Since its inception, hundreds, or perhaps thousands of years ago, when the first person laid on a wooden plank and rode a wave to shore, the sport of surfing has been in a continuous state of evolution. The heavy wooden boards ridden by ancient Hawaiians were eventually modified to include a single tail fin. Boards became lighter with the adoption of Balsa, and then fiberglass. More hydrodynamic, thinner, sharper fins were designed. Shorter, more maneuverable boards were developed, as was the leash. One fin became two fins, and eventually thrusters and quads. Surfing begat skimboarding, then windsurfing and kiteboarding. Foils, first developed for other forms of watercraft have since been adapted for surfing, opening up a whole new realm of wave-riding possibilities.
As board designs and riding styles have changed, so to have the injury patterns associated with the sport. In his 1971 chapter on surfing injuries (Encyclopedia of Sports Science and Medicine, MacMillan & Co), Blankenship notes that the injury pattern seen among surfers during that era “might well be duplicated by placing a [person] in a 3-foot barrel, adding 1 or 2 rolling pins of 15-20 lbs. mass, sealing the barrel, and rolling it at 15-20 mph.” In other words, mostly blunt-force injuries that are randomly distributed. With increasing adoption of smaller and lighter pointy nosed thrusters with their sharper and more numerous fins, lacerations became much more commonplace. Widespread use of leashes decreased the number of injuries caused by other people’s boards, and likely decreased the incidence of drowning, but increased the number of injuries from one’s own board. Aerial maneuvers and more aggressive turns made possible by the short board era increased the prevalence of knee and ankle injuries which had been relatively rare among surfers in previous generations.
Now foils, with their long, sharp wings and mast, as well as higher top-end speed may harbinger a whole new set of surfing related injuries. Non-foilers have already sounded the alarms, much in the same way they did with the introduction of the SUP. In this edition of Surfing Medicine we explore some of these injury trends. Tcheyan describes a midshaft femur fracture sustained by a kite boarder, and our editorial staff present a case of a foiling injury to the foot. While surfing-related injuries remain relatively uncommon compared to other traditional and ‘extreme’ sports, and many can be avoided, they do keep us surf-docs in business!
On a more positive note, we review a study by Berg et al titled Characteristics of surfers as bystander rescuers in Europe, which finds that the vast majority of experienced surfers have performed in-water rescues, undoubtedly saving numerous lives. A touching memior of 30-years of SMA conferences and the positive influence they have had on one Aussie’s life is put forth by Stephen Titus. After reading Stephen’s article you can’t help but sign up for the next SMA conference in Tavarua, the Baja, or beyond – after negotiating the travails of the COVID pandemic this last year and a half, you deserve it!
With much Aloha.
Andrew Nathanson, MD, FACEP, FAWM
