Knee injuries in surfing are on the rise. And although the fact that surfers are adding more dynamic maneuvers to their aerials, on bigger waves, and in more critical places, with greater potential consequences to landing them, the reasons for failure and injury in the knee are often quite predictable.
In this month's Surfline Health and Fitness feature, we'll hear from Dr. Warren G. Kramer III, MD, Carolyn Perry, MS, PA and Dr Tim Brown, DC. Drs Kramer and Brown are Co-Medical directors for the ASP, Northern Hemisphere. Matt Gray, RPT, Mark Kazuki, RPT, Peter Park, CSCS, Surf Performance Coach, Matt Griggs and Dr John Pecora, DC also contributed to this feature as we discuss one of the most injured joints in the surfing and what outside factors and forces, combined with predictable muscle imbalances in joints above and below the knee (hips and feet), create the eventual set up for the knee joint to become vulnerable to injury.
It would be no coincidence if you were to begin to see the common connection between being able to move smoothly and efficiently, through normal range of motion with basic fundamental movement patterns, correlating highly with improved function, performance, recovery, and injury prevention. Before we get into some of the ways we assess the entire body (not just the knee) for factors that may lead to knee pain and injury, let's discuss some of the common knee conditions we see happen at WCT events and/or after-the-fact in the sports injury clinic.
Surfing is a rigorous sport that is not only physically challenging but also repetitious in nature. These elements put the surfer at risk for a multitude of injuries.
What are the most common knee injuries?
-MCL Tear
-Medial Meniscus Tear
-ACL tear (For example: Timmy Reyes, Trent Munro)
-Patellofemoral pain (Overuse from squatting and hard turning.)
-Multi-ligament injuries (For example: Shea Lopez ACL, PCL & MCL tears.)
-Saphenous Neuritis (Numbness on the inside lower leg from pinching the nerve while straddling a surfboard.)
What should a surfer do if they get a knee injury?
Surfing is a relatively safe sport in comparison to others. However, when you do get hurt, it is important to act promptly. When you or a fellow surfer suffers an injury, paddle in so you can evaluate the severity of the injury. Rule of thumb: when in doubt, suss it out.
When do you need to be seen for a diagnosis?
Generally speaking, any direct blow to the head/neck or spine requires swift medical attention. Other common injuries that require prompt medical treatment are: lacerations, fractures, joint dislocations or any injury that is debilitating. If you experience swelling of the joint, extreme pain with gentle range of motion, instability or are unable to weight bear, a sports medicine physician or orthopedist should evaluate you in a timely manner. While waiting to see one you can protect, rest, ice, compression and elevate. (PRICE.)
How long should you wait to surf following a joint injury? Ligament? Meniscus?
There are three grades of ligament and tendon injuries, from grade 1 (mild) to grade 3 where it is a complete rupture, with grey areas in between. For this reason, the time back from injury can be as short as 7-10 days from as long as 6-12 months. A normal return to surfing after a clean up of the meniscus is 4-8 weeks. A normal return after an ACL reconstruction is 5-8 months.
Reducing the swelling and obtaining the return of full range of motion of the joint (with doctor's recommendation), is the first priority after diagnosing an injury. During the post-injury process, stretching and strengthening of non-involved muscles -- above and below and even on the opposite side of your body -- is paramount to assisting your body get the quickest recovery possible. This also decreases the chance of re-injury, by transferring the forces away from the injured area. Strengthening can begin when the injury has healed sufficiently -- based upon time and functional improvement in basic movements, like squat and lunge -- to prevent re-injury
Based upon review of evidence-based, journal-published science, most injuries (knee, back, shoulder, etc) occur due to muscle imbalances caused by dysfunction in performing basic movement patterns, amplified further by imbalances that are created during sport specific participation and training. Case in point: in surfing, your front leg and your back leg are getting two totally different workouts, and the "training to surf" goal is to have them be balanced and functional with stability, endurance and flexibility.
Also factored in are your specific repetitive activities of daily living (such as sitting, computer, driving, etc.) If the goal is balance, function and stability, all these things must be considered and factored into your training program so you can prevent your knees (and other joints) from being imbalanced, repeatedly over stress |
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