I am also a landscape gardener which as you would imagine involves a lot of repetative strain on the upper body / arms , i’m hoping it’s the work that has caused this and not the surfing. thanks for any info you can pass my way.

    Malcolm.

    Swansea, Wales, U.K.

  • owen miller

    so if we think we are paddling wrong, then what is the proper way to paddle without damaging your rotatorcuff.

  • Tim

    I’m with the Owen…. what is the proper technique to prevent rotator cuff injuries? You spent a lot of time talking about bad form and imbalance, but nothing about how to correct it. I have had some issues with both shoulders from surfing and am curious as to what the good doctor’s technique is.

  • sam

    I dislocated my shoulder surfing, it went back in but the damage was already done – tore off bone, cartilage and ligaments. Eventually I had to get an arthroscopic latarjet operation (using 2 titanium rods to hold everything in place). 4 months later and I can surf again but it isn’t anywhere near 100% yet. I’m 19 and in pretty good health, any rehab hints would be greatly appreciated. Sam, Brisbane, Australia.

  • Jeff Mull

    @owen miller and Tim. According to Dr. Brown, the best way to prevent rotator cuff injury when paddling is to not bring your arm in front of your body when you take your stroke. It’s all about keeping the natural motion of your shoulder aligned. An analogy Dr. Brown used is to imagine that you’re trying to keep an orange between your shoulder blades when you paddle. You want to try to squeeze the juice out of it with every stroke. That type of stroke, where your arm isn’t coming across your body, will take some stress off the rotator cuff. Hope that helps.

  • shane

    my worst shoulder injury was from duck diving a way-too short borad on a big day in CR..I underestimated the thickness of the wave and ended up with my R shoulder over-protracted about 6 inches too far resulting in a torn RTC/ supraspinatus, torn biceps tendon, and torn labrum. I actually decided against surgical intervention and found that doing a lot of lower and middle trap strengthening via prone “y”‘s and “t”‘s over the swiss ball helps.. Also mixing up my paddling style so that my elbows are more bent and paddling more like a crab and less like a swimmer helps. Overall, if you decrease the lever arm or length of your paddle stroke, your rotator cuff will incur less torque, your larger muscle groups work harder, and you end up in the water longer (without surgery if possible ;))..

  • http://rota.com/ Here

    Hey, nice post on Rotator cuff. I never heard of that before. Thanks. Bye, Midas.

  • JD

    Would have been great to see more detail in this article.

  • Lauren Polivka

    Good article and insight from Dr Brown and I agree with him 100%. However, as a physical therapist I treat paddling and surfing injuries, its not just knowing how the injury develops, but what are the best exercises, the proper form of doing them, and intensity/frequency etc of each one that relates to a surfer to heal a damaged shoulder and how to prevent a future or reoccurring one. Those PT’s that have sport specific experience can help greatly with this. I would suggest highlighting some actual exercises in blogs or videos to help surfers. One exercise can be great but still a million ways you can do something wrong when you think you are doing good. And when a surfer is injured we know that doesnt stand well. Feel free to contact me if needed. – Lauren P

  • http://randyssouthbayhomes.com Randy Cutshall

    My worst wipeout occurred in 1990 at Sunset Beach on the north shore of Oahu. It was solid 8 to 10 feet and I got clipped by the wave as I approached the end bowl section. My shoulder separated and my leash wrapped around my neck. I was really deep and my board pulling on my leash w/it wrapped around my next was strangling me. It was the left shoulder so I reach over w/my right hand and yanked my shoulder back into the socket. Then I unwrapped the leash around my neck and was so deep used the leash to pull my way to the surface. I remember it being so black down there that when I got the leash off of my neck I didn’t know which way was up!

  • jimmy

    I tore the supraspinatus tendon clean off my right shoulder when i was 26, had surgery to repair it and 3 years on it feels 100%, in the meantime my left shoulder has had repeated partial tears which drive me crazy! 6 weeks out of the water at a time and continued “nursing” it has become a way of life..oh well, the price for 15 plus years of surfing and 10 years glassing and sanding surfboards (heavy on the shoulders)… a part 2 to this good article would be great with maybe some specific techniques for paddling, post surf rotator cuff specific stretches, excercises ..

  • flavio

    in order to heal, first you need to let your body rest for a couple of weeks, then the pain starts to go, proper posture is a basic requirement and that needs to have a professional to help you out. accupuncture, work out with a rubber band and other physioterapy equipments are gonna complete the package.

  • Mark Griffiths

    I recently went surfing a local reef I came off in the tube and hurt my hand on a submerged rock I went to the local hospital and they said it was a fracture of the wrist. I was put in plaster and was to come in for a further x-ray after 2 weeks.
    I returned to the hospital they took it out of plaster no fracture and I went to physio quite happy. In physiotherapy they determined that I had injured the cartilage they bends your wrist I am now awaiting a MRI scan to determine the extent of the damage then it will require key hole surgery to fix it . I wish I had broken it it would be fixed by now, I got so down I went surfing the other night on painkillers but a few days later the wrist was agony again . I guess I have to wait for the surgery but I am a keen surfer and not a great patient . I love your magazine and I have bought it since was 12 years old.
    Kind regards
    Mark Griffiths
    Swansea UK

  • Max Davis

    @Malcolm. I am just learning to surf but wanted to let you know that I was diagnosed with a blood clot in my leg two years ago. This was due to a congenital condition of my Veina Cava (big vein in my left leg) which unfortunately means I have to take Warfarin for life now. Basically I was born with the Vein being to thin for the blood to get through properly. I just thought I’d let you know as it may help you get to the bottom of yours. They gave me a CT scan after the ultrasound which showed the problem with the Vein so maybe request a CT scan if you havent had one yet? Hope this is in some way helpful. Cheers, Max

  • Al Goodwin

    I too was confused by the piece. When I saw the heading I thought I was going to get some gold on my painful rotator cuff. I had already figured it is from surfing.
    I think the heading is mis-leading ‘cos I didn’t read anything about rehab except ‘opening up the muscles around the shoulder’…doesn’t mean anything to me as for everyday posture mimicing my shoulders pulling me through the water I can’t for the life of me think of how that happens as I wander around with my arms at my side like everybody else!

  • zack

    broke my collarbone and put a surf fin through my hand surfing a reefbreak, 33 stitches and 2 staples and its still hurting im going through pt for my collarbone, guess its the nature of the beast though.

  • Owen

    I injured my right knee about a week ago whilst out of water training for the winter season here in Ireland. Under weight I forced the inside of my kneecap out sideways, It took six weeks for the swelling to go down and to see a consultant. Now it’s another eight to ten weeks until I get an MRI, they suspect a medial collateral ligament tear and meniscal damage which I might have to get surgery for.

    I had some irriation in my left shoulder predominately in the first year or two of surfing, but managed to work out my form and additional exercises out of the water to strengthen the shoulder. I’ll probably start to add exercises using a resistance band for the unused deltoids and supraspinitus muscle after reading this. Resistance bands are cheap and you can do an innumerable amount of exercises with them.

    The hardest part is staying out of the water, I feel really shitty. I’ve completely avoided the beach for six weeks, just because I knew if I saw the surf I’d go in regardless.

    But today’s the day, it’s absolutely pumping all week gonna go take a look and see the guys.

  • chris

    Been surfing about 16 years I have been fighting a rotorcuff injury about 5 years now the worst time was last year. A sold 10 ft swell it came out after I caught a wave. Going back out in the inpact zone it poled out felt like my arm was gonads be riped off going next month for surgery. Cant weight. Big swell today and couldent surf because. It came out last night in my sleep its no bs take care of your shoulders. Because your surfing will suffer

  • George A

    This is all great input from another guy who is new to surfing 4 years but now has L shoulder pain after rough NJ Sept ’12 session standing in impact zone to paddling out. Arm movement makes joint noises I can fell but Xray’s negative (MRI’s expensive) . I am currently on non steroid anti inflammatory pill (NSAID) but am doing some gentle stroke exercises. I thinks the bent arm stroke /crab/ orange squeeze between the blades make sense. Strokes for swimming need to be adapted to paddling style. Buy the way for this guy in his forties, that wave jet short board is catching my eye LOL:)

  • Dave Casey

    The best way to rehab and prevent further injury is yoga. I was standing, walking sitting, running, lifting all wrong, parts of my body weren’t doing their jobs. Now even though i’m not Kelly Slater, I know how to mobilise my body prior to a surf and that has improved my riding out of sight. You can get results with just occasional yoga (2-4 times per month), but try to go at least once a week. The positions that constitute yoga actually force your body to slowly chip away at misalignment that causes wear and tear on the joints. Some parts of your body will become more flexible, other parts stronger. You’ll find muscles that you didn’t know you had. Some people are put off by the lack of personalisation in yoga, but this is it’s strength – it acknowledges that our structural differences are minor, those that do exists are often overblown by the subjectivity of our own opinions. Yoga allows optimal form and function to re-establish itself against the habits and restrictions your body has developed in modern life. Most importantly it will happen ‘sympathetically’ – in the natural order – e.g. Maybe your shoulder problem is related to your poorly misaligned spine and your weak hip tilt – how would you know? And if you did know, which is the “root” of the problem. Yoga will let your body work it out for itself, while you just relax and enjoy the benefits.

  • Ari Gabinet

    For George up there in the comments with the popping sound in your shoulder . . . I had the same symptom — then aggravaed and got worse, couldn’t raise my left arm last spring. I have bad calcification from a broken collarbone and a pacemaker — those two things were abrading my biceps tendon, making that sound and causing the pain. Lots and lots of posture correction type exercizes and exercises to open up my chest — the whole slumping inward from to omany bench presses, too mcuh hunching over keyboards. Lots of yoga type stretches and strengthening exercises for middle back and rotators . . . and not only am I pan free, but I stand up straighter and more attractive to women, dogs, wildebeests and marine invertebrates. ;-)

  • I Worlock

    After parting company with my board during an ill advised venture out into a storm swell, we came back together with a bang and I put the imprint of my jawline into the underside of my board. The impact knocked me (briefly) unconscious and the next thing i knew was the dark, sandy, swirling depths. Shitting my pants, I climbed my leash and headed straight for shore, my vision popping bright sparks from the oxygen starvation. I was physically beat when I hit the beach and couldn’t understand where the blood on my foot was coming from as I crouched there shaking. It seemed to be running out from the ankle of my suit – running all the way down from the TEAR ACROSS THE THROAT that the split rail of my surfboard had given me! It looked terrible, but wasn’t deep and actually stopped bleeding on its own within 1/2 hour (which meant you could see all the neck structures – cartilage, glands & soft tissue). The worst part was lying still in the hospital whilst the nurse was poking about the inside of my neck with tweezers trying to get all the glass fibers that the jagged rail split had left behind. Gory stuff!

    Funnily enough though, it didn’t really keep me out of the water for long. I missed far more time after mangling my shoulder joint being an idiot with my mates on the beach after a session, what with recurrent dislocations, a reconstruction and all the rehab, so in many ways that was the worse injury. Although my rotator cuff must have taken a shredding, it doesn’t give me much grief but I regularly get pain under my shoulder blade – except when in the water. That’s my excuse for spending all that time in the water – its rehab!

  • Tjalling

    I got clipped 3 weeks and tore a muscle in my ass. The initial injury wasnt that bad and I went surfing 1 week later. I made a take-off an felt an excruciating pain in the injury, this time my impatience had forced the injury and i could barely walk up and downt he stairs, let alone stretch my left leg. I have been waiting for the past 2 weeks for the muscle to recover, I have been practicing some take-offs on dryland, but still its impossible to strecht and i simply cannot make the movement necessary for a take-off. The surf is pumping and next week i travel with a few mates to Chicama (Peru), I am so pissed off at myself for not taking time to recover properly..

    CONCLUSION: with every injury you gotta be super super patient and give it rest.

  • Markel

    it’s very interesting article but it’s not clear how to paddle properly (some pictures would really helpful). I got elbow tendonitis in both elbows, especially left arm, and it seems that never will recovery again, would be interesting an article about how to rehab this, cheers!

  • Glider

    Some specifics would be helpful.

  • RIck

    What a pointless article. WHAT are the rehab exercises one can do? WHAT is the proper paddling technique, if we’re all doing it wrong? WHY bring any of this up if you don’t offer any suggestions or solutions. Idiotic.