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                Individual Enquiry

               Research Paper 2009

  Title: An investigation into the incidence of
         pain and injury amongst surfers in the

  Author:      Clare Reed

  Supervisor: Alan Coles BscHons,

         The British School of Osteopathy
        275, Borough High Street, London SE1 1JE


   Title: An investigation into pain and injuries encountered amongst
                             surfers in the UK


Aims: The aims of the study are to increase understanding of nature of pain

and injuries encountered by surfers and contribute to the scarce a mount of

research in this area. It is also to understand more about the management,

treatment and possible prevention of surfing injuries.

Method: Questionnaires were distributed among surfing shops in the South

West of England. A total of 37 surfers participated in the study, 8 females and

29 males. The mean age of the surfer was 28 for males and 21.5 for females.

The average number of years participants had surfed for was 5 with an

average of 10 hours surfed per month.

Results: The median number of injuries was 2. The most common most

recent injury was to the shoulder and neck (24%) followed by the low back

(22%). The most common type of injury was muscle (22%) and injuries were

most frequently caused by repetitive paddling (30%). Most participants did not

seek treatment (60%) and only 7 participants (19%) had seen an osteopath.

Most participants disagreed osteopaths didn’t understand surfing injuries and

that they were not available in their area. On average participants also neither

agreed or disagreed that osteopaths cost too much.

Conclusions: The results of this small survey suggest that the most common

injuries amongst surfers in the UK are from repetitive paddling and occur

mainly in the shoulders. Also most surfers do not seek treatment for injuries

and that this does not affect recovery rate. It also showed that those who had

seen an osteopath, felt osteopaths understood more about surfing injuries


than those who hadn’t. The implications for osteopathy and further research

are that a larger sample size is needed. Also further research looking into

training patterns in regards to prevention of injuries would be beneficial.

Keywords: Surfing, Injuries, treatment, osteopath,



History of surfing

Surfing is the term used to describe riding over a wave in any surfcraft

towards the shoreline. The aim of the sport is to manoeuvre smoothly on an

unbroken wave. The further back on the wave, nearer the curl, the better. A

lot of the time surfing is spent paddling for the waves, often in a hyper-

extended position. Research by Mendez-Villanueva and Bishop (2005) shows

that 40-50% of the time surfing is spent paddling with wave riding only

accounting for 4-5 % of the total time.

        Surfing is an ever changing sport which is increasing in popularity

everyday. It has been around for thousands of years, originating in Hawaii

and enjoyed by all members of the tribe. In the 19 th century the sport nearly

deceased as religious missionaries frowned upon it. The sport slowly regained

its popularity and it is thought that the 1920s Hawaiian Olympic Swimmer

Duke Kahanamoku publicised the sport and made it recognised worldwide.

Since then the sport has continued to boom with International surfing

competitions for men and women. There are now an estimated eighteen

million surfers worldwide. (Taylor et al 2004)

Osteopathic relevance

Osteopathy looks at the diagnosis, treatment, prevention and rehabilitation of

musculoskeletal conditions.(GOst 2008)This study aims to give an i nsight into

the musculoskeletal injuries encountered by surfers in order to get a better

understanding of their injuries and look into ways of prevention.


Many osteopaths may not consider that statistics about surfers is of any

relevance to their patient population. However in recent years the sport has

become more and more popular with i ncreased publicity on TV and internet,

and improved transport links making it more accessible..These factors may

alter their patient demographics with them more likely to see a patient with an

injury due to surfing. Also in certain areas such as the South West of England

and in the North East the sport is prevalent making it much more likely that an

osteopath in these areas to see a patient with a surfing injury.

        Surfing is an active water sport with its own unique injuries. Jeremy

Kuniyoshi M.D a radiology resident at the University of California San Diego

said that ‘without an understanding of some of the unique aspects of surfing

injuries’ physicians are ‘apt to take additional time trying to determine what

happened.” (Pathria and Smith 2004). A basic understanding of the sport and

how injuries occur would be beneficial in diagnosis and in giving optimal


        The research is relevant to osteopaths as it will give a better

understanding of how to treat a patient who is a surfer, not only by helping to

understand some of the injuries as stated above, but also as a person. For

many surfers surfing is not only a sport but a way of life. It forms a large part

in their lives, psychologically and physiologically (Renneker 1987).

One of the key osteopathic principles is that ‘the body is a unit, and the

person represents a combination of body, mind, and spirit’ (Gevitz 2006,p121-

129)which should be considered when treating a patient. For many surfers

surfing is ‘a means of attaining psychological and physical well-being’


(Renneker 1987 p 60). This must be kept in mind when treating a patient and

looking at their expectations and their long term management.

Previous research

There has been little published research into injury trends and rates within the

sport. A lot of research that has been published on surfing also isn’t found on

many computer literature searches. Most published research has been carried

out in Hawaii, New Zealand and Australia with a minute amount from the UK

looking at surfing injuries. The research so far has found an injury rate, on

average of 4 per 1000 days surfing (Lowden et al 1983) and 6.6 per 1000

hours surfing for professional surfers (Nathanso n 2007). Although some of the

research suggests that the injury rate for surfers is fairly low compared to

rugby and skiing (Lowden et al 1987), it does have its own set of unique

injuries. Lacerations and injuries due to hyperextension of the cervical and

lumbar spine are typical examples. Overuse injuries in the back, shoulder and

neck can also occur as a result of a prolonged extended paddling posture and

repetitive stroke action. Although only a few, there have been reported cases

of nontraumatic myelopathy associated with the maintained extension posture

and inexperienced surfers (Avilez-Hernandez et al 2007).

        The majority of the research has found lacerations the most common

injury sustained. However in some research for example Nathanson et al

(2007) found high levels of strains and sprains. Most research has looked little

at musculoskeletal injuries, acute or chronic. This research aims to see where

musculoskeletal injuries are prevalent. It will look also look at whether surfers

sought treatment and their experiences with osteopaths .Unlike Ruldoph


(1989), which looked only at patients treated by plastic surgeons, this study

will consider the injuries encountered where the surfer did not seek treatment

and why.



The research was carried out in an anonymous questionnaire format, to be

completed by a number of recreational surfers in Devon, England. The

questionnaires were in paper form and were placed in shops around Devon

that had agreed to distribute them from early Autumn until February 2009. A

closed box was placed in the shop for the responses. It was decided against

doing a hospital survey, like those done by Allen et al (1977) and Roger

(2002) as it would not include minor injuries and those where treatment was

not sought. The questionnaire method was used as it enables a large sample

base and decreases the chance of coercion by the researcher compared to

the interview method. The questionnaire used was based on the one used by

Vizinczey-Lambert (1995).It was changed to focus more on the type and

cause of injury. Questions about participant’s opinions of osteopathy were

also added. A pilot study of 10 surfers and non-surfers was first carried out in

summer 2008 to test the clarity and timings of the questionnaire. Some

wordings of the questions were then changed to make their meaning clearer.

Ethical considerations

The research proposal was first submitted to the British School of Osteopathy

Research Ethics Committee. It did not proceed until approved. Participants

took part in the research at their own freewill and could terminate their

involvement at anytime. All questionnaires were also kept anonymous.

Data Analysis

The data was coded and inputted onto SPSS. Certain data was gro uped to

make it easier to analyse. The demographics of participants were analysed


looking for any skew in the population. Percentages, independent sample t-

tests and Mann Whitney U tests were done using SPSS. Graphs were done

using Microsoft Excel. Common injury trends were compared, looking at how

the injury occurred and the type. Where surfers sought treatment and whether

it affected recovery rate was also analysed. For inferential statistical tests the

probability value was set at < 0.05



80 questionnaires were handed out in total. 37 people completed the

questionnaire giving a return rate of 46%.


Table 1. Demographic data of participants
                             Age (Years)                 Height (m)         Weight (kg)
              N (% )         Median, IQR*                Mean (S.D)         Mean (S.D)
Male          29.00          28.00, 18.00                1.80 (0.06)        75.50
              (78.80%)       to 36.50                    ***                (10.50)***
Female        8.00(21.60%) 21.50, 19.25                  1.67 (0.05)***     58.00
                             to 23.50                                       (6.80)***
*IQR = Interquartile Range
*** Height and weight were significantly different between males and females at p<0.001

The demographic data of participants is shown in Table 1. Height and weight

were normally distributed but age was positively skewed (Skewness = 0.957,

S.E of skewness = 0.388). An independent samples t-test was conducted to

compare the number of years surfed between males and females t(35) = 1.97,

p= <0.01 and > 0.005. There was a significant difference, in number of years

surfed with females surfing less (m=3.75 sd =1.75) than males (m=10.41,

sd=9.35). The median number of years surfed by both males and females was

5, and 10 was the median for the number of hours surfed in a month.

The median number of injuries surfers reported was 2. There was no

statistical difference between the number of years surfed and the number of

injuries (as defined as 1 or more than 1 injury) which can be seen using an

independent samples t-test.

t(24)=-1.22, p= >0.20. Participants with one injury had been surfing a mean of

9.76 (sd= 10.43) years and participants with more than one injury having

surfed a mean of 5.33 (sd = 5.41).


There was also no significant difference in the number of hours surfed a

month and number of injuries. The mean number of hours surfed a month for

participants who had had one injury was 12.65 (sd=11.45) and 11.44 (sd=

9.76). There was also no statistical difference between age and number of


40.5% of participants had at one point had an injury to the face and head.

31.5 % had injured their shoulders in the past.

The most common recent injury was to the shoulders and neck (n=9) followed

by injury to low back (n=8). See Graph 1.

Graph 1: A Graph to show the most Recent Injuries

   Frequency (n)

                        Shoulder Arm &   Head   Thorax   Low    Hip   Leg
                         & neck   hand                   back

There was no significant difference between the type of injury and whether it

occurred to the low back or to the shoulders and neck.

There was also no significant difference between the type of injury and

whether it occurred to the head or not. 37.8% of participants said the weather

contributed to their injury.


29.7% of injuries were due to repetitive paddling as seen in graph 2, with the

most common injury being muscular at 21.6%

There was no significant correlation between how the injury occurred and

whether it was to the head, shoulders and neck or low back. A Ma nn Whitney

U test comparing the type of injury and whether it occurred to the shoulders

and neck or to the low back gave a result of U=34.5, p=0.89. A Mann Whitney

U test comparing the type of injury occurring to the head and to the rest of the

body showed an insignificant difference with U=103.5, p=0.75

Man Whitney U tests also showed no significant difference between how the

injury occurred and whether it was to the shoulders and neck, low back or to

the head.

(Shoulders and neck U=75.0 , p=0.09, low back U=97.0 ,p=0.59, head U=

67.0, p=0.09)


                              Graph 2: A Graph to show the most coomon cause of



  Frequency (n)














                                                            ll o






























                                                                                    ll o














22 participants (59.5%) did not seek treatment. 30.6% said this was because

the injury got better on its own. There was no significant difference between

whether the participant sought treatment and recovery time with a Sig (2

tailed) = 0.47. There was also no difference in whether they sought treatment

and if the injury reoccurred.

Only 7 (18.9%) participants had ever been to an osteopath.


Table 2: A Table to show participants opinions of Osteopaths
               Osteopaths     Osteopaths     Osteopaths    Osteopaths
               only treat     don’t          cost too      not available
               spinal         understand     much          where I am
               Injuries       Surfing
  Number       36             35             36            35
  Number       1              2              1             2
  Median       2 = disagree   2 = disagree   3 = neither   2 = disagree
                                             disagree or

A Mann Whitney U test showed there was a difference between whether

participants had seen an osteopath and their opinion on whether osteopaths

don’t understand surfing injuries (U= 34.0, p=0.019). Those that had not seen

an osteopath gave a median response of 2= where they disagreed that

osteopaths didn’t understand surfing injuries, whereas those that had seen an

osteopath gave a median response of 1 = strongly disagree.



The aims of this study were to find common injury trends, areas of injury and

nature of injuries amongst surfers. It also aimed to see where they sought

treatment and look at some of their opinions of osteopaths.

Data Gathering

37 questionnaires were returned from the 80 dispersed in shops around

Devon. The research was carried out between September 2008 and February

2009. There were 29 males and 8 females and the average age was 21.5 for

females and 28 for males. These demographics correlate with other studies

by Nathanson et al (2002) and Taylor et al (2004). The male to female ratio

shows that the sport is quite male dominated which correlates with Booth

(2001) who talks about the fraternal structure of surfing culture. Participants

surfed for an average of 10 years with females surfing less (mean= 3.8)

compared to males (mean= 10.4). The average number of years surfed is also

comparable to the studies by Nathanson et al (2002) and Taylor et al (2004).

This is a small sample size incorporating a small area of the country. Although

it was carried out in a prime UK surfing location (Alderson, 2008) further

research would need to be carried out as a more representative sample of the

surfers in the UK. Research over a longer time scale and including the

summer months would give a larger sample size and also incorporate the

surfers that only surf in the summer months. Working with surfing

associations, for example the British Surfing Association, may also help

contacting a larger number of surfers.


Incidence of Surfing Injury

Much of the previous research carried out looked at injury rates (Lowden et al

1987, Nathanson 2007). Feedback from the shops where the questionnaires

were located said that many surfers didn’t fill out the questionnaire as they felt

they had never had any injuries due to surfing. The questionnaire also

focused on having had injuries and so did not lend itself to those who had

none. The research therefore misses out a large proportion of the surfing

population and so injury rates can not be calculated.

Surfing injuries

The most common ‘most recent injury’ was to the shoulder and neck (24.0%)

closely followed by low back (22.0%) and the head (16.0%). This corresponds

with Lowden et al’s study (1987) which also reported high levels of shoulder

injury, although the study is quite dated. More recent research by Taylor

(2004) and Nathanson et al (2007) also found most chro nic injuries were

musculoskeletal and occurred mainly to the shoulders and low back.

In this study the most common type of injury was muscle (21.6%). This

contradicts previous research which found lacerations the most common

injury (Lowden et al 1983, Taylor 2004). It is however consistent with the

studies of Nathanson et al (2007) who found high levels of strains and sprains

in chronic injuries. Foo (2004) also found that 66.0% suffered some muscle

soreness following a surfing session.


The most common cause of injury was due to repetitive paddling (29.7%).

This was inconsistent with studies by Frisby (2001) and Nathanson et al

(2002) who found injury from the fin of own board the most common cause.

These studies were carried out in New Zealand and Hawaii respectively

where the waves are larger and there is bigger surf which may account for

differences in injuries. Only 37.8 % of participants in this study said that the

weather contributed to their injury with the most common reason being the

cold. This suggests different injuries could be more prevalent in different

weather and surf conditions. This study also does not compare acute and

chronic injuries which make some comparisons with other studies difficult.


A high percentage of participants did not seek treatment (59.9%). This had no

effect on the recovery time or if the injury reoccurred. Foo (2004) also found

low numbers of injuries being seen by medical, allied or alternative

practitioners (15.0%). In this study only 7 participants (18.9%) had seen an

osteopath. The only other study to look at osteopath’s involvement is Foo

(2004). In his study 10.0% saw an osteopath mainly for muscular strains and

non-specific low back pain. The slight increase in percentage in this study

could be due to the larger number of osteopaths in the UK compared to

Australia where Foo’s research was carried out. Also the increasing pop ularity

in osteopathy could account for this.

The low numbers of surfers seeking treatment from osteopaths could suggest

that there may not be a role for osteopaths regarding surfing injuries. However

again this is only a small sample size in Devon and may not represent surfers


throughout the UK. The majority of participants neither agreed nor disagreed

that osteopaths cost too much, and disagreed that osteopaths weren’t

available in their area. There was a significant difference between participants

that had seen an osteopath and those that hadn’t and their opinion on

whether osteopaths understood surfing injuries. Those that had seen an

osteopath strongly disagreed and those that hadn’t disagreed. This shows

that once they have seen an osteopath they think osteopaths understand

surfing injuries more. This suggests that more publicity by osteopaths about

their capabilities of treating surfing injuries could get more surfers interested in

osteopathic treatment


This study doesn’t look into different ways surfers warm up, stretch and train

to prevent injuries. Mendez-Villanueza and Bishop (2005) comment on how

unique surfing is and that the only way to practice is in the water. They

suggest improving general fitness and upper body strength can help improve

a surfer’s overall performance. This in turn could help prevent injury.

Renneker (1987) also found many surfers have limited flexibility of shoulders,

low back and hamstrings. It is also possible that improving flexibility could

decrease the number of musculoskeletal injuries.

Further research into whether stretching and different training patterns affect

injury rates would be useful when advising surfers. Renneker comments that

educating surfers can help them spend ‘minimum time seeing doctors and

maximum time surfing’ (Renneker 1987, p 161). However Taylor et al (2005)

looked into surfer’s perceptions of wearing protective headgear and found that


half would prefer to risk injury than wear protective headgear. This leads to

further questions as to whether surfers would then follow this advice.

Further Limitations

The questionnaire method was used to avoid coercion by the researcher and

to get a larger sample size and spectrum of people to be considered. It does

however depend on self-reported injuries. Gabbe et al (2003) found when

looking at footballers’ 12 month sports injury history that only 61% could recall

their injuries accurately. They also found that as ‘the number of injuries

necessary to recall increased, the accuracy of their recall declined’ (Gabbe et

al, 2003, pp.547) with a trend of under reporting injuries. In addition to this,

the questionnaire depends of self-estimates on the number of hours surfing,

weather and how the injury happened which could be unreliable .



The study found that more men than women surfed with on average men

surfing for more years. Muscle was found to be the most common type of

injury and repetitive paddling the most common cause.

The majority of participants did not seek treatment (59.9%) with only 7

participants (18.9%) seeing an osteopath. On average participants that had

seen an osteopath in the past tended to disagree more that osteopaths didn’t

understand surfing injuries compared to those that had not seen one.

Further research with a larger sample size and area is needed. Research

looking at injury rates and whether stretching and different fitness regimes

affect injury rate would be useful to help give advice to surfers.



  I would like to thank the shops for distributing my questionnaire and to my

  parents for helping me get the results. Thank you also to Melanie Wright,

    Hilary Abbey and Alan Coles and everyone else who has helped me.



Alderson A (2008) Surf UK: The definitive guide to surfing in Britain (3 rd ed.)
John Wiley and sons. UK

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Aviles-Hernandez I, Garcia-Zozaya I, Devillasante JM (2007) Case Report:
Nontraumatic Myelopathy Associated with Surfing, The Journal of Spinal Cord
Medicine 30(3):288-293

Booth D (2001) From Bikinis to Boardshorts: Wahines and the Paradoxes of
Surfing Culture, Journel of Sport History, 28(1):3-22

Foo P and Nicholls P (2004), Surfing Injuries in Recreational Surfers,
Department of Human Development, School of Health Sciences, Victoria
University of Technology

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reported 12 month sports injury history?, Br J Sports Med;37:545-547

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[accessed online on 12/02/08]

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Medical Journal of Australia Vol 2, pt 12 pages 613-616

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Appendix 1

                        Participant Information Sheet

Study Title:
An investigation into pain and injuries encountered amongst surfers in
the UK.

Invitation paragraph
You are invited to take part in a research study. Before you decide if you wish
to take part please take the time to read the following information on why the
research is being done and what it will involve. The study is about the types of
injuries encountered by surfers in the United Kingdom. Thank you for reading
this and please feel free to ask any questions – contact details are at the end
of this sheet.

What is the Purpose of the Study?
This is a study investigating the nature of pain and injuries associated with
surfing. The information collected will be used for a final year research project
at the British School of Osteopathy as part of the Bachelor of Osteopathy
degree course.

The aims of the study are to increase understanding of nature of pain and
injuries encountered by surfers and contribute to the scarce amount of
research in this area.
Also, to understand more about the management, treatment and possible
prevention of surfing injuries.

Why have I been chosen?
This is an anonymous questionnaire survey. You have been chosen because
you are a recreational surfer who may be interested in participating due to
your interest in surfing and previous experience of injuries sustained due to

What does it involve?
It will involve a single questionnaire which takes approximately 3-4 minutes to
complete. It is up to you to decide if you wish to take part in this study.
Whether you decide to take part, or not, will have no bearing on your standing
as a surfer.

What do I have to do?
You will be asked to answer questions on your general surfing history and
height and weight, past injuries encountered from surfing and whether or not
you sought treatment. You will then leave the completed questionnaire in the
closed box in this shop and it will be collected at a later date by the


Will my taking part in the study remain confidential?
The questionnaire is anonymous and all information will be kept confidential.
Only the researcher, the supervisor and the research team at the British
School of Osteopathy will have access to the information. All data will be
stored on a secure password protected computer and in a locked cabinet. It
will be destroyed 6 years following completion. All names and any other
identifiable information will be omitted from the written paper.

You are free to withdraw at any point up to the data entry on the computer
when the information will be coded and the questionnaire cannot be identified.
A number is present on the Questionnaire. If you wish to withdraw, give this
number to the researcher and your questionnaire data will be removed from
the study.

What will happen to the results from the study?
The results from the research will be written up into a research paper. The
final copy will be stored in the British School of Osteopathy library. If you wish
to have a summary of results at the end of the study in July 2009, please
contact the researcher at the address below.

Who is organising the research?
I am an undergraduate student studying for a Bachelor of Osteopathy at the
British School of Osteopathy. My contact details are:

Clare Reed
275 Borough High Street

I am supervised by a qualified osteopath. His contact details are:

Alan Coles
The British School of Osteopathy
275 Borough High Street

Thank you for taking time in reading this information sheet. If you require
anymore information please feel free to get in contact.


Appendix 2
            Questionnaire Survey About Surfing Injuries
About you:

1. Age:              Years ____

2. Sex:              Male ____                      Female ____

3.                   Height ____                    Weight ____

4. For how many years have you surfed?

5. Approximately how many hours do you surf in a month?           _____ hours

6. Do you surf goofy (right foot forward) or regular (left foot forward)?

                                             Left   ____          Right ____

7. Do you do any other sports?               Yes    ____          No    ____

If so which? ………………………………………………………………………

About your surfing injuries:

8. Have you ever experienced any musculoskeletal injuries or pain due to
surfing? (eg. in muscles, ligaments, joints, bones)
Please indicate all relevant areas on the diagram with a cross



Please answer the following questions about your most recent injury.

9. Please circle the cross on the previous diagram for you most recent injury.

10. What type of injury was it? (Please tick as many as appropriate)

Skin (lacerations)           ____
Muscle                       ____
Ligament                     ____
Joint                        ____
Bone                         ____
Other                        ____ Please specify:……………………………...

11. How did the injury occur? (Please tick one)

Hit by own board             ____
Hit by another board         ____
Thrown against object        ____
Fell off board awkwardly     ____
Repetitive injury paddling   ____
Lifting boards               ____
Other                        ____ Please specify ……………………………….

12. How long ago did the injury occur?

13. Do you think the weather conditions contributed to your injury? (Please

____ Yes      ____ No

If yes, what were the weather conditions like?


Treatment for your surfing injury :

14. Did you seek any medical assistance? (eg. GP, Sports Therapist,
Osteopath, Chiropractor, Physiotherapist, Other?)

____ Yes         ____ No       If yes, who? ……………………………………….

If no, why not? (Please tick one)

Prefer self treatment          ____
Got better on its own          ____
No time                        ____
No money                       ____
Didn’t know who to see         ____
Other…                         ____

15. Approximately how long did the injury take to recover?

_____Days ____Weeks _____Months                     ____Years        ____Ongoing

16. Did the injury reoccur? ____ Yes           ____ No

If yes, how many times?        ____

17. Have you ever consulted an osteopath for surfing injuries?

                               ____ Yes        ____ No

If yes, go to question 18
If no, go to question 20

18. What was the injury? ………………………………………………………..

19. How successful do you feel osteopathic treatment was? Please circle one

Very effective       Effective          Fairly           Not very        Not at all
                                      effective          effective       effective
        5                  4              3                  2               1


20. Do you agree or disagree with the following statements? Please tick one

                        Strongly    Agree     Neither    Disagree    Strongly
                        agree                                        Disagree
                        5           4         3          2           1
Osteopaths only treat
spinal/ bony injuries
Osteopaths don’t
understand surfing
Osteopathic treatment
cost too much
Osteopaths are not
available when I am

Please feel free to add any further comments about your surfing injuries and
your experiences of treatment:





Thank you very much for taking the time to complete this questionnaire. Now
please place it in the sealed collection box in the shop.


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