Low back pain is a common condition that keeps many of my surfing patients out of the water, or at the very least hindering their performance. I most often hear it described as a nuisance, pressure, or sharp pain in the center, or slightly off-center of the low-back; this pain is typically felt during the paddling task of surfing. The biomechanics of surfing, specifically being in the prone position and paddling, can create an enormous amount of pressure on the low-back spinal joints, known as facets. For one to lay flat on a surfboard to paddle, the lumbar spine (low-back) needs to extend – this is the motion felt as the low-back bends inward toward the surfboard. Extension is needed in the lumbar spine during the prone-paddling position, because the individual surfer needs to see where they’re going; as the chest/sternum rises from the surfboard to articulate the surfer’s vantage point, the lumbar-spine must bend-inward to allow this.
So What Gives With Low-Back Extension?
Please understand that when I work with a surfing-patient, that I will evaluate them beforehand. By evaluating a patient, I’m able to differentially diagnose what type of low-back pain they have. This is important, because there are many different types of low-back pain that all require their own specific treatment. Back pain can include muscle strains, ligament sprains, inflamed disc(s), nerve impingements, etc. For our purposes of discussing low-back extension, we will not be concerned about the specific low-back pain diagnosis, but rather the mechanics of low-back extension and how they relate to generalized low-back pain.
If low-back pain is being felt during paddling, then pain is occurring with lumbar spine extension (or hyper-extension). With lumbar spine extension, the spinal joints (running just off-center on both sides of the spine) are loaded, or compressed. With hyper-extension or prolonged extension, the compression within the joints builds to the point of discomfort. Imagine if you tried to straighten out your elbow as far as it could go. Then you tried to push it straighter. Then you held that pressure into a straightened position for 2-3 hours. Your elbow would hurt, right? That’s because the joint is being compressed for a long period of time. As lumbar spine facet joints become perturbed from compression, they can contribute to impinging nerves, muscle strains, and other types of low-back pain.
How to Manage Surfing Back Pain
DISCLAIMER – Nothing in this article should be interpreted as Physical Therapy treatment. This article should not be interpreted as receiving a formal diagnosis either. This article is meant to be received as generalized information and should not replace Physical Therapy treatment or seeing a doctor to receive a diagnosis. If any of the stretches feel uncomfortable or painful, then stop doing them. Please seek the advice of your local doctor and/or Physical Therapist for more specialized treatment.
Typically 3 major things are occurring if lumbar spine extension is causing pain while surfing: decreased upper extremity range-of-motion; tight iliopsoas (hip flexor) musculature; decreased core/abdominal awareness. (Please keep in mind, that this is a generalization).
If the upper extremity has a decreased ability to reach overhead, the low-back will compensate with excessive extension. Being that paddling is a bilateral upper extremeity overhead/elevation task, surfers with restricted upper extremity elevation extend excessively through their lumbar spine. Decreased movement of the shoulder joint, leads to increased movement at the lumbar spine, causing more compression of the facet joints. Upper extremity elevation can be limited by a tight shoulder joint (known as a capsule), or restricted musculature, mainly the latissimus dorsi (aka “the lats”). Stretching upper extremity elevation can be easily accomplished with the lat stretch seen below. Each stretch can be held for 30 seconds x 4 repetitions each.
If the iliopsoas musculature (hip flexor muscle) is tight, the low-back will compensate with extension as well. The reason for this is that the iliopsoas musculature originates from the front of your low-back vertebrae, and then traverses obliquely downward to attach to the upper portion of your thigh bone. Being in a prone position (i.e. paddling), moves the hips in extension. If the iliopsoas musculature is tight, the lumbar-spine extends inward toward your board; this is due to the fixed position of your thighs. Stretching the iliopsoas muscle group on both sides will help reduce spinal joint compression during the paddling task. This can be accomplished by a simple hip flexor stretch. Each stretch can be held for 30 seconds x 4 repetitions each.
The last thing one can do to mitigate the lumbar spinal facet compression occurring during the paddling task is bracing the abdominal musculature. I tend to think of abdominal bracing in several ways: if you knew someone was going to punch you in the stomach, you would tighten your abdominals to prevent the wind from being knocked out of you - that is abdominal bracing. It’s also a similar sensation if you were to refrain from having a bowel-movement. Abdominal bracing is a firmness in the abdominal musculature. This is a conscious thing taking place while you’re paddling; your brain is telling your stomach muscles to contract and maintain a contraction while you’re paddling. As muscle activity stays constant in your core musculature, your low back spinal facets are less susceptible to the compression effects of lumbar spine extension.
If you're an avid (or even a weekend warrior) type of surfer, then I think these 2 simple stretches have to be in your workout regimen. Without them, muscle tightness will accrue indefinitely; lat tightness will accrue from surfing overuse without proper conditioning; hip flexor tightness will accrue from sitting at a desk all day. As tightness eventually settles in on the non-training surfer, injury will eventually occur at some point. By maintaining adequate length in the lats and hip flexors, the lumbar spine will be less susceptible to generalized types of pain from extension. If stretching is done in combination with an active practice of engaging the core musculature during paddling, then the chances for spinal injury drop significantly. Feel free to comment regarding questions. Good luck, and get out there!