Pilates for surfers: paddling shoulders and the lower back, the pop-up, balance, the hips and ankles, what the evidence shows, and a routine

Surfing is mostly paddling

Contest surfers paddled for about half the time and rode waves for 4%. Paddling was the commonest cause of injuries that build up over time (37.1%) and of shoulder injuries (57.68%).

Sources 1, 2, 3

No Pilates study in surfers

We found no Pilates or yoga study in surfers, and no trial of any programme to prevent surfing injuries. Pilates is an addition to the strength, paddling and warm-up work on our surfing page.

Sources 4, 5

The back of the shoulder, not more stretch

Surfers with sore shoulders tend to lack outward-turning range and strength, the opposite of throwers. Pilates can train the shoulder blades and the back of the shoulder.

Sources 6, 7

Keep back extension short

Paddling already holds your back arched. A rare spinal cord injury, surfer's myelopathy, follows long back arching in beginners; one review names Pilates among back-arching activities, though no case after Pilates has been reported. Skipping Pilates back extension on a learning day is our suggestion.

Sources 8, 9, 10, 11

Strength and paddling have the evidence

Five weeks of heavy pull-ups and dips made surfers paddle faster, pop-up speed went with upper-body strength, and paddling intervals in the water improved paddling. Pilates goes beside that, on flat days or after a surf.

Sources 12, 13, 14

The sea first, and no breath-hold practice

Rips, cold water and the seabed decide outcomes more than any exercise; the warning signs below give the RNLI's and Swim England's advice. Pilates breathing isn't breath-hold training, and breath-holds don't belong in the water.

Sources 15, 16, 17, 18

Mostly paddlingStrong evidence

In 42 contest heats, world-class surfers paddled for 51% of the time, sat still for 42% and rode waves for 4%; New Zealand contest surfers paddled for 54% at an average 64% of their maximum heart rate, and recreational UK surfers paddled for 47% of a session. Paddling is done lying face down with the chest lifted and the back muscles working.

Sources 1, 19, 20, 8

Sudden injuriesEmerging evidence

Across 19 studies, cuts and other skin injuries were 46% of sudden injuries, and being hit by your own board the commonest cause (38.6%). Australian surfers had 1.79 major injuries per 1,000 hours, most often to the shoulder, ankle and head; competing, more than 6.5 hours a week and aerials raised the risk. Contest injuries were more likely in overhead waves and over rock or reef. In UK surfers, the head was the commonest site and 65% never needed professional treatment.

Sources 21, 22, 23, 24

Injuries that build upStrong evidence

Across 20 studies, the back took 29.3% and the shoulder 22.9% of injuries that build up over time, and paddling was the commonest cause. In 1,473 New Zealand surfers, 64% of shoulder injuries and 58% of lower back injuries had become long-lasting, and long spells of paddling caused 40%. In Australian competitive surfers, the lower back was the commonest injured region.

Sources 2, 25, 3, 26

Shoulder dislocationsEmerging evidence

In a Cornwall emergency department, shoulder dislocations were 10% of surfers' injuries that didn't need admission, which the authors called a higher-than-expected rate. The shoulder lines in the warning signs below apply.

Source 27

Heads, necks and concussionEmerging evidence

In US emergency departments over 20 years, the board caused 53% of surfing head and neck injuries and the ocean floor 10%, and concussion was 5% (8% under 20). Of 40 elite Australian surfers, 13 had had a diagnosed concussion, mostly from hitting the water. Surfing has no tested return-to-surf guideline: the International Surfing Association's rulebook only allows a surfer to be removed from competition after an assessment, and we found no concussion guidance from Surfing England, so the UK grassroots guidelines apply.

Sources 28, 29, 30, 31, 32

Women surfers: thin evidenceMixed evidence

Only 19% of injury findings in surfing research compared women and men, so most of this page rests on studies of men.

Source 33

What Pilates offers, and what it doesn't

Pilates trains trunk control, the shoulder blades and the back of the shoulder, upper-back rotation, hips and one-leg balance, on a mat or on spring-loaded equipment. It doesn't supply paddling strength and speed, pop-up power, sea safety or surf skill (our reading).

Sources 34, 35

No Pilates study in surfersStrong evidence

Our searches of PubMed, Europe PMC, Crossref and ClinicalTrials.gov found no Pilates study in surfers; the only hit was a review of surfer's myelopathy that mentions Pilates. No yoga trial in surfers exists either.

Sources 4, 10

Heavy pulling for paddlingEmerging evidence

Seventeen surfers did 5 weeks of heavy pull-ups and dips and paddled faster over 5, 10 and 15 m and over 400 m than surfers who didn't; already-strong surfers gained less. Pull-up strength went closely with sprint-paddling speed, and shoulder strength and range went with faster paddling in 32 surfers.

Sources 12, 36, 37

Paddling intervals and a home programmeEmerging evidence

In 24 teenage surfers, 5 weeks of 30-second intervals cut 400 m paddle time by about 16 seconds, with no group that didn't train. In 22 recreational surfers, a land-based home programme 3 times a week for 8 weeks improved pop-up time and how they rated their surfing; its exercises aren't described.

Sources 14, 38

Core and balance training in surfersMixed evidence

The only core training study in surfers had 19 juniors and no control group; its authors say training on wobbly surfaces is overused by surf coaches. In 32 national-team surfers, suspension-strap and traditional balance training both improved balance tests, suspension training more; the same trial appears in three papers, and no study shows balance training makes people better surfers.

Sources 39, 40

Core training in athletesEmerging evidence

Across sports, core training improved trunk endurance and balance most, and speed and power a little, at low certainty in team sports. It hasn't been tested in surfers.

Sources 41, 42

A warm land warm-upEmerging evidence

In 19 advanced surfers in a cold wave pool, a land warm-up followed by keeping warm raised core temperature and wave scores by about a fifth. It was tested for warmth and performance, not injuries, and our surfing page has it.

Source 43

Stretching doesn't prevent injuriesStrong evidence

Across 25 trials in other sports, stretching didn't prevent injuries while strength training cut them to about a third. Athletes with very flexible joints had about 3 times the odds of a shoulder injury, on low-quality evidence.

Sources 44, 45

Outward turning, not more stretchMixed evidence

Paddling works mainly the muscles that turn the arm in and pull it down. Surfers with shoulder complaints had less range and strength turning the arm outwards, and in 13 competitive surfers the outward turners were relatively weak, more so on the non-dominant side. A review proposes strengthening the outward turners, stretching the inward turners and moving the upper back; it hasn't been tested.

Sources 6, 7

What to work on

Our reading: endurance at the back of the shoulder (Y-T-W raises, band turn-outs, prone swimmers), the shoulder blades (wall angels, scapular push-ups) and upper-back rotation, which elite surfers had more of than people who don't surf (about 64 against 41 degrees). Stretch the front of the shoulder only where it's clearly tight.

Source 46

A loose or dislocated shoulder

If you're hypermobile, don't use mobility work to push further: the NHS says "do not overextend your joints just because you can". See a GP if you think you have joint hypermobility syndrome: for example, your joints keep dislocating, or you keep getting sprains, strains, pain or stiffness.

Stop an exercise, or shrink its range, if you get the feeling the shoulder is about to slip out (editorial).

Sources 45, 47

Paddling arches your backEmerging evidence

Paddling holds the trunk lifted and arched with the back muscles working, and the back is the commonest site of surfing injuries that build up over time.

Sources 8, 2

Surfer's myelopathyEmerging evidence

A rare injury to the spinal cord without any impact, almost always in beginners: in 19 Hawaiian cases, everyone had sudden low back pain while surfing, then numbness and weakness in both legs within 10 to 60 minutes, and 17 were surfing for the first time. Across 64 reported cases, only 42% made a neurological recovery. Lying arched on the board for a long time is the suspected cause, and knowing the signs is the best prevention.

Sources 9, 48, 49

Pilates back extension

One review says the condition covers any activity that arches the back, naming gymnastics, yoga and Pilates. Our search found cases after gymnastics, swimming and weightlifting, and no case after Pilates or yoga. Our suggestion: keep the swan, swimming, double-leg kick and rocking short, and skip them on a day you've spent learning to surf. Get out of the water if back pain starts suddenly.

Sources 10, 11

Teenagers

Back pain that is worse arching back and has lasted more than a couple of weeks can be a stress fracture of the spine (spondylolysis): get it checked.

Source 73

The pop-up is strengthEmerging evidence

Faster pop-ups went with upper-body strength: maximal strength in weaker surfers and fast, dynamic strength in stronger ones. A review found the pop-up and landing both trainable. Pilates can rehearse control in the plank and push-up positions; the power comes from strength work.

Sources 13, 50, 51

Ankles, landings and balanceEmerging evidence

Senior elite surfers had better ankle range and sense of position, and landed more softly and steadily, than juniors and recreational surfers. A screening score built on ankle range, strength and landings was lower in the juniors later injured, in 32 surfers. Better surfers balanced better on unstable support. These are associations.

Sources 52, 53, 54, 55

Legs matter tooEmerging evidence

In 19 professional surfers, jump height and squat strength went with wave speed and heat scores, so surfing isn't only an upper-body sport.

Source 56

What we'd work on

Our reading: the knee-to-wall rock for ankle range, the 90/90 switch, side kick and bridge for the hips, and one-leg balance and the hip airplane for a steady stance, both sides equally.

Pilates breathing isn't breath-hold trainingStrong evidence

Pilates breathing is in through the nose and out through pursed lips while you move. It doesn't train you to hold your breath under a wave.

Swim England says "Do not practise prolonged breath-holding" and "Never hyperventilate": over-breathing lowers carbon dioxide, so the urge to breathe comes late and a swimmer can lose consciousness underwater. The Royal Life Saving Society UK says shallow water blackout can happen at any depth and "the swimmer may experience no warning symptoms prior to the blackout"; breathe normally before going under, don't resist the urge to breathe, and never swim alone.

Sources 57, 17, 18

Fitness, not drillsMixed evidence

In 11 competitive surfers, breath-holding after paddling went with aerobic fitness, and the authors suggest fitness as the training target. Practise slow breathing on land, with no holds.

Source 58

Before a surf

The active land warm-up on our surfing page, not long holds or a Pilates class (our suggestion).

Source 43

After a surf or on flat days

Our suggestion: the 25-minute dryland class once or twice a week, and strength work twice a week built around pull-ups and dips. A hard reformer class counts as training, not rest.

Source 59

Long back extension on a learning day

Keep the swan, swimming, double-leg kick and rocking small and short, and leave them out on a day you've spent learning to surf (our suggestion). No case after Pilates has been reported.

Sources 9, 10

A loose or dislocated shoulder

Leave out the leg pull back, push-up and side bend, which put weight on the arm near the end of its range, until your physiotherapist clears them. Keep the open book's top arm low, and do scapular push-ups on a wall.

Breath-holds

No breath-hold drills in Pilates or in the water, and no fast or forceful breathing before going under.

After a head knock

Only the stages you've been cleared for; rolling, upside-down and head-down moves wait, as our Pilates after a concussion guide sets out.

Someone in trouble in the water

Tell the lifeguards, or call 999 (112 in Ireland) and ask for the coastguard. If a rip takes you, don't swim against it: stay with your board or Float to Live, and raise your hand and shout.

Source 15

Cold water

Water at 15°C or below can cause cold water shock, and the average sea around the UK and Ireland is just 12°C. The sudden cold makes you gasp and can make your breathing up to ten times faster, and heart rate and blood pressure jump, which can cause a heart attack even in young, healthy people. If you go in unexpectedly, take a minute, because the first effects pass in under a minute, and Float to Live. Wear a wetsuit thick enough for your session. Our swimming page has more on cold water.

Shivering, pale, cold and dry skin, blue or grey lips, slurred speech, slow breathing, tiredness or confusion can mean hypothermia: go to A&E (accident and emergency) or call 999. Get them somewhere sheltered, take off wet clothes and wrap them in a blanket, but don't use a hot bath or rub their arms and legs.

Sources 16, 60

After breath-holding in the water

Swim England says anyone rescued after losing consciousness underwater should go to hospital straight away, and anyone who feels ill after prolonged underwater breath-holding should "seek medical advice urgently". Practise breathing on land, and never hold your breath or over-breathe in the water.

Source 17

A head injury

Call 999 if someone has hit their head and has been knocked out and hasn't woken up, can't stay awake or keep their eyes open, has a fit, has fallen from a height of more than 1 metre or 5 stairs, has problems with their vision or hearing, has clear fluid coming from their ears or nose, has new numbness or weakness, has problems with walking, balance, understanding, speaking or writing, hit their head at high speed, or their behaviour has changed. Get help from NHS 111 if they're being sick, feel dizzy or take medicine that thins the blood. If you're told to go to A&E (accident and emergency), don't drive yourself there if you have hit your head.

The NHS says to get help from NHS 111 if, after a head injury, you're being sick, feel dizzy, take medicine that thins your blood, were drinking alcohol or taking drugs at the time, or have any other symptoms you're worried about. See a GP if symptoms last more than 2 weeks, and don't play contact sports for at least 3 weeks.

With a suspected concussion, if in doubt, sit them out. The UK's grassroots guidelines say no sport for at least 24 hours, get checked by a healthcare professional or NHS 111 within 24 hours, follow a staged return, and no competition before day 21; if symptoms last beyond 28 days, stay out of sport and see a doctor. Pilates waits too: gentle breathing and mobility fit the early, light-activity stages; bodyweight strength work can start in the light aerobic exercise stage, which allows "low intensity, body weight resistance training"; and springs, weights and harder trunk work come later (our reading). Our concussion guide has the stages.

A surfer who is dazed after a wipeout needs help to shore and shouldn't paddle back out (our suggestion).

Sources 61, 62

A neck injury after hitting the seabed

Severe neck pain is a red flag that needs urgent assessment, and someone with a suspected neck injury should be moved only by trained professionals. Tingling or pins and needles on one or both sides, problems walking or sitting upright, a sudden "electric shock" feeling, or weak hands, arms or legs need urgent help. Call 999 and the lifeguards, who are trained to get injured people out of the water (our suggestion).

Sources 62, 72

Sudden back pain, then leg symptoms: call 999

Sudden low back pain while surfing, followed by numbness, tingling or weakness in both legs or trouble peeing, can be surfer's myelopathy. The NHS lists back pain with symptoms in both legs, or changes in your bladder or bowels, as a 999 call.

Call 999 or go to A&E: loss of feeling or numbness around the genitals or bottom, new trouble peeing or controlling your bladder or bowels, changes in genital sensation during sex or problems with erections or orgasm, or pain, tingling, weakness or numbness in both legs. These are signs of cauda equina syndrome, which needs treating in hospital urgently. Don't drive yourself.

Source 63

A shoulder that comes out

Call 999 or go to A&E: after a fall or injury, your shoulder looks out of place or has changed shape, you cannot move your arm, or your shoulder is painful, bruised or swollen. Do not drive yourself, and do not try to put it back in yourself.

Your shoulder has partly or fully come out of joint, or you worry it might.

Sources 64, 65

A deep cut from a fin or a reef

Press on it firmly with something clean. Call 999 or go to A&E if the bleeding won't stop, the blood spurts and is bright red, you lose feeling near the wound, it's a bad cut on your face or palm, the wound is very large or deep, or something is stuck in it.

Source 66

Chest pain or fainting: call 999

Call 999 if:

• You get sudden pain or discomfort in your chest that doesn't go away; it can feel like squeezing or pressure, burning or indigestion.
• The pain spreads to your left or right arm, or your neck, jaw, stomach or back.
• You have chest pain and feel sweaty, sick, light-headed or short of breath.
• Someone faints while exercising, can't be woken within 1 minute, or has chest pain or a pounding, fluttering or irregular heartbeat.

Sources 67, 68

Unusual breathlessness

Call 999 or go to A&E (accident and emergency) straight away for severe difficulty breathing (gasping, choking or not able to get words out), a chest that feels tight or heavy, pain that spreads to your arms, back, neck and jaw, lips or skin turning very pale, blue or grey, or sudden confusion. If you're more short of breath than usual, or your heart is racing, fluttering or skipping beats, contact NHS 111.

Source 69

Stop the session if

You feel any pain or become unwell, as the NHS advises for its Pilates videos, and especially for chest pain or pressure, unusual breathlessness, dizziness or fainting. If you have a health problem, an injury or any symptoms, get advice from a healthcare professional, such as a GP, before you start.

Source 70

Before you start

The NHS advises getting advice from a healthcare professional first if you have a health problem, an injury or symptoms, or have recently had a heart attack or an operation.

Source 70

"Surfers only need upper-body strength"Emerging evidence

Paddling is about half a session and pull-up strength goes with paddling speed, but leg strength and power went with wave speed and heat scores, and better surfers had better ankle range, landings and balance.

Sources 1, 36, 56, 52, 55

"Pilates breathing helps you survive a hold-down"Strong evidence

Nobody has measured it, and Swim England and the Royal Life Saving Society UK warn against breath-hold practice and over-breathing, which can cause a blackout without warning.

Sources 17, 18

"Back bends are the best Pilates for surfers"Mixed evidence

Paddling already holds the back arched, the back is the commonest site of injuries that build up, and long arching is the suspected trigger of surfer's myelopathy in beginners. What surfers' shoulders tend to lack is outward-turning strength.

Sources 8, 2, 9, 6

"Balance boards make you a better surfer"Mixed evidence

Balance training improved balance tests in one trial, but no study shows it improves surfing, and the authors of a core study in surfers say wobbly-surface training is overused.

Sources 40, 39

"Pilates prevents surfing injuries"Mixed evidence

No study has tested it, and no programme of any kind has been tested to prevent surfing injuries: a review of surfing injuries calls for research on training to prevent them. For safety in the sea, follow the RNLI's advice on rips and cold water.

Sources 4, 5, 15, 16

"You need a reformer for real Pilates"Mixed evidence

In footballers, mat and reformer Pilates both improved performance tests. Our dryland class needs only a mat, a band and a wall.

Source 71