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)
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.
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
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.
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.
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
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
(Shoulders and neck U=75.0 , p=0.09, low back U=97.0 ,p=0.59, head U=
Graph 2: A Graph to show the most coomon cause of
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
Number 36 35 36 35
Number 1 2 1 2
Median 2 = disagree 2 = disagree 3 = neither 2 = disagree
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.
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.
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
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.
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.
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Participant Information Sheet
An investigation into pain and injuries encountered amongst surfers in
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
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
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:
275 Borough High Street
I am supervised by a qualified osteopath. His contact details are:
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.
Questionnaire Survey About Surfing Injuries
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) ____
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 ____
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
5 4 3 2 1
Osteopaths only treat
spinal/ bony injuries
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.