Looking at Surfing Injury Statistics With Dr. Cliff Kapono and Matt Rott

I don’t know about you guys, but as I’ve gotten older, I’ve spent a lot of my free time managing injuries so that I can surf without (or at least with less) pain. The irony of surfing is that it is not only hard on the body in terms of repetitive motion injuries and stress, but it also can result in acute injuries that make it more difficult to surf and do other activities. These injuries nearly always come as the result of wipeouts, whether they involve hitting the reef, the surfboard, another surfer, or even just the water. Lacerations, joint injuries, broken bones, and head and neck trauma can all put us out of the water for long periods of time and make it more difficult to surf at a high level without pain. 

Study Overview

In order to manage my injuries and avoid getting new ones, I do a lot of research about exercises and best practices that I can follow to stabilize and protect my body. One thing I realized, however, is that there are so many different potential injuries I am never sure which ones to prioritize with my management. Fortunately, surfer/scientist Dr. Cliff Kapono recently reviewed a scientific study about the prevalence of surf-related injuries to different parts of the body. He talks about the study on his Instagram account, and Hawaiian South Shore’s Matt Rott (who happens to be close friends with Dr. Kapono) is going to dive a bit deeper and explain the study in simpler terms.

Instagram: cliff_kapono

Trip Context and Relevance

This is an interesting topic, because Cliff and I were actually on a trip together five or six years ago when he got severely injured. We actually had to air-lift him to the capital city of the country we were in, because we thought he had broken his neck. As it turned out, he was okay (well, relatively okay—his neck received mild trauma and he had a big chunk torn out of his head by the reef), and it was a good reminder of the importance of having travel insurance and an emergency plan whenever you are traveling. Anyhow, having been through an emergency like that with Cliff (you actually see a picture of him in a neck brace from that trip in his Instagram video), I know how important this topic is to him, so I’m not surprised that he decided to cover it in a post.

Sampling, Scope, and Limitations

The study that Cliff presents is a stratified aggregation of hospital data drawn from the National Electronic Injury Surveillance System (NEISS), which gives us an average representation of the percentage of injuries to different body parts resulting from surfing or windsurfing and treated in the emergency department. In simpler language, this means that 100 hospitals were selected from across the United States to serve as a representative sample, and all the surf- and windsurf-related injuries that were treated in the ER between 2021 and 2023 were counted and compared to show us which body parts are most likely to suffer injuries. Although this study by Ryan Scheinkman, et al, from the University of Miami School of Medicine (published in Archives of Dermatological Research) doesn’t look at all of the hospitals in the country, the sample is diverse enough that it should provide a comprehensive average.

It is important to note that not all 50 states in the US have active surf and windsurf scenes (largely due to the fact that around half of the states don’t have coastline, wave pools, or bodies of water big enough to support windsurfing populations). Thus, while this is intended to be a representative sample, the number of injuries noted is actually quite low at 126. This is likely also due to the fact that some hospitals in coastal areas are more likely to receive ER visits from surfers than others, both due to the trauma levels of the respective hospitals and their proximity to waves that are more or less dangerous and that have different sizes of local and visiting surf populations. It is entirely possible that the hospitals included in the sample simply do not receive many surf-related injuries, leading to such a small number over the three-year study period.

Key Findings by Body Region

All of that being said, the study provided clear data about the prevalence of injuries to different body parts. Of the 126 injures included in the NEISS data between 2021 and 2023 (which might have included an arm laceration that I suffered at huge Waimea Bay in January 2021!), 54 percent were to the head and neck. This makes sense, since head and neck injuries tend to be traumatic and are more likely to result in visits to the ER. They also appear to be common injuries with surfers, likely due to falling head first into shallow water or onto their boards. 

The second most commonly reported injuries were to the lower extremities, meaning the legs, knees, ankles, feet, and hips. Again, this makes sense, considering the fact that knee injuries are pretty common when riding on moving equipment such as surfboards, as well as the fact that knee injuries such as ligament and meniscus tears are often catastrophic and require hospitalizations.

Credits to the 2024 the International Society of Dermatology | https://pure.amsterdamumc.nl/

The next most common were injuries to the upper extremities, including arms, elbows, and shoulders, at 15 percent. One would think that shoulder injuries make up a majority of these injuries, although there was insufficient data in the study to confirm that research. 

Finally, injuries to the upper trunk (chest and back) came in at 4.8 percent, while injuries to the lower trunk (stomach and lower back) came in at 3.2 percent. The fact that these percentages were lower is likely due to the fact that the trunk is less susceptible to twisting injuries, and largely requires blunt force trauma or lacerations (i.e., direct impact with the board or bottom of the ocean) to result in ER visits, but again, there is insufficient data in the study to support these assumptions.

ER-Only Limitation

One thing to note is that this study only looks at injuries that result in visits to the emergency room, which typically means serious injuries that cause grievous bodily harm. It is entirely likely that other body parts suffer more minor injuries that don’t result in ER visits (such as lacerations, bruises, sunburn, and sea life stings and bites). While this is technically a limitation to the study that can skew the statistics when it comes to total number of surf-related injuries, the study still has value as an indicator of which body parts are most likely to suffer serious injuries, which by definition are more likely to result in extended periods of time out of the water or the impairment of our future surfing performance.

Practical Takeaways

So, what important lessons can we learn from all of this data? The biggest thing is that the most common serious injuries we are likely to experience while surfing are head and neck injuries, followed by injuries to our extremities (likely our knee, ankle, elbow, and shoulder joints). As such, it is a good idea to protect our heads, necks, and joints while surfing, whether by wearing protective equipment (such as helmets), making better choices in waves of consequence (particularly heavy, shallow waves), and being proactive about strengthening our joints to help prevent serious injuries in the case of accidents and bad wipeouts. Hopefully, by taking all of these preventative measures and being more conscious about the risks involved in surfing, we can avoid serious injuries and maximize our time in the water!

PROTECT YOURSELF WHEN SURFING WITH OUR SURF GEARS

Frequently Asked Questions

This FAQ is informational only and not medical advice. See a licensed clinician for diagnosis or treatment.