SurfPulse » Ask Beth

Ask Beth: What Should I Do About Pain in My Upper Ribs?

beth — Sun, 27 Dec 2009 02:32:02 +0000

QUESTION: What should I do about pain in my upper ribs?

Hi Beth:

Today I came out of the water from surfing and had pain on my left side, upper ribs. It hurts to laugh, breathe deep, etc. I am pretty sure it’s not a cracked rib or anything, as I haven’t had extreme pain, but even if it’s bruised I’m reading that I won’t be able to surf for 4–6 weeks! I’m really bummed about this and wondering what I can do to make it heal quickly, as well as what kind of exercise could I do to stay fit while I let it heal. Could I swim or exercise in the ocean?

Thanks!
Kristin

ANSWER:

Hey Kristin,

Well, if your self-diagnosis is correct, then rest is the best thing to heal the injury. You may also have some tissue damage to the area that is really sensitive. The main thing I would steer clear of is any exercise that causes pain to the area. You want to let every action try and be pain free so it can heal. Not sure if swimming in the ocean (or swimming at all) is going to let that area relax. Swimming forces you to use your lats as well as many other muscles in the area surrounding your ribs. Give it a whirl, but if it hurts, I would stick to lower extremity activities, most likely in the gym. The pool might be a better bet since the water surface is calm…????

My main goal would be to get back in the H20 for surfing, but I would also want to maintain some sort of fitness. SO, if you feel comfortable with your diagnosis (never hurts to go to a doctor), I would just try different activities and see how the body reacts to them. You may find as your breathing increases, the pain increases. Also, abdominal work and upper body activities may be a no-no.

I hope you are comfortable in a gym because it may be your only resource for fitness. Let me know what you figure out and we can go from there.

I am sure there are some modalities in a physical therapist’s office that would increase the rate of recovery. I would definitely look into that.

Hang in there. You will be surfing before you know it.

Hasta,
Beth

Ask Beth: Do you recommend using a Vasa Trainer for surfing fitness?

beth — Mon, 12 Oct 2009 22:22:14 +0000

QUESTION: Do you recommend using a Vasa Trainer for surfing fitness?

Hi Beth,

Would you recommend this vasa trainer machine for surfing fitness? I keep hearing about it and some surfers rave. I’m landlocked and need to get ready for vacation as last time the paddling killed!

Thanks!
Bobby

ANSWER:

Hey Bobby,

I too have heard good things about the vasa trainer. I would say give it a whirl and see what you think. Check online to see if there are any ”get fit for surfing” workouts that are done on the vasa trainer. It is probably pretty boring, so finding maybe some interval-type training might make it more fun. Or throwing it into some circuit training.

I also have a surf trip coming up and have not been able to find the time to surf. I have a one-year old and the old days of surfing every day after work are gone. To stay fit, I have been riding a ton, running a bit, yoga here and there, and trying to fit in two days a week of upper body weights. I figure the more fit I am all around, the better I will recover during my surf trip. The one area that I feel really out of shape is my speed in popping up. I guess throwing in some plyo training would be helpful. It is always good to be strong and flexible from head to toe to prevent any overuse injuries that may occur on a surf trip. I am also going to try and get in the pool a few times (unless I can go surfing) pre-surf trip. My friends put out a great video for weight lifting for surfing called “Surf Stronger.” You may wanna check that out.

Good luck and let me know what you think of the vasa trainer. Especially when you get back from your trip. Unfortunately the best way to prepare for a trip is by surfing, but some of us are not that lucky.

Hasta,
Beth

Ask Beth: How can I avoid surgery on a torn rotator cuff?

beth — Sun, 24 May 2009 23:33:28 +0000

QUESTION: How can I avoid surgery on a torn rotator cuff?

Beth,

I have been having a terrible time with my shoulder lately. Three years ago I partially tore my rotator cuff and impinged it surfing with webbed paddling gloves. I did phsical therapy and it got better, but it still troubled me sometimes. Lately, it sort of locks up on me and causes tremendous pain when I am doing some random movement, like lifting my arm up or putting on a shirt. It will then hurt considerably for a while, and limit my range of motion and my activities (can’t surf!). I’ve been practicing yoga for a little while now, and there are times when my shoulder will lock up in various postures (not weight-bearing postures). This is really getting me down—I want to avoid surgery, but it just gets worse and worse. I’ve also developed a sore neck on that side and wonder if it could be related. I was hoping you could point me in the right direction.

Thanks,

Gareth

ANSWER:

Hey Gareth,

Sounds to me like you need to revisit your doctor and get a new diagnosis. If it isn’t getting better on its own and it is totally getting in the way of the things you love to do (not to mention things you have to do!) then go get some help! It is great that you started yoga; however, sometimes these kinds of injuries need complete rest prior to starting any kind of exercise. Some basic stretches surrounding the area are probably doable, but I would first go to a doc and then a physical therapist to get these particular stretches/exercises.

I am sorry this is flaring up again. Time to take care of the pain over the summer, before the fall spectacular really gets under way! Hopefully, that shoulder only needs a wee bit of TLC!

Let me know what the doctor says.

Hasta,

Beth

Ask Beth: How can I stretch tight muscles between my shoulders?

beth — Mon, 09 Feb 2009 02:17:06 +0000

QUESTION: How can I stretch tight muscles between my shoulders?

Hi Beth,
I am extremely tight between my shoulders, at my spine. It feels as though the muscles have become so tight there that they are causing a nerve pinch between my vertebrae.

I am trying some massage and stretching but it is really difficult to get this area isolated for stretching.

Any suggestions?
Thanks,
Rama

(P.S. Your Q&A site is great!)

ANSWER:

Hey Rama,

I feel your pain…or used to until I started yoga. Yes, yoga has saved me from many an ache and a pain. I used to have the tightest rhomboids, back and neck and was constantly doing random stretches and going to a bodyworker. I finally got fed up and realized that I needed to stretch out my entire body from head to toe to get the whole spine area to release. I also found that 10–20 minutes of stretching one area was not enough to make changes.

So my suggestion to you would be to figure out a good overall stretch routine or get yourself signed up for some basic yoga classes to learn all the poses. The great thing about yoga poses is that many of them target more than one area. I found that yoga was strengthening my super-weak small muscles (especially in the back and lower traps) which gave my aching muscles a break.

Good luck and try to find the time to do this. Yoga has totally improved my surfing, not to mention several other areas in my life.

Hasta,

Beth

Ask Beth: How can I knee-paddle again after ACL replacement surgery?

beth — Tue, 08 Jul 2008 00:29:56 +0000

QUESTION: How can I knee-paddle again after ACL replacement surgery?

Hey Beth,

I had ACL replacement surgery in February, and am almost ready to be released, but cannot sit on my heels without excruciating pain. This means no knee-paddling!

Can you suggest guidelines to break up these adhesions? I currently cycle daily, and will begin roller skiing and inline skating next month. I’m also a competitive x-c skier.

Thanks!
Jerry

ANSWER:

Hi Jerry,

Below is the info from Lance, the kick ass surfer/PT master. Very helpful info. My input is to just make sure that your muscles surrounding that joint stay super strong and you are not compensating once you get back into your regular activities. You are going to have to be on top of this injury for awhile even when you start to feel better. Especially in keeping everything nice and open.

Best of luck. I agree with the knee-paddling….No big deal as long as you are able to surf!!

Hasta,
Beth

Hello Jerry,

Breaking up scar tissue can be difficult, you have to keep on it. I’m assuming that “almost ready to be released” means that you are working with a physical therapist, so you most likely have a program for working on the end range flexion. If not, then find a PT who will work with you to show you a program and do some manual therapy. There are no magical techniques, it just takes time and persistence. Sitting on your knees is one of the last things to return after this type of surgery. You have to keep stretching, slow and gentle. If you push too hard, you are going to irritate the tissue and cause further inflammation, possibly leading to more scar tissue. Hopefully, the limit is anteriorly and superficial secondary to adhesions from the incisions or patella tendon (patella tendon repair). This type of limitation will stretch out easier than limitations deep in the joint.

For now, you will have to paddle prone, this is better than not surfing. Make sure you are ready for a return to surfing by asking your rehab team because you are only six months out. At six months you feel strong and ready, but you have to be careful because the graft is still gaining stability. The other sports you are doing do not require deep knee flexion like knee-paddling. You should be okay there. Good luck!

Lance Harriman, MSPT
Potrero Physical Therapy
415-701-1000
www.potreropt.com

Ask Beth: Should I Consider a Hip Replacement?

beth — Mon, 19 May 2008 00:23:55 +0000

QUESTION: Should I consider a hip replacement that may end my active lifestyle?

Hi Beth,

I am a 58-year old male who has pretty much given up on surfing because of an arthritic hip. I am contemplating a hip replacement. I know that with a hip replacement I will not be able to surf, but my main concern is if I will be able to continue with some other actiities that are dear to me.

My doctor is pretty much non-commital, reminding me that a hip replacement is for old folks to walk around on only. Presently I bicycle to work five days a week, 18 miles a day, with a couple of good climbs. I work as carpenter which, as you can imagine, makes for a rather active day. I find bicycling to be presently very comfortable, and work rather uncomfortable, but tolerable. What do you think? Would continuing with this routine with a hip replacement be possible? Would it hasten its wear excessively? Do you know of any other knowledgeable sources I could contact?

Thank you very much for your time and input,
A Surfing Carpenter

ANSWER:

Hey there,

Below is the response from my fellow surfer/PT Lance. My only other suggestion would be to try out some alternative ways to help ease the pain, like accupuncture, and see if it can make your lifestyle tolerable for another few years. The later in life you have a hip replacement procedure done, the better. I totally understand the willingness to do anything to get back in the water, but a total hip replacement is a BIG deal.

Best of luck and let us know what you decide to do!

Hasta,
Beth

Hello Beth and Mr. Carpenter Man,

Hip replacements can be amazing in terms of reducing pain and increasing function. Some people go on to lead very active lives following hip replacements. I don’t see why you should not be able to work, bike, and possibly even surf (small gentle waves). The activities to avoid are impact sports. Surfing could be classified as an impact sport, but I think at some level, wave riding is a possibility in the future. If nothing else, at least go out and body board. Half the stoke with surfing is just getting out in the water and washing away your worries.

There is a rehab period following the surgery in which certain movements and activities must be avoided in order to maintain the integrity of the replacement. Make sure you get good rehab and work hard with your home exercise program. Pool therapy is a great way to restore the mechanics and strength of the lower extremity without exacerbating your symptoms pre- and post-surgery. Do consult with your physician and rehab team on specifics of what you are allowed to do: they know more about the specifics of your case. If you live in the Bay Area, we do free consults at Potrero Physical Therapy. Good luck!

Lance @ Potrero Physical Therapy

Ask Beth: Torn rotator cuff—when I can I surf again?

beth — Sun, 09 Jan 2005 08:00:00 +0000

QUESTION: When can I surf again after a torn rotator cuff?

Beth,

I have a couple small tears in the rotator cuff in my left shoulder, which were diagnosed by MRI. I’m going to PT 3 times a week, is there any reason not to surf? I haven’t been since I did it 2 months ago!

Thanks,

Jonathan S.

ANSWER:

Part 1:

Hey Jonathon,

Below is a response from a wonderful PT who lives and surfs here in SF. My main recommendation would be to not surf until the tears are healed as you would hate yourself if you surfed once and set yourself back another month or so. I would also recommend doing as much trunk/core fitness plus leg strengthening and cardio work to maintain a high level of fitness once you are able to surf again. Ask your PT what you can and can’t do. Check out what the pro below has to say.

Hasta,

Beth

Part 2:

Jonathon,

Sometimes Beth consults me with questions from SurfPulse. I am a physical therapist who has spent a lot of time surfing. Two months out of the water can be frustrating. Don’t worry, you will get back to surfing. I am assuming that you and your medical team are trying to avoid surgery, so at some point you will need to start tailoring your rehab for returning to surfing. I would first consult your current PT and orthopedic MD for their opinion, they know a lot more about your situation.

Before returning to surfing you will want to make sure you have full range of motion and strength without symptoms. For example, when you mimic the movements for surfing, there is no pain. If you have symptoms with the movements or afterwards, the cuff is being irritated. Small tears can progress to larger tears and this is what you want to avoid. Your physical therapy program should be addressing the mechanics of your shoulder to allow you to paddle and go from prone to standing without straining the tissues of the shoulder.

Beth is a very smart Exercise Physiologist who has done a lot of work with surfers. She can help you with designing a few great return-to-surfing simulation exercises. I hope this helps! Take advantage of the down time to cross train and get in shape with exercise and nutrition. Good luck!

Lance Harriman, MSPT Potrero Physical Therapy

(Posted 1/9/05)

Ask Beth: My shoulder hurts & clicks. What’s going on?

beth — Tue, 14 Sep 2004 08:00:00 +0000

QUESTION: Why does my shoulder hurt and click?

Hello,

Hey Beth,

I have something going on with my shoulder. I’ve been surfing for a couple of years, the last year pretty consistently at OB and Pacifica (2-3 times per week). For the last few weeks I’ve been going out longer than usual, sometimes up to 3 hours, and Monday morning I woke up with a sharp pain in the middle of my right shoulder. I took some ibuprofen, rested, and the pain went away. But now when I make a circling motion with my arm (like a swimming backstroke), I feel the muscles crunch and hear a clicking sound. What’s going on, and what should I do about it?

Thanks,

Jason T.

ANSWER:

Jason,

Welcome to my world, or should I say, my old world. When I was a competitive swimmer a thousand years ago and swimming 12 workouts a week, I had the same gig going on. But every night it felt like someone was inserting a knife into my arm.

Without getting a professional diagnosis, my educated over-the-Internet guess is that you have a bit of impingement going on in your shoulder- or a bit of tendonitis. I am guessing these two scenarios because you did not complain of a major blow to the shoulder area and because you have increased your surfing time. So basically, I am guessing you have an overuse injury and some swelling going on in the shoulder joint. The shoulder girdle is super complex with lots of tendons, ligaments, muscles, bursas, tissue, etc all flowing in different areas and all wanting to lie perfectly in their spot. As we surf and surf and surf and don’t ever stretch or rest, that area gets out of whack and pissed off! The clicking and crunching is often a result of this. Things aren’t flowing smooth so they make noise! If I have been surfing a ton and then finally get my butt into my yoga class, my shoulders sound like grunge music. At the end of the yoga class, they are finally quiet and well lubed.

I wish that I had known this during my swimming career because it would have saved me a lot of pain and could have improved my career! Yoga has saved my life and my shoulder, hip, back, neck, ankle… you get the idea—pains. It opens up your upper body so we don’t stand slumped forward, thins out the ultra bulky neck muscles so our head can actually turn comfortably, and allows the spine to sit properly. All of which help out the shoulders. Ice and Advil definitely help, but are more of a band-aid for the problem. You have to take a different route to prevent it from continuing.

Again, this is just a guess as to what is going on. A doctor definitely knows better than me—so go see one to make sure! I hope this helps. I apologize for the ramble session, this is just a pain I know all too well!

Hasta,

Beth

(Posted 9/14/04)

Ask Beth: How can I improve my recovery after knee surgery?

beth — Mon, 21 Jun 2004 08:00:00 +0000

Hi Beth,

I just had ACL reconstruction surgery (hamstring graft) after an injury I sustained at Salmon Creek about two months ago. I know I’m looking at a long recovery, and a long time out of the water, but are there specific exercises I can be doing to increase my rate of recovery? How about surf-specific exercises? Should I pursue wearing a brace for my return to the water? Anyway, any information about this bummer of an injury you could pass my way would be great.

Mahalo,

Jamie

ANSWER:

Hey Jamie,

Sounds like you are doing the right thing with a good PT. Keep strengthening those muscles surrounding the knee but do it carefully! The problem I used to see in PT with eager athletes was they were super eager and pushed it too far. This resulted in unnecessary pains and inflammations. As for when you can surf, I have to say that you need to listen to your PT and doc. They know best and know the integrity of the joint, the new graft, and the strength of your “borrowed” hamstring. YOU may feel physically ready but the whole joint may say no way!

As for now, you can definitely keep your upper body and trunk in shape by lifting weights and doing sit-ups. It may get boring but it is better than nothing and a great way to keep your surfing muscles strong. Not to mention a great time to work on strengthening muscles, which get ignored while surfing. Take some time to stretch out the whole body while you are at it. It will definitely help your recovery.

Get in the pool as soon as the doc or PT gives you the a-okay. Swimming is not only great fitness for surfing but water also helps with the swelling in the knee. Water running is also a great alternative for conditioning and helps increase flexibility of the joint. (That is, of course, once you are allowed to add some leg exercises).

As for a brace, it’s not a bad idea when the time comes for you to surf. A brace gives some stability- but more important- it reminds you that you are injured and need to be careful. It is not just the act of surfing that could hurt your knee. It is also walking out, duck diving, unknown hazards (much of surfing!), cutbacks, etc.

Be safe, smart, and remember that it is better to let the knee heal 100% and avoid any setbacks. You don’t want to have to go through this again!

Hasta,

Beth

(Posted 6/21/04)

Ask Beth: Recurring rib injury: What rehab can I do? How long should I rest?

beth — Mon, 12 Apr 2004 08:00:00 +0000

Hello,

I am a 35-year-old male, and I’m new to surfing. In January, a career change offered me the opportunity to surf every day (2-3 hours per day). Since then I have suffered from persistent episodes of severe pain in the intercostal rib region. I originally injured my left side in late February 2003. The pain kept me from surfing, and it continued to be felt acutely while breathing & moving. The pain is a knife-like sensation that occurs while in a back-extension form (e.g. paddling). I have injured my ribs multiple times, so I recently took another 6-week break from surfing. I also started taking the anti-inflammatory Vioxx. The medication provided immediate relief for my every day activities. I started surfing again last week and immediately encountered the same pain on the right side. I stopped surfing during my second session after hearing a ‘popping or cracking sound’ on my right side.

I can perform other activities, including swimming, yoga, running without significant pain. Whereas, paddling with any degree of effort produces immediate & severe pain, which lingers and carries on to my normal activities for weeks.

I have already seen a couple of doctors about this condition. The most recent being a prominent Canadian physician who representsan NHL hockey team. He was the one who prescribed the ‘Vioxx’. Although the Vioxx did alleviate a good deal of my pain away from surfing it did nothing to help my first session in the waves (last weekend) and so far has produced no significant benefits after this incident.

What do you think is going on? How long should I stay out of the water? And can you suggest any rehab techniques or exercises to prevent future injuries?

Thanks in advance for your help,

Kevin

ANSWER:

Hey Kevin,

After many questions of others in my field, and a wee bit of research done by yours truly, I have a little feed back for you.

What I have found is a couple of different “syndromes” that sound like they fit your ailments. One is called Tietze’s syndrome, which is an inflammation of the rib and cartilage junction. The rehab suggested for this was ice, rest, anti-inflammatory drugs, and massage. Any inflammation in this area can take a long time to heal and rest is usually the best bet. It is a very sensitive area and a lot of the tissue is thinner than paper (they say cellophane thin).

Another name for something similar to Tietze’s syndrome is costal chondritis, which is the inflammation of the intercostals between the ribs. Again, another very fragile area which needs the same rest, ice, etc. as above. Another surfer was diagnosed with this condition, and he said it took him 5 months of rest to get over the pain. And yes, that was rest out of the water.

Now, in order to prevent this from happening again once the symptoms are gone, I assume that realigning your spine may help so that you rest differently on your board. Another option would be to change your paddling position, so you don’t rub as much on the rib area.

Since you have had neck and back problems, I would highly suggest getting into a good stretching regime and maybe seeing a chiropractor to check out your alignment. If you live locally (SF area) I know a ripping surfer, who is also a chiropractor. Always a nice combo! By stretching and readjusting your body/spine you may find that you can paddle and lie on your board in a more comfortable manor.

I hope this helps. Let me know if you want the name of the chiropractor.

Hasta,

Beth

(Posted 4/12/04)