Ask Beth |
How to Surf Longer, Safer, Harder
SHOULDERS Surf Fitness Index:
ANSWER- Part 1:
Check out what the pro below has to say.
ANSWER- 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
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 2 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 over use 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!
Thanks a lot,
Bummer on the shoulder. Sounds to me like you jammed it good. You may have pushed your humerus head hard into the shoulder socket and could have done a number of things. There is a lot going on in the shoulder girdle, which makes it a very difficult area to self diagnose. You could have pulled/torn a muscle; you could have aggravated/torn the labrum or any part of the socket, etc.
So, basically what I am saying is you may want to get a doctor's diagnosis so you can further your rehab without causing any more injury.
However, it sounds as if it is getting better by giving it a bit of TLC. The next step after the pain subsides and you get some range of motion back would be to do some shoulder strengthening exercises with a Theraband. You would definitely want someone to show you how to do these exercises properly. This is when a visit to a physical therapist would be a good call. Once your shoulder is stronger you could start adding more aggressive weight lifting and then get back into swimming or surfing.
I just gave you a very general guideline but again it depends on what kind of injury you are dealing with. I always like to know because I want to avoid hurting it again. Keep up the stretching, etc. and let me know if you have any more questions.
My theory is that this tightness makes it very difficult to paddle evenly and I will continue to favor my right side. This leads to a continual increase in right side dominance, overuse, and tightness. No bueno. So, My suggestion would be to try and stretch out your bod’, so that your dominant side is not pulling on your spine more than the other side. This will allow you to be more even.
From there, you can start to strengthen and focus on the weaker side and get it up to par. The gym is a great place to do this. I have several tennis players working on only their non-dominant side in the gym while they stretch out their dominant arm. They need to "catch up" with their strong arm. Similar for baseball pitchers, quarterbacks, etc.
Anyways, if this doesn't make sense let me know. Good luck!
What's your take? Should I be more worried? Should I see a doc?
The localized tenderness in your shoulder could be several things: tendonitis, bursitis or tissue damage. I’m sure you could call it an overuse injury based on the amount of time you spend in the water, but whether or not it is from overuse, you should get a doctor’s diagnosis.
Good luck and let me know what the doctor says.
Thanks for any advice you can give me.
What I would do is get a script from your doctor to get some really good physical therapy sessions. I say really good because you need to go to someone who will tell you why this is happening and fix the problem, not put a "Band-Aid" on the pain. You may need some deep tissue work, some good exercises to reeducate the muscles, and some specific stretches to help break down some existing scar tissue. All of this should be done without aggravating the tendonitis. Tendonitis is basically an inflammation of a tendon and generally needs rest to get better. The more inflamed the area, the longer the rehab.
I hope this helps. It stinks when you can't do your daily activities pain free! Happy shoveling!
As for your paddling muscles, there are many ways to target the rhomboid/scapular muscles, the lats, and the shoulders. Lifts such as rowing, reverse flies, overhead press, pushups, chest press, one arm bent over row are a few that target the shoulder blade muscles.
For the lats, you could do lat pull downs, pull ups, certain kinds of pushups, straight arm pulls, and several other lifts which mimic the paddle stroke. I make up exercises all the time! For the shoulders, your basic dumbbell raises (front, side, and posterior) and most of the other exercises I already mentioned will do the trick.
The key to getting stronger in the gym for surfing is knowing which muscles you use while you paddle (the proper paddle!) and then targeting them in the gym. The band is also a great medium for doing modified paddling exercises.
When considering how many reps/how much weight... VARY IT! No paddle out is ever the same and when going for a wave, we tend to sprint really hard. So you need to do some days where you train aerobically (higher reps, lighter weights) for the long, tedious paddle outs or strong ocean current sessions. And then on other days, you need to focus on pure strength. On the latter type of days, add in heavier weights and fewer reps.
There are a few good surf books which have sections on lifting weights that you may want to check out. Surf Flex by Paul Frediani or Fit to Surf by Rocky Snyder which can be found on Amazon.com.
Oh, and never ever neglect the trunk/core area. It’s WAY important in protecting the spine from use and abuse.
Good luck with all of this info and happy weekend warrior-ing!!!
I surf 3 to 4 times a week on average, for 1 to 3 hours each time. As of yet, I have no discomfort in the shoulder area and no pain after surfing.
What do these noises mean and what should I do about them?
However, I took it upon myself to fix it through intensive stretching... yes, YOGA! At the beginning of a yoga class, when they ask you to raise your arms over your head, I am embarrassed that the person next to me is also able to hear the snap, crackle, pop going from my shoulder- especially after a surf session (or 2, 3 or 4 sessions). At the end of the class, my shoulders are running like well-oiled machines.
So here is my theory proven only by the study performed on myself: there are tons of rotator cuff muscles and stabilizing muscles in the shoulder joint that pull the head of your humerus bone in many different directions when tight. Thus, the bone doesn't sit well in its socket and glide smoothly while moving. Stretching can loosen things up and let it go back to its happy, comfortable position.
Again, this is my "Beth-ism" and works for me but may not work for you. As always I have to tell you that if you are concerned or think it may be more, you should definitely go get it checked out by a doctor. I am making a "chair guess" while drinking a cup of Joe before going to work!
Let me know what you think of my Beth-ism, and get yourself on a good stretching program.
I have the pain in the front of my shoulder, it was originally diagnosed as bicep tendonitis from lifting too much. It is painful when I lift so I completely quit that. The latest time it came from throwing a football one day, and then I surfed like 4 days in a row. The pain has lasted longer than normal now, right in front of the shoulder head. Even to lift my arm up over my head for a few seconds is tiresome.
The problem is I have loss of range of motion in my neck along with Nerve pressure there. My shoulder exhibits tendonitis symptoms… some days the pain is worse than others, but for the past month I haven't even been able to think about surf. Any suggestions on treatment and what kind of doctor and therapist to see?
I had shoulder problems, tendonitis, for years during my competitive swimming stint. It was BRUTAL… sharp pains that woke me up at night. Unfortunately, back then no one diagnosed it and all I did was rest, take Advil, and continue swimming. I did not have any tears, which is why I want you to go to a doctor to rule that out.
As I started surfing 4 1/2 years ago, the pains came back with a vengeance. I started to going to an amazing body worked here in Mill Valley who then turned me onto to yoga. I only go to yoga 2x per week, but it has SAVED me and I no longer need to spend loads of dough on a body worker. BUT, I want you to figure out what you have and why the nerves are acting up. It could be that you are out of alignment and something is pressing funny on your nerves. But again, you gotta get that looked at.
BTW, where do you live? I know some good doctors and body workers in the City. Let me know. Get it taken care of before another offshore day with a northwest swell hits!!
Michael has a long history of dislocating both his shoulders. He had surgery on his right shoulder approximately 11 years ago and this past Monday, he severely dislocated that same shoulder. Throughout the years he has dislocated his left and the right shoulders; however, this is the most severe injury to date and it occurred to the shoulder which had previously been operated on. He is now concerned that he will not be able to surf or practice any of his other sports.
His questions to you are: 1) Are you aware of any existing corrective surgery that will alleviate this problem? 2) If so, what is the best technique? And 3) Can you recommend any highly qualified surgeons who specialize in shoulders, or extreme sports injuries? We live in Hermosa Beach, and he is willing to travel to have this problem fixed.
Thank you in advance for your time and assistance.
I am not sure of any surgeons in your area, but I am almost positive there are some great ones in the greater LA area. It is better to have things done locally if possible so that if any problems occur, you are close by. Not to mention the most important part of any injury is the rehab so you want to go to a place that works directly with your surgeon or one they recommend. It is just as important to find an incredible rehab facility, preferably one who understands and embraces your active lifestyle, as it is a great doctor.
Sounds to me like you may need to be on a consistent rotator cuff strengthening program for both of your shoulders since this is a common occurrence. Not to mention a stretching regimen that will strengthen and lengthen your muscles at the same time, i.e., yoga!
Are there any surfers in your area who are orthopedic surgeons or physicians? Perhaps they who could refer you to a local one?
Let me know if you need any more info. And good luck, I hope that this is something that’s fixable without having to go under the knife. Once you get your diagnosis, try to exhaust all means of repairing it (body workers, acupuncture, etc.) before getting it cut on. Unless there is absolutely no alternative.
I will think good thoughts because those northwest swells and off shore winds are on their way!
I just moved back to CA 6 months ago and have been surfing every day since. Recently I have been getting a serious pain on my left side... right on my "wing" muscle (lateral muscle)? It also hurts to laugh, which sucks.
I know two people who have started surfing with me and are experiencing the same pain, in the same spot. Is this normal for beginner surfers? I stretch each time I go out, and after I come in. I am not too concerned because both of my friends have the same pain. I am sure it is probably a muscle that I haven't used too much in the past. Is this normal???
Thanks a lot,
Beth: Before I answer this, do you think it is part of your rib cage or part of your lat muscle (the wing area)?
Matthew: It is more in the lat muscle… only on my left side, and a few inches down from my armpit.
Beth: Hey Matthew,
It is totally random that you and your friends all have the same muscle pain/strain/pull. You guys must all paddle the same and all overcompensate somehow to have pulled that muscle. So, my "guess" is that you guys are paddling wrong and doing something to overuse your left lat (Latissimus dorsi) muscle. Again, this is just an "Internet guess." (It's hard to tell without seeing you guys surf, paddle, or what your body structure is like). If the pain is as bad as you claim, you should probably take some time off to let the muscle heal. If it is really bad, then a doctor's visit is a good idea. When in doubt- see the doc.
If you're not too concerned about it, my advice would be to: A) Stretch everything, B) Get a massage, and C) Take a swim lesson or have a pro paddler watch your stroke and see what you are doing wrong.
If none of these ideas help, then I would: A) Go see a doctor and make sure you didn't hurt something, B) Figure out why you did this so you can prevent it from happening again, and then C) Strengthen your upper body and learn how to paddle properly!
Surfing is a tough sport to get in shape for when you are starting out, and it takes awhile to build the proper muscles. You definitely need to add a stretching regimen to help prevent these muscle pains from happening. Good luck, M.
Sorry I couldn't make it to the July seminar… I will definitely make it to the next seminar.
I was wondering if you had any literature on surfing specific fitness training, especially anything on shoulder rehabilitation. I dislocated my shoulder a few years ago while in the military and don't have any real problems with it unless I use it heavily, like swimming or weight lifting.
Thanks for your help, Matt
BTW, you can get these books on Amazon.com.
These surfers should stretch out their chest and biceps and try to strengthen their back. For example, doing some triceps pull-downs (back of arms), side raises (lateral deltoid muscles), rowing (shoulder blade muscles), and lat pull-downs (lats). Basically, what kind of surfer are you? Do you know what muscles you are using while paddling? If no, you need to learn what these muscles are and start to wake them up in the gym so that you use them while surfing.
If this doesn't come close to answering your question, let me know. Hope you had a good 4th of July!
I am 43 and I live on the Texas Gulf coast and believe it or not there is some type of surf here, just enough to keep tuned up for Central America and Mexico. I would love to attend one of your seminars but due to logistics I will be unable to attend. Do you have any suggestions on how to stretch a really bad shoulder?
The orthopedic doctor recommends joint replacement in a couple of
years, or when pain sets in. I have dropped my weight program and am
totally concentrating on cardio work to keep in shape. I would appreciate info you could give me.
Have the doctor guide you in the right direction with Physical Therapy and eventually strengthening to prevent further problems with that shoulder. Avoiding any kind of surgery is WAY CRUCIAL if possible. Once those things are addressed, and you are still in need of stretches, I would get involved with a basic Hatha type yoga class and make sure the teacher understands shoulder problems. Yoga has saved my shoulders from chronic pain because it not only stretches the actual shoulder, but all the surrounding muscles up and down my spine (and throughout my body, for that matter) that effect my shoulder area. So just performing specific shoulder stretches is not enough, you need to get the whole body involved!
Good luck and let me know the diagnosis. Hope you score some surf soon. Me,
I am off to Tavarua!
In terms of recovery time, I really don't have an answer for you since I have not seen your shoulder. I would consult my therapist on that. With regards to expediting your recovery time, I would suggest a bit of massage therapy from someone who is knowledgeable in the rehab/shoulder arena. I would also stick heavily with my PT regimen and continue with the good stretching. Over-stretching is a no-no. Let pain be your guide and if you have overdone it, back off a bit. Too much pain can slow down your recovery rate.
Once your range of motion improves, I would have your PT put you on a solid rotator cuff/upper body exercise program to strengthen your atrophied muscles. If you jump back into surfing prior to performing specific strengthening exercises, you may end up compensating and then re-injuring your shoulder. Swimming is not a bad substitute to surfing and a great way to work on your range of motion.
Good luck, Patrick. And remember, patience IS a virtue!!!
You mentioned you have a good massage therapist in SF who understands the shoulder and back tightness that surfers get. Can you let me know the name and number of that person. Also I have very tight shoulders and upper body, I am doing Astanga yoga twice a week. What stretches do you recommend for the shoulders?
Finally, I have moved down from a hybrid (7' 6") to a short board (6' 8"). I used to catch everything, now I miss a lot of waves. Other than lots of surfing and swimming, what weight work do you recommend for strengthening my paddling.
Thanks your column is great.
My body worker dude is here in Mill Valley and he rocks. His name is Rick Kutten and his # is (415) 381-4959. If Mill Valley is too far away, let me know and I can ask around for a good one in SF.
As for good upper body stretches, you should definitely ask your yoga instructor to show you some. I think the entire practice is helpful. It is hard to get a good stretch from just one because unfortunately, "your ankle bone is connected to your... hip bone," and so on. Tight gluts or hamstrings can increase the tightness felt in your low back resulting in tight shoulders, etc. See what I am gettin' at? This is why I am sold on serious stretching for over an hour at a time at least 2 days per week.
I can totally relate to moving down in board size. You are on the right path for getting stronger. What I find is that you slowly get used to your new board size and actually get into different shape for your new board. The best way to get stronger for a shorter board is to ride it a ton. The weight room can also help by increasing the strength, size, power, and endurance in your muscles. I am actually giving a seminar on upper body strength on the first Tuesday in June in SF at a local surf shop. Check out our web site or contact me if you are interested.
Smaller boards are tough though. You are definitely not going to catch as many waves on a shorter board- especially if you just made the switch. You are going to have to learn how to better position yourself and get comfortable with taking off closer to where the wave is actually breaking. I have taken many a pounding while trying to get comfortable on my shorter board... but it is worth it!
Let me know if you have any more questions and do check out the surf
seminars I am offering. They may help.
What is the best exercise for deltoid tendonitis? I would appreciate any advice you can give me.
First of all, did you get a doctor's diagnosis of your condition or did you
do a self diagnosis? You actually have 3 different deltoid muscles and many
other muscles connecting in and around the shoulder joint. In most cases, a
tendonitis is a swelling or inflammation of a tendon and rest, ice, and
anti-inflammatory drugs are the best rehab. After the signs and symptoms are
gone, then you want to figure out what is up with your body structure and
why you got the tendonitis in the first place. Was it overuse of the muscle,
are you super tight in your upper body, are you paddling properly, are you
lifting weights, etc. Get back to me on the specifics of your injury. Hope you had a great Easter!
HI Beth. I am 46 years old father of 2 living in Boca Raton Florida. I
surf mostly weekends when it is rideable. Most of the time there is
a strong wind current requiring constant paddling. I am riding a 7'3"
surfboard with plenty of buoyancy. I usually reach fatigue in my shoulders
at 15 minutes of paddling. What exercises do you recommend for the
paddling stroke. Thank you very much. Have a nice day.
Man, can I relate. Here in Northern California we often deal with the gnarliest currents. It is quite difficult to keep up with them if you are only able to surf on the weekends.
I would definitely suggest trying to swim at least 2 other days per week. If you can swim for 45 minutes straight (or break it up with some interval sets) then your arms will be ready for the longer paddle sessions. If you don't have a swimming background, see if a buddy can give you a few tips on the proper swimming technique. The more efficient you are in the pool, the better muscle recruitment you will have to mimic the paddle stroke. On top of swimming, you could also try and build the strength and endurance within your paddling muscles by lifting weights at the gym. If you are unfamiliar with weight training, I would hire a trainer, preferably with a surfing or swimming background, for a one time session to put you on a surfing specific regimen. If you hate the gym or don't want to pay for it, pushups, pull ups, and triceps dips are better than nothing. Good luck and know that you are DEFINITELY not alone in the "paddles from hell"!
I just ran across the site with your tips column and found some great info. I was wondering if you have any knowledge on the condition of a separated AC joint. I did it sometime ago (2 yrs maybe) and didn't even know it. I kept up the pull-ups, some weight lifting , etc. and now it seems there's some arthrosis there. I had major pain while paddling so I went to the doctor. You know it's serious if it hurts while surfing.
I believe it's arthrosis of the AC joint. From what I've read this usually follows the separation sometime later down the line. In my case I never went to the doctor to diagnose the separation until 2 years later, this past June, because I felt no pain until then. The bump was there but since I felt no pain for 2 years I continued the pull-ups, etc. at a pretty heavy rate of use on the shoulder, then last June it got to where I was in intense pain in the areas I described.
I went to rehab for the joint separation and I did exercises to strengthen the surrounding area. The pain is pretty much still there although down a notch or so. I was looking at a site on the internet and saw the symptoms for arthrosis of the separated ac joint and the conditions are matching. Pain in the front of the shoulder, pain going down towards the chest and going down the upper back. Also this clicking noise. Any tips rehab or treatments? Let me know. I'll also hook you up with some Latin music CD's if you enclose your address, as I'm a marketing manager for Universal Music Latino.
I actually went and checked out on the internet the difference between arthritis and arthrosis and there isn't much of one. They are just different stages of a similar injury. Do you have pain-free range of motion when you're not surfing? Trouble sleeping or pain in the morning? Are there any cysts formed on the bones?
What I would do is get back on a serious rehabilitative program for the rotator cuff. Sounds like you have been doing some pretty aggressive exercises for a not so happy shoulder joint. I would start to do the band work I assume you did post initial injury in order to strengthen the small muscles that hold the shoulder girdle together.
The first thing you want to make sure is that you do have full range of motion and that your muscles surrounding the area are nice and flexible. If one area is severely tight, then you may have an imbalance which is causing a major pull in the shoulder area. So flexibility is key.
For right now, let pain be your guide. If surfing kills it, you may need to back off and let things rest for a bit. You may want to go back to your physical therapist and get a guideline for what needs to happen. Getting you back in the water is the goal and you don't want to make things worse or prolong the pain by "guessing" your symptoms and the cure.
Good luck and give me some feedback. If you need some recommendations for a good physical therapist or a killer yoga class- let me know. It definitely sounds like you may need some guidance.
Anyway, I did see a sports medicine MD around Oct10th, who also thought it
was rotator cuff tendonitis, and he prescribed a set of exercises that he
thought would clear it up in 6 weeks. He said at the time he thought after
an week or so of rest I should be able to go out for "easy" surfs. Well, I
live at OB so I don't know if that is possible. I have continued to surf
about 1 to 3 times a week. It's sore but I live with it. I would love to
get back to 4 times a week. And so, here is the question -- if I want to
avoid shoulder arthritis should I totally stay out of the water until it
totally gets better, like for 6 weeks or something? I hate to do that, but
I am getting towards 40, and I really do not want face arthritis or something
that is permanently debilitating. Any thoughts?
For example... is it due to poor posture? Are you compensating elsewhere due to pain so you are super tight in certain areas? Is it surfing that aggravates it or are you not stretching enough? Rest will probably make your shoulder a lot happier but if taking the time off is going to kill you, I would try a few other measures. (Again this is my opinion based on your complaints. Basically, be smart and listen to your body)!
Start taking a yoga/stretching class if you don't already. In rehab, range of motion comes first and then you start strengthening the injured area. You may be super tight. I would also try to get a few sports massages from someone who knows injury. I know of a great yoga place here in the City.
Ideally, rest is probably the number one helper but it still isn't going to
assure you that the next time you surf, you won't re-injure yourself. Figure
out what caused it in the first place and tackle that problem. Good luck and let me know if this helps!
As for your shoulder, rest is key as is Advil until the pain and swelling subside. I definitely suggest a good stretching regime, which focuses on stretching your chest, bicep, and other anterior muscle groups to help prevent the dreaded "surfer stance" with the shoulders rolling forward. Yoga is not a bad idea as you are forced to hold your stretches for a long time and you tend to get an overall body stretching experience. However, if you tore something during the initial accident, you may feel a lot of pain when stretching. If you have insurance, I would highly suggest a checkup with a Physical Therapist or an Orthopedic surgeon to rule out any tears within the rotator cuff.
I imagine you have some scar tissue surrounding your injured wing which will continue to aggravate you until you get rid of it. Again, this can be done through a series of stretches or yoga, but you may benefit greatly from a few visits to the massage therapist. Try to find someone who has a background in sport related injuries and see if they can give you any answers. Shoulders can be tricky and if one area is tight, then you may feel pain in random parts of the joint.
Once the pain has subsided and you have regained full range of motion, I would then suggest a rotator cuff strengthening program to strengthen the opposite "surfing" muscle groups in order to create a balance in your shoulder girdle. Please consult someone to rule out any potential tears!!
Good luck and let me know if you have other questions. Happy turkey day!
In other words, Beth is going to be sharing some information that she believes could improve the average, healthy surfer's well-being. But don't complain if you get hurt. Surfing, especially big wave surfing, can be very dangerous and everyone participating in sports such as these should thoroughly evaluate all of the possible consequences before getting involved... and especially before pushing their limits in any capacity. Surf hard but surf safely.