Shoulderpain ?

This is why your shoulder hurts while surfing

 

While surfing, most of us spends more time (80-90%) with paddling than actually standing on the board (only 10-20% ). So, without any doubt we address quite a lot of workload on our shoulders with paddling on a regular surf session.

This may not apply to you if you are pro surfer catching wave after wave, you have the correct paddle technic and you are spending most of your time either in the water or in the gym getting fit for surfing.
But for many others, who surf on weekend or even on holiday basis especially with incorrect paddling, this overload causes an imbalance in the shoulder muscles. Sooner or later this will lead to a sore shoulder. Most surfers, struggling with shoulder problems come to the conclusion, that they have too week shoulders, go to the gym and train the deltoids, witch makes the problem even worse.

A sharp pain starts during paddling and often fades away after surfing. Than it comes back at the next session, but it does not fade away anymore. It gets worse and worse and eventually starts hurting every time the arm is lifted above shoulder level or later even while sleeping.

Diagnosis

The reason for shoulder pain is always individual and one should always see a specialist instead of making self-diagnosis after reading this or any other article. Still I can say it safe, that if you surf and have above mentioned symptoms you have a big chance to have a shoulder impingement.


Anatomi

The shoulder as a joint (the glenohumeral joint) is basically a ball and a socket. Best to imagine as a lengthwise halved avocado in a vertical position, that still has it’s seed in it, but in this case the seed is actually bigger than the avocado itself. The socket, or avocado (the glenoid) is attached to a triangle, called the shoulder blade (scapula), which rests over the ribcage, high on the back. The other partner of the joint, the seed, is attached to a shaft (upper arm). With every movement of the upper arm, the avocado seed turns in the halved avocado.

The humeral head (the seed) is fixed to the glenoid with a little underpressure (vacuum), ligaments and the primary shoulder muscles group called the rotator cuffs. The rotator cuffs are built up of 4 muscles (M.supraspinatus, M.infraspinatus, M.subscapularis and M.teres minor) which are inserted almost directly on the humeral head, very near to the pivot point of the arm movements. This way they are not only performing the rotational movements of the arm, but also playing a very important role of centering and positioning the humeral head in it’s socket. 

The deltoid muscle is that big muscel that makes the bodybuilders shoulders so big and round.
It is a secondary muscle, which has three parts. They lift our arm forward, sideward or backward depending on the contraction. It’s origin is on the acromion (shoulderbone),  a structure of the shoulderblade that hangs over the glenohumeral joint.

The insertion point of the deltoid is on the upper arm, a bit further away from the humeral head and further away than the insertion points of the rotator cuffs.

This way a contraction from this muscle will have two effects.

First, the arm will swing up in direction of the contraction with the humeral head rolling in its socet.  Than as a secondary effect an upward shear force will be applied on the joint pushing the humeral head upward. If the primary muscles, the rotator cuffs are strong enough the humeral head will be held in the glenoid perfectly and we don’t even notice this shearing force only the arm will swing up as we originally planned the movement.

Neverthless the shoulder is a very unstable joint. The avocado socket only contacts 30 percent of the seeds surface. This enables the greatest range of motion of any joints in the body, that allows us to move our arms in almost every direction. But however this range of motion in the same time means a high grade of instability as well which can lead to injuries.

 

The deltoid is generally stronger and bigger muscle than the muscles of the rotator cuffs. During paddling we use the deltoid a lot to lift our arm out of the water which makes the deltoid even stronger. This eventuate an imbalance which can results in the humeral head sliding upward and hitting the shoulderbone (acromion) above it.

There is a lot of soft tissue between the humeral head and the acromion, firstly for example the tendons of some muscles of the Rotator cuff or the Biceps which will be pinched between the two bones. This action causing not only pain, but can result in damaging or even tearing the tendons.


Most often the problem does not start with surfing

 

  The pain might does, but the problem does not start in the water. Keeping the underarm on the office         desk and on the computer keyboard will make the shoulder fall down-forward into protraction. 40 hours a   week in the office for a longer period would fix the shoulder complex in this position which narrows the       range of movement of the whole shoulder.

  Imagine now, that your shoulder is hanging down-forward in protraction and you are lying on your board     with your shoulders completely down, very close to the water. In this case to swing the arm forward the     arm need to be lifted higher as the shoulder itself to not hit the water. That’s a lot of work for the deltoid.     Believe it or not lifting the arm in the air becomes a bigger challenge than actually sinking it underwater     and pushing the body forward against the resistance of the water. The deltoid gets strained from the           workload which helps to develop the above mentioned impingement process.

 

 

 

 

    

With chest down on the board, the arm must be lifted over shoulder during exit and recovery phase of the stroke. More work for deltoid.

 With the chest up, arm can swing lower as shoulder during      recovery phase of the stroke.

 

As I mentioned earlier, no one should save time from visiting a specialist based on this or on any other article when having shoulder problems. However the following  two advices can prevent a shoulder impingement and its further complications like tendon tear. For sure, it will make your paddling more effective.
Firstly Correct your paddle position by lifting your chest high up, and secondly get your shoulder muscles in balance by making your rotator cuffs stronger and stretching your deltoids regularly after each surfsession.


Correct your paddle position. By lifting your chest away from your board, the shoulders will be in a higher position. This enables you to swing the arm forward without the need of lifting it over shoulder level, which will minimize the work for the deltoid.

In addition if you bend your elbows during the lift, the load of your hand will be closer to the pivot point making the lift even easier.
Although the goal is to get the shoulders in a higher position I have mentioned chest on a purpose. You don’t want to put more shoulder muscles under stress around the shoulderblade. Many surfers are trying to lift the shoulder with the trapezius which results the shoulder is not further from the water but be closer to the head, causing not only shoulder pain but a stiff nack. Lift the chest high and let the shoulder muscles relax! Keeping the chest high, your spinal erectors (M.erector spinae) will get busy on the thoracic region. To make sure they bear the load, you will need to make them strong, but first it might be worth to increase your spine mobility for less resistance, so the muscles need to work less.

Spine mobility
A very good exercise for this is doing Thoracic Spine Extension on a foamroller.
Start position: Place the foamroller under your back in the thoracic region. Keep your feet on the ground and bend your knees. Put your hands behind your head and bring your elbows together. Let your head fall back in your hands or if possible all the way to the floor and bend yourself around the foamroller.

Action: Roll slowly forward and backward on the roller while contracting your abs to avoid too much extension at the lower back region! Roll slowly, let your weight to do the work and make sure that you roll only on the thoracic region and not on the neck or the lower back! You can pause on points where you feel extra stiffness and wait until it eases off.

 

Strengthening the spine erectors

Start position:
Lie prone on the mat with your forehead down, the arms by the sides, palms facing down.  

Action:
Lift your arms and chest off the mat, while contracting your abs as well, so the extension will be distributed on the whole spine and not only on the lower back. Keep your legs straight and together. Hold the position for 5-10 breaths and release by lying back down on the mat, than repeat.

      

 

 

 

 

Tips: your spine erectors need to hold this position during a whole surf session. So you don’t need to move your trunk up and down constantly, your goal is endurance.      
For keeping the motivation higher you can add some paddle moves to it and imagine you are escaping a freak sett, but remember, you are not training shoulder now, so do not grab any weights!


Strengthen your Rotator Cuff:

Start position:
Fix a resistance band on the doorhandle or on any object in elbow level.
• External rotator (M. Infraspinatus): Stand sideways with the affected shoulder away from the door. Flex elbow in 90°, arm rotated inward. Hold the resistance band in front of your body.

      

 

   

 

 

 

 

Action: rotate your arm outwards away from the door so far as it goes (should go almost 90° to the side) while keeping the elbow tight next to your body, than rotate back for release.


• Internal rotator (M. subscapularis):
Start Position: Stand sideways with the affected shoulder to the door. Flex elbow in 90°, arm rotated outward. Hold resistance band.

        

 

 

 

 

 

Action: rotate your arm inwards to your abdomen, while keeping the elbow tight next to your body, than rotate back for release.

Tips: It is very important by both exercises not to lift the arm away from the body, only rotate. For safety you can hold a towel with your elbow to your flank during the hole exercise.

Again you are training for stability and endurance, ergo you do not need to make fast movements. The slower you move the better or you can even hold the end position for a few seconds before release.


Streching deltoids:

Hold arm across your body at chest hight. Use your other hand to pull the arm to stretch closer to your chest. Hold it for one minute and changes sides. Repeat 2-3 times each sides.

 

 

 

As you see these are very simply exercises and you can squeeze them all in a 10 minute daily routine every morning.