Yoga for surfers: paddling shoulders, the pop-up, the lower back, hips and breath-holding, what the evidence shows, and a class

No yoga trial in surfers

We found no trial of yoga, Pilates or stretching in surfers, and no trial of any programme to prevent surfing injuries. Yoga is an addition to the strength, paddling and warm-up work on our surfing page, not a replacement.

Sources 1, 2

Paddling wears the shoulders and back

Contest surfers paddled for about half the time and rode waves for 4%. Injuries that build up over time were mostly in the back (29%) and shoulder (23%), and paddling was the commonest cause.

Sources 3, 4

Surfer's shoulder lacks outward turning

Surfers with sore shoulders had less range and strength turning the arm outwards. A review proposes, but hasn't tested, strengthening the outward turners, stretching the inward turners and improving upper-back movement: yoga's prone holds and twists fit that.

Source 5

Keep backbends short, especially as a beginner

Paddling holds your back arched. A rare spinal cord injury, surfer's myelopathy, almost only affects first-time surfers lying arched on the board. Our suggestion: keep yoga backbends short, and skip deep ones on a lesson day; we found no adult case caused by yoga.

Sources 6, 7, 8

Breath-holding belongs on land, if at all

After 30 seconds of paddling, surfers could hold their breath for about 28 seconds, 79% less than at rest. Over-breathing first lengthens a hold while oxygen keeps falling, which is how blackouts happen. Practise slow breathing on land, and never practise breath-holding in the water.

Sources 9, 10, 11

Stretch after, not before

Stretching didn't prevent injuries across 25 trials in other sports, and long holds just before activity sap power a little. Use the active surf warm-up before, and yoga after a session or on flat days.

Sources 12, 13

Mostly paddling

In 42 contest heats, surfers paddled for 51% of the time, sat still for 42% and rode waves for 4%. In another study they paddled for 54% of the time, at an average of 64% of their maximum heart rate. Paddling works the muscles that turn the arm in and pull it down, lying face down with the chest lifted.

Sources 3, 14

Where surfers get hurt

Across 19 studies, skin injuries such as cuts were the commonest sudden injuries (46%), and being hit by your own board the commonest cause (39%). In UK surfers, head injuries were the commonest (24%), and 65% of surfers never needed professional treatment. In 40 elite Australian surfers, 13 had had a diagnosed concussion, mostly from hitting the water, and drowning caused 58% of Australian surfer and bodyboarder deaths.

Sources 15, 16, 17, 18

Injuries that build up

Across 20 studies, the back took 29% of gradual-onset injuries and the shoulder 23%, and paddling was the commonest cause (37%). In 1,473 New Zealand surfers, 64% of shoulder injuries had lasted 3 months or more, and long spells of paddling caused 40% of gradual injuries. Across 10 studies, paddling caused about 58% of shoulder injuries.

Sources 4, 19, 20

No yoga, Pilates or stretching trialStrong evidence

PubMed found 40 records and Europe PMC 3 for yoga, Pilates, stretching or flexibility with surfing; none was a trial in surfers. A review calls for research into training to prevent overuse injuries in surfing, because none has been tested.

Sources 1, 2

The surfer's shoulder: a proposal, untestedMixed evidence

Surfers with shoulder complaints had less range and strength turning the arm outwards, the reverse of throwers. In 13 competitive surfers, the outward turners were relatively weak, more so on the non-dominant side, and in 32 surfers, pull-up strength and a better balance of outward to inward turning went with faster sprint paddling. The suggested programme hasn't been tested.

Sources 5, 21, 22

Upper-back rotationEmerging evidence

Fifteen elite male surfers turned their upper backs further than controls (about 64 against 41 degrees). That suggests rotation matters for surfing; it doesn't show that training it prevents injury.

Source 23

The pop-up is strengthEmerging evidence

Faster pop-ups went with greater upper-body strength in small studies. Yoga can rehearse the hand and foot positions slowly; it won't build the power, which our surf strength workout does.

Sources 24, 25

Stretching doesn't prevent injuriesStrong evidence

Across 25 trials, stretching showed no protective effect, while strength training cut sports injuries to under a third. Holds of 60 seconds or more just before activity cost about 4.6% of performance, and stretching researchers agree stretching isn't an all-round injury prevention strategy.

Sources 12, 13, 26

More flexible isn't betterEmerging evidence

Athletes with hypermobile joints had about 3 times the odds of a shoulder injury, on low-quality evidence. Strength and control come first for a loose shoulder.

Source 27

What to work on

Our reading of the review's proposal: endurance at the back of the shoulder (prone Y-T-W raises, locust, band turn-outs), upper-back rotation and gentle extension, and a stretch for the front of the shoulder only where it's clearly tight. Our yoga for the rotator cuff guide covers sore shoulders in more depth.

Sources 5, 21

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.

Skip binds and deep shoulder openers, and keep the arm low and in front in chest openers.

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

Sources 27, 28

Paddling arches your back

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 6, 4

Surfer's myelopathyEmerging evidence

A rare injury to the spinal cord without any impact, almost always in beginners: in 19 cases in Hawaii, 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 7, 29, 30

Yoga backbends

One review lists yoga among activities that arch the back and could, in theory, bring this on, but we found no adult case caused by yoga. Our suggestion: keep sphinx, cobra and locust short, leave out long or deep backbends (wheel, bow, camel) on a day you've spent learning to surf, and get out of the water if back pain starts suddenly.

Source 8

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.

Rehearse the shapes slowly

Low cobra puts your hands under your shoulders as before a pop-up, a low lunge practises the front foot stepping through, and warrior II and chair pose practise a low, steady stance. These are shapes, not power: pop-up speed comes from upper-body strength.

Source 24

Ankles and balance

Senior elite surfers had better ankle range than juniors and recreational surfers, as our surfing guide reports. The knee-to-wall rock and one-leg poses fit a yoga class (our suggestion).

No surfing study

We found no study of hip range or hip pain in surfers, and hips were only 4% of UK surfers' injuries. Hip work in our class is for comfort in a low stance, not a proven fix (our reading).

Sources 31, 16

Before a surf: the active warm-up

Short, flowing moves are fine before you paddle out; save holds of 30 seconds or more for after. Our surfing page has a 15-minute land warm-up with hops, jumps and fast pop-ups.

Sources 13, 26

After a surf or on flat days

Upper-back twists, a short sphinx, shoulder-blade holds, hips and slow breathing: our 25-minute class puts them together. Stretch the front of the shoulder only where it's clearly tight (our suggestion).

Nobody has measured hold-downsStrong evidence

We found no study that measured how long surfers are held under in wipeouts, and no trial of breath-hold training in surfers.

Source 32

Paddling cuts your breath-holdEmerging evidence

In 11 competitive surfers, 30 seconds of hard paddling cut breath-hold time by 79%, to about 28 seconds. Fitter surfers held their breath longer after paddling.

Source 9

Breathing drills: small gains, at restMixed evidence

In 27 students, 12 weeks of yoga training lengthened breath-holds at rest from about 32 to 45 seconds, with no comparison group. In 22 novices, 13 days of breath-hold training lengthened holds from 44 to 75 seconds, almost all of it by putting up with the urge to breathe for longer. None of this was tested in water or after paddling.

Sources 33, 34

Over-breathing before a hold is dangerousStrong evidence

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.

In a lab study, over-breathing first lengthened holds from 111 to 133 seconds but let oxygen fall further. In New York, 16 people were harmed by dangerous underwater breath-holding and 4 died, all of them advanced or expert swimmers.

Sources 10, 35, 11, 36

Cold water makes you gasp

In water at 15°C or below, the sudden cold makes you gasp and breathe fast, and the first effects pass in under a minute. Float to Live while they pass (the RNLI's advice).

Sources 37, 38

What to practise

Our suggestion, on land only:

• Slow breathing for a few minutes before and after a surf: in through your nose for about 4, out for about 6, with no holds.
• No breath-hold drills, no fast or forceful breathing (kapalabhati, bhastrika) and no over-breathing before going under.
• Never practise breath-holding in the water, and never alone.

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 39

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 37, 38

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.

Sources 11, 36

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. Yoga waits too: gentle breathing fits the early, light-activity stages, and no head-down poses or inversions until you're cleared (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 40, 41

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).

Source 41

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.

Sources 42, 7

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.

Source 43

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.

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 44, 45

During yoga

A joint pain that is sharp, gets worse during a session, lingers into the next day or changes how you move is a reason to use an easier version, and to see a GP or physiotherapist if it keeps happening (the rule in our plans). Muscle soreness for a day or two after something new is normal. In a hot class, stop if you feel dizzy, sick or unwell; our hot yoga guide lists the signs of heat illness.

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.

"Yoga breathing lets you hold your breath for minutes under a wave"Strong evidence

Nobody has measured hold-downs, surfers held their breath for about 28 seconds after paddling, and breathing drills give small gains at rest. Over-breathing first can cause a blackout without warning.

Sources 32, 9, 10, 35, 11

"Stretching before a surf prevents injuries"Strong evidence

Across 25 trials in other sports, stretching didn't prevent injuries; strength training did. Use an active warm-up.

Sources 12, 26

"The more flexible the better"Emerging evidence

Hypermobile athletes had more shoulder injuries, and the surfer's shoulder lacks outward-turning strength, not stretch.

Sources 27, 5

"Upward dog and wheel are the best poses for surfers"Mixed evidence

Paddling already holds your back arched, and long back arching is the suspected trigger of surfer's myelopathy in beginners. What surfers' shoulders tend to lack is outward-turning strength and shoulder-blade endurance.

Sources 6, 7, 5

"Yoga is what makes you a better surfer"Emerging evidence

No trial shows it. Pull-up strength went with faster paddling and upper-body strength with faster pop-ups.

Sources 22, 24