Surfers Neck


Surfers Neck

With surfing becoming one of Australia’s most popular past times, the rate of injury is rapidly increasing. Due to the physically demanding nature, surfers who enter the water with little to no warm up are prone to the phenomena “Surfers Neck”. The following article details not only injury statistics but also treatment, management and various preventative exercises. This one is a must read for all surfers (from novices to fanatics) and a prevention guide to ensure you will remain in the surf all season.

Injury statistics

Studies of competitive surfers report a general injury rate of 2-13 injuries per 1000 hours of surfing. Most injury statistic research have shown that board con-tact and lacerations are most common causes of in-jury and also that surfing in above head high waves or over rocky/reef bottom doubles injury risk. With re-spect to surfers’ neck, injury prevalence is poorly documented. A review of over 60 recently published surfing injury articles did not discuss this condition whatsoever.

Front quadrant paddling

Diagnosis and treatment

Surfers’ neck is an ‘overuse’ or ‘intrinsic injury’ and is very common amongst surfers over 40 years of age. It is accepted as a degenerative condition of the cervi-cal spine – commonly at the C5/6 level (between ver-tebrae 5 and 6 as highlighted on the computer gener-ated MRI scan). The C5/6 level is a ‘point of fulcrum’ or in other words, where the spine hinges into exten-sion movement. This correlates with the paddling po-sition; lying down and looking forward. As a conse-quence of long term and repeated load, the joints can start to form marginal osteophytes or small boney projections. If severe these boney lips can encroach on the nearby nerve roots and ultimately cause re-ferred arm pain. All of these progressions are associ-ated with neck pain, headaches, muscle spasm and restricted neck range of motion.

Plain view X-rays will show the state of the joints and MRI will show soft tissue involvement including nerve root irritation.


From a biomechanics point of view, these degenera-tive joints have increased accessory glide movement or hyper mobility. This is the key to managing the condition well. The C5/6 hypermobile segment must be protected from repeated force, excessive extension movement and load.

All surfers’ neck presentations are best assessed by professionals including sports physiotherapists. A thorough history is required and whiplash injuries should be noted. A complete examination should in-clude manual spinal joint examination and assessment of shoulder and upper back flexibility to gain a clear picture. There are also some strength tests that are often used with swimmers to make a profile that are relevant to the surfer.

Sensible guidelines and exercises

  • Deload the C5/6 level by im-proving thoracic (upper back) and shoulder flexibility.
  • Avoid high grades of manipu-lation of the neck as this can increase hyper-mobility or lax-ity
  • Strengthen the neck—the deep neck muscles need to be active to prevent ‘spinal buck-ling’
  • Care re poor sitting posture (e.g in front of computer etc) as this accentuates a chin poke posture, upper back cur-vature and round protracted shoulder posture.
  • Improve lower back and shoulder blade strength to lift shoulders while paddling.
  • For Females—Avoid bikinis tying around the neck—’Hive Swimwear’ has a wise variety of well designed functional and fashionable swimwear tops with strap configurations that pass over the shoulders and give optimal support.

Favorite Exercies

Surfers exercises

The purpose of this article is to accurately describe the degenerative nature of ‘surfers neck’ so that bet-ter understanding will facilitate bet-ter self management and allow the avid surfer to enjoy surfing into their 60’s.

Surfing is a great fitness pursuit and lifestyle.

Aloha 🙂

Peter Hogg
APA Titled Sports Physiotherapist Noosa Sports and Spinal Physiotherapy Olympic Winter Institute of Australia – Sports Physiotherapist (avid surfer)

1. Am J Sports Med. 2015 Furness et al. “Incidence rate of acute surfing injuries”
2. Acta Ortop Bras. 2013 de Moracs et al. “Prevalence of injuries in surfing”
3. Wilderness Environ Med. 2009 Hay et al. “Recreational surfing injuries in Cornwell”
4. Am J Sports Med. 2007 Nathanson et al. “Competitive Surfing Injuries”

Peter Hogg

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