Physiological aspects of surfboard riding performance

Surfer's neurapraxia - an uncommon surfing injury of the saphenous nerve

Surfer's neurapraxia is a rare surfing injury of the saphenous nerve secondary to persistent compression of the saphenous nerve along the medial thigh by the surfboard when paddling prone and while sitting upright on the board waiting for a wave. Symptoms may be nonspecific and consist of pain in the medial thigh with or without radiation along the saphenous nerve distribution (medial leg, medial ankle, medial arch of the foot). The saphenous nerve tension test can be utilized to reproduce the symptoms of surfer's neurapraxia. Treatment consists of conservative management while refractory cases may benefit from injection with local anesthetic. The authors propose the Obana Plan (WATER) for prevention of surfer's neurapraxia, consisting of Wetsuits, Abduction, Timing, Exercise, and Rest. Overall, surfer's neurapraxia is a benign condition that can be prevented and managed conservatively.

Surfing Time-Motion Characteristics Possible to Gain Using Global Navigation Satellite Systems: A Systematic Review

The popularity of surfing has increased exponentially, reaching its recent debut in the Olympic Games. However, surfing suffers from a relative immature technological market, while in other sports some technologies such as global navigation satellite systems (GNSSs) have become an essential work material for strength and conditioning and head coaches. This article aims to systematically review surfers' time-motion demands based on GNSSs. A systematic review of relevant articles was carried out using five main databases (PubMed, ProQuest Central, SCOPUS, SPORTDiscus, and FECYT (Web of Sciences, CCC, CIDW, KJD, MEDLINE, RSCI, and SCIELO)) until 23 March 2024. From the 238 studies initially found, 9 were included in the qualitative synthesis. In these, GNSS devices were employed with male (n = 143) and female (n = 28) surfers from different levels during competition and training situations. The studies show that the intermittent nature of the sport is evident, with substantial periods spent paddling and waiting punctuated by relatively brief high-intensity efforts when riding waves at high speeds. Notable differences emerged between competition and training demands, suggesting potential mismatches in how athletes currently prepare compared to event requirements. These novel insights allow quantifying surfing's harsh physiological requirements and could guide conditioning practices to better meet the sport's unique characteristics across populations. Therefore, training should emulate the lengthy aerobic capabilities needed for the paddling volumes observed, while also targeting the anaerobic systems to meet the repeated high-intensity surf riding efforts. However, inconsistencies in methods and reporting practices limit direct comparisons and comprehensive profiling of the sport's physical characteristics.

The characterization of thermal perception in recreational surfers wearing wetsuits

The purpose of this study was to characterize the perception of heat loss, comfort, and wetness in recreational surfers wearing wetsuits, to compare these data with changes in skin temperature reported in prior studies, and to examine the impact of wetsuit thickness, zipper location, and accessory use on thermal sensation and comfort. Following their surf session, nine-hundred and three male (n = 735) and female (n = 168) recreational surfers responded to a series of questions regarding thermal comfort/sensation, wetsuit characteristics, and surfing history. Average whole body thermal sensation rating was 0.8 ± 3.6 on a scale of -10 to +10 and average whole body thermal comfort rating was 1.5 ± 1.2, midway between "just comfortable" and "comfortable." Overall, surfers felt coldest in their feet, hands, and head. Under their wetsuits, surfers felt the coldest, wettest, and least comfortable in their chest, lower legs, lower arms, and upper back. Wetsuit accessory use had the greatest impact on regions identified as coldest, least comfortable, and wettest. These data suggest that wetsuit design should focus on optimizing water access points and improving accessories for the feet, hands, and head.

Surfboard riders are at risk of low energy availability - A pilot study

BACKGROUND

Surfing is a rapidly growing sport and recreational activity. The previously reported, intermittent high-intensity energetics of surfing place athletes and recreational participants at risk of low energy availability (LEA).

AIM

As such, this pioneering study aims to be the first to investigate LEA risk and the second to investigate dietary intake in surfers.

METHODS

Twenty-one intermediate and advanced surfers (female - 5, male - 16) were recruited to complete an online self-administered questionnaire and 4 consecutive 24-hour food logs to establish LEA risk and asses dietary intake. The Low Energy Availability in Female Questionnaire and Eating Disorder Examination Questionnaire were used to identify at-risk individuals in females and males, respectively, with respective cut-off's of ≥8 and ≥2.3.

RESULTS

Fifty-seven percent were classed as at-risk of LEA (50% and 80% in males and females, respectively). No significant relationship of competitive status, surfing ability and body mass index on risk classification was found. However, a non-significant medium effect of age was observed (p = 0.338, R = 0.549). And 77% of the 70 total analysed food records showed inadequate carbohydrate (CHO) consumption.

CONCLUSION

In summary, an alarmingly high portion of surfers are at risk of LEA and dietary inadequacy. Future studies should confirm whether surfing organisations need to intervene, by addressing limitations of the present study including a small sample, which was heavily biased away from female and high-level competitors.

Surfboard Related Orbital and Periocular Injury

PURPOSE

The objective of this study is to present the complexity of surfboard related orbital and periocular injuries and to discuss the different prevention aspects of such injuries.

METHODS

A retrospective review was performed on surfing related orbital and periocular injuries cases in a single tertiary medical center over a period of 10 years.

RESULTS

Six patients at a mean age of 34 (range 20-50) years were evaluated. All were amateur surfers. Five patients had an orbital fracture, 3 had a full thickness eyelid laceration, 3 had lacrimal drainage system damage and 3 had intraocular findings related to trauma, but no perforation of the globe was observed. Two patients had complete optic nerve avulsion or transection, 1 of them had extraocular muscle transection. Five patients underwent surgery and 2 required an additional surgical intervention. At the end of follow-up, 3 patients had an unrepairable lacrimal drainage damage, 2 had a malposition of an eyelid, 2 eyes remained blind, 1 patient had a hypoglobus, and 1 had hypoesthesia in distribution of infraorbital nerve.

CONCLUSIONS

Surfboard related orbital injuries may cause a severe orbital injury, which may debilitate and disable a previously active and healthy group of young people. Hence, protective gear wear should be more vigorously encouraged as already been done in other sports.

Musculoskeletal pain related to surfing practice: Which role for sports rehabilitation strategies? A cross-sectional study

BACKGROUND

Surf practice contributes to overuse injuries and musculoskeletal pain. Relationship between the type of surfing practiced and the onset of pain is not fully understood as well as the potential role of rehabilitation in preventing it.

OBJECTIVE

To investigate musculoskeletal pain and to deepen whether the age and the anatomical region involved influenced the pain appearance in relation to four surfing disciplines.

METHODS

A cross-sectional study was carried out. An online survey was addressed to a group of Italian surfers (practicing surf, kitesurf, windsurf and stand up paddle since at least 1 year), collecting demographic data, discipline practiced, location of musculoskeletal pain.

RESULTS

One hundred and twenty-six surfers were involved in the study. Spine and upper limbs pain was more frequent compared to lower limbs one in the surf (p< 0.001) and in the windsurf groups (p= 0.007). In the kitesurf group a greater prevalence of pain was observed in spine and lower limbs compared to upper limbs (p= 0.017). Low back pain is the most represented among the spine pain subgroups (p< 0.001). Pain was lower in younger athletes (p= 0.007).

CONCLUSIONS

Understanding risk factors and biomechanics of musculoskeletal pain is essential to realize prevention training strategies. Rehabilitation in sinergy with specific training allows pain-free activity, optimizing its overall health benefits.

Injury patterns in competitive and recreational surfing: a systematic review

CONTEXT

Despite the growing evidence regarding surf-related injuries, investigation seems to overlook the differences between professional and recreational surfers' injuries and their specific risk factors.

OBJECTIVE

This review aimed at identifying differences in injuries sustained by recreational and competitive surfers. It also presents research gaps and suggests recommendations for future injury research and prevention.

METHODS

Study search was conducted on MEDLINE/PubMed, SportDiscus and Web of Science databases. To be included studies needed to report original data, clearly specify if recreational and/or competitive surfers were included, provide information regarding acute surfing injuries and/or analyse data concerning those injuries.

RESULTS

17 studies were included in the analysis. All included studies had at least Oxford Centre for Evidence-Based Medicine level of evidence 3. The percentage of recreational surfers sustaining at least one injury ranged from 31% to 35% in the 12 months prior to data collection and from 88% to 100% in lifetime while 42% to 49% and 81% to 100% of competitors were injured over the same periods. Competitive surfers appear to have a higher injury risk. Both recreational and competitive surfers appear to sustain more frequently skin, joint/ligament and muscle/tendon injuries affecting the lower limbs and caused by contact with their own equipment.

CONCLUSIONS

Competitive status, less surfing experience, older age and prior surgical injuries are risk factors for sustaining injuries while surfing. The most common types, anatomical locations and mechanisms of injury seem to be similar between recreational and competitive surfers.

Surfing on the world stage: a narrative review of acute and overuse injuries and preventative measures for the competitive and recreational surfer

Surfing has rapidly grown in popularity as the sport made its debut at the Tokyo 2020 Olympic Games. Surfing injuries are becoming more relevant with the globalisation and increasing risks of the sport, but despite this, little is known about surfing injuries or prevention strategies in either the competitive or recreational surfer. Prior research demonstrates that surfers are injured at a frequency of 0.74-1.79 injuries per 1000 hours of surfing. We reviewed the literature for the incidence, anatomical distribution, type and underlying mechanism of acute and overuse injuries, and discuss current preventative measures. This review finds that skin injuries represent the highest proportion of total injuries. Acute injuries most frequently affect the head, neck and face, followed by the lower limbs. Being struck by one's own board is the most common mechanism of injury. Non-contact acute ligament injuries have increased as surfing manoeuvres have become more acrobatic and overuse musculoskeletal injuries are highly correlated with paddling. However, there is a paucity of research for surfing injuries, and studies on overuse musculoskeletal injuries and prevention are disproportionally under-represented. Most of the prior studies are limited by small sample sizes, poor data collection methodology and geographical constraints. Further research is needed to establish preventative measures for both acute and overuse surfing injuries and to ensure the increasing popularity of surfing is met with an improved understanding of sport risks and safety. Specifically, we recommend research be prioritised regarding the efficacy of training programmes to prevent surfing-related overuse musculoskeletal injuries.

Learning to Kitesurf Using an Adapted Prosthesis: A Case Report

CASE DESCRIPTION

Kitesurfing is a sliding water sport whose popularity and number of practitioners are growing around the world. We describe an athlete of this sport who has undergone a transfemoral amputation (right leg, at the distal third), who uses a knee prosthesis that requires flexion and extension to absorb the shocks encountered. Kitesurfing under these circumstances calls for a proper prosthesis that accommodates the various strenuous maneuvers of the sport. Mr. M, 36 years old, nonprofessional athlete, uses a special prosthesis of this type.

OBJECTIVE

We report on Mr. M, a person with a transfemoral amputation, who wanted to learn to kitesurf.

STUDY DESIGN

This was a case report study.

TREATMENT

A prosthesis consisting of a thigh socket interface (Iceross Seal-In X TF, Iceland), knee (SymBiotechs XT9), and a foot (MotionFoot MX), which in addition to being saltwater-resistant, combines low weight and resistance to the shocks inherent to the sport.

OUTCOMES

Mr. M uses this prosthesis for kitesurfing with good results in both learning and improving. During the waterstart, he must be sitting on the beach and cannot shorten his left leg. This prosthesis adjusts its tension depending on the weather and water conditions and if the subject changes sports in such a way that it should be tensioned or relaxed depending on the needs of the new sport.

CONCLUSIONS

This prosthesis is adapted for kitesurfing and allows precise adjustments to kitesurfing maneuvers. It has allowed the user to perform the movements of the sport with success.

Oxygen Uptake of Wave Surfers and Complementary Parameters in Front Crawl and Surfing-Paddling Tests

ABSTRACT

Godoy, DF, Cadore, EL, Feitosa, WG, Correia, RdA, and Castro, FAdS. Oxygen uptake of wave surfers and complementary parameters in front crawl and surfing-paddling tests. J Strength Cond Res 35(9): 2645-2650, 2021-The aim of this study was to assess the reliability of the oxygen uptake and complementary parameters (heart rate [HR], blood lactate concentration, and rate of perceived exertion [RPE]) obtained from surfers swimming and paddling in a swimming pool. Fourteen recreational male surfers (37.7 ± 4.7 years old) were evaluated in (a) a maximal 300-m front crawl test and (b) paddling in a surfboard test, both at the same intensity and for the same duration. Peak oxygen uptake (V̇o2peak) during the tests (direct method), HR, blood lactate concentration (LA), and RPE were assessed. Two-way analysis of variance, a simple Student t test, effect size calculation, intraclass correlation coefficient, and limits of agreement were applied. In general, the tests presented similar results (except for HR), with low agreement, high intraclass correlation, and average to large effect sizes between swimming and paddling. The results suggest that surfers training in a swimming pool should not simply be swimming. Front crawl swimming and surf paddling are 2 distinct actions that should be practiced and tested on their own merits rather than assumed to be interchangeable.

Development of evidence-based classification for para surfers with physical impairments: A narrative review

The sport of competitive para surfing is growing internationally without established classification procedures. A classification structure is essential for equitable sport competition and worldwide sport progression. This narrative review summarizes the existing knowledge on Paralympic classification and surfing biomechanics. Its primary purpose is to describe the development of an evidence-based para surfing classification structure that follows the International Paralympic Committee (IPC) Classification Code. Two databases-PubMed and Google Scholar-were searched for three themes: "Paralympic classification", "performance determining factors in surfing", and "impact of impairments on surf performance". The IPC Classification Code and IPC regulations were obtained from the IPC website and official publications. Seventy-six relevant articles were utilized to guide the design of this preliminary para surfing classification structure. A conceptual framework on athlete characteristics, adaptive sport characteristics, and use of equipment is presented to build the essential knowledge base for continual growth of para surfing. This classification structure and conceptual framework will support para surfing sport expansion and help pave the way for its inclusion in the Paralympic Games.

Are the Kinetics and Kinematics of the Surf Pop-Up Related to the Anthropometric Characteristics of the Surfer?

The surf pop-up is a unique and challenging skill, critical to successful surfing. Hypothesizing that anthropometric characteristics of surfers influence the pop-up performance, we aimed to measure kinematics and ground-reaction forces (GRF) during a simulated pop-up motion, and to relate these variables with anthropometric characteristics. Twenty-three male surfers (age: 28.4 ± 10.1 years old; body mass: 68.3 ± 10.8 kg; height: 1.73 ± 0.07 m; time of practice: 12.4 ± 8.9 years; arm-span: 1.75 ± 8.9 m) perform a simulated pop-up in the laboratory, while GRF and 3D motion-capture data were acquired. The duration of the pop-up was 1.20 ± 0.19 s (60% push-up and 40% reaching/landing phase). During the push-up, the hands were placed 0.46 ± 0.05 m apart and generated a relative total peak-force of 0.99 ± 0.10 N/Weight, with symmetrical impulse of 0.30 ± 0.05 N·s/Weight for the dominant and 0.29 ± 0.07 N·s/Weight for the nondominant hand. Elbow angles were not different during the peak force application (110 ± 18° vs. 112 ± 18°, respectively) of the push-up phase. During the landing phase, the feet were placed 0.63 ± 0.10 m apart and generated a relative peak force of 1.63 ± 0.18 N/Weight. The impact force during landing was applied unevenly between the rear foot (28%) and the front foot (72%). In conclusion, most anthropometric-related variables showed no relationship with performance variables, with the exception of an inverse relationship between muscle mass and pop-up total duration. We also observed no differences in upper- and lower-body kinematics between the dominant vs. nondominant hands and among surfers who preferred a regular vs. “goofy-foot” stance. Finally, the force profiles between hands were similar and symmetric, while the lower extremities during the reaching phase were different, with the front foot applying greater force than that of the rear foot.

The impact of a single surfing paddling cycle on fatigue and energy cost

Surfing is one additional sport proposed by the Tokyo 2020 Organizing Committee. Surprisingly, substantial efforts to understand surfing energetics are recent, and the impact of a single surfing paddling cycle on fatigue and energy cost is still not clear. Since surfing paddling technique is highly specific, experiments in real practice conditions are necessary to provide deeper insights. Through a biophysical approach, biomechanical and energetics responses of surfing paddling were quantified and compared from 16 competitive male surfers (23.5 ± 10.0 years old, 65.3 ± 11.4 kg and 1.72 ± 0.01 m) during two sets (PRE and POST) of 10 s all-out tethered paddling plus 20 m sprint paddling, interposed by 6 min of endurance paddling. Faster surfers presented lower energy cost during sprint PRE (r² = 0.30, p = 0.03) and endurance (r² = 0.35, p = 0.02) relative surfing paddling velocities. Although the energy cost was higher for a lower velocity at maximal paddling velocity POST, the energy cost of surfing paddling increased with absolute velocity according to a power function (R² = 0.83). Our results suggest that fatigue seems to occur even following a single surfing paddling cycle. Developing a powerful and endurable metabolic base while reducing energy cost during surfing paddling should be seen as key factors in surfing training programs.

Chronic and Gradual-Onset Injuries and Conditions in the Sport of Surfing: A Systematic Review

The majority of the previous literature investigating injuries in surfing have focused on acute or traumatic injuries. This systematic review appears to be the first to investigate the literature reporting on chronic and gradual-onset injuries and conditions in surfing populations. A search strategy was implemented on five databases in June 2020 to locate peer-reviewed epidemiological studies on musculoskeletal injuries or non-musculoskeletal conditions in surfing. A modified AXIS Critical Appraisal Tool was used to appraise all included texts. Extracted data included key information relevant to the epidemiology of the injuries and conditions. Twenty journal articles were included with the majority rated as good quality and a substantial agreement between raters (k = 0.724). Spine/back (29.3%), shoulder (22.9%), and head/face/neck (17.5%) were the most frequently reported locations of musculoskeletal injury, whilst the most common mechanism of injury was paddling (37.1%). Exostosis was the most frequently described injury or condition in surfing populations, with the most common grade of severity reported as mild obstruction. The key findings of injury type, location, severity, and mechanism can be used to develop relevant injury management and prevention programs for the surfing population, with an emphasis on chronic or gradual-onset spine/back and shoulder injuries, paddling technique, and education on the development and management of exostosis.

The Surfer's Shoulder: A Systematic Review of Current Literature and Potential Pathophysiological Explanations of Chronic Shoulder Complaints in Wave Surfers

Background

Wave surfing will debut in the next Olympic Games and is increasingly popular as a sport. Chronic shoulder complaints are frequently reported amongst surfers, though literature researching its pathophysiology and prevention is scarce. This article provides an overview of the current literature, proposes a potential pathogenesis and a potential physiotherapeutic prevention program for surf-induced shoulder complaints.

Methods

A systematic review was performed considering the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for articles regarding kinematic analysis of the surf paddling movement. Data sources were Embase, MEDLINE (PubMed) and Research gate. We included case series and cohort studies that originally studied or described the paddle movement made by wave surfers, studies that reported on kinesiologic analysis with nerve conduction studies and studies on 3D motion analysis of the shoulder while paddling.

Results

Eight original articles were included that analysed the shoulder movement in paddling surfers. Muscles that are active during paddling are mainly internal rotators and muscles that are involved in shoulder flexion. Internal rotators are active in propelling the surfer through the water, though external rotator strength is only used while the arm is out of the water.

Discussion

In surfers with shoulder complaints, external rotation range of motion and external rotation strength are impaired. Scapulothoracic dyskinesis may occur and subacromial pain syndrome may coincide. Further research should address potential pectoralis minor shortening, which may lead to aberrant scapular tilt and lateral rotation of the scapula. The surfer’s shoulder is characterised by external rotation deficit, as opposed to internal rotation deficit in the thrower’s shoulder, and it differs substantially from shoulder complaints in swimmers. Therefore, a specific prevention or rehabilitation protocol for surfers is required. Decreased thoracic extension may thereby alter the risk of scapular dyskinesis and hence increase the risk of impingement around the shoulder joint. A potential physiotherapeutic prevention programme should address all these aspects, with the main goal being to increase external rotator strength and to stretch the internal rotators.

Conclusion

There is a high incidence of chronic surf-induced shoulder complaints in surfers. Symptoms may arise due to imbalanced training or scapular dyskinesis, which may subsequently trigger subacromial pain. Physiotherapeutic prevention should include stretching of the internal rotators, external rotator training and optimisation of thoracic extension and scapulothoracic movement.

The Incidence of Pediatric and Adolescent Concussion in Action Sports: A Systematic Review and Meta-Analysis

BACKGROUND

This was a systematic review and meta-analysis of the incidence of concussion risk in youth athletes involved in action sports (AS).

METHODS

A search of PubMed and Web of Science (from January 1980 to August 2020). Titles, abstracts, and full text were screened according to predefined inclusion criteria to find relevant studies. Moreover, the methodological quality of the studies selected was assessed.

RESULTS

Nineteen of 1.619 studies were included in the systematic review and 14 in the meta-analysis. Motocross, sailing and snowboarding presented the highest incidence rates per 1000 athlete exposure at 39.22, 3.73 and 2.77 respectively, whereas alpine skiing had the lowest incidence rates resulting in 0.30. Overall risk of concussion was estimated at 0.33 (CI: 0.22, 0.45). Regarding the methodological quality, we have to report that 26.3% of the studies reported the definition of concussion while 36.8% presented age and gender-specific incidence rates. The mechanism of injury and follow up were reported only in one study.

CONCLUSIONS

There are significant differences in the rates of incident youth concussion across AS. Despite some limitations, the data from this research can serve as the current sport-specific baseline risk of concussion among youth athletes who practice action sports.

The Effect of Different Cadence on Paddling Gross Efficiency and Economy in Stand-Up Paddle Boarding

Background: Due to the importance of energy efficiency and economy in endurance performance, it is important to know the influence of different paddling cadences on these variables in the stand-up paddleboarding (SUP). The purpose of this study was to determine the effect of paddling at different cadences on the energy efficiency, economy, and physiological variables of international SUP race competitors. Methods: Ten male paddlers (age 28.8 ± 11.0 years; height 175.4 ± 5.1 m; body mass 74.2 ± 9.4 kg) participating in international tests carried out two test sessions. In the first one, an incremental exercise test was conducted to assess maximal oxygen uptake and peak power output (PPO). On the second day, they underwent 3 trials of 8 min each at 75% of PPO reached in the first test session. Three cadences were carried out in different trials randomly assigned between 45–55 and 65 strokes-min⁻¹ (spm). Heart rate (HR), blood lactate, perceived sense of exertion (RPE), gross efficiency, economy, and oxygen uptake (VO₂) were measured in the middle (4-min) and the end (8-min) of each trial. Results: Economy (45.3 ± 5.7 KJ·l⁻¹ at 45 spm vs. 38.1 ± 5.3 KJ·l⁻¹ at 65 spm; p = 0.010) and gross efficiency (13.4 ± 2.3% at 45 spm vs. 11.0 ± 1.6% at 65 spm; p = 0.012) was higher during de 45 spm condition than 65 spm in the 8-min. Respiratory exchange ratio (RER) presented a lower value at 4-min than at 8-min in 55 spm (4-min, 0.950 ± 0.065 vs. 8-min, 0.964 ± 0.053) and 65 spm cadences (4-min, 0.951 ± 0.030 vs. 8-min, 0.992 ± 0.047; p < 0.05). VO₂, HR, lactate, and RPE were lower (p < 0.05) at 45 spm (VO₂, 34.4 ± 6.0 mL·kg⁻¹·min⁻¹; HR, 161.2 ± 16.4 beats·min⁻¹; lactate, 3.5 ± 1.0 mmol·l⁻¹; RPE, 6.0 ± 2.1) than at 55 spm (VO₂, 38.6 ± 5.2 mL·kg⁻¹·min⁻¹; HR, 168.1 ± 15.1 beats·min⁻¹; lactate, 4.2 ± 1.2 mmol·l⁻¹; RPE, 6.9 ± 1.4) and 65 spm (VO₂, 38.7 ± 5.9 mL·kg⁻¹·min⁻¹; HR, 170.7 ± 13.0 beats·min⁻¹; 5.3 ± 1.8 mmol·l⁻¹; RPE, 7.6 ± 1.4) at 8-min. Moreover, lactate and RPE at 65 spm was greater than 55 spm (p < 0.05) at 8-min. Conclusion: International male SUP paddlers were most efficient and economical when paddling at 45 spm vs. 55 or 65 spm, confirmed by lower RPE values, which may likely translate to faster paddling speed and greater endurance.

Orthopedic Injuries in Professional Surfers: A Retrospective Study at a Single Orthopedic Center

BACKGROUND

Literature regarding surfing injuries is scarce and most studies report a high number of minor injuries. Recent literature suggests that musculoskeletal injuries are more common than previously reported. In the mid 2000s, competitive surfing has seen an increase in aerial maneuvers, as they have become more highly rewarded by the judging panel, which may be contributing to a change in injury patterns. Our goal was to evaluate orthopedic injuries in professional surfers.

HYPOTHESIS

Orthopedic injuries in professional surfers are diverse and have evolved with skill and technology.

STUDY DESIGN

Retrospective observational study.

LEVEL OF EVIDENCE

Level 4 Case Series.

METHODS

Medical records of professional surfers from a single orthopedic center between 1991 and 2016 were reviewed. Injuries sustained while surfing and chronic injuries related to surfing were included. Site of injury, diagnosis, and treatment were recorded along with demographic data.

RESULTS

In total, 163 injuries in 86 athletes were recorded. The median injury age was 28.5 years (range 12-62 years) and 92.6% of patients were male. The most frequently injured body parts were the knee (28.2%), ankle (22.1%), and shoulder (19%). Most knee injuries were of the medial collateral ligament at 49%, with 75% of ankle injuries being sprains, and in shoulder, 48% had instability, 42% had a rotator cuff tear, and 35% had a superior anterior-posterior labral tear. Lower extremity injuries primarily affected the surfers' back leg (72.5%). In all, 34.6% of all injuries required surgical intervention and involved shoulder injuries most the time.

CONCLUSIONS

The most common orthopedic injuries in professional surfers involve the knee, ankle, shoulder, hip, and back. Surfers' rear extremities were preferentially injured which is the extremity responsible for power and torque. Shoulder injuries increased the probability of an operative intervention. Last, overuse injuries (femoral-acetabular impingement, rotator cuffs) occurred in the older surf population compared with more acute injuries (ankle sprains/fractures, anterior cruciate ligament tears) which is also consistent with time to surgery.

Gradual-onset surfing-related injuries in New Zealand: A cross-sectional study

OBJECTIVES

Gradual-onset injuries associated with surfing have not previously been closely examined. This study investigated the duration, mechanisms, body locations and types of gradual-onset injuries in a sample of New Zealand surfers.

DESIGN

Retrospective, cross-sectional online survey.

METHODS

Self-identified surfers reported gradual-onset surfing-related injuries experienced in the preceding 12 months.

RESULTS

Respondents (n=1473, age range 8-74 years) reported a total of 550 gradual-onset major injuries: 44% acute duration (<3 months) and 56% chronic (≥3 months). The injury incidence proportion was 27%. Shoulder (146 injuries, 64% chronic), low back (115 injuries, 58% chronic) and neck (105 injuries, 46% chronic) were the most commonly reported injury locations. Prolonged paddling was the most commonly reported mechanism of injury (40% of all injuries). Incidence proportion for gradual-onset major injuries was 6% higher for greater surfing abilities compared to lower abilities (p=0.01), and 13% higher for long boarders compared to short boarders (p=0.001). Respondents reporting any gradual-onset surfing injury, compared to those with no injury, averaged 3 more years surfing experience (p<0.001), were 3 years older (p<0.001), and reported 43h more surfing exposure in the preceding 12 months (p<0.001).

CONCLUSIONS

The most common gradual-onset surfing injuries involved the shoulder, low back, and neck, most frequently attributable to paddling. Risk factors for these injuries included board type, higher ability, older age, more hours/year, and years of surfing. These findings affirm the existence of sufficient injury burden to justify investigation of surfing injury prevention initiatives.

Sex differences in competitive surfers' generic and specific strength capacity

To compare the pop-up and counter movement jump (CMJ) and to analyse the relationships among the variables between sexes and different ages [under (U16), over (O16) 16 years] in male and female competitive surfers. Eighty-three surfers were divided according to sex, male (n = 55) and female (n = 28), and to age, U16 (n = 47) and O16 (n = 36). Vertical jump and pop-up movements were measured through the vertical ground reaction force with a force plate. CMJ demonstrated that the O16 male group exhibited significantly greater force compared to females in the concentric phase of the jump (CMJ_FMAX) (p < 0.01, ES = 1.82, large). Female U16 and O16 groups presented increased unloading rates in the eccentric phase compared to male surfers (CMJ_ULR) (p < 0.05, ES = 0.73, moderate and p < 0.05, ES = 0.12, trivial, respectively). O16 males obtained significantly greater values than O16 females in the push-up phase (POP_PUSH) (p < 0.05, ES = 0.76, moderate). Moderate correlations were found between lower-body power capacity and the pop-up (r = 0.32; ± 0.16 CL, p < 0.01, 98.1/1.9/0, very likely, moderate). General and skill-specific strengths are different in competitive male and female surfers, dependent upon their age range. The moderate association between CMJ and pop-up suggests that the pop-up might be influenced by other factors such as coordination or upper-body strength. Therefore, competitive surfers should also train the upper body strength and overall coordination in order to improve the performance of the pop-up movement.

Real-Time Surf Manoeuvres’ Detection Using Smartphones’ Inertial Sensors

Surfing is currently one of the most popular water sports in the world, both for recreational and competitive level surfers. Surf session analysis is often performed with commercially available devices. However, most of them seem insufficient considering the surfers’ needs, by displaying a low number of features, being inaccurate, invasive or not adequate for all surfer levels. Despite the fact that performing manoeuvres is the ultimate goal of surfing, there are no available solutions that enable the identification and characterization of such events. In this work, we propose a novel method to detect manoeuvre events during wave riding periods resorting solely to the inertial sensors embedded in smartphones. The proposed method was able to correctly identify over 95% of all the manoeuvres in the dataset (172 annotated manoeuvres), while achieving a precision of up to 80%, using a session-independent validation approach. These findings demonstrate the suitability and validity of the proposed solution for identification of manoeuvre events in real-world conditions, evidencing a high market potential.

A Comparison of Two Commercial Swim Bench Ergometers in Determining Maximal Aerobic Power and Correlation to a Paddle Test in a Recreational Surfing Cohort

The recent addition of surfing to the Tokyo 2020 Olympic Games has fueled a surge in commercial and research interest in understanding the physiological demands of the sport. However, studies specific to maximal aerobic testing of surfers are scarce. Therefore, the primary aim of this study was to compare two commercially available swim bench (SWB) ergometers in the determination of maximal aerobic capacity in recreational surfers. A secondary aim was to correlate (independent of one another) the two ergometer findings of VO2peak to the time taken to complete a water-based 400-m paddle test. This cross-sectional study consisted of 17 recreational surfers aged between 18-58 years. Participants were randomized to either the SwimFast ergometer or VASA ergometer and tested for maximal aerobic capacity, followed by a 400-m paddle test. There were no significant differences between the two SWB ergometers in the determination of relative VO2peak (mean difference 0.33 mL/kg/min; 95% CI -1.24-1.90; p = 0.66). Correlations between VO2peak obtained from maximal paddling effort on the SwimFast and the VASA and the 400-m paddle test (total time (s)) showed a negative significant correlation r = -0.819, p = 0.024; r = -0.818, p = 0.024, respectively. Results suggest that either ergometer (SwimFast or VASA) can be used to determine peak aerobic capacity within a recreational surfing cohort. The significant correlation of the two SWB ergometers and the 400-m paddle test suggest that the 400-m paddle test may be a suitable field-based method of determining aerobic capability. Collectively, these preliminary findings provide initial evidence for similarities in VO2peak on two commercial ergometers and their correlations with a field-based test. However, further research is needed with a larger sample size and inclusive of competitive surfers to provide robust findings which can be generalized to the surfing population.

Time-motion analysis of competitive surfers: Portuguese championship

BACKGROUND

Time-motion analysis has been used to provide detailed insight into surfers' performance. This study evaluated surfers' activity times at the Portuguese surfing championship in order to account for the time spent in each surfing activity.

METHODS

Eighty-seven individually recorded videos of surfers were analyzed, showing their activity over the entire heat, and video analysis software was used to obtain each surfer's activity profile in the competition.

RESULTS

The results breakdown by time percentage show that the surfers were paddling 50.9% of the time, sprint paddling for wave 1.9%, were stationary 34.1% of the time, wave riding 3.7%, and involved in miscellaneous activities (e.g., duck diving, board recovery, etc.) 9.4% of the total time. Average times spent in each surfing activity were 18.6 seconds for paddling, 2.9 seconds for sprint paddling for a wave, 21.7 seconds for the stationary period, 11.5 seconds for wave riding, and 6.9 seconds for miscellaneous activities.

CONCLUSIONS

The data revealed that the most performed heat activity was paddling, allowing us to conclude that surfing is basically a long-arm paddling activity and that this activity constitutes a specific surfing competition demand, which in turn means that individual surfer's data can be used as a starting point for the development of tailored conditioning training programs.

Surf Session Events' Profiling Using Smartphones' Embedded Sensors

The increasing popularity of water sports—surfing, in particular—has been raising attention to its yet immature technology market. While several available solutions aim to characterise surf session events, this can still be considered an open issue, due to the low performance, unavailability, obtrusiveness and/or lack of validation of existing systems. In this work, we propose a novel method for wave, paddle, sprint paddle, dive, lay, and sit events detection in the context of a surf session, which enables its entire profiling with 88.1% accuracy for the combined detection of all events. In particular, waves, the most important surf event, were detected with second precision with an accuracy of 90.3%. When measuring the number of missed and misdetected wave events, out of the entire universe of 327 annotated waves, wave detection performance achieved 97.5% precision and 94.2% recall. These findings verify the precision, validity and thoroughness of the proposed solution in constituting a complete surf session profiling system, suitable for real-time implementation and with market potential.

Electromyographic Analysis of the Surf Paddling Stroke Across Multiple Intensities

Nessler, JA, Ponce-Gonzalez, JG, Robles-Rodriguez, C, Furr, H, Warner, M, and Newcomer, SC. Electromyographic analysis of the surf paddling stroke across multiple intensities. J Strength Cond Res 33(4): 1102-1110, 2019-Surfers spend a majority of their time in the water paddling. The purpose of this study was to examine activity in 5 muscles that contribute to paddling at different velocities and to characterize oxygen use, paddling cadence, and surfboard motion at each velocity. Twelve recreational surfers completed an incremental paddling test on a short surfboard in a swim flume. Surface electromyography was recorded bilaterally from latissimus dorsi, upper and mid trapezius, and posterior and mid deltoid. Electromyographic activity increased as water velocity increased for all muscles, but the change in activation between endurance and sprint paddling was greatest for latissimus dorsi (p < 0.001). At higher water velocities, the middle deltoid was activated earlier in the paddling stroke (p = 0.005). Oxygen use, paddling cadence, and surfboard roll/yaw increased with increasing water velocity. These data may be useful for athletes, trainers, and equipment designers interested in increasing power and efficiency of the paddling stroke.

Differences in V[Combining Dot Above]O2peak of Surfers When Paddling in Water vs. on a Swimbench Ergometer

Furr, HN, Warner, ME, Copeland, TL, Robles-Rodríguez, C, Ponce-González, JG, Nessler, JA, and Newcomer, SC. Differences in V[Combining Dot Above]O2peak of surfers when paddling in water vs. on a swimbench ergometer. J Strength Cond Res 33(4): 1095-1101, 2019-The purpose of this study was to test the hypothesis that surfers would achieve a higher V[Combining Dot Above]O2peak when tested in a swim flume vs. on a swimbench ergometer. Forty-eight surfers (male: 38, female: 10) aged 18-45 years participated in the study. Protocol 1 and 2 both measured heart rate, oxygen consumption (V[Combining Dot Above]O2), and respiratory exchange ratio while subjects performed an incremental paddling test both on a swimbench ergometer and in a swim flume. Protocol 2 additionally measured muscle activity and changes in skin temperature. V[Combining Dot Above]O2peak was significantly higher in the swim flume (33.03 ± 1.04 ml·kg·min) vs. on the swimbench ergometer (29.86 ± 1.08 ml·kg·min) (p value < 0.001). There were also significant differences in muscle activation and changes in skin temperature between the flume and ergometer (p-value < 0.05). Surfers significantly increased their V[Combining Dot Above]O2peak in the water suggesting previous reports of V[Combining Dot Above]O2peak likely underestimated surfer's aerobic fitness when measured on a swimbench ergometer. Future research investigating the aerobic fitness of surfers should be conducted while paddling in water or account for the 11% difference in V[Combining Dot Above]O2peak when tested on a swimbench ergometer.

Return to surfing using an adapted prosthesis: A case report

BACKGROUND

Surfing with transfemoral knee prosthesis requires flexion of the hip, knee, and ankle and balance between flexibility and stiffness of the prosthetic limb. We report on Mr D, a transfemoral amputee, who wanted to surf again. Case Description and Methods: Technical specifications were based on Mr D's complaint. The prosthesis is salt water resistant and combines a shock absorber associated with elastic tendons to permit the knee to bend easily and to facilitate eccentric braking. Surfing was observed using videos of movements and subjective analysis of compensations. Findings and Outcomes: Mr D uses this prosthesis for surfing with good results and got back to his former level using compensations. During the takeoff, he cannot shorten his left leg. He makes a circumduction movement to put his leg in front of the board.

CONCLUSION

This prosthesis is adapted for surfing and allows precise adjustments to surfing conditions. Clinical relevance Appropriate prosthesis design can enable return to surfing for a transfemoral amputee.

A Comparison of Aerobic Fitness Testing on a Swim Bench and Treadmill in a Recreational Surfing Cohort: A Pilot Study

The intermittent manner of surfing accentuates the importance of both the aerobic and anaerobic energy systems. Currently, the optimal method of assessing surfing-specific aerobic fitness is using a swim bench (SWB) ergometer; however, their limited availability presents a barrier to surfers wanting to know their maximal aerobic power (VO_2peak). As a result, the aims of this pilot study were to determine the VO_2peak of recreational surfers using a new commercial SWB ergometer and to propose and examine the feasibility of a regression model to predict SWB ergometer VO_2peak values. A total of nine recreational surfers were assessed where body measurements were conducted followed by maximal aerobic capacity testing (swim bench and treadmill) to profile the cohort. Findings demonstrated that VO_2peak values were significantly greater (p < 0.001) on the treadmill compared to the SWB ergometer (M = 66.01 ± 8.23 vs. 37.41 ± 8.73 mL/kg/min). Peak heart rate was also significantly greater on the treadmill compared to the SWB ergometer. Multiple regression analysis was used to produce a model which predicted SWB VO_2peak values with an R² value of 0.863 and an adjusted R² value of 0.726. The physiological profiling of the recreational cohort coupled with a surfer’s predicted SWB VO_2peak value will allow for identification of surfing-specific aerobic fitness levels and evidence-based training recommendations.

The Effect of Environmental Conditions on the Physiological Response during a Stand-Up Paddle Surfing Session

Stand Up Paddleboard (SUP) surfing entails riding breaking waves and maneuvering the board on the wave face in a similar manner to traditional surfing. Despite some scientific investigations on SUP, little is known about SUP surfing. The aim of this study was to investigate the physiological response during SUP surfing sessions and to determine how various environmental conditions can influence this response. Heart rate (HR) of an experienced male SUP surfer aged 43 was recorded for 14.9 h during ten surfing sessions and synced with on board video footage to enable the examination of the effect of different surfing modes and weather conditions on exercise intensity. Results indicated that the SUP surfer’s HR was above 70% of HR_max during 85% of each session, with the greatest heart rates found during falls off the board (~85% HR_max) and while paddling back to the peak (~83% HR_max). Total time surfing a wave was less than 5%, with the majority of time spent paddling back into position. Wind speed positively correlated with HR (r = 0.75, p < 0.05) and wave height negatively correlated with wave caching frequency (r = 0.73, p < 0.05). The results highlight the aerobic fitness for SUP surfing, where wave riding, paddling back to the peak, and falls appear to be associated with the greatest cardiovascular demand and demonstrate that environmental conditions can have an effect on the physiological response during SUP surfing sessions.

A Performance Analysis of a Stand-Up Paddle Board Marathon Race

Stand-up paddle boarding (SUP) is a rapidly growing sport and recreational activity in which little scientific research exists. A review of the literature failed to identify a single article pertaining to the physiological demands of SUP competition. The purpose of this study was to conduct a performance analysis of a national-level SUP marathon race. Ten elite SUP athletes (6 male and 4 female athletes) were recruited from the Stand Up Paddle Surfing Association of Australia to have their race performance in the Australian Titles analyzed. Performance variables included SUP speed, course taken, and heart rate (HR), measured with a 15-Hz global positioning system unit. Results demonstrated that there was a variation in distance covered (13.3-13.9 km), peak speed (18.8-26.4 km·h), and only moderate correlations (r = 0.38) of race result to distance covered. Significantly greater amounts of time were spent in the 5- to 10-km·h speed zones (p ≤ 0.05) during the race. Peak HR varied from 168 to 208 b·min among the competitors with the average HR being 168.6 ± 9.8 b·min. Significantly higher durations were spent in elevated HR zones (p ≤ 0.05) with participants spending 89.3% of their race within 80-100% of their age-predicted HRmax. Marathon SUP races seem to involve a high aerobic demand, with maintenance of near-maximal HRs required for the duration of the race. There is a high influence of tactical decisions and extrinsic variables to race results. These results provide a greater understanding of the physiological demands of distance events and may assist in the development of specialized training programs for SUP athletes.

Competition Load Described by Objective and Subjective Methods During a Surfing Championship

Fernández-Gamboa, I, Yanci, J, Granados, C, Freemyer, B, and Cámara, J. Competition load described by objective and subjective methods during a surfing championship. J Strength Cond Res 32(5): 1329-1335, 2018-The aims of this study were to describe the competition load of surfers during a single heat through objective and subjective methods and to analyze the relationship between objective and subjective methods with the judges' score. Ten competitive surfers were fitted with a global positioning system (GPS) during a competitive heat. The GPS was synchronized with a chronometer and a stationary video camera to identify the surfer's specific actions. After the end of each heat, participants were assessed for the rating of perceived respiratory and muscular exertion (RPEres, RPEmus), and also, official scores from every participant were collected. A very large significant relationship between wave-riding distance and respiratory perceived exertion heat load (RPEres HL, r = 0.79; ±0.26 confidence limit [CL], p < 0.01, 99.5/0.4/0.1, very likely) was found. Active time was also very large and significantly related to both RPEres HL (r = 0.75; ±0.29 CL, p < 0.05, 99.0/0.8/0.2, very likely) and muscular perceived exertion heat load (RPEmus HL, r = 0.83; ±0.22 CL, p < 0.01, 99.8/0.2/0.0, most likely). Very large significant correlation was obtained between the RPEres and score (r = 0.83; ±0.22 CL, p < 0.01, 99.8/0.2/0.0, most likely). The subjective method seems to be a good instrument to assess the HL of a surf competition. Wave characteristics seem to be an important factor in perceived exertion during competitive surfing.

Injuries in extreme sports

Extreme sports (ES) are usually pursued in remote locations with little or no access to medical care with the athlete competing against oneself or the forces of nature. They involve high speed, height, real or perceived danger, a high level of physical exertion, spectacular stunts, and heightened risk element or death.Popularity for such sports has increased exponentially over the past two decades with dedicated TV channels, Internet sites, high-rating competitions, and high-profile sponsors drawing more participants.Recent data suggest that the risk and severity of injury in some ES is unexpectedly high. Medical personnel treating the ES athlete need to be aware there are numerous differences which must be appreciated between the common traditional sports and this newly developing area. These relate to the temperament of the athletes themselves, the particular epidemiology of injury, the initial management following injury, treatment decisions, and rehabilitation.The management of the injured extreme sports athlete is a challenge to surgeons and sports physicians. Appropriate safety gear is essential for protection from severe or fatal injuries as the margins for error in these sports are small.The purpose of this review is to provide an epidemiologic overview of common injuries affecting the extreme athletes through a focus on a few of the most popular and exciting extreme sports.

Finger Trauma Due to Surfing; A Case Series and Analysis of Fracture Patterns

Background: The purpose of this study is to research the type of lesions to the hand and fingers in the sport of surfing.

Methods: All surfing related hand injuries reported to our hospital between January 2008 and September 2015 were analyzed.

Results: Thirty-seven patient files held a clear description of a trauma related to the surf sport. We found three finger sprains, five wounds needing suture, including one digital nerve lesion and one ring finger with flexor tendon injury, three fingertip amputations and twenty-six digital fractures. The fracture type was similar in twenty-one patients: an open extra-articular transverse fracture of the distal phalanx. Thirty-one injuries were caused by the surf leash.

Conclusions: From this case series we can conclude that surfing may lead to significant trauma to the fingers, mainly due to the leash. This can be caused by grasping the leash while it snaps to tension, which may lead to hyper flexion of the distal phalanx, resulting in a typical trans-phalangeal fracture. Also, when the leash is wrapped around a finger or grasped near the attachment of the leash to the board, ring avulsion-like trauma may occur, leading to open fractures or (partial) amputations. Recognizing that surf leash trauma causes a particular type of fracture to the distal phalanx, may lead to better education of surfers and the development of safer surfing equipment.

Influence of practice time on surfing injuries

Abstract Introduction: studying the influence of surfing on the prevalence of injuries may contribute to prevention. Objective: to analyze the influence of time practicing sports and the occurrence of previous surgery on the profile and prevalence of injuries caused by surfing. Methods: Sixty-six Brazilian surfers (26.16 ± 0.73 years old) participated in this study. Anthropometric data, physical activity level, surfing practice time and the prevalence of injuries (type of injury, anatomical region affected, and mechanism of injury) were evaluated. To assess which of the studied variables exerted significant influence on the mean number of injuries, a Poisson log-linear model was adjusted through R software (p < 0.05). Results: most surfers were classified as eutrophic (73%), very active (60.6%), had an average practice time of 10.1 ± 1 years, and were not members of a surfing federation (74%). It was also observed that 90.9% of participants reported injuries caused by surfing and 44.9% affected the lower limbs. The majority of these injuries affected the integumentary system (46.6%). The main mechanism of injury was impact with the board or seabed (40.4%). Furthermore, it was found that surfing federation members presented an average of 58.4% more injuries than non-members (p = 0.007). Surfers who had undergone previous surgeries showed an average number of injuries that was 56.9% higher than other surfers (p = 0.012). In addition, it was found that for each extra year of surfing, the average number of injuries increased by 2.5% (p = 0.0118). Conclusion: the average number of injuries increased with increment in time practicing the sport, previous surgery and membership in a surfing federation.

Spinal Cord Injuries in Wave-Riding Sports: The Influence of Environmental and Sport-Specific Factors

Spinal cord injury is a nonfatal, catastrophic consequence of wave-riding sports. With surfing at the core, a multitude of activities have evolved that attempt to harness the power of ocean waves. The unique qualities of each wave-riding sport, in combination with the environmental factors of the ocean, define the risk for potential injuries. As wave-riding sports have become more advanced, athletes continue to push physical barriers. Taller waves are attempted while incorporating aerial maneuvers, all without protective equipment.