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<div class="editorbox"> '''Original Editor '''- [[User:Lucinda hampton|Lucinda hampton]] '''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}}</div> | <div class="editorbox"> '''Original Editor '''- [[User:Lucinda hampton|Lucinda hampton]] '''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}}</div> | ||
<div class="editorbox"> | <div class="editorbox"> | ||
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</div> | </div> | ||
== Introduction == | == Introduction == | ||
Surfing 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%.<ref name=":0">Furness, | Surfing is popular with participants on coastlines throughout the world. At some stage, most surfers experience some degree of [[Back Education Program|lower back pain]] or stiffness. A 2014 Australian study reporting it as the highest-ranking of surfing injuries at 23.3%.<ref name=":0">Furness J, Hing W, Abbott A Walsh J Sheppard JM, Climstein M. [https://www.researchgate.net/publication/321739698_Retrospective_Analysis_of_Chronic_Injuries_in_Recreational_and_Competitive_Surfers_Injury_Location_Type_and_Mechanism 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) </ref>[[File:Surfing.jpg|right|frameless]]The most common form of lower back pain when surfing is characterised by tight muscles and a constant dull ache, and is most often caused by an over-arching lower back and a very stiff upper back. Unfortunately, many surfers are also plagued by back pain that hinders or terminates their participation in the sport.<ref>Hammer RL, Loubert PV. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2953347/ 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)</ref> | ||
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.<ref>Bazanella, N.V., Garrett, J.G.Z.D.A., Gomes, A.R.S., Novack, L.F., Osiecki, R. and Korelo, R.I.G., 2016. [http://www.scielo.br/scielo.php?pid=S1809-29502016000400394&script=sci_arttext&tlng=en#B3 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)</ref> | 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.<ref>Bazanella, N.V., Garrett, J.G.Z.D.A., Gomes, A.R.S., Novack, L.F., Osiecki, R. and Korelo, R.I.G., 2016. [http://www.scielo.br/scielo.php?pid=S1809-29502016000400394&script=sci_arttext&tlng=en#B3 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)</ref> | ||
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NB - This page describes and evaluates the common forms of surfers back. If assessment reveals any eg.[[The Flag System|red flags]], [[Spinal Masqueraders|spinal masqueraders]], suspected [[Lumbar Spine Fracture|spinal fracture]] be sure to liaise with appropriate medics and investigate as needed. | NB - This page describes and evaluates the common forms of surfers back. If assessment reveals any eg.[[The Flag System|red flags]], [[Spinal Masqueraders|spinal masqueraders]], suspected [[Lumbar Spine Fracture|spinal fracture]] be sure to liaise with appropriate medics and investigate as needed. | ||
== Common Causes of Back Pain in Surfers == | == Common Causes of Back Pain in Surfers == | ||
The most common reasons for low back in surfers is due to one or | The most common reasons for low back in surfers is due to one or more of the following:[[File:Surfing Hawaii.jpg|right|frameless|343x343px]] | ||
# Large amount of time spent in the prone position. Furness et al<ref name=":0" /> (2012) finding that 38.5% of chronic lower back injury were attributed to both prolonged paddling and lying on the surfboard, both of which involve lying prone.<ref name=":0" /> | |||
# 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<ref name=":0" /> (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.<ref name=":0" /> | |||
# 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).<ref>Liisa Airaksinen [https://www.theseus.fi/bitstream/handle/10024/63501/Airaksinen_Liisa.pdf?sequence=1&isAllowed=y THE ROLE OF CORE STABILITY IN] | |||
[https://www.theseus.fi/bitstream/handle/10024/63501/Airaksinen_Liisa.pdf?sequence=1&isAllowed=y 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) | [https://www.theseus.fi/bitstream/handle/10024/63501/Airaksinen_Liisa.pdf?sequence=1&isAllowed=y 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) | ||
</ref> | </ref> | ||
# Insufficient flexibility and strength of muscles in lower kinetic chain and spine. | |||
# Poor surfing technique eg in "pop up"; with paddling. | |||
== Subjective Assessment == | == Subjective Assessment == | ||
Questions to ask include: | Questions to ask include: | ||
* Past back problems? | |||
Past back problems? | * Any accidents falling off board? | ||
* Check for any red flags i.e recent malignancy, unremitting pain, weight loss etc. | |||
Any accidents falling off board? | * Is it chronic, sub-acute or acute? | ||
* Recent changes in surfing regime. | |||
Check for any red flags i.e recent malignancy, unremitting pain, weight loss etc. | * 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 chronic, sub-acute or acute? | * Is it only with certain movements or manoeuvres? | ||
* Inquire if they have ever had surfing lessons or technique coaching. | |||
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 | |||
== Objective Assessment == | == Objective Assessment == | ||
Include at a minimum the following | Include at a minimum the following: | ||
* Surfing position and "pop up" technique - look out for: hyperextension back | * Surfing position and "pop up" technique - look out for: | ||
* Check movement in spine looking for :stiff or | ** hyperextension of the back | ||
* Muscle lengths and strength should be assessed in the major muscles involved in surfing.These include: core muscles as involved in stabilising/supporting pelvis | ** stiff segments in the back | ||
* Neurodynamic tests: LLTT's | ** 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 hypermobile 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|quadratus lumborum]] | |||
** [[Erector Spinae|erector spinae]] | |||
* [[Neurodynamic Assessment|Neurodynamic tests]]: | |||
** LLTT's | |||
== Physiotherapy Treatment == | == Physiotherapy Treatment == | ||
A good treatment program will address correction of :highlighted tight or weak areas | A good treatment program will address the correction of : | ||
* highlighted tight or weak areas | |||
* [[posture]] | |||
* [[Core Stability|core stability &]] [[Core Strengthening|core strengthening]] | |||
* faulty movement patterns | |||
* deficits in flexibility, strength, and coordination.<ref>Surfline [https://www.surfline.com/surf-news/tim-brown--team-offer-advice-on-back-injuries-in-surfing_38952/ 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)</ref> | |||
==== | ==== Manual Therapy ==== | ||
[[File:Foam Roller.jpg|right|frameless|200x200px]] | As a physical therapist ,you have lots of good [[Manual Therapy]] skills to improve the client's condition. These skills include:[[File:Foam Roller.jpg|right|frameless|200x200px]] | ||
* [[Maitland's Mobilisations|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. | |||
==== | ==== Stretches ==== | ||
[[File: | [[File:Hip Flexor Stretch.png|right|frameless|200x200px]] | ||
Include some or all of the following [[Stretching|stretches]]: | |||
* [[Psoas Major|Hip flexor]]<nowiki/>s stretch (shown in image), | |||
* [[Quadratus Lumborum]] stretch | |||
* [[Erector Spinae|Erector Spinae]] stretch | |||
* [[Latissimus Dorsi Muscle|Latissimus Dorsi]] stretch | |||
* Thoracic and or Lumbar rotation and extension stretches | |||
* [[Gluteal Tendinopathy|Gluteal]] muscles and any other relevant muscles found to be tight | |||
==== | ==== Core muscle training ==== | ||
Perform | Perform [[Core Stability|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 ==== | ||
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.[[File:Phy4.jpg|frameless]] | These will provide [[Exercises for Lumbar Instability|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.[[File:Phy4.jpg|frameless]] | ||
==== Surfing Technique Guidance ==== | ==== 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. | 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 | |||
=== Conclusion === | === Conclusion === | ||
Line 93: | Line 105: | ||
This video gives some technique guidance to lessen the load on the low back | This video gives some technique guidance to lessen the load on the low back | ||
{{#ev:youtube|https://www.youtube.com/watch?v=IvrG1nOn_ZA|width}}<ref>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)</ref> | {{#ev:youtube|https://www.youtube.com/watch?v=IvrG1nOn_ZA|width}}<ref>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)</ref> | ||
== References == | |||
<references /> | <references /> | ||
[[Category:Sports Injuries]] | [[Category:Sports Injuries]] | ||
[[Category:Conditions]] | |||
[[Category:Lumbar Spine]] | |||
[[Category:Lumbar Spine - Conditions]] | [[Category:Lumbar Spine - Conditions]] |
Latest revision as of 16:23, 13 November 2021
Original Editor - Your name will be added here if you created the original content for this page.
Top Contributors - Lucinda hampton, Wanda van Niekerk, Kim Jackson, Tony Lowe and Shaimaa Eldib
Introduction[edit | edit source]
Surfing 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%.[1]
The most common form of lower back pain when surfing is characterised by tight muscles and a constant dull ache, and is most often caused by an over-arching lower back and a very stiff upper back. Unfortunately, many surfers are also plagued by back pain that hinders or terminates their participation in the sport.[2]
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.[3]
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 Surfers[edit | edit source]
The 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[1] (2012) finding that 38.5% of chronic lower back injury were attributed to both prolonged paddling and lying on the surfboard, both of which involve lying prone.[1]
- 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[1] (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.[1]
- 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).[4]
- Insufficient flexibility and strength of muscles in lower kinetic chain and spine.
- Poor surfing technique eg in "pop up"; with paddling.
Subjective Assessment[edit | edit source]
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.
Objective Assessment[edit | edit source]
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 hypermobile 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:
- LLTT's
Physiotherapy Treatment[edit | edit source]
A good treatment program will address the correction of :
- highlighted tight or weak areas
- posture
- core stability & core strengthening
- faulty movement patterns
- deficits in flexibility, strength, and coordination.[5]
Manual Therapy[edit | edit source]
As 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.
Stretches[edit | edit source]
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[edit | edit source]
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[edit | edit source]
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[edit | edit source]
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
Conclusion[edit | edit source]
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 Viewing[edit | edit source]
This 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
References[edit | edit source]
- ↑ 1.0 1.1 1.2 1.3 1.4 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)