The following scenario inspired this article:
I was suiting up at the beach the other day and overheard two surfers talking. One said, “man, my shoulder was killing me out there. I think my rotator cuff is torn.”
The other responded, “Oh yeah, you probably do. XXXX had one of those too. He just rested, did yoga, and got this Voltaren gel – he used the gel religiously and swore by it. That really seemed to clear it up. You should try that.”
As a Physical Therapist, I shuddered hearing this shoddy advice. So what happens when this advice doesn’t work? Use more gel? I couldn’t help but be frustrated for this injured surfer. I wish I could say that was the first time I’ve come across that scenario, but unfortunately it was not. Inadequate advice does nothing to heal injuries, return surfers to the water in a timely manner, improve performance, or truly treat the occurring pathology. For the most part it’s guesswork – and half the time it makes people worse.
It’s obvious to us as surfers that we use our shoulders during surfing. A lot. Specifically, their primary function is to paddle us into a position to catch a wave (especially if you’re surfing Ocean Beach), and then to get us into the wave. For most of us that have surfed for more than one year, we have probably either suffered from a surfing related shoulder pain, or at least talked to others who have. (For the purposes of this discussion, I will not be referring to traumatic shoulder pain – e.g. fractures). Most of the time the pain occurs with the paddling task itself; however pain may be present with during only the pop-up motion of getting to your feet. In my current Physical Therapy practice I evaluate and treat surfing related shoulder pain on a very regular basis. Although there are common “surfing-shoulder” patterns, I find it very interesting to note that every patient with shoulder pain is different in their own unique way. This is important, because different types of shoulder pains require different types of treatment – i.e. your pain probably won’t get better from the exercise your buddy showed you in the parking lot that helped with his shoulder pain; in fact, it may make it worse.
Typically how it works is this: your shoulder hurts, and now you can’t surf. You talk to some friends, and maybe learn some tricks – rest, ice, arnica, arm-circles, yoga, etc. Then you try to surf again, and the dang shoulder acts up again. So now you decide to go see a doctor about it. Your general doctor then refers you an orthopedic doctor. This exam may include some imaging (x-ray, MRI). After the orthopedic exam, you’re typically offered Physical Therapy, cortisone injections, and/or shoulder surgery. Other non-conventional methods of western practice may include the use of chiropractic care, acupuncture, Reiki, etc. (for whatever reason, I find these alternative routes of care very popular amongst our surfing culture). So what’s my advice? I think if you’re experiencing mechanical surfing related shoulder pain (e.g. “it hurts when I move my arm like this), then you need to see someone that understands the scope of how shoulder pathology presents, and how it relates to the biomechanics of surfing – in other words, start with seeing your general doctor and go from there.
I personally believe that a proper evaluation of your shoulder pain is the best bet. I’m a little biased, but I tend to believe that Physical Therapists do this better than anyone else. A proper shoulder evaluation should determine WHAT your shoulder pain source is, and potentially WHY (there can be many reasons) it’s present – for the surfing shoulder, the reason(s) why are typically due to tissue that’s too tight, weak, etc. causing some sort of compensatory pain at your shoulder. Once the WHAT and WHY are established, then generating a tailored treatment for YOUR shoulder can be presented. This reduces your risk of making your pain or condition worse by following general advice found online, recommended by friend in a parking lot, etc. Just think: a specific pain requires specific treatment. You wouldn’t take your standard shortboard out at Mavericks, right?
But what if you’ve had an MRI and it showed a rotator cuff tear? Is it possible the rotator cuff is NOT your pain source? Sure, why not? This is called a false positive. (For an interesting read, check out this recent NY times article). If you’re debating shoulder surgery, then you want to be absolutely positive that your pain is stemming from your rotator cuff tear; otherwise your surgery may not address your pain source properly. If your pain source is in fact rotator cuff in nature, then going through with surgery is a decision that you, and your orthopedic surgeon will discuss. My advice is to get a Physical Therapist’s feedback to confirm your symptoms. My belief is that if you’re about to get your shoulder operated on, then an MRI, an orthopedic MD, and a PT all saying the same thing allows you to be more confident in your surgery.
I’ve treated a lot of surfers with shoulder pain in my practice, and I can say that there is a light at the end of the tunnel. I promise. Not all shoulder pains require surgery. Not all pain sources are rotator cuff in nature. Specific shoulder pain treated with general advice goes about as good as surfing a twin fish in big, thumping surf. In my opinion, shoulder pain should not permanently debilitate you to the point of never surfing again. Most shoulder pains are treatable. In conclusion, if your shoulder pain is limiting your participation, or even performance with surfing, then do yourself a favor: get a proper biomechanical evaluation and learn what’s affecting YOUR shoulder.