Surfing combines explosive paddling power, rapid pop-up mechanics, rotational balance, and repeated impact from wipeouts — creating a unique blend of overuse and acute injury risks. Whether you surf the South Florida break recreationally or competitively, Dr. Ezra Miller, PT, DPT provides sport-specific in-home physical therapy to get you back in the water in Boca Raton, Delray Beach, and Pompano Beach.
Common Surfing Injuries
- Rotator cuff tendinopathy / shoulder impingement — paddling is the highest-volume activity in surfing; thousands of paddle strokes per session load the rotator cuff
- Lower back pain — prone paddle position demands sustained lumbar extension; the pop-up creates rapid lumbar load
- Knee sprains / MCL injury — wipeouts and board impact create acute knee torsional stress
- Neck pain — sustained cervical extension in prone paddle position
- Surfer's ear (exostosis) — not a PT condition; requires ENT evaluation
- Lacerations / contusions from board contact — wipeout mechanism
- Ankle sprains — leash entanglement and sand impact
The Paddle-Pop-Up Combination: Why the Back Hurts
The surf back injury cycle is driven by two positions: sustained prone lumbar extension during paddling, followed by a rapid flexion-rotation of the pop-up. For surfers with existing disc pathology or tight hip flexors, this combination becomes a pain cycle that repeats every session.
Effective surf back rehab addresses both the paddle position (thoracic extension mobility, pec minor stretching) and the pop-up mechanics (hip flexor flexibility, explosive hip extension strength). Treating only one side of the equation leads to recurrence.
Return-to-Surf Protocol
Phase 1: Pain Control & Mobility (Weeks 1–2)
Lumbar and cervical manual therapy. Hip flexor lengthening for back extension tolerance. Posterior shoulder and posterior capsule stretching for paddle position. Shoulder rotator cuff assessment.
Phase 2: Strength & Movement Patterns (Weeks 2–5)
Rotator cuff endurance: high-rep, low-load external rotation and Y/T/W exercises. Core: plank variations in prone paddle position, bird dogs. Hip extensors: glute bridges, Romanian deadlifts. Pop-up mechanics: land-based practice on board or mat.
Phase 3: Return to Water (Weeks 4–8)
Start in whitewater (low difficulty), progress to green waves. Volume management: 30-minute sessions initially, progressive extension. Pop-up mechanics check: minimize lumbar stress during pop-up pattern.
Frequently Asked Questions
Can I paddle board while I wait to surf again?
Often yes — SUP is lower intensity for the shoulder and eliminates the pop-up load. It's frequently used as active recovery during surf injury rehab.
I've had back surgery — can I surf again?
Depending on the surgery type and recovery status, yes. Post-surgical clearance from your surgeon is required. Dr. Ezra then develops a sport-specific return-to-surf program aligned with your surgical restrictions.
Ready to Return to Surfing?
Dr. Ezra Miller comes to you — Boca Raton, Delray Beach, Pompano Beach and surrounding South Florida. No waiting rooms. No generic programs. Just expert, one-on-one return-to-sport PT designed around your body and your game.
Call (954) 901-7211 Book a Free Consult