Surfer’s Myelopathy: Rare Spinal Injury Linked to Surfing

Introduction: Understanding Surfer’s Myelopathy

Surfer’s myelopathy is a rare, non-traumatic spinal cord injury that predominantly affects novice surfers. The condition was first identified and formally documented in 2004 through case studies observed in Hawaii, a global hub for surfing enthusiasts. In these initial reports, young and healthy individuals—most of whom had little to no prior surfing experience—suffered sudden onset back pain and weakness in their lower limbs following extended periods spent lying prone on a surfboard. These early findings linked the condition to hyperextension of the lumbar spine, a posture commonly adopted during surfing.

What makes surfer’s myelopathy particularly striking is its association with an activity perceived as relatively low-risk. Surfing, while physically demanding, does not typically bring to mind the idea of spinal cord injuries. Yet, for a small subset of individuals, this condition can lead to significant and sometimes permanent disability. Early cases highlighted a range of outcomes—from transient symptoms resolving within days to severe paralysis requiring long-term rehabilitation. These variations underscore the need for better understanding and prevention strategies.

The history of surfer’s myelopathy provides a fascinating glimpse into how modern medicine identifies and responds to emerging conditions. Initially, reports were anecdotal and scattered, but they prompted a wave of research into the etiology and pathogenesis of this unusual syndrome. By pooling data from hospitals and medical facilities in surfing hotspots, researchers have gradually pieced together the common threads that define surfer’s myelopathy. Among these, the repeated hyperextension of the lumbar spine and its impact on blood flow to the spinal cord emerged as key factors.

Interestingly, surfer’s myelopathy is not the first condition to link spinal injuries to recreational activities. It falls within a broader category of rare, activity-induced spinal cord pathologies, which include conditions like gymnastic myelopathy and yoga-associated myelopathy. These parallels have fueled ongoing investigations, particularly into how biomechanical stress and vascular dynamics interact to precipitate spinal cord ischemia. Understanding these mechanisms not only aids in diagnosing surfer’s myelopathy but also offers broader insights into spinal health.

The recognition of surfer’s myelopathy has also had significant implications for public health education, particularly in regions where surfing is a popular recreational activity. Awareness campaigns aimed at beginners emphasize the importance of proper posture, hydration, and physical conditioning to minimize risk. These efforts align with the broader goal of promoting safe participation in sports without creating unnecessary fear.

While surfer’s myelopathy remains rare, its potential severity makes it a condition that warrants attention from both the medical community and the general public. The early cases in Hawaii not only brought the condition to light but also highlighted gaps in knowledge about spinal cord injuries linked to recreational activities. Since then, advancements in imaging techniques and clinical research have improved diagnostic accuracy, enabling healthcare providers to differentiate surfer’s myelopathy from other conditions with similar presentations, such as herniated discs or transverse myelitis.

Cause of Surfer’s Myelopathy

Surfer’s myelopathy has its roots in the repetitive mechanical stresses experienced by the spine, particularly the neck and cervical spine, while surfing. Constant flexion of the neck and compression of the spinal cord can lead to damage and progressive impairment of this crucial structure.

Excessive flexion of the neck while paddling, sudden changes in position on the board, as well as falls and impacts related to surfing contribute to the occurrence of this condition. These repeated actions generate significant forces and pressures on the spinal cord, which can lead to tissue damage and neurological disruption.

Mechanical stress on the spine can cause compression of the intervertebral discs and surrounding structures, leading to inflammation and symptoms characteristic of surfer’s myelopathy, such as numbness, muscle weakness and coordination problems.

It is essential to understand that surfer’s myelopathy is often the result of a combination of factors, including frequency and intensity of surfing sessions, individual technique, and genetic predisposition to spinal problems. Recognition of these risk factors can guide the prevention and management of this specific condition in surfing enthusiasts.

Symptoms of Surfer’s Myelopathy

Surfer’s myelopathy is characterized by a range of symptoms related to spinal cord injury, resulting from the repetitive mechanical stresses associated with surfing. The clinical manifestations of this condition can vary in intensity and combination, but several symptoms are commonly observed.

One of the predominant signs of surfer’s myelopathy is numbness and tingling. Affected people may experience abnormal sensations, often described as tingling or tingling, in the upper or lower limbs. These symptoms are indicative of sensory disturbances resulting from alterations in the transmission of nerve signals along the spinal cord.

Muscle weakness is also commonly observed. Muscles in the upper or lower limbs may lose strength, leading to a decreased ability to perform precise, sustained movements. These symptoms of muscle weakness can affect the quality of daily life and participation in sports activities, including surfing.

Coordination problems are another significant aspect of surfer’s myelopathy. Alterations in the transmission of nerve signals can lead to difficulties in coordinating movements, affecting balance and the ability to perform complex motor actions, which can directly impact surfing performance.

Neck and back pain are commonly reported symptoms. The stresses placed on the spine during surfing can lead to persistent pain, requiring special attention in the assessment and management of the condition.

Gait disturbances may occur, with individuals experiencing difficulty walking in a stable and coordinated manner. These gait alterations may be associated with muscle weakness and coordination problems, impacting overall mobility.

Finally, bladder and bowel control problems may be seen in some individuals with surfer’s myelopathy. These sphincter disorders result from damage to the spinal cord, affecting the normal regulation of bladder and intestinal functions.

Pathophysiology

The pathophysiology of surfer’s myelopathy lies in the repetitive mechanical stresses placed on the spine, particularly the neck and cervical spine, during surfing. These constant and specific movements associated with surfing, such as excessive neck flexion, rotation, and impact during falls, can lead to progressive damage to the spinal cord.

Excessive neck flexion is a key component of the pathophysiology. While paddling, surfers frequently adopt a neck flexion position to paddle and maintain balance on the board. This repeated action, combined with impacts during falls or waves, exposes the spinal cord to considerable mechanical forces, leading to repetitive microtrauma.

These mechanical stresses can cause compression of the intervertebral discs, herniated discs and damage to the surrounding tissues. These structural alterations of the spine can result in direct compression of the spinal cord, disrupting the normal transmission of nerve signals.

The resulting lesions can affect the sensory and motor pathways of the spinal cord. Symptoms, such as numbness, tingling, muscle weakness, and coordination problems, reflect this disruption in nerve communication. Damage to nerve fibers can lead to decreased muscle sensitivity and strength, impacting the ability to perform precise, coordinated movements.

The pathophysiology of surfer’s myelopathy may also involve inflammatory processes in response to repetitive microtrauma. Inflammation can make damage worse and contribute to the painful symptoms associated with the condition.

Medical imaging, particularly magnetic resonance imaging (MRI), is often used to visualize structural abnormalities of the spinal cord and confirm the diagnosis. A thorough clinical assessment, combined with radiological studies, is essential to understand the nature and extent of damage, which then guides the appropriate management for each patient.

Surfing and Physical Health: Posture, Strengthening and Preventative Advice

Correct posture when swimming in a prone position requires extension of the lumbar and thoracic spine to lift the upper chest off the deck of the surfboard and enable ergonomic swimming. Muscle strains at the cervical and lumbar level are relatively common, probably due to the sustained isometric contraction of these muscles during swimming. For example, surfing after long periods of inactivity often leads to burning muscle pain in the trapezius and rhomboid muscles. Likewise, hyperextending the neck, to compensate for insufficient lumbar extension while surfing, can worsen neck pain. Fortunately, most neck and back spasms due to overuse resolve spontaneously, but physical therapy can also improve acute symptoms. A proper warm-up before surfing (especially in cold water) and regular stretching of your lower back, hamstrings and hip flexors can help prevent this common problem.

Active activation of the core musculature during swimming creates a solid swimming platform, unloading the muscles of the lower back. Therefore, land-based exercises aimed at improving core strength in surfers are essential. Previous observations suggest that although surfers have more powerful shoulder flexion and extension than other athletes, they often have weaker core strength. Persistent neck pain despite conservative treatment may be due to cervical disc injury, degenerative arthritis in older surfers, or thoracic outlet syndrome. Symptoms are exacerbated by movements that severely stretch the lower back, such as diving under approaching waves or standing up (going from lying to standing) on ​​a surfboard. Stress fractures of the pars interarticularis usually heal with conservative therapy but often require 4 to 6 months off from sports, although some may require spinal fusion later in life.

The Physiological Issues of the Surfer: Postural Impact and Vascular Risks

Novice surfers tend to spend more time in hyperlordosis compared to experienced surfers. The vulnerability of this posture, combined with the time spent in it, can significantly predispose them to the development of spinal cord disease following an event such as venous thrombosis. The persistent pressure of the surfboard on the surfer’s trunk can impede the flow of the inferior vena cava, worsening complications related to weakened venous blood flow. Suddenly moving from a pronated hyperextension position of the lumbar spine to a plank squat position and the associated Valsalva maneuver may contribute to increased spinal pressure and ischemia. This rapid transition from lying on the board in a hyperextended position to squatting to perform the Valsalva maneuver represents a significant change in stress on the spine. Less experienced surfers may be more prone to this abrupt transition, exposing their spine to additional pressures and increased risk of ischemia.

The balance between these different positions is crucial, because the occurrence of complications, notably venous thrombosis, can be exacerbated by impaired blood circulation. Surfers should be aware of the potential impacts of these postural changes on their spinal and vascular health. Knowledge of these risks can encourage safer practices when transitioning between these positions, thereby minimizing stress on the spine and improving blood circulation.

In sum, the progression of surfer posture, from lying on the board to crouching to execute specific maneuvers, represents a physiological challenge and can have significant implications for the health of the spine and blood circulation. venous. Understanding these mechanisms by surfers, especially beginners, is essential to minimize potential risks and promote safer and healthier surfing.

Preventative measure to prevent surfer’s myelopathy

In the specific context of preventing surfer’s myelopathy, preventive measures can be implemented to mitigate the risks associated with surfing and reduce mechanical stress on the spine. These measures aim to promote a proactive approach to minimizing risk factors and promoting the spinal health of surfers. Here are some recommendations to prevent surfer’s myelopathy:

Education on Technique and Posture:

Educating surfers on proper technique and posture is fundamental. By emphasizing the importance of maintaining a natural curvature of the neck and back when paddling and standing up on the board, mechanical stress on the spine can be reduced. Surfers should be aware of movements that can cause excessive neck flexion, preventing potential injuries.

Muscle Strengthening and Flexibility:

An exercise program focused on muscle strengthening, with emphasis on the muscles of the neck, back and core, can help stabilize the spine and reduce stress on the spinal cord. Flexibility exercises to maintain appropriate range of motion can also be beneficial in preventing stiffness and tightness.

Use of Protective Equipment:

Using protective equipment, such as properly fitted flotation vests, can help minimize the impact of falls and keep surfers safe. Specific equipment designed to reduce pressure on the neck and spine may also be considered for surfers particularly prone to back problems.

Limitation of Practice Time and Adequate Rest:

Excessive surfing, especially in extreme conditions, can increase the risk of injury. Encouraging surfers to take regular breaks and respect their body’s limits can help prevent excessive fatigue and reduce strain on the spine.

Preventative Strategies for Surfer’s Myelopathy

Surfer’s myelopathy, though rare, can have significant consequences for those affected. As the condition is most commonly associated with novice surfers, preventative strategies focusing on proper preparation, hydration, and technique can play a crucial role in reducing the risk of injury. By incorporating these practical measures, individuals can enjoy surfing safely while minimizing potential harm.

Warm-Up Exercises

One of the most effective ways to prevent surfer’s myelopathy is through proper warm-up routines. Engaging in a series of targeted exercises before hitting the waves can help prepare the body for the demands of surfing:

1. Dynamic Stretching: Perform stretches that target the spine, shoulders, and core muscles. Examples include cat-cow stretches, spinal twists, and shoulder rolls.
2. Core Activation: Strengthen the core with exercises such as planks, bird-dogs, and pelvic tilts. A strong core supports spinal stability and reduces strain on the lower back.
3. Back Extension Exercises: Gentle back extensions, like cobra pose or prone press-ups, can increase flexibility in the lumbar spine and prepare it for hyperextension during paddling.
4. Cardiovascular Warm-Up: A light jog or brisk walk on the beach increases circulation and prepares the body for physical activity.

Spending 10–15 minutes on these exercises can significantly enhance flexibility, strength, and spinal resilience, reducing the risk of injury.

Hydration Tips

Proper hydration is a cornerstone of injury prevention, particularly for conditions involving ischemia or blood flow restrictions like surfer’s myelopathy. Dehydration can impair circulation, increasing the likelihood of spinal cord ischemia during prolonged physical activity. Here are some essential hydration tips for surfers:

1. Pre-Surf Hydration: Drink at least 500–700 ml of water 1–2 hours before surfing.
2. Electrolyte Balance: Incorporate electrolyte-rich beverages to replenish sodium, potassium, and magnesium levels, especially in hot climates.
3. During Surf Breaks: Take short breaks to hydrate, particularly during long surfing sessions.
4. Post-Surf Rehydration: Restore fluid levels by drinking water and eating hydrating foods like fruits and vegetables.

Maintaining hydration before, during, and after surfing helps optimize blood flow and reduce the risk of spinal cord complications.

Posture Adjustments

Incorrect posture during paddling is a significant risk factor for surfer’s myelopathy. Prolonged hyperextension of the lumbar spine can compromise blood flow to the spinal cord. Adopting proper paddling techniques can mitigate this risk:

1. Neutral Spine Alignment: Avoid excessive arching of the lower back while lying prone on the surfboard. Instead, aim for a gentle lift of the chest while keeping the neck relaxed.
2. Paddling Technique: Use the shoulders and arms efficiently to propel the board, minimizing reliance on spinal extension.
3. Frequent Position Changes: Alternate between paddling and resting in a seated or kneeling position to reduce continuous spinal strain.
4. Take Breaks: Periodically stretch or stand up in shallow waters to relieve spinal pressure.

Surfing instructors play a vital role in teaching these techniques to beginners, ensuring they adopt safe practices from the start.

Awareness and Education

Awareness is a powerful tool in preventing surfer’s myelopathy. Education initiatives targeted at novice surfers can emphasize the importance of preparation, hydration, and proper technique. Surf schools, clinics, and online resources can provide valuable information, empowering individuals to take proactive steps.

By incorporating these preventative strategies, surfers can significantly reduce their risk of developing surfer’s myelopathy. A combination of physical preparation, hydration, and mindful posture adjustments ensures a safer and more enjoyable surfing experience for individuals of all skill levels.

Conclusion

Surfer’s myelopathy is a rare, non-traumatic spinal cord injury predominantly affecting novice surfers due to prolonged spinal hyperextension during paddling. The condition’s pathogenesis involves ischemic injury to the spinal cord, likely resulting from compromised blood flow during sustained hyperextension. Clinically, it presents with acute back pain, progressing to neurological deficits such as lower limb weakness or paralysis.

Diagnostic evaluation typically includes magnetic resonance imaging (MRI) to identify characteristic spinal cord changes. Management strategies focus on early intervention with corticosteroids to reduce inflammation and comprehensive rehabilitation to maximize functional recovery. Preventative measures emphasize proper surfing techniques, adequate physical conditioning, and awareness of early symptoms to mitigate risk.

Ongoing research aims to deepen understanding of surfer’s myelopathy, enhance diagnostic accuracy, and develop effective treatment protocols. Increased awareness among surfers and healthcare professionals is crucial for early recognition and management, ultimately improving outcomes for those affected by this uncommon yet significant conditi

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