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Surf Shoulders: How to Prevent Surfing Related Shoulder Pain & Injuries

shoulder pain, rotator cuff injury, shoulder impingement
Shoulder Pain from Paddling & Surfing

Surfing and paddling can lead to a condition called Upper Crossed Syndrome (UCS), which is characterized by a specific pattern of muscle imbalances. Repetitive paddling can cause overdevelopment and tightness of certain muscles, leading to UCS. This condition is characterized by tightness in muscles used in surfing and weakness in other muscles that are not as frequently used.

Surf shoulders, from repetitive paddling, can result in a classic pattern of muscle tightness and weakness which can cause chronic pain and injury.

Surf Shoulders - Upper Crossed Syndrome

Classic Pattern: Tightness vs. Weakness

  1. Tight: Pecs, Upper Trap, Levator scapula, and Suboccipitals

  2. Weak: Rotator cuff, Serratus Anterior, Rhomboids, Lower Traps, deep neck muscles (cervical flexors)

Postural Changes with Surf Shoulders

Surf Shoulders Upper Crossed Syndrome Janda
Upper Crossed Syndrome

Posturally, UCS is accompanied with forward head posture, rounding in the upper back, and protracted/internally rotated shoulders. Muscle tightness in the chest can pull the shoulders and upper back into a rounded position, resulting in a stretch weakness in the upper back and rotator cuff. Furthermore, surfing specifically uses pecs and lats, which are internal rotators. Tightness in the pecs and lats used for paddling can limit shoulder external rotation mobility and muscle activation of the ER’s, which aid to stabilize the shoulder.

Postural Changes:

  1. Forward head/Thoracic Kyphosis (Upper back rounding)

  2. Hinging at C4-5 (Mid neck)

  3. Shoulder blade winging

"Muscle imbalance is an impaired relationship between muscles prone to facilitation and muscles prone to inhibition." – Vladimir Janda

Shoulder Mechanics & Joint Centration

Upper Crossed Syndrome (UCS) can have a significant impact on the mechanics of the shoulder, making it difficult to maintain proper joint centration. Joint centration refers to keeping the bone properly aligned within the joint, much like a golf ball sitting centered on a tee. In the case of the shoulder, which is a ball-and-socket joint, muscle imbalances caused by UCS can pull the joint out of alignment, leading to issues such as shoulder impingement, instability, and even rotator cuff tears. These issues can occur because the shoulder is at a mechanical disadvantage, making it harder to maintain proper alignment within the joint.

Shoulder mechanics & joint centration
Joint Centration

Paddling Related Shoulder Injuries

Shoulders are the most flexible joints in the body, but this also makes it more vulnerable to injury. Paddling, an important aspect of surfing, requires a great deal of stability to keep the shoulder joint properly aligned. Shoulder muscle imbalances can lead to premature wear and tear and cause pain related to rotator cuff tears, shoulder impingement, or shoulder instability. However, there is good news! Both static and dynamic training can help to improve paddling strength and endurance, while also reducing the risk of injury. By focusing on strengthening as injury prevention, surfers can enjoy more time in the lineup, and less time recovering from injuries.

Why Should I care?

  • UCS is extremely common in surfers from paddling

  • Can lead to shoulder impingement, shoulder instability, or rotator cuff tears

  • Increased hinging at C/T junction and C4-5 ➡️ neck pain, radicular (nerve) pain or neuromuscular impairments of shoulder

What Can I do About it?

Tissue Release of TIGHT muscles

  • Pecs

  • Upper Trap

  • Levator Scap

  • Scap release

Strengthen WEAK muscles

Thoracic Mobility

These specific exercises are tools to help manage symptoms and promote better shoulder mechanics for paddling to reduce risk of injury. Experiencing shoulder pain and don’t know what to do about it? This is where PT comes in! Knowing how and when to progress is key to a successful injury recovery. Stop prolonging your recovery by scrolling for quick fixes. Let’s figure out what the issue is to make a specific personalized plan for your recovery!

See you in the water,


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