Expert medical adviceTreatment of injuriesNutrition for surfersTHE BOOKSurfing & Health is a must for surfers and all health professionals related to this fantastic sport.Offering a fundamental and complete A to Z guide covering all major aspects of surfers' health, it offers expert medical advice on acute and chronic surfing injuries, including treatment, rehabilitation and preventative strategies based on PILATES core training exercises. This book includes topics on travelers' disease, hypothermia, skin cancer prevention, shark attacks and other marine animal accidents, women's surfing, and in-depth information on physical training, nutrition advice, psychological strategies to improve concentration and performance. The book also includes a first aid chapter for beach assessment and intervention
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Dr. Joel Steinman
Meyer & Meyer Sport
British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library
Surfing & Health
Maidenhead: Meyer & Meyer Sport (UK) Ltd., 2009
All rights reserved, especially the right to copy and distribute, including the translation rights. No part of this work may be reproduced—including by photocopy, microfilm or any other means—processed, stored electronically, copied or distributed in any form whatsoever without the written permission of the publisher.
© 2009 by Meyer & Meyer Sport (UK) Ltd.
Aachen, Adelaide, Auckland, Budapest, Cape Town, Graz, Indianapolis, Maidenhead, Olten (CH), Singapore, Toronto
Member of the World
Sport Publishers’ Association (WSPA)
E-Mail: [email protected]
To God, for the creation.
To the memory of my father, Dr. Luiz Steinman, who introduced me, with wisdom, to the art of life and medicine.
To the love and affection of my mother, who helped me jump over my first waves.
To the love of my children, Rodrigo, Gabriel, Sam and Victor, and to my wife, Ana Cristina, who enlighten and teach me.
Fabio Gouveia –
Fernando de Noronha Archipelago, Brazil
I thank the following for their support: Mormaii
Association of Professional Surfers – ASP
Association of Professional Surfers – South America
International Surfing Association – ISA
Pan American Surfing Association – PASA
Brazilian Confederation of Surf – CBS
The Santa Catarina Surf Federation – Fecasurf
Joaquina Surfing Association – ASJ
Tao Pilates Institute of Sports Medicine
Dr. Steinman earned his medical degree from the Santa Casa College of MedicalSciences of São Paulo, Brazil in 1982. He comes from a family of doctors and has beensurfing for more than 30 years.
Convinced of the beneficial effects that surfing has on health and for spirit, theauthor has exercised the art of medicine and surfed in various places and countries, suchas Hawaii, Indonesia, Australia, Fiji, Portugal, Spain, Israel, France, Panama, Mexico,Peru, to name a few.
Dr. Steinman conducted extensive postgraduate studies in Sports Medicine inAustralia, studied acupuncture in China and Spine Manipulation-Chiropraxy in Brazil. Hismedical degree is in pediatrics. Inspired by several fellow members of the SURFERS’SMEDICAL ASSOCIATION, Dr. Mark Renneker, Dr. Geoff Both, Dr. Simon Leslie, Prof. BrianLowdon (in memoriam) for a number of years, he has written a medical column for Brazil’sleading surf magazines, such as the former MagazineInsideand then MagazineFluir. Heis the doctor for the Santa Catarina Surf Federation and the Brazilian Confederation ofSurfing and has been the Medical officer for the Brazilian World Surfing Contest (WCT) inBrazil since 2002.
He is the author of various articles about sports medicine, nutrition and meditation,and published a pioneer study on sports injuries and accidents in Brazil.
A practitioner of Pilates, qigong, yoga and natural medicine, Dr. Steinman hasparticipated in various courses and programs concerning holistic and preventive health invarious communities, including Grajagan in Indonesia and Tavarua in Fiji.
He is a member of the Surfer’s Medical Association, the Brazilian Society of SportsMedicine, the Brazilian Society of Rehabilitation Medicine and the Brazilian Medical Societyof Acupuncture. Dr. Steinman lives with his family in Florianópolis, on the island of SantaCatarina, where he surfs and directs the TAO PILATES Institute of Sports Medicine thatoffers top a quality medical and health team for “sportspeople.” TAO PILATES Instituteoffers quality courses and workshops in Brazil and Europe for health professionals on Pilatesfor Medical Rehabilitation and Training, Spinal Manipulation and Meditation.
Fernando de Noronha Archipelago, Brazil
About Dr. Joel Steinman
Introduction: Wayne Rabbit Bartholomew
Preface: Dr. Marco Aurélio Rayundo
An Important Message
Master and Senior Surfers: Surfing – The Elixir of Long life
The Ideal Age to Begin Surfing
Surfing Injuries and Accidents
Cuts and Lacerations
Hip and Pelvis Injuries
Common Knee Injuries
Ankle and Foot Injuries
Common Eye Injuries
Surfing in the Tropics and Common Infectious Diseases
Surfing Cold Waters – Hypothermia and Cramps
Sun, Surf and Skin Cancer
Attacks by Sharks or Other Sea Animals
Asthma and Surfing
Testicular and Prostate Problems and How to Prevent them
Surfing in Special Conditions
Principles of Exercise Physiology for Surfing Training and Competition
Pilates for Surfers – Control, Core and Functional Training
Techniques for Surviving Wipe Outs
Nutrition for Competitive and Free Surfing
By Dr. Joel Steinman and Dr. Tania Rodrigues
Food Supplements and Ergogenic Resources
By Dr. Joel Steinman and Dr. Tania Rodrigues
Athletes and Illegal Substances – Doping
Competitive Surf and Sports Psychology for Performance and Emotional Freedom
First Aid – Drowing, Rescue and Cardiopulmonary Resuscitation (CPR)
Immobilizing and Transporting an Accident Victim – Techniques to Immobilize Upper and Lower Limbs
Health and Ecological Risks in Surfboard Production
Body Boarders and Health Problems
Surfing the Pororoca in the Brazilian Amazon
By Serginho Laus
Tao – The Spirit of Surfing
Appendix 1: Surf Trip First Aid Kit
Appendix 2: Jet Lag and Surfing
Appendix 3: Formulation of Vitamins and Minerals for Joint Protection
Photo & Illustration Credits
Surfers have been blazing the trail of adventure in true pioneering spirit for nearly 100 years. Ever since legendary Hawaiian waterman Duke Kahanamoku gifted surfing to the world, generation after generation has spread the seeds of surfing to every coastline on the planet. It is well documented that surfers are the modern-day Marco Polos, mapping uncharted waters, discovering exotic new breaks, interacting with ancient cultures and developing a lifestyle that is the envy of the free world.
On these expeditions of discovery, surfers have had to adapt to changing environments and develop a code of risk management that has been handed on to the next traveller through word of mouth and story. Trekking into the unknown is a time-honored rite of passage for any true surfer; the very essence of the surfing lifestyle requires a spirit of nomadic adventure. It has been more a case of trial and error that we step bravely into unknown lands and, at times, horror stories emerge from surfers in far-off lands completely unprepared to deal with reef cuts, infections, tropical disease, fin lacerations, waterborne illness, broken bones, debilitating injury, malnutrition and encounters with marine creatures.
In time-honored fashion, surfers refined travelling first aid kits and gleaned health tips and the means to avoiding tropical disease through information handed down generationally by their fellow travelling surfers. However, surfers have been crying out for a comprehensive journal that covers the entire gamut of health issues in surfing, from A to Z.
It is with great pleasure that I present Surfing & Health by Joel Steinman. For many years, Joel has compiled information and techniques from both his personal travels and experiences, as well as from a research of best practices in many areas of health and from all corners of the world. From all that living data, Joel has created what is no less than an encyclopedia of health, all related to surfing and with the objective of not only being educational but to promote a state of health and well-being as one enjoys the surfing experience.
Surfing & Health is a wonderful contribution by a truly inspirational surfer.
Wayne Rabbit Bartholomew
1978 World Surfing Champion
President ASP International
Some basic medical concepts apply to all sports. But the further we plunge into the field, the more we find that each sport has its own characteristics.
Surfing, as a sport of mass appeal, is a recent phenomenon and the advantages and dangers of its practice have never before been considered in such depth.
Santa Catarina, in southern Brazil, is a perfect place to surf, where numerous events, including those on the WCT and WQS circuits, attract the world’s best surfers and an enormous number of fans.
It is here that Dr. Joel Steinman, who is also an excellent surfer, has attended to and treated countless surf-related injuries. This experience makes him an authority in the field.
This book is an indispensable guide for athletes, especially those who travel to distant locales with little medical support. But it is also for doctors who want to better understand this marvelous, yet sometimes dangerous, world of surf.
Dr. Marco Aurélio Rayundo
Doctor and owner of Mormaii, a pioneering company in the development of surf in Brazil
Jaws – Hawaii
Surfing is a millenary sport. It was born in Polynesia, set root in Hawaii and grew and spread throughout California. It has crossed the oceans and is now practiced on all of the world’s beaches where there are good waves.
Surfing purifies the body, mind and spirit.
In Brazil, after many years of marginalization and social discrimination surfing has been taken up by people of all economic classes and professions, and has become recognized as a definitively healthy sport, which places the surfer in deep and direct contact with nature.
The magic of the sport and the search for the perfect wave transform the surfer into a happy, traveling dreamer!
The sound of the waves is the surfer’s mantra and the waves themselves are like temples. Each surfer has his or her own Mecca. For many, it would be the Indonesian Archipelago. Its more than 13,000 islands bathed by the Indian Ocean is one of these locations that join the magic, surprise, malaria and countless tubes and dream waves on beaches such as Gland, Nias, West Java, West Sunbawa, the Mentawai Islands and a dozen crests never surfed before.
The paradise islands of the North Pacific are home to the history and legend of the constant, powerful and dangerous waves of Hawaii’s north shore, with Pipeline, Sunset and the giant waves of Waiamea and Jaws.
The South Pacific has infinite crystal tubes on the islands of Fiji and Tahitia, where, at the peak of Teahupoo, are found some of the world’s most dangerous waves.
Australia also has tremendous opportunity for surf, with consistently great waves. The island continent receives swells from the Indian and Pacific Oceans. The hundreds of waves in the land of the kangaroo and aborigines include: Bell’s Beach, Margareth River, Kirra, Burleigh Heads, Angorie, Black Rock, Ulladula, Red Bluff, Turtles, Gnaraloo, Maldives, Ilhas Reuniao and Mauricius Island. They are the dreams of surfers in the Indian Ocean.
The icy waves of Alaska, Greenland, Ireland, and England are not very popular, but they and the somewhat warmer peaks of the French Coast at Hossegor, Biarritz and Lacanau, also offer good times, as does the Spanish coast at Mundaka, and the Portuguese beaches at Peniche, Ericeira and Alagarve.
Although they are not frequent, waves are surfed and worshiped in Israel and during the Italian winter on the coast of Sardenha.
The consistent surf in Morocco, Madeira and the Canary Islands stir the North Atlantic.
The little explored east coast of Africa and the famous peaks of Durban and Jeffrey’s Bay to the south represent the opportunities for African surf.
On the Asian coast there are New Guinea, the Philippines and Japan.
The coast of California lives and breathes the culture and business of surf from the mountainous and icy waves of the Mavericks to the north, to the traditional and popular peaks at Santa Cruz, Santa Barbara and San Diego.
In Central America, the fun is found at the Mexican beaches of Baja California, Rio Nexpa and Puerto Escondido, and in the tropical surf in El Salvador, Costa Rica, Panama, and the Carribean islands of Puerto Rico, Barbados and other beaches.
South America takes the spotlight with the surf in the Galápagos and Montanita in Ecuador, with the consistent Peruvian waves at the peaks of Pacasmayo, Chicama and Punta Hermosa and is revealed in the icy waves of Chile, from Iquiqui to the north until Punta de Lobos to the south.
Opportunities for surf in Brazil range from the unique and fantastic river waves of the pororoca in the Amazon region to the recently discovered Tahiatian style waves at Lobos Island in Torres, Rio Grande do Sul. They include the surf paradise of Fernando de Noronha, the waves of the Northeast, the peaks in Rio de Janeiro and São Paulo, and the 400 km of the Santa Catarina coast with the consistent waves at Imbituba, Praia da Silveira, Praia da Rosa, Campeche, Praia Mole and Joaquina.
This book was written to help the soul surfer or the competitive surfer to realize his or her dream of surfing this infinity of the world’s waves. In an in-depth and practical manner, it provides the latest information and essential techniques needed to remain healthy, giving emphasis to physical conditioning, disposition, nutrition and knowledge about prevention and treatment of sports injuries and health risks. In addition to being a serious manual of Sports Medicine, it is also a source of inspiration for a more healthy life and a search for equilibrium of body, mind and spirit.
This book is not meant to be a substitute for professional medical care, but as a supplement for those who want to better understand their health problem.
Before utilizing any type of treatment, always consult your doctor.
Advances in medical science are rapid and some of the information contained in this book about medication and treatment may be subject to change.
A sport like surfing should be practiced in good health.
Surf inspires health.
Health is a blessing.
A healthy body, mind and spirit, the health of good food and of the waves.
The health of Planet Earth,
The health of the Universe,
The health of the Eternal,
God bless everyone!
Dr. Joel Steinman
The living legendof world surf calmly surfs a tube
Surfing provides curing energy. It is a sport capable of prolonging and improvingquality of life.
This book is for surfers of all ages, shapes, genders and colors. But we will begin by looking at the primary health issues of those surfers whose memories go back before boards had keels and webcams monitored the waves.
Older surfers have significant differences in body composition, aerobic capacity and muscle strength than younger ones. Nevertheless, surfers with many years of regular training have much less decline in these areas than those who do not exercise or participate in sports. Many master surfers have played sports throughout their lives and are strong and flexible, with excellent cardiopulmonary capacity relative to their untrained peers.
Maximum heart rate and, subsequently, cardiac output decrease with age. Blood pressure also increases as blood vessels become less supple and respiratory capacity decreases due to the decreased elasticity of the lungs, chest wall, and pulmonary vasculature. Muscles and bones become weaker, and connective tissue loses flexibility and becomes more susceptible to injury.
Afonso Freitas, 76. He is considered theoldest surfer in Brazil. He is the author ofthe book Health in Our Hands.
Neuronal atrophy (aging of the nerves) may impair motor response, body awareness, balance, thirst, and thermo-regulation. Fat-free mass typically decreases and body fat increases. Women experience a redistribution of body fat with menopause.
Many of these changes are significantly attenuated by regular surfing combined with exercise that includes aerobic, strength, and flexibility training.
It is important for the weekend surfer to complement surfing with other aerobic sports,such as swimming, cycling, jogging, rowing, or dance, in order to achieve idealcardiovascular protection. This is the principle of cross training, which is based on theidea that no one sport is complete.
One of the most common diseases related to aging is arteriosclerosis, or the deposit of fats on arterial walls. It begins early, in babies, and progresses with age. There is truth to the saying: “The age of a person is determined by the age of his or her arteries.” The more fat on the arterial walls, the greater the difficulty blood will have in reaching the different portions of the body, in particular the heart and the brain, leading to premature aging.
Illustration 1: Increased fat deposits on arterial walls increase the risk of heart attack and stroke.
Arteriosclerosis, also known as chronic degenerative disease, is a leading cause of death. It is most severe among people 50 and older, when heart attack and stroke are most frequent.
With an increasing number of surfers over 50, the prevention of fatty deposits in the arteries is essential so that those who love the waves can continue to surf.
The principal risk factors for the deposit of fat on arterial walls are:
Modern medicine has confirmed that it is possible to reduce the amount of fatty plaque on arterial walls by adopting a lifestyle that most surfers know well and which should include
Surfing regularly, in addition to reducing sedentary habits, combats obesity and diabetes, and reduces cholesterol, triglycerides, uric acid and blood sugar levels. It also helps to reduce high blood pressure and functions as a natural tranquilizer (except when there’s a crowd!). It even decreases the desire for alcohol and cigarettes.
Nevertheless, for an aerobic exercise such as surfing to have a protective effect on the body, it should be practiced under the following conditions:
Ari Ciampolini, 74, father of 5 surfers (in memoriam). Hebuilt his first board in the 1960s in Guarujá, São Paulo, ahollow plywood plank, with straight edges and no keels.
In a regular surfing session, a surfer spends 40-50% of the time paddling, 35-40% waiting for a wave and 5-10% surfing.
The average heart rate, during 60 minutes of surfing, is about 135 beats per minute (depending on the individual and the wave conditions). This characterizes surfing as an aerobic sport, which means it’s good for your heart.
Aerobic capacity is the ability of the body to assimilate and distribute oxygen to the muscles. Among men and women, maximum aerobic capacity, known as VO2 max, (see Chap. 25) typically decreases approximately 10% per decade after age 30. This decrease can be attenuated by surfing.
One study found no change in VO2 max over 10 years in a group that trained 3 hours per week at 86% of VO2max. Another study found that age-related loss of aerobic capacity was reduced by up to 50% in men who pursued regular endurance training.
The peak heart rate declines about 0.75 beats per minute per year. However, with training, aerobic capacity can increase in both older men and women.
Morongo, a Brazilian medical doctorand Mormaii owner enjoyingBrazilian power in the early 70s.
Because of their training – and at times genetic composition – athletes, particularly those in endurance sports, have hearts that beat more efficiently and thus fewer times per minute than average people. A low heart rate, of about 70 beats per minute or fewer at rest, normally indicates good health and response to training.
Surfing increases the heart’s efficiency. The heart rate during surfing is a good parameter by which to measure your aerobic endurance.
The peak heart rate declines about 0.75 beats per minute per year. However, with training, aerobic capacity can increase in older surfers.
To calculate your ideal heart rate during training, use the following formula:
Your heart rate when training should be between 65-80% of your maximum cardiac frequency.
For example, if you are 18 years old, your maximum heart rate should be 202 beats per minute. Thus you should exercise at an intensity where your heart rate is between 121 and 161 beats per minutes, or that is, you should be slightly winded, but still capable of speaking. See the table below to assist your calculation.
Table 1. Maximum Heart rate and zone of aerobic training by age
You can monitor your heart rate during training by using a “Polar” monitor strapped with a belt around your chest that sends signals to a special meter that serves as a receiver. These devices usually do not work in the water but offer excellent monitoring during training on land.
If you do not have this type of device, take your pulse manually by lightly placing the index and middle fingers on the wrist or throat, as in the photos below. Count the number of beats in 15 seconds and multiply by 4 to obtain the number of beats per minute.
How to count your heartbeats
Normally, the best moments to take your pulse are
If your pulse at rest is between 50-70 beats per minute this may indicate that surfing is increasing your aerobic capacity by reducing the heart rate at rest. This is good, your heart is working more efficiently!
Attention: If you are older than 30 and decide to begin surfing, running, cycling, or any other sports, you should have a complete medical examination before you begin. This check-up is especially important if you have a family history of heart disease or have been sedentary for a long time, have high blood pressure, diabetes, are overweight, smoke, suffer from stress, tiredness, anxiety, insomnia or have total cholesterol above 200mg/dl of blood. The medical examination will help identify surfing’s effect on medication and other possible side effects. It will check for chronic diseases, osteoarthritis and other musculoskeletal risk factors. A treadmill electrocardiography (“stress”) test is a basic way to screen for cardiovascular disease and test aerobic fitness.
Surfing, as any sport, should be individually modified to allow safe participation bysenior athletes with:
Medical problems requiring multiple medications
Controlled heart arrhythmias
Blood pressure problems
Surfing regularly decreases the risk of death from cardiovascular disease. Nonetheless, there is an increased risk of acute cardiovascular problems during or after strenuous exercise, so senior athletes should “cool-down” after each wave and surf session with a light swim or similar activity.
Life guard stations and emergency medical teams should strongly consider having an on-site automated external defibrillator (AED) at master and senior events for basic life support.
Functional muscle strength, including “core muscles,” are essential for surfing performance and to prevent injuries (see Chapter 24).
With aging, the decline of muscle size parallels the decline of muscle strength. A progressive decrease in muscle size begins in young adulthood. It occurs relatively slowly until about 60 years of age, when the rate of decrease increases.
Functional muscle strength among senior athletes can be positively affected by surfing and a strength and core training program, even those in their 90s.
Morongo, Mormaii pioneer. His healthy lifestyle and positive attitude have not changed at 60 plus years of age.
With surfing, the strength increase is proportionately greater than the increase in muscle size.
It is important to remember that as we age, the years of accumulated microtrauma increases the incidence of tendinosis (tendon degeneration). In addition, senior athletes probably have slower healing, a slower metabolic rate and less effective circulation of oxygen and nutrients. They are therefore at greater risk of injuries, such as strained and sprained tendons.
Although their physiological responses to exercise programs may be slower and less pronounced than in younger athletes, a well-planned training program is often remarkably effective for seniors in decreasing musculoskeletal pain, improving performance and generally improving health and well-being.
Linked to the pleasure of being in contact with the forces of nature, the aerobic component of surfing stimulates the production of endorphins and other chemical substances in the brain that reduce stress and offer a sense of well-being and positive mood changes.
World-famous U.S. surfer and medical doctor, Dorian Paskowitz, has remained active into his 80s. His basic philosophy of life is a total commitment to health.
Older surfers include:
John H. “Doc” Ball was the oldest American surfer when he passed away at the age of 94 in December 2001. He continued to surf throughout his final years. He was also one of the best surfer photographers ever!
LeRoy “Granny” Grannis, 83, was a surfer for 67 years. He was Doc Ball’s best friend.
Woody Brown is 91 and lives in Maui, Hawaii.
Anona Napoleon, a 60-year-old-native Hawaiian, has surfed for 50 years.
Fred Van Dyke, 73, is a pioneer of big surfing waves. He wrote the classic surfing book,
Thirty Years of Surfing the World’s Biggest Waves.
Rabbit Kekai is 81, a waterman and a world-class big wave surfer. He is considered the principal protégé of Duke Kahanamoku, the “Ambassador of Hawaiian Surfing and of the Aloha Spirit.”
In addition to surfing and exercise, good health requires a healthy diet, rest, a good night’s sleep, leisure and a positive mental attitude.
Scientific studies are indicating that a safe and intelligent hormone replacement therapy is a great strategy to keep muscle strength, general health and performance.
To continue surfing until the end of your life, do not confuse the absence of disease with health. Regular exercise and check-ups are important.
Each day that we consciously seek true health is a day in search of life. If we give up this quest, we allow disease to take over.
Morongo and his athletes!
Morongo in Hawaii
9-times WorldChampion first rode on asurfboard when he was a kid nearhis home in Cocoa Beach, Florida
The first waves leave a positive impression on the spirit of a young surfer.
Surfing helps the social integration of children and teenagers and stimulates ecological concern. It raises their awareness of the importance of physical, mental and spiritual health.
In locations with strong surf cultures, such as Hawaii, the United States in general, Australia and Brazil, you can find surfers riding the waves with their grandchildren, clear proof that surfing is a sport that can be enjoyed for a lifetime.
While surfing can be practiced into one’s 80s, what is the ideal age to introduce children to surfing?
If one of the parents is a surfer, a baby may ride that first wave by its first birthday, and in extreme cases, while still in the womb.
The first wave
From 1 to 6 years of age, physical activity should be fun and stimulate the development of physical and mental abilities needed in daily activities. These activities should help children develop their aptitude and courage and use their wonderful free time to burn energy.
Healthy children must be comfortable in the water and know how to swim well in order to surf. Swimming is one of the healthiest sporting activities and can begin at six months.
Playing on the beach, building sand castles, contact with the waves and perhaps paddling a small float are the first steps of the young surfer from 3 to 5 years old.
At this early age, it is recommended that parents use a long board for a child to ride his or her first waves. Its breadth and flotation make it easier to push in the water thus allowing the child to quickly stand up and feel the emotion of the first wave.
First board at the swimming pool
From 6 to 12 children should begin lessons to acquire experience and contact with various sports.
Children should be introduced to a range of sports, such as swimming, gymnastics, soccer, tennis, tae-kwon-do, basketball, track and field, skating, cycling and, of course, surfing. Each child’s physical abilities should be respected and participation should be encouraged without pressure.
Fortunately, there are many surfing schools that can help children to train and play safely.
Children who choose to participate in organized surfing competitions should be advised to engage in a variety of activities that they enjoy and delay sport specialization until adolescence.
However, in sports such as gymnastics, diving, figure skating, and more recently even surfing, children often specialize at a very early age to gain command of the required skills.
We recommend that young surfers participate in other activities to get all the benefits from a cross-training program.
Kids playing near theMormaii Training Center:“Aragua”,Praia Mole,Florianopolis Brazil
Strength training may make a critical difference in preventing injuries for those children who specialize in surfing at an early age. Strength training is particularly important for the child who has previously been relatively inactive and then begins intensive sporting activity.
All of the musculoskeletal structures —the bones, musculotendinous units, and ligaments —must gradually and progressively adapt by gaining strength and size to support the demands placed on the child’s body. Increased strength occurs mainly from neuromuscular adaptation, and there is little hypertrophy of the skeletal muscle. A strength-training program for children must be well supervised. Many sport injuries in children can be prevented by a program that combines strength and flexibility training. In addition to improved performance, the goals of a youth strength-training program are learning safe strength training principles, improved balance and proprioception, and injury reduction.
We encourage core training exercises that use the child’s own weight, such as push-ups and pull-ups, or exercises using balls to balance on, which increase challenges because of the instability.
It is best if the strength-training program is part of a conditioning program with specific phases. The components of the conditioning program should vary in intensity and volume during the year. Other components of the conditioning program typically include flexibility and aerobic and anaerobic training (see Chapter 24).
Those who coach or provide healthy care for prepubscent children who exercise in hot or cold conditions must always be aware of how a child’s response to these environments differs from that of an adult. Children have greater skin surface area relative to total body mass than adults. Therefore, they are more susceptible to developing hypothermia and hyperthermia.
A good, warm and flexible wetsuit will help to prevent hypothermia (see Chapter 16)
Young children also do not have fully mature thermal regulatory mechanisms, and the intensity and composition of their sweat is different from adults. Children often do not feel thirsty until they are quite dehydrated, so they must be encouraged to drink during exercise, long before they begin to feel thirsty. Furthermore, children proportionally generate more thermal energy than adults due to relative physiological and metabolic inefficiency.
Their gait mechanics are not yet mature, so they typically expend more energy for a given amount of surfing, compared with adults. The best treatment for illness or injury caused or exacerbated by the heat is prevention. Adequate hydration is key.
Surfing encourages a comprehensive development of a child’s growing body, increasing aerobic capacity and motor control. The objective in this period of life is to make a child a complete athlete, and not a precocious surfer, because despite good flexibility, muscular strength, power, concentration and stamina for prolonged activity still need to be developed. Despite the overall benefits, the risk of muscular imbalance, which can cause chronic back problems in the near future, is critical to consider, and a progressive core training program must be initiated as soon as possible to develop trunk stability (see below).
Unilateral sports, such as soccer, tennis and volleyball stimulate asymmetrical development; that is one side of the body becomes more developed than the other. This may lead to postural imbalance and musculoskeletal problems. In these sports, compensatory and muscular equilibrium exercises are important for the treatment and prevention of these alterations.
In tennis, for example, the fact that a child uses only one arm to play over years of training and competition can lead to a discrepancy in the size and length of one arm in relation to the other, with disproportional development of the musculature and loss of elasticity and flexibility. In grave cases, this can cause accelerated degeneration of the joints and deformation of the spinal column.
Prepubescent children have more joint laxity and often more musculotendinous flexibility than adolescents and adults. They rarely sustain musculotendinous strains. However, patellar tendon and Achilles tendon pain are not unusual among jumping athletes (who may have both problems) or kicking athletes (who often strain the patellar tendon). The weakest link in this age group is most often the growth plate rather than the ligament.
Tennis player – Bruno Rosa
The physis (growth plate) can be three to five times weaker than adjacent connective tissue structures, depending on the rate and phase of growth.
Fractures of the growth plates can be difficult or impossible to recognize on simple x-rays, so a careful clinical examination is needed to rule out these diagnoses before allowing a return to surfing and to provide appropriate immobilization until healing is complete. Surfing injury rates increase with age throughout childhood. Increasing specialization in surfing at a younger age seems to be related to increased injury rates, particularly from overuse injuries, among prepubescent athletes. Greater volume and intensity of training appears to increase the risk of injury among children and adolescents.
Young Cayman surfing. Surfing is a fun andcomplete sport that encourages symmetrical andtotal growth of a child’s body.
From 12 to 15 years of age, a child enters puberty and experiences an explosion of sexual and growth hormones. There is a significant increase in muscular mass, height and weight.
While boys gain muscle mass due to the effects of testosterone, girls gain both lean body mass, as well as fat. As a consequence, from ages 6 to 18, the “average” (50th percentile by age) boy increases his body fat percentage from 10% to 13% while the average girl increases hers from 14% to 25%. Athletic adolescent males typically have 5% to 12% body fat while most athletic adolescent females have 16% to 18%.
But bones grow relatively faster than muscles and tendons. This “mismatch” is particularly notable with muscles that cross 2 joints, such as the hamstrings, rectus femoris, iliotibial band, and gastrocnemius, significantly reducing the flexibility of the adolescent and leading to an increase in sports injuries. Stretching should be stimulated regularly.
Another important factor to be considered by adolescents is concerning decreased strength of growth plates and adjacent bone at periods of fastest growth (near peak height velocity) and the risk of increased injury.
The mechanism of avulsion injury is typical among teenage surfers. It is most often a sudden violent muscular contraction, during a surfing maneuver or a wipe out followed by a movement like a leg split.
The youth may have pre-existing pain in the region of the apophysis (the special area in the bone where a tendon is attached) from repetitive or chronic injury before the avulsion injury occurs.
Treatment includes determining and removing the cause of the injury (tight muscle, biomechanical abnormality, incorrect technique (too much intensity or repetition for the tissues to adapt), active rest, and appropriate rehabilitation. In addition to traction injuries to apophyseal growth plates, repetitive stress may also injure a growth plate that is responsible for longitudinal growth.
Adolescents must also pay attention to weight control for psychosocial reasons, as well as avoid substance experimentation and abuse.
At this age, it is important to develop a team spirit through group participation, broaden respect for sports and their rules, team members and competitors, and learn to work towards a goal.
Brazilian WCT star Neco Padaratz, who wasaround 12 years old, receiving an award fromEdson “Ledo” Ronchi and Morongo.
The importance of surfing should be emphasized in schools as a type of physical education for children of this age who can participate in tag-team type competitions.
Many amateur and professional surfers began to surf at 12 to 15 years old. A fun board or a mini-Malibu fascilitate learning, but small boards are most common.
Neco Padaratz, a Brazilian surfer who has spent many years on the WTC circuit, began to play with a Styrofoam board at the age of 8 and had his first surfboard at 10.
Surfing encourages respect for the ocean and its forces, an awareness of the need for good eating habits and good physical health. Getting up before the sun with friends to be the first to surf at the peak, and the first surf trips are great experiences for a young surfer.
Surfing integrates teenagers with their community and awakens and strengthens their social and ecological awareness.
Between 12 and 15, a surfer can begin to specialize. Training will build cardiovascular endurance, muscular strength, speed, elasticity and flexibility, motor coordination and quick reflexes.
Talent hunterNetão and hispupils at theMormaii TrainingCenter, Aragua
ISA-World Surfing GamesParade, International SurfingAssociation
It is in this phase that participation in championships should be encouraged. Fábio Gouveiawas world amateur champion at about 18 years old.
Ian Gouveia,son of Fabio
Brazilian surfing team. World JuniorChampionship, ISA Games, France, 2008
Mormaii Training Center,Aragua, Praia Mole, Florianópolis –Santa Catarina, Brazil
The table below presents a comparison between the initiation, peak and conclusion of participation in different competitive sports and illustrates certain characteristics and particularities of each sport, including surfing.
Table 1. Sport, initiation, peak and concluding age.
Note: The ages in this table are averages and not absolute. There may be variations and exceptions.
Like Olympic gymnastics, competitive surfing has had increasingly younger initiation ages, with the youngest beginning at about 5. Nevertheless, the average starting age is 6 to 10.
A surfer reaches peak performance at about 25 to 28. This is about the average age in terms of peak performance for psycho-motor, mental and technical development. A competitive surfer’s career usually concludes at around age 30 to 36.
Kelly Slater competed for his 9th world surfing title at age of 36. Layne Beacheley, 36, seven-time ASP Women's World Champion, has been on the tour for 18 years now!
In Olympic gymnastics, the peak age is about 14 to 16, and a career ends at about 18 to 20. It is clear that surfing has one of the earliest initiation and latest termination ages among all sports. In other words, it can be enjoyed in good health for the longest amount of time.
There are obviously individual variations among surfers and athletes of other sports.
Despite the many physical and psychological benefits that surfing offers to the development of children and teenagers, the long hours of competitive practice can cause attrition to the spinal column in the region of the intervertebral discs, in addition to premature aging of bone structure (see Chapter 6).
The most common postural imbalance problems found in young surfers include:
Excessive stress on the lower back caused by surfing initially leads to a progressive muscular imbalance characterized by a swayback or lordosis posture (see Chapter 6). This is caused by tension in the lumbar and rear thigh muscles that become shortened and weak, while the abdominal muscles, if they are not well developed, become even weaker (especially the lower ones). If this muscular imbalance is not corrected, excessive pressure is transmitted to the intervertebral discs and can cause compression of these shock absorbers, leading to disc dehydration and degeneration, and possibly even herniated discs. The pressure may also affect the joint cartilage, causing degeneration and arthrosis.
This condition is frequently aggravated among athletes who do not stretch and among teenagers who have rapid bone growth and whose muscles and tendons do not accompany this growth. The repeated movements that rotate and compress the backbone progressively strain the region.
It is therefore essential to correct this muscular imbalance to prevent back pain. I recommend a core training program based on the Pilates method in order to correct the muscle imbalance and develop trunk stabilization, coordination and motor control. It will also help prevent the most common surf injuries.
Long hours exposed to the sun during a surfer’s life is a risk factor that must be considered. The regular use of sun protection to prevent premature aging and skin cancer is of extreme importance (see Chapter 17).
For children who are beginning to surf: Never surf alone, always have someone on the beach to supervise, avoid crowds, and respect the order of priority on the waves.
Gabriel Steinman takinghis first stepson a board
Great sport for socializing:Rodrigo Steinman andfriends getting ready
Young, talented surfer
The most common surfing accidents and injuries, and their prevention
Surfing is comparatively safer than most sports, so parents can let their children practice with few worries.
Surfing is one of the most complete sports. It combines aerobic and anaerobic activity of moderate to high intensity.
The risk of collision comes principally from the contact of the surfer with his own board, another surfer or with the sea bottom (sand, rock or coral).
Surfing requires a high level of neuromuscular ability and involves movements of the upper and lower limbs, the abdomen and the spinal column.
Some people associate surfing with danger because it is practiced in the ocean, which at times can be hostile, and surfers are exposed to wind, sun, rain, cold, different types of ocean bottoms, wave size, tidal variations, currents, sharks and other elements.
Yet surfing has a much lower risk of accidents than other so-called extreme sports, such as skateboarding, windsurfing, kitesurfing, parachuting, hang gliding, paragliding, rollerblading and snow skiing.
A number of studies conducted in the United States compared injuries related to surfing and other sports, and found that in a single year, there was a tremendous difference between the rate of injuries in surfing, 9,900, compared to 38,000 in squash, 137,900 in skateboarding and nearly 1,370,900 in American football.
The reality is that traditional amateur and recreational surfing is safe. Despite the growing popularity of surfing and changes in board design that have made them faster, allowing surfers to perform powerful maneuvers, there has not been a significant increase in the rate of injuries in the past 15 years. However, there have been changes in the types of injuries.
A study conducted in Victoria, Australia by Brian Lowdon in 2005 found less than one injury per surfer per year (0.26 injuries/surfer/year) – an injury rate that has been quite stable over the past 6 years.
In a study I conducted in collaboration with the Sports Center of the Federal University at Santa Catarina, Brazil (2003), the rate of injuries that prevented an athlete from surfing for one or more days or that required medical attention was 2.5 per 1,000 surfing days, which is even less than that found in Australian studies conducted by professor and surfer Brian Lowdon (1983), which found 3.5 injuries of moderate to grave severity for every 1,000 days of recreational surfing and 4.0 injuries per 1,000 surfing days for professional surfers.
In a study conducted among competitive surfers in 2007, Andrew Nathanson found 6.6 acute surfing injuries per 1,000 hours of competitive surfing and 2.9 injuries per surfer per 1,000 heats. The risk of injury is more than double in large waves.
The injury rate in moderate waves is much lower than that found in parachuting, soccer, rugby kitesurfing and snow skiing as seen in Table 1.
Table 1. Rate of moderate to serious injuries in different sports
Injuries per 1,000 days of training or play
Research among U.S. student athletes revealed that wrestling and volleyball are among the sports with the highest rates of serious injuries as shown in Table 2, which indicates the number of injuries per 100 athletes, during a year, in different sports.
Table 2. Indicates the number of injuries per 100 athletes, during a year, in different sports.
Track and Field
Changes in board design since their initiation in Polynesia have changed the type of injuries found in surfing. The weight of the first boards made them difficult to maneuver and most surf injuries in the first half of the 20th century were related to bangs from the boards and being dunked by waves.
Sketch at the Bishop Museum in Hawaii titled: Surf Swimming by Sandwich Island. Many legends and songs tell of the spectacular achievements of male and female surfers.
Hawaiian surfer in the late 19th century
The beach boys of Waikiki, including the ambassador of surfing, Duke Kanhanamoku Photo: Herb Wetencamp
Members of the Palo Verde Surf Club, the first California club Photo: Dr. Jack Ball
In this photo of Snow Maclister, the danger is focused on the neck region New Castle. 1928.
Wally Froiseth was one of the first to modify the format of the tails in order to prevent slipping
In the 1940s, most boards were still flat and made of solid wood, they were 6 to 10-feet long, heavy and thick, with a flat bottom and slightly rounded edges. They were known as “basic redwoods.” Injuries were caused by boards hitting the body and head. Photo: Dr. Jack Ball
Bob Simmons and Joe Quigg introduced fiberglass. Historic surfboard collection of Rennie Yater
The first balsa boards were thinner, had narrower tails and a “V“ carved on the bottom that allowed the surfer to establish a good angle with the wave and expand the space for the surfer to move. Mickey Munhoz with the “balsa redwood” board San Onofre style. Photo: Jeff Divine
The ability to ride tubes increased with the mono-keels, which provided greater board stability. They allowed new maneuvers but also new possibilities for accidents from lips and wipe outs.
Since the late 1950s, the era of the Malibus and the changes in boards caused by the use of polyurethane blocks allowed surfers to explore new limits.
Over the last 30 years, boards have become smaller and lighter. They have evolved from one to two to three to four keels.
The breakthrough of three fins or thrusters – developed by Simon Anderson – allowed fantastic board stability.
Surfing maneuvers have evolved with boards keels.
Board design changes have created surprising hydrodynamic flow, allowing surfers greater flexibility and more radical movements, markedly changing the repertoire, speed and power of maneuvers and turns. This has increased the risk of serious, traumatic injuries to the head, shoulders, knees and spinal column and the appearance of chronic over-use injuries. The nature of injuries in surfing, in addition to being directly related to the personality of each surfer, result from the changes in surfboard design.
TWIN FINS – (four-time champion) Mark Richards’ generation
The Surfboards of the ‘70s
Shaper creativity and hydrodynamics stimulated the evolution of surfboards Shapers M.Dio; Mark Jakola and Avelino Bastos.
M. Giorgi – Indonesia
Three Fins (thruster) created by Simon Anderson in the 1980s, changed surfboards’ stability and became the most popular
The adventurous spirit and courage of the big riders who search for large waves (at Marvericks, Todos os Santos, Jaws, Teahoopo, etc), which are more powerful and dangerous, and the growing practice of tow-in surfing, have led to more serious wounds and traumas.
Many severe traumatic injuries are caused by the collision of a surfer with the surfboard, with another surfer or with the sea bottom (sand, rock or coral). The most common injuries (see Table 3) are cuts (44%) and bruises (16.9%) followed by muscle and ligament injuries (15.5%), jellyfish stings (8.9%) and broken bones (2.5%). Injuries involving eyes and ears are common. Fortunately, catastrophic injures involving the spinal column and the head or drownings are not frequent, as shown in the table below. Older surfers, more experienced surfers, and those surfing large waves have a higher relative risk for significant injury.
Nathanson’s study among competitive surfers in the United States and Taylor’s Australian study had confirmed an overall low rate of surfing injuries similar to our Brazilian study.
Taylor’s found that lacerations account for 42% of all acute injuries, contusions 13% and sprains and strains 12%. However, he found a higher incidence of fracture (8%) and head and neck injuries (37%).
Andrew Nathanson’s study of competitive surfers found more sprains (39%), lacerations (30%) and dislocations or fractures (11%,). This is related to the high performance powerful and acrobatic maneuvers used by competitive surfers.
Table 3. Incidence of injury by type
In contrast, studies of recreational surfers have consistently found that lacerations, predominantly to the head and lower extremities, are most common.
The observed injury rate at professional contests was 8.7 per 1,000 surfer heats, as compared with 2.7 per 1,000 surfer heats at amateur contests. But the professional contests were, on average, held in larger surf, more often over a hard bottom, and longer in duration.
Most injuries take place when the surfer is riding a wave (62%). A smaller number of injuries occur from board recoil (9%), paddling (7%), getting in or out of the water (6%), or while duck diving (6%) (see Table 4).
Table 4. Moment of injury
Injuries are most common to the lower limbs, head and upper limbs. (Table 5)
Table 5. Injuries to different parts of the body
Similar results were found in the U.S. and Australian studies.
Nathanson found that the most frequently injured body parts were the lower limbs (45.8%) and the head and face (26.2%). Taylor found that 37% of acute injuries were to the lower limbs and 37% to the head and neck.
Cuts and bruises were most common to the feet, arms and legs (see Table 6).
Table 6. Incidence of cuts and scrapes to different parts of the body.
Bruises are more common to the legs, arms and head (see Table 7).
Table 7. Incidence of bruises to different parts of the body
Muscular sprains are most common to the groin. They most often occur when an athlete’s foot slips during a maneuver or when a surfer is hit by a strong lip, which causes an extreme and abrupt stretch of the thigh’s abductor muscle. The lumbar region is affected in 23.4% of the injuries as a result of intense and explosive rotations to the spinal column while surfing (see Table 8).
Table 8. Incidence of muscular strains to different body parts
Injuries to the ligaments more frequently occur at the knees, ankles and shoulders and are most common in tubes, drops, snaps and floaters (see Table 9).
Table 9. Incidence of ligament injuries to different body parts
Eye injuries may occur, and can be serious. Fortunately they are less common when nose guards are used on the boards to cover the pointy board tip.
Fractures represent a small portion of injuries among amateur and recreational surfers (2.5%), however, the incidence increases among competitive surfers – among whom they account for 8.5%. They most often affect the lower limbs (58%), with the leg (tibia) and ankles most commonly affected (20%). But they can also affect the back, nose, arms, feet and teeth.
Dislocations (3.2% of all injuries) were most common to the shoulders and more frequent among competitive surfers (among whom they account for 10.7% of injuries).
“Surfer’s rib” is an isolated fracture of the first rib, which is usually caused by the execution of a lay back.
Fortunately, it is not common for injuries and accidents to threaten a surfer’s life.
It is estimated that grave traumas that require hospitalization occur in one of every 175,000 days surfed. Although they are not frequent, fractured necks and backs can be caused by collisions with a sand or coral bank and can leave an athlete paraplegic or tetraplegic. Fractures, vertebral compression and herniated discs are common after trauma and are more frequent when surfing large and heavy waves.
Grave multiple trauma to the head, multiple fractures, ruptured spleens, and injury to the axiliar artery are not commom. However they can occur – and cause death – but usually this occurs among experienced surfers, who are surfing large waves. This occurred with Tahitan surfer Briece Tacerca, who was killed by the lip of a wave at Teahupoo in 2000.
Fractured femurs are not common in surfers but may occur. This X-ray shows a fractured femur caused by a wipe out of a healthy 25-year-old surfer. It required surgery to place a plate and screw
Teahupoo, Tahiti, some of theworld’s most dangerous waves
Approximately eleven surfers have died while surfing the Pipeline over the past 10 years and there have been hundreds of serious injuries. Head trauma, with contusion and lacerations are quite common.
To mention a few injuries: Tamayo Perry received 50 stitches in his scalp and Australian Steve Clements came close to drowning. The Tahitian-born Malik Joyeux, a Teahupoo specialist, drowned at Pipeline, most likely due to a head contusion, caused by a blow from the lip.
These kinds of accidents at Tahiti, Pipeline and other spots have raised discussions about the use of a helmet when surfing peaks with dangerous banks. In 2000, Neco Padaratz was probably saved by his helmet when he struck the reef at Teahupoo.
Although head injury accounts for a considerable proportion of total injuries when surfing, very few surfers wear protective headgear.
There has been a heated debate about the use of helmets, but there is no doubt that they can save lives in certain situations. They help avoid cuts and bruises to the head and reduce the intensity of contusions and the possibility of a “knock out” that can lead to drowning.
Many surfers argue that the phenomenon of deceleration, known as whiplash to the head and neck, caused by using a helmet during a wipe out, is not a threat.
Neco Padaratz in Teahupoo
Nevertheless, because of the potential risk of death from head wounds, surfers should consider the use of protective headgear, especially when surfing near stone or coral reefs. In addition to a helmet, a surfer should try to protect oneself from the board during a fall by getting into a fetal position.
When using a helmet, be careful when “duck diving” and keep your forehead close to the board, because waves can fill the helmet with water and force the head back.
Some characteristic surfing injuries include:
Drownings, which may occur among unprepared or poorly trained surfers.
Jellyfish stings were responsible for 8.9% of injuries. They usually affect the upper limbs.
Perforated ear drums can be caused by direct trauma to the ear drum when hitting the water during a wipe out.
Skin injuries, such as rashes or irritations, due to friction of the chest and abdomen with paraffin are frequent in the summer and spring. Irritations to the neck and underarms are also frequent due to friction of the skin with wetsuits.
Injuries caused by lightning can occur while surfing. Do not surf when there is lightning nearby.
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