Surfer’s Neck – Medical Anatomy
Surfing is enjoyed by many people around the world. Surfing involves dynamic movement on unstable surfaces and requires good body strength coordination and balance. A common problem among surfers is surfer’s neck (and surfer’s back)
Vertebral nerves and the muscular facet foramina of fascia are some structures that may be involved in pain mechanisms. Fortunately, these problems can usually be corrected with some good manual therapy techniques, surf technique corrections (if needed), and good rehabilitation A program that includes stretch strengthening and coordination as well as posture training.
Mode of Injury / Pathological Process
Neck Pain is a common niggle for surfers and is often caused by overuse.
Common causes may be attributed to
- More time spent in a horizontal position with the neck extended. Prolonged extension of the anterior cervical joint in a closed compressed position (during running) increases the demands on the structure of the upper spine and associated soft tissues.
- There is insufficient width in the thoracic which increases the width required on the cervical spine.
- The rotational cutting and twisting movements of the spine and neck can make the neck vulnerable to overuse injuries.
- Insufficient flexibility and strength of the upper kinetic chain and spinal muscles.
- Poor surfing technique eg with paddling
- Poor Postural Alignment Vulnerable to Injury
- Poor breathing technique, i.e. the upper chest and neck muscle breathing pattern is not diaphragmatic breathing.
Surfer’s neck is a very common surfer’s condition and is usually related to paddling, but neck pain can also occur after surfing. The cervical spine is in a state of extension for a long time. Therefore, the muscles of the upper and lower back at the back of the neck are in a constant state The contraction causes tension and shortening of the trapezius and other neck muscles.
The most common explanation would be that pain will only occur a few hours after the surf session as the neck muscles go into spasm. Often if left unchecked the pain can become more severe as the neck pain can begin to involve the attachment muscles muscles bones and even muscles. These can be causing more severe symptoms. tooth. ROM restricted cervical spinal radiculopathy
Neck Disability Index
Neck Pain and Disability Scale
Tragus to wall test (if postural changes are noted)
Hi-Low Breathing Assessment
Management / Interventions
Exercise therapy appears to be beneficial for people with neck pain. Some evidence supports muscle relaxants for acute neck pain associated with muscle spasms, conflicting evidence for epidural corticosteroid injections for radiculopathy, and weak positive evidence for cervical facet joints Radiofrequency denervation 
As a physical therapist, you have many good manual therapy skills to improve a client’s condition. Work the suboccipital extensors minor and deep cervical flexors as well as any tight muscles in the chest shoulders and upper back. Usually this will involve mobilizing the stiff upper Chest.
Use techniques from: Maitland mobilizations massage ball techniques ( ball release exercises on the upper torso can help reduce tension in the area around the neck) soft tissue release trigger pointing Kaltenborn techniques Active Release Techniques Stretching a PNF contract with me relax the reciprocal inhibition and so on.
Include a broad cervical spine and some or all of the following (see illustration) .
Sternocleidomastoid trapezius upper and middle suboccipital extensors cervical spine extensors and extensors ( chin tucksneck flexor stretches) anterior chest muscles and thoracic spine.
Yoga or Tai Chi are also great to work on flexibility
Stability and endurance
Exercise the stabilizer muscles of the cervical spine and shoulder girdle. Examples include upper cervical flexors, scapular extensors (scapular retractors), and shoulder stabilizers.
These will provide stability to the neck and shoulder straps which is critical to its performance and neck protection. They provide stability and support for the neck throughout the movement and vital protection for the body during surfing.
Pilates is also a great way to gain spinal stability and core strength.
Surfing Technique Guidance
Instructs methods of reducing cervical extension while paddling. For example, while extending the neck to teach how to engage the entire upper spine, not just the cervical spine, the instruction needs to mobilize the thoracic spine in order for this to happen. Check that the muscles are flexible and coordinated enough for surfing posture. Rehab as needed.
NB seek out surfing coaches if required
Teach proper diaphragmatic breathing and control, instead of breathing from the upper chest and neck muscles Activating upper chest breathing can cause excessive tension in the neck muscles. A 2017 study linked respiratory dysfunction (DB) to health conditions, including low back pain and Neck pain and adverse effects on the musculoskeletal system . Another study points to the importance of diaphragmatic breathing for functional movement. Inefficient breathing can lead to muscle imbalances. Motor control and physiological adaptations can change. Exercise…Further research is needed to validate respiratory re-education programs and their role in treating pain disorders, preventing injury, and improving movement patterns. 
Check for incorrect position e.g. anterior head posture thoracic kyphosis (see photo). When the classic head forward thoracic kyphosis posture is present surfing (and paddling) will be prone to injury/pain in the neck. Train the patient for proper alignment and mobilize and strengthen the thoracic spine cervical spine as appropriate. A recent study which reported that head tilt is a cause of pain through postural misalignment.
Be vigilant in your research looking for signs of recent trauma or red flags
Surfer’s myelopathy Surfer’s myelopathy is an atraumatic thoracic/conus medullaris myelopathy with only nearly 42% muscle recovery that equally affects healthy young unknown surfers with no pre-existing spinal cord disease. Symptoms usually begin with back pain and progress rapidly to complete or incomplete myelopathy. Surfer’s myelopathy needs to be made clear to emergency physicians. Novice swimmers and coaches should be educated on the early signs and symptoms of this condition.
Vertebrae injury or fracture a retrospective analysis of surfer’s in Australia found an incidence of .5% and .3% respectively A wide range of injuries occur in the cervical spine and depend on the position of the surfer when they hit the surface compared to the force vector of the waves. Flexion extension axial load rotation and various combinations can cause fracture fractures or spinal cord injuries (especially fractures). Be sure to include recent trauma in psychoanalysis.
Spinal cord injuries – rare spinal cord injuries and cervical fractures are definitely more dangerous and occur when athletes collide with the seafloor. As the wave rider prepares to catch the crest of the next wave they must measure waves according to their order and potential traumatic injuries on the seafloor when thrown from the board (ie watch out for large waves that cannot be seen). Physicians who diagnose a patient with a traumatic head injury that occurred while riding a wave must be aware of these environmental risks and demographic risks if can cause exceptional injury. It becomes even more important in the sport of wave riding with easy access to equipment and ocean and no experience (AKA tourism)
The International Surfing Association estimated that 23 million people took part in surfing worldwide in 2014. Help them enjoy good treatment and some grooming.
The image of the Norwegian surfer looks a little eager to me!
- ↑ Cohen SP. Epidemiology, diagnosis, and treatment of neck pain. InMayo Clinic Proceedings 2015 Feb 1 (Vol. 90, No. 2, pp. 284-299). Elsevier. Available from: https://www.mayoclinicproceedings.org/article/S0025-6196(14)00833-7/fulltext (last accessed 18.9.2019)
- ↑ Kiesel K, Rhodes T, Mueller J, Waninger A, Butler R. Development of a screening protocol to identify individuals with dysfunctional breathing. International journal of sports physical therapy. 2017 Oct;12(5):774. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5685417/ (last accessed 20.9.2019)
- ↑ Bradley H, Esformes JD. Breathing pattern disorders and functional movement. International journal of sports physical therapy. 2014 Feb;9(1):28. Available from:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3924606/ (last accessed 20.9.2019)
- ↑ Kim DH, Kim CJ, Son SM. Neck pain in adults with forward head posture: effects of craniovertebral angle and cervical range of motion. Osong public health and research perspectives. 2018 Dec;9(6):309.Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6296804/ (last accessed 20.9.2019)
- ↑ Freedman BA, Malone DG, Rasmussen PA, Cage JM, Benzel EC. Surfer’s myelopathy: a rare form of spinal cord infarction in novice surfers: a systematic review. Neurosurgery. 2015 Oct 30;78(5):602-11.Available from: https://www.ncbi.nlm.nih.gov/pubmed/27082966 (last accessed 18.9.2019)
- ↑ Meir R et al. An investigation of surf participation and injury prevalence in Australian surfers: a self-reported retrospective analysis. Gosford Australia Southern Cross University ePublications@SCU; 2011 Available from:https://epubs.scu.edu.au/cgi/viewcontent.cgi?article=1901&context=hahs_pubs (last accessed 18.9.2019)
- ↑ Dimmick S, Sheehan P, Brazier D, Anderson SE. Injuries sustained while surfboard riding. Skeletal radiology. 2013 Apr 1;42(4):463-5. Available from: https://link.springer.com/article/10.1007/s00256-012-1536-9 (last accessed 18.9.2019)
- ↑ Jump up to:8.0 8.1 Falconi A, Flick D, Ferguson J, Glorioso JE. Spinal cord injuries in wave-riding sports: the influence of environmental and sport-specific factors. Current sports medicine reports. 2016 Mar 1;15(2):116-20. Available from:https://journals.lww.com/acsm-csmr/fulltext/2016/03000/Spinal_Cord_Injuries_in_Wave_Riding_Sports___The.17.aspx?exportImagesToPpt=true (last accessed 20.9.2019)