Having recently read ‘The Surfer’s Shoulder’. We thought it would be a good idea to ‘bite-size’ the information for you, hopefully giving you some key take away points that might help you prevent or resolve your shoulder pain.

‘Surfer’s Shoulder’ is one of the most common surfing conditions we see in clinic. It is thought that 40-60% of time spent in the water when on a surfboard is paddling. This repetitive motion of the shoulder during paddling is more often than not the cause of ‘Surfers Shoulder’.

Paddling consists of two phases: the ‘propulsion’ and ‘recovery’ phase. During the propulsion phase the hand and arm enter the water and pull against the water until its perpendicular under the body. The arm then continues and pushes against the water from directly underneath the body in a backwards motion until the arm starts to withdraw and lift out of the water. At this point it enters the recovery phase. This motion repeats itself several hundred times within a surf session.

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It is thought that 40-60% of time spent in the water when on a surfboard is paddling

During each phase of the paddle, different muscles work to produce the movement.

During the propulsion phase it is internal rotation and flexion (moving to extension) of the shoulder that is the dominant movement, driving the surfer forward. Pectoral major, lattisimus dorsi, triceps and subscapularis are the main muscles that are activating through this range.

During the recovery phase it is the deltoid and trapezius working to retract the arm out of the water. Here, is the only time the external rotators of the shoulder activate, when the arm is out the water to help stabilise the shoulder joint.

It is therefore thought that the tight and strong internal rotators (pec major/subscap) of the shoulder are the dominant muscles working and that there is a lack of strength of the external rotators (supra/infraspinatus and teres minor). This causes an imbalance of the muscles working around the shoulder, potentially causing an upward migration of your arm bone into your shoulder joint that can result in pain.

surfer with shoulder injury image of
The repetitive motion of the shoulder during paddling is more often than not the cause of ‘Surfers Shoulder’.

This however isn’t the only reason for ‘Surfers Shoulder’. A lack of thoracic extension can also be a culprit to causing shoulder pain. Throughout our paddling, thoracic extension should be maintained to allow correct positioning of the scapular which creates optimal overhead range of movement of the shoulder. With a slouched posture and stiff upper back, trying to repetitively paddle will inevitably cause pain.

It’s not all doom and gloom however. With the right exercises and a bit of time taken each day to perform them, you should be able to balance out your shoulder strength and flexibility as well as improve the mobility of your upper back.

Shoulder strength, prone W L T Y image of
Scapular retraction training combined with external rotator strengthening
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External rotation strength of the shoulder using dumbells

These exercises help with the endurance of thoracic extension and the strength of the rotator cuff muscles.

We recommend starting with W and progressing through L, T and Y as able. You can hold these postures for 30’s to begin with, building to 90’s and repeat each one 3 times.

External rotation with dumbells: chose a weight thats not too light or too heavy. Normally we say the right weight for you is when you are able to achieve 8-10 reps with the last few reps being a bit of a struggle without losing form (very important!). Repeat this for 10 reps and repeat for 3 sets.

Both these exercises should be done daily.

Happy Surfing!


1. The Surfer’s Shoulder: A Systematic Review of Current Literature and Potential Pathophysiological Explanations of Chronic Shoulder Complaints in Wave Surfers’ by Langenberg et al (2021) - Surfing Medicine International.