Preventing Injuries: What Surfers May Not Know

Therapydia Treat Surf Injuries

Feeling sore after getting out of the water? It may not be entirely obvious that you may be developing an injury somewhere in your body. Feeling any type of tightness or nagging aches in your shoulders or knees may mean that you’re not moving correctly when you’re on the water. Most surfing-related injuries could be prevented by knowing how to better engage certain parts of your body. Surf injuries lead to a progressive downgrade of a surfer’s performance since those aches and pains get in the way of how well you surf.

If you do feel some aches after getting out of the water, you may need some help with how you move. You may not have known how to use certain muscles to allow you to get the most out of your surf routine.

Don’t Cheat By Rotating Through The Knees

Surfing requires significant range of motion and stability across many major joints. Many surfers start developing injuries when they get stuck in a specific movement pattern. To start with, knees can take a beating when surfing. If your knees are feeling sore, you’re not going to produce as powerful of turns. As a surfer, it’s critical to have a healthy knee joint and quality strength throughout the muscles of the legs and hips. When surfing, your knee can get into some awkward or unnatural positions that put too much strain on your knee joints. Relying on just your knees to produce the force you need to make those turns can cause pain in your knee joint. These issues could range from damage to the cartilage, ligaments, and tendons around your knee joint to having your knee joint start to misalign.

Activate Above Your Knees

Consider moving throughout your entire body as you cut and turn through the waves. One solution to help your knees out would be to rotate through your shoulders and trunk (i.e. chest and ribcage). Flowing from turn to turn involves leading with your shoulder and hips. When leading into a really tight turn, it’s especially helpful to utilize your hips. Getting low and staying balanced while tube riding also requires a lot of hip, knee, and ankle flexibility and strength. Surfing creates tight hip flexors (i.e. muscles surrounding your hips) because straddling the board keeps those muscles contracted for long periods of time. Having tight hips can restrict how well you rotate during a turn. When this happens, it goes back to that knee pain. You’ll compensate for the force needed to turn by using your knees, which will strain them. Better hip flexibility and strength can also help with the fundamental squat position, you’ll see better stability and more lower body control while you’re out there surfing.

Those Achy, Creaking Shoulders

Surfer’s also have a high risk for overusing and putting too much strain on their shoulders. When surfing, you’re constantly pulling your shoulders forward in the water. Over time, this becomes a habit and you begin stretching and irritating the muscles around your shoulder. Paddling also strengthens certain muscles in the shoulder while weakening the rotator cuff muscles (i.e. muscles around upper arm and top of shoulder). This leads to a type of injury called shoulder impingement, which occurs when you constantly compress the rotator cuff tendons of your shoulder with a lot of overhead movement (i.e. paddling). Strengthening the muscles that surround the back of your shoulder will take the stress off of those overused muscles in the front. Working on balancing the pressure across your shoulder muscles will prevent any inflammation or pain that may come from having your shoulder impinged. Paddling also takes a lot of power and flexibility coming from your back and core. If you consider how your entire body moves when you paddle, you’ll put less stress on certain parts of your body and begin to utilize major muscle groups.

Surf With Your Whole Body

While some moves may require the use of certain muscles more than others, it’s important to have strength and flexibility across your body. Surfing is as dynamic of a sport as it gets—moving on open water is anything but simple. Your body has to punch back against the force of the waves while also moving well. Each wave will have an effect on your board and ultimately on your body. Working through your movements and figuring out the cause of your pain will help you move your best—and surf your best.

Right Workstation, Wrong Posture

chair posture ergonomics

Did you finally buy that top-end office chair only to find out that your neck and back still hurt during the day?

High end office chairs often come equipped with contoured lumbar support which is fine, but truth be told; the best lumbar support comes from you supporting yourself with your own muscles.

The quickest way to stop hurting yourself at work is to lift your chest, slightly tuck your chin back and gently feel the muscles of the low back lifting the pressure up off your sit bones.

Standing is better than sitting – however bad standing can still result in many of the problems found with sitting. Your muscles are designed to lift the pressure off of more delicate structures such as joints and cartilage. Your muscles can help protect your delicate joints but only if you consciously use them.

Using Technology To Help Chronic Back Pain: A Physical Therapist’s Thoughts on Lumo Lift

lumo lift back pain posture

I was fortunately gifted a Lumo Lift a few weeks ago. Lumo Lift is a small device that clips onto your shirt and it uses subtle vibrations to remind you to straighten up when you slumping into poor posture. You can also customize your experience—from a 3 second vibration delay to 10 minutes— set goals, and track your physical activity through the Lumo Lift App. I instantly took it out of the box, downloaded the app and followed the simple setup instructions. I wore the Lift all day for three consecutive days and tracked my steps per day and posture. Then I passed off Lumo Lift to one of my patients suffering from chronic low back pain.

Why Exercise Isn’t Always Enough For Back Pain

I often tell my patients that they need to incorporate a systems based approach to stopping their low back pain.  Specific exercises are important to gain the flexibility, strength and coordination needed to facilitate proper posture with sitting, standing, bending, sports performance, etc.  However, my professional opinion is that exercise alone does very little to keep lower back pain from reoccurring.  

Ultimately most chronic back pain cases persist because patients are constantly causing irritation to their lumbar spine without realizing it. Poor posture is the number one cause of back pain. Bone spurs and disc bulges are now largely believed to be predictable responses to the way we distribute forces across our spine.  Research tells us that sitting in a chair and slouching puts a lot of pressure on our spines. Not surprisingly, most patients with back pain say that sitting causes more pain than standing.  

The Patient’s Result

My patient with low back pain wore the Lumo Lift for five days and very surprised at how often he was falling into poor postures. He believes that the gentle vibration from Lumo Lift has in fact decreased his lower back pain and made him more mindful of his positioning.  

I plan on continuing to send patients home with Lumo Lift.  I always tell my patientsit only takes one unfortunate episode of slouching or bending over the wrong way to set off an episode of acute back pain.  

Lumo Lift seems like an easy, consumer friendly way to help reinforce proper static seated and standing postures.   

Traits of Physical Therapy Patients Who Beat the Odds

physical therapy recovery program

Over the past five and a half years of treating patients for 40+ hours per week, I have seen several patients beat the odds – by a lot! These folks were given very low expectations from neurologists, orthopedic doctors and even other physical therapists.

Sometimes their gains seemed to defy what the science taught us to be possible. What causes such incredible outcomes? Is it great therapy? No, I can’t accept such credit. There seems to be some golden, intangible thread that allows these patients to beat their prognosis. I have tried to read between the lines when working with these patients to better understand what they seem to know and learn how to teach their incredible skills to other patients.

What 4 traits do these patients have in common?

1. The ability to suspend their disbelief: The ability to take one step and a time and be process orientated instead of end goal orientated. The ability to suspend judgement on one’s condition or situation.

Why is this important?: Simple logic – if you don’t swing the bat, you can’t hit the ball. Every great modern accomplishment by humans was initially thought to be impossible. Someone always has to be the first to do what has never been done.

2. Setting intentions is foundation of luck: No you can’t magically speak yourself into getting better after suffering a major physical trauma. However, if you intend on getting better, you are more likely to ask important questions and surround yourself with healthcare providers who are talented enough to help you on your journey.

Why is this important?: Dr. Wayne Dyer says it best with his book “The Power of Intention” that if you intend to succeed then success chases you instead of you chasing it.

3. The ability to put stress in it’s place: A powerful exercise that we teach our patients to do is to set a timer and let yourself worry about your aliment for no longer than 10 minutes per day. During those 10 minutes it is okay to cry, wring hands, complain, etc. After those 10 minutes, turn the stress switch to the off position and focus on how the exercises, information and hard work will help your situation improve.

Why is this important?: Stress in small amounts can be a catalyst and cause incredible motivation. Stress in large amounts bogs the body down and disrupts mental focus needed to accomplish difficult challanges.

4. Assembling the right team: Working with therapists and physicians that mesh well with your personality.

Why is this important?: Rehabilitation needs to be a constructive team effort. Undergoing therapy can be a long process that is incredibly trying mentally and physically. Therapy works best when patient and therapist personalities compliment each other instead of disrupt each other.

Giving credit where credit is due: During one of my student internships, I was fortunate enough to be mentored by Steve Schall of Norfolk Physical Therapy in Virginia. I once asked Steve why he would create incredibly lofty and unlikely goals for patients. Steve answered simply:

“I’m not going to be the one to place limitations on anyone”.

Why a Former Pro Contest Surfer Is Taking a Surfing Lesson

I started surfing frequently when I was 12 and I spent all of my teenage years either surfing or skateboarding. During my 20s I was fortunate enough to obtain surfing sponsors that brought me to wonderful surfing destinations all over the world and supplied me with the best equipment. I surfed many times in professional and invite-only events for both shortboarding and longboarding and even performed well in novelty events such as tandem surfing and stand up bodyboarding. When I wasn’t surfing, I taught surf lessons to newcomers and up and coming surfers with high aspirations.

When I turned 24, I stopped surfing in contests, voluntarily dropped most sponsors and committed myself to the Doctor of Physical Therapy program at Old Dominion University. I imagined that after graduating, I would work full time as a physical therapist but still continue to compete in a few B-list professional contests in Hawaii and do this until I was in my early 40s. But then I had a change of heart…

For the Love Of Surfing

Now at age 32, I am in the best physical shape of my life. Being in the health and wellness field has changed my view of what it means to be at my highest personal athletic performance. Rather than trying to prove myself in professional events, I am surfing for it’s own sake and learning new novel forms of the craft.

Today, I spend my time body surfing large waves and stand up paddling smaller surf in addition to riding a short modern board. I have realized that in order to keep outperforming my 20 year old self, I have to surf smarter and I need to seek out new ways of learning about my technique flaws. There are many learning curves in surfing and getting feedback from friends and other surfers or watching replays captured by Solo Shot / GoPro can help you identify performance gaps that are holding you from the next level.

Physically speaking – surfing in not a difficult sport. Cognitively speaking – surfing may be the single hardest physical activity out there. I believe that most surfers would most greatly improve their performance not through better equipment or finding better waves, but simply spending more time in “deep practice”. The Talent Code by Daniel Coyle speaks volumes about the concept of “deep practice” or in other words increasing your cognitive awareness of what makes someone a better performer. The idea of being process orientated rather than goal orientated. For me, I made the switch of being goal oriented (wanting to win contests) to being process oriented (deeply analysis of technique).

Now instead of worrying about contest results, I focus on timing, exact positioning of my back arm during turns on the wave, breath control when flying down a big wave, etc. As author Daniel Coyle pointed out, learning exact techniques and then spending time repeating and deeply analyzing techniques allows for your body to create more myelin. Myelin insulates nerve fibers, increasing the speed at which impulses are conducted. The more myelin – the faster you can fire nerve impulses / correct mistakes and perfect techniques.

In speaking of technique corrections, many of us saw the video capturing John Florence fracturing his ankle. John Florence is highly regarded as one the best surfers in the world with excellent technique in any conditions. Back in 2013, he was surfing in Australia and performing a routine maneuver when he broke his right ankle. While most of the surf media chalked this injury as a “freak accident”, it is noticeable within the video as to exactly what happened.

Watch his back leg, notice how his hip-knee-foot are not in alignment. If he had pushed his back knee outwards during the aerial rotation it would have most likely avoided the excessive ankle torque that caused the fracture. Basically, instead of his hip pushing outwards to bring the knee and ankle in alignment, his body instead used his knee and shin as a fulcum to destabilize and fracture his back ankle.

Even hearing John’s own explanation of the injury – it doesn’t sound like he had yet figured out that these injuries don’t have to happen. My advice to John would be to practice keeping hip-knee-ankle stability on land as to make proper positioning of his back leg flawless – then slowly translate that positioning into actually riding waves. Because there is so much to think about when riding a wave, proper ergonomic alignment in surfing should be practiced deeply on land and then added into actual surfing.

Movement science can be multi disciplinary. Often I have worked in conjunction with surfing coaches to better a surfer’s performance. A surfing coach can teach the athlete how to add speed, power and flow (contest judging criteria) into their surfing. A physical therapist is better suited though to help an athlete understand how to better command their body and avoid injury while trying seemingly dangerous maneuvers.

From Instructor To Student

Next summer I am finally taking my first surfing lesson. Twenty five years after my first surf session in Cocoa Beach beach I am going to Northern Costa Rica to work with a performance coach. I look forward to finding new ways to accelerate my learning curve. The best athletes are the best because they never stop learning (and figuring out how to avoid injury).

I will be attending the Surf Simply resort in Costa Rica. After listening to many of their podcasts it is apparent that the coaches are truly surf scientists. If there was such a thing as a PhD is surfing, these folks would deserve the title of “Dr.”.

Whether you are a surfer, an athlete or just someone who wants to achieve better balance – never stop learning and know that most injuries are truly avoidable if you have adequate command and understanding over your body.

Stop “Hanging Out” on Your Joints

thoracic and neck posture

Growing up, our parents and teachers nagged us to sit up straight. And they were right to do so. I see people hanging out on their joints all the time, instead of utilizing their postural muscles to keep them upright. Improper posture not only puts excessive stress on your joints but also your ligaments and muscles, too. Over time, this could result in damaged joints, increased pain, or poor movement patterns. Although we know it’s important to have proper posture, why is it so difficult to do? Our lifestyles and technology work against our efforts to have better form. In this post, I’ll focus on our lifestyle choices that impact our joints and will post a follow-up blog post on how technology impacts our joints.

Shoes Impact Foot Muscle Development

We start wearing shoes before we can walk causing us to never develop the muscles in our feet. The benefits from the support provided by our shoes is offset by the lack of development in our foot muscles resulting in flat, unresponsive feet. Collapsed arches can occur through “hanging out” on the arch to hold your body weight up. This will stretch the ligament supporting your arch, eventually resulting in a flat foot. This why a lot of people are not ready to transition to “barefoot” running or a minimalist shoe because they can’t control their feet.

foot posture collapsed arch

Knee and Pelvis Lockout

At the knees, a person can lock their knees out into hyperextension causing posterior knee pain. I commonly see people hang out on their hips to the point of pain or discomfort and then when that occurs they switch over to their other hip until that one hurts.

knee posture hyperextension unlocked

In addition to their knees, people also lock out their pelvis in an anterior tilt thinking this is good posture until their back hurts, or they posteriorly tilt, sitting on their sacrum (a non-weightbearing bone) until their back hurts. Our lifestyle of sitting in our car, at desks or in front of the table at dinner time coupled with improper posture can lead to hip and back pain. Moving up to the thoracic spine where people hunched over and it looks like gravity is just beating them down. Since everything we do is in front of us, we let our shoulders fall forward, which perpetuates the issue at the thoracic spine, followed by protruding the neck and extending at the base of our skull just to look forward!

hip posture

Improve Your Posture Today

Although it’s easy to fall into bad posture patterns, there are many exercises that can help people of all ages improve their posture, awareness, and to combat the technology and lifestyles we have been enjoying. Here’s an exercise you can do today to improve your posture:

posture ergonomics kona hawaiii

  • Find a bare wall and place your low back flat against it, bringing your feet away from the wall to make this easier.
  • While holding the low back flat, bring your shoulders and head to the wall. Do this by bringing the shoulders down and back and performing a chin tuck at the neck.
  • Holding this for a count of 10 seconds for 10x is a good way to turn on the postural muscles and place you in a better position.

Read this post to find out how to make free and cheap workplace ergonomic improvements. Give us call or email us if you would like to work on your posture and we would be more than happy to assist you on your journey!

Don’t Slack on Your Balance!

slacklining balance training physical therapy

Including balance training in your daily routine is just as important as brushing your teeth. Life is constantly challenging us in ways that may increase our chance of injury if we are not prepared. Daily activities such as walking (especially on uneven surfaces), climbing stairs, and even getting in and out of your car might increase your fall risk if you slack on your balance maintenance.

Speaking of “slacking”, have you ever cruised by a park, only to have your attention captivated by a group of seemingly circus-like individuals walking across a thin line between trees, much like a tightrope but with less tension? If you haven’t seen or heard of it before now, welcome to the world of slacklining. This activity, which started as a general off-season activity for rock climbers, has developed into an increasingly popular outdoor activity aimed toward developing advanced balance skills while also encouraging a deeper connection with nature and the community. Much like other athletic pursuits, slacklining boils down to a few general components that are essential in everyday life. In addition to a focused mind, proper body awareness, and relaxed breathing, it is absolutely impossible to walk the line without good balance.

There are three general systems that work together to create a properly balanced body and can be developed with the help of a physical therapist. These include:

  • EYES: When we close our eyes, the whole world changes. Our vision gives us important feedback about our immediate surroundings, allowing us to plan accordingly. Have you ever tried to stand on one leg while closing your eyes? Taking one’s vision out of the picture will automatically make balancing more difficult, but it also makes the body work harder to use the other two systems which will only become stronger with time.
  • INNER EAR: Inside each ear, we have three small canals coated with a waxy substance which is home to tiny crystals. These crystals are sensitive to our bodies’ movements and respond any time the head turns or the body’s position changes, such as doing a somersault underwater. Without proper function, this particular movement would cause the world around you to spin!
  • PROPRIOCEPTION: Our position in space is constantly being assessed via tiny receptors in our muscles and joints called proprioceptors. This system is challenged by changing one’s base of support, such as standing on one foot, stepping onto uneven ground, or even a thin/shaky slackline hanging mid-air. When our proprioception is challenged, we rely on our vision and inner ear more; thus, a slackliner must gaze forward to focus his/her eyes on a stable spot while maintaining an upright head position despite the constantly moving body.

When you initiate your own balance training, you’ll be amazed at how challenging yourself daily can lead to significantly noticeable benefits.

So if the moment presents itself, get out and try something new and challenging, like slacklining! Or come up with your own home balance training practice to improve your balance skills. Meanwhile, be sure to check with your local physical therapist for a comprehensive movement and balance assessment to give the best of yourself toward whatever your passion may be.

Annual Assessments By Physical Therapists – Why Should You Care


Nobody waits until their teeth are rotting out to see a dentist. It is ingrained in us to see a dentist twice a year for a routine checkup because the health of our teeth is connected to our overall health. But what about the health of your musculoskeletal system? You use it every moment of your life from sitting to sleeping. With a yearly analysis of your movement patterns you can stop injuries in their track.

In today’s world, we see a pandemic of chronic neck, knee, shoulder and back pain.  Most patients who come to see us did not experience sudden injuries – they have suffered from slowly growing chronic pain. Most often these problems are either preventable or largely correctable by changing the way someone moves: sitting, standing, bending / squatting.

Chronic pain can easily result from lots of little injuries that add up during the day from moving incorrectly. If left uncorrected, improper movement can greatly accelerate degenerative changes within one’s joints leading to further pain and debility.

Don’t wait for degenerative changes to occur. See a physical therapist every year to discuss any minor aches and pains, correct any flaws in your movement patterns and benchmark your movement patterns over time.

Continuous Rehab: Sitting, Standing and Bending Properly To Avoid Neck and Back Injury

proper posture

Ok so rehab exercises are good for chronic neck and back problems but what about the other 23 hours of the day…?

This brings up a good point, exercise only works if you are making a habit of increasing your body’s awareness and posture.

Proper Posture and Biomechanics

For instance, exercises to help someone recover from a “slipped disc in the neck” are probably minimally efficient if the sufferer does not also change the way they use their neck.  I am a strong proponent that exercises for chronic neck and back pain only are effective if ergonomics and biomechanics are also changed to load the spine more evenly.

Unfortunately most studies within the field of physical therapy discuss in one form of treatment versus another, usually contrasting a particular set of exercises versus is leading different set of exercises to see which is more effective. Posture and proper biomechanics are highly regarded yet not widely studied necessarily when it comes to chronic neck and back pain.  This is probably due to the fact posture my mechanics would be difficult to study within a population of people going about their normal daily routines.

We in the physical therapy community has gotten fond of saying “some conditions can’t be treated, they have to be changed”.  I have seen many patients over the years that have tried seemingly everything to lessen their pain; – everything except for change the one thing that is probably causing the pain to continue.

I can’t say it enough, posture and proper movement – using the body how it is designed to be used is incredibly effective.

It seems strange in the advanced information age that we as adults have to be taught how to sit, stand and bend properly.  However – what we must remember is that the human condition has rapidly changed with the onset of the industrial age allowing for modern conveniences and repetitive stresses that are both detrimental forces for reshaping our bodies.

Anthropologist tell us that we are designed to stand, squat, and lie down.  We are not designed to sit in chairs.  This idea might sound far-fetched but in thinking of it, our closest relatives monkeys, apes and chimpanzees never sit on their rear-ends. They  squat or lie down.

In short, the body does not come with an owners manual and most injuries that come through our doors are either entirely preventable or at least somewhat preventable with the proper application of biomechanical principles.

Know Pain, Know Gain

Pain is the number one reason people seek out medical services, but how much do you know about your pain? As a medical community, I believe we are good at describing pain (acute, chronic, burning, aching, the dreaded 0-10 scale, etc), but how good are we at actually helping patients understand their pain? Pain is a subjective experience, meaning each person experiences pain differently. This is probably obvious, but how much thought have you truly given it? Pain has been proven to be impacted by many things including diet, stress, emotional state, physical activity, past experiences, setting, and beliefs. For example, most people would agree that if you sprain your ankle it will hurt, but what if you sprained your ankle while crossing a busy intersection or running from a dangerous animal? Your brain essentially makes a decision very quickly that it does not care about the danger signal from your ankle, because you are about to get hit by a car or become a meal for an animal! Once you get to safety however, the brain will decide that the danger signals from your ankle are now relevant and you will have pain. Another example is how people can have pain in a limb that is no longer there, “phantom limb pain”, and there are even studies showing that you can have pain in a limb that isn’t even yours!

Basically, my point is that pain is much more complex than injured tissues. One of the main concepts that I like to educate my patients on is that pain does not equal tissue damage. Pain is a warning or danger signal, much like an alarm, that something may be wrong within the body. Your brain makes the decision if something should be painful in order for action to be taken. That action could be removing the painful stimulus like a splinter or discontinuing an activity like running or going to your healthcare provider. But what happens if the pain persists after an injury or surgery and lasts months or even years?

When you have persistent pain it can be difficult to get an answer to “why do I have pain?”. Many tests, medications, injections, and potentially surgeries are done with limited relief or explanation. Generally speaking, our bodies will heal itself as best it can in 3-6 months. When pain persists longer than this it is termed chronic pain. This is where the sensitivity of the nervous system comes into play. Many things may actually be responsible for your pain while not causing any real tissue damage, such as applying light pressure to the skin or even prolonged sitting. Sometimes your nervous system or “alarm” can become too sensitive, much like a smoke alarm going off when you’re cooking. One of the main goals in patients with chronic pain is to decrease this sensitivity of the nervous system and re-conceptualize what pain really means. There are many ways to do this, but the first one is education. Here are links to some quick videos that discuss the concepts I mentioned here and more. Please take the time to watch and comment below. If you are interested in hearing more please contact our clinic and I will be more than happy to discuss pain with you or share the multiple resources that I have available!

Lorimer Mosely TEDx Talk

Understanding Pain: What to do about it in less than five minutes?

– Tyler Patrick, PT, DPT, ATC, CSCS