The Surfers Shoulder
Written by Tony Gill.
As a shoulder specialist physiotherapist in Bristol I see quite a few surfers shoulders.
Often labelled as a swimmers shoulder, there are specific differences between these conditions:
1: Swimmers performing crawl rotate around the central axis or spine, imagine a hog on a spit. Surfers cannot rotate around this central axis in the same way due to the buoyancy of the board. This requires more force to be produced at the shoulder, as the trunk musculature cannot generate the same force through the rotational movement as a swimmer can.
2: The stroke in surfing requires more power in mid-range of the stroke as you are riding far higher on the surface of the water and unable to generate any power at the end of a swimmers stroke as your arm is already clear of the water. This means you have to generate more power in the middle of the range which increases the stress of the shoulder as the hand is further away from the trunk. It’s basic physics of the long lever.
3: Surfers manage to generate force through good thoracic and lumbar extension range and dynamic stability. If they lack this, the shoulders are far more likely to have to overwork as a compensation for the stiffness or weakness. Anecdotally, I find this seems to be especially so for the weekend surfer who spends many hours on a day to basis hunched like a prawn in-front of a laptop or desktop. ( you know who you are!!)
There is an old saying “you are what you eat” – the same holds true for what you do.
I suspect sitting flexed for hours a day teaches habitual postures, tightness’s and weaknesses that are difficult to break once or twice a week on a board. Usually this effects 30-60 year olds and in my practice seems to effect the office worker more often than a manual worker. I acknowledge this may be a bias of my client group rather than a true link between impingement and posture.
4: The swim stroke on a board has to be further away from the body due to the width of the board which increases the lever effect on the shoulder. This in turn increases the stresses placed on the stabilisers of the shoulder ball into its socket. (Rotator cuff)
5. Surfers ask for short sprint power repetitively to get through the breaking waves and then another sprint to catch the wave. It is rare a swimmer operates on sprint/rest/sprint/rest approach to a given distance. Their swim tends to be paced.
6: Surfers push up on an unstable surface, swimmers don’t. This can increase the stress on the top joint of the shoulder where the collar bone joins the scapula called the A/C joint. For some of is this joint already starts to have arthritic changes in our 30’s and while this is usually not a problem, if irritated already can flare with continual push up postures that surfing requires.
Both swimmers and surfers suffer from impingement symptoms. In layman’s terms the ball needs to stay centralised into the socket but is only able to do this by activating 4 dynamic muscles called the rotator cuff. If they fatigue the powerful Latisimmus Dorsi Upper Trapps and Deltoid act together to internally rotate and elevate the ball in the socket which increases the joint pressure and over time can cause pain and dysfunction.
So what can you do?…… If you live in the South West you should be visiting us at Bristol Physio!
The simple rules I apply to all rehab are:
What movements cause the pain?
What areas seem to be weak?
What areas seem to be tight or stiff?
Can we address the dysfunction and optimise function?
i.e. what task is being required of the body?
How is this different from the norm?
How do we optimise the desired function?
If therapists miss the unique differences and requirements a surfers shoulder is under, we fail to address the primary problems driving your pain.
If your suffering from a painful shoulder with surfing, my advice would be to see a good therapist who understands the stresses places on surfers shoulders and how to address this. If we the therapist are not teaching you how to change this and address the problem within 3-5 sessions then your either being lazy with your rehab, we haven’t identified all the dysfunctions to correct or it might not be able to respond to rehab and requires more help in the form of a steroid injection or surgical input.
Your welcome to come see us in Bristol but be prepared to be actively involved in your own rehab as its your body and therefore will require you to make the changes to optimise your recovery.
If your interested in rehabilitating your own shoulder we have a few links to sensible exercises below for common problems associated with surfers shoulder issues. But this is not a recipe and I would always advise seeing a good shoulder Physio.
Thoratic Flexibility and Strength
Rotator Cuff External Rotation Elevation with Band
Press Up Plus
Dynamic Side Plank