Marc Adams, DO graces us with excerpts from his soon-to-be published book Surf Stronger, Paddle Longer. Marc presents a compelling, unique, and somewhat unorthodox treatise on human biomechanics and the physical and emotional flow of surfing based on osteopathic teachings and the Alexander technique. If you’d like to learn how to avoid the destructive forces of gravity and the “Stiff Brain Syndrome” and want to continue surfing into a ripe old age, read on!
Surf Stronger, Paddle Longer: A new approach to advance your performance, avoid injuries, and surf and standup paddleboard for a lifetime – by Marc Adams, D.O.
(Part 1 of a 2-part series for Surfing Medicine using excerpts from Chapters 1 and 4 of the manuscript for Surf Stronger, Paddle Longer)
Chapter 1 – Introduction
Surfing is a sensuous sport. Being at the beach riding waves creates youthful feelings of exhilaration. Surfers and standup paddleboarders agree they want to continue their sports as long as they live because they love the sensations. Many individuals have attempted to describe these sensations in words, in photographs, in paintings, and in sculpture. Few have tried to capture the feeling through movement. None have been able to replicate and perpetuate the sublime sense of well-being via a scientifically sound application of movement patterns that will help improve athlete’s surfing and standup paddleboarding performance, help them avoid injuries, and improve their health until now. The Surf Stronger, Paddle Longer approach delivers the elixir of every surfer’s and standup paddleboarder’s life by delineating a clear method for proper body mechanics. This is the user manual for the human body for surfers and standup paddleboarders.
Balance, fluidity, buoyancy, freedom, weightlessness, expansiveness, ease – these are some of the words surfers use to describe the sensations of the sublime act of riding waves. Maybe you have even experienced sensations of a deeply spiritual nature. These are the sensations that would be nice to feel continuously.
These experiences are rare in other sports and most other recreational activities, but are almost universal among surfers and stand-up paddle boarders. Reflecting these same thoughts, legendary Hawaiian surfer Gerry Lopez wrote something similar in the Summer 2012 issue of Stand-Up Journal (page 78). Describing a standup paddle-surf trip with some long-time friends to Baja California he wrote “… What is that stoke, that incredibly strong feeling that comes from a small, simple thing like a good turn or cutback, a brief tube ride, or even just the sight of a nice section on an empty wave as one is paddling back out? It may be some kind of chemical, emotional thing – or maybe its deeper than that? I like to believe that we tap into an inner space on a spiritual level in some way…”
Since I was a teenager sitting in class doodling perfect waves I have had a few questions about these surfing experiences:
- How can I recapture that indescribable feeling more often, even in my everyday activities?
- How can I be a stronger, more fit surfer to be able to maximize my sessions when a swell does arrive?
- How can I avoid injuries and strain so I can surf and paddle into old age?
After 30+ years of surfing both U.S. coasts and internationally these questions have become more important to me. As life accelerates and the joyfully difficult responsibilities of a career and parenthood commence, for most surfers, answering these same questions also becomes more pressing. This book will answer these questions presenting a unique approach to your wellness not only as an athlete but also as a parent, student, sibling, spouse, coach, coworker, and co-inhabitant of our planet.
In the 1994 sequel to the classic surf movie “The Endless Summer”, Pat and Wingnut travel to Costa Rica. Bruce Brown narrates a segment about one of the aging stars of the original 1966 movie and states “Robert (August) owns a little piece of property nearby and plans on living there, as he puts it, Forever, or until I die, whichever comes first.” This statement also implies “surf forever”, and that is the driving force of this book. How can we 1) stay fit 2) avoid injuries to be able to surf and stand-up paddleboard to 3) re-experience the beautiful sensations forever?
There are now more surfers and stand-up paddle boarders than ever before. There are more competitive events for more professional surfers, more surfers riding more types of boards, more aging surfers, and more surfers riding waves in extreme conditions. There are more stand-up paddleboarders with many varied reasons for starting the sport such as exercise, competition, preventing boredom when the ocean is flat, or simply having an activity to share with family and friends. Nearly 100% of the surfers and stand-up paddleboarders I meet express the same sentiment as Robert August had – they want to surf/standup paddleboard forever. Injuries from poor technique can halt a competitive career, and could even curtail what could otherwise be a long life of surfing and paddling purely for pleasure.
In my medical practice and while listening to surfers and stand-up paddle boarders in the water and on the beach I hear enthusiasm about their board riding, but I also hear physical complaints of neck pain, shoulder problems, low back pain, headaches and also knee, wrist and hand strains making these sports less enjoyable and at times impossible to continue. Earlier in my career as a physician I thought these physical problems were just an unavoidable part of such physically demanding activities and an inevitable consequence of aging. I had also thought these were likely not even the direct result of surfing or stand-up paddleboarding because these are the same common musculoskeletal ailments seen in the general population.
However, in the course of my medical training and practice I came across several approaches to health and movement that strongly influenced my day-to-day practice and also led me to reexamine the mechanics of surfing and stand-up paddleboarding. Over 20 years ago, as an undergraduate student, I worked as a Physical Therapy Aide and learned the fundamentals of a biomechanical view of musculoskeletal ailments. In medical school I deepened my knowledge of biomechanics and manipulation and also began to learn a philosophy of vitalism in Osteopathy embracing the spiritual aspects of an individual’s health. An Osteopathic mentor of mine inspired me to study Homeopathy and apply those principles to the energetic components of a person’s constitutional makeup. I learned from delving into theories and experiences with acupuncture, mindfulness meditation, structural integration, chakra work through Reiki, Tai Chi, Qi Gong, and the flowing forms of yoga. I was then led to behavioral optometry that showed me how even subtle changes in our sensory systems, such as minor adjustments in prescription lenses, can lead to health or disease. After all those years of continuous research and revision of my care for patients I still felt lacking in organization for applying all of these great ideas to surfing and standup paddleboarding until I immersed myself in the study and practice of the Alexander Technique. It is a beautifully practical way to learn how to change destructive habits of moving and thinking. It also provided a framework for a teaching method to be applied to surfing and standup paddleboarding.
I will further describe these influences throughout this book, but the point here is it became clear to me the way surfers and stand-up paddleboarders use their body very often directly leads to health and performance problems. More importantly, it also became clear someone can be taught to correct the use of their body to surf stronger, paddle longer, and surf “forever, or until you die, whichever comes first”. It also became clear that applying this combination of approaches produces the same physical sensations as surfing and stand-up paddleboarding – balance, fluidity, buoyancy, weightlessness, ease, peace – even when not surfing or paddling, and its application can be learned from written instructions such as are provided in this book.
There is an inherent mechanism in our bodies programmed for balance and a smooth, easy motion of the joints. To create an image of this innate tendency toward poise, consider an infant or toddler you know and picture his/her movement. When you observe a child go through the developmental stages of crawling, sitting, standing and walking you can’t help but wonder, “How does that kid hold up that huge head?” It is certainly not with muscular strength. It is with balance. It is from following and not interfering with the body’s natural abilities. Why do children so infrequently have back pain when you can clearly see that they violate every reproach of doctors, physical therapists and personal trainers by walking around with their big bellies sticking out like Joe Sixpack with no tightening of their core muscles whatsoever? (See Figure 4.6a and 4.6b)
Figure 4.6a
Figure 4.6b
Figure 4.6a and 4.6b: How do you bend down to pick up a sippy-cup full of milk? This is proper use. Her spine is lengthened, she is giving full attention to the task at hand in that moment. Every part of her body is engaged, and forces are distributed equally throughout her body. She does not need to tighten her “core” to do this. See if you can do the same.
Most current approaches to physical fitness emphasize core strength to the point that makes you believe that if you don’t tighten your abdomen 24 hours per day then your spine will disintegrate. In later chapters about exercise and about low back pain we will discuss more in depth why that is not true and why that approach has not seemed to decrease the incidence of low back pain which in the US has been conservatively estimated to occur in over 80% of adults over their lifetime. We will also discuss why that view may actually be responsible for causing back pain and a myriad of other dysfunctions. This book will demonstrate how to rediscover the even distribution of forces evident in most children which allows for such effortless movement patterns. That balance and ease is wired into us. Even if we have lost it, we can get it back.
Chapter 4 – The combined technique of Surf Stronger, Paddle Longer
Primacy of the head-neck relationship
We have discussed the primary importance of the head-neck relationship in regards to the principles of the Alexander Technique (Chapter 3). We have also discussed the importance of cranial motion in Osteopathy’s Primary Respiratory Mechanism (Chapter 2). In Osteopathic philosophy and treatment there is an old adage that states that a treatment should start and end by balancing the occipito-atlantal joint ensuring the free flow of cerebrospinal fluid across the cranio-cervical junction.* There is an accumulating mountain of medical research evidence to support these clinical observations of the importance of the head-neck relationship to human health.1,2,3,4
At a June 2013 conference of the Osteopathic Cranial Academy David Harshfield, M.D. presented some very interesting findings from not yet published research studies involving the imaging and measurement of fluid flow across the head-neck junction. Dr. Harshfield is a radiologist who works for NASA studying the neurologic sequelae of a microgravity environment on astronauts’ central nervous systems in addition to his clinical work in both diagnostic and interventional radiology at the University of Arkansas. His research uses Cine MRI in an upright position to visualize the movement of cerebrospinal fluid across the cranio-cervical junction. Taking multiple patients with abnormally low cerebrospinal fluid flow across the head and neck the subjects then underwent manipulation of the upper cervical spine. The Cine MRI was repeated demonstrating a clearly improved flow of cerebrospinal fluid, which also correlated with an improvement of patient’s various neurological symptoms such as headache.
Dr. Harshfield also presented a theory of the development of many neurodegenerative diseases such as Alzheimer’s dementia, Parkinson’s disease, and Multiple Sclerosis. The histologic characteristics of these disorders has been described in great detail previously, yet the pathophysiology leading to their development has not been elucidated. It is starting to emerge in the scientific literature1 (although it has been known empirically by Osteopaths for over 140 years and Alexander Technique teachers for over 110 years) that the free flow of cerebrospinal fluid and blood across the head and neck, when compromised by a biomechanical obstruction, could be the major determinant of the development of these central nervous system disorders.2
The health of any system depends on a fluctuation of resources bringing nutrients in, and an effective system for elimination of waste products. The flow of fluids governs that exchange
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*The occiput is part of the base of the skull. The atlas is the 1st cervical vertebrae. Their articulation joining the head to the neck is the occipito-atlantal joint. The term cranio-cervical junction may be a better word because it describes the region without giving emphasis to just the bony articulation, but also includes all of the tissues, fluids, and spaces where the head sits atop the spine. Head-neck junction is also used synonymously here as more of an everyday language term.
in biological systems. This is true of the human body, the oceans, a river, a lake, a garden, or a septic system. If the brain cannot effectively drain blood and cerebrospinal fluid then there is stagnation. It will become swamplike and metabolic waste products such as amyloid-B and Tau proteins will accumulate, both of which have been characterized as present in excess in diseases such as Alzheimers.
Cine MRI can be used to predict who may be prone to developing these profound neurologic diseases and also other more subtle neurologic disorders, or even symptoms not attributed to a full disease state that nonetheless can seriously impact people’s lives such as headache, fatigue, and decreased concentration. This predictive strength can be used to direct specific treatments such as manipulation, medications, surgery3 or other approaches that improve the flow of fluids across the craniocervical junction. However, Cine MRI and upright MRI machines are not currently a widely available diagnostic tool and they are expensive. Ultrasound will likely become the imaging study of choice.
Ultrasound is a much less expensive and an infinitely more portable diagnostic imaging device. Dr. Harshfield has been teaching astronauts to perform ultrasound studies that measure the arterial and venous blood flow and vessel diameter at the top of the spine near the craniocervical junction. Because arteries have firm vessel walls whereas veins are soft and compressible the outflow of blood through veins will usually be compromised first in an area of mechanical restriction. If the arteries pumping blood into the brain are functioning fine, but the venous outflow is obstructed this will cause a congestion of fluids in the brain. This leads to what is being called “stiff brain syndrome”. This measurement potentially could be used to predict the occurrence of neurodegenerative disorders.4 It could also be used more generally to measure a person’s “brain health”.
There is still much research to be done to determine what type of treatment will most effectively improve the flow of blood and cerebrospinal fluid across the cranio-cervical junction, which approach will last the longest, which is the least costly, and which is the least invasive with the fewest side effects. My clinical experience tells me Osteopathic treatment reinforced by Alexander Technique lessons will be shown to be the most effective, least invasive, least dangerous, and least costly. Nevertheless, these concrete medical research studies already emphasize the overall importance of the head-neck relationship to an individual’s health. It can be extrapolated that the head-neck relationship would have extreme importance to an athlete’s performance in physically demanding sports such as surfing and standup paddleboarding.
Most people have developed habits of how they use their mind and their body that interfere with the head-neck relationship. The Alexander Technique can be helpful to reestablish the right relationship. Some people have had injuries that disrupt the head-neck relationship. This injury could be as early in life as during a traumatic, or even during a seemingly “normal”, birth. Head-neck imbalance could also be from traumatic injuries later in life that do not completely resolve and Osteopathic Manipulative Treatment may be necessary to guide the person back toward health by balancing the entire body, particularly the head-neck relationship.
I often simplify things when explaining to my patients the importance of the head neck relationship by pointing out some basic anatomy in that region. Traversing this cranio-cervical junction are many structures. They are all packed into a very tight space. The brainstem is here which controls your vital functions such as breathing, heart-rate, and consciousness. The cerebellum and pyramidal tracts are there which control the motor coordination for your entire body. Cranial nerves IX-XII, which control muscular action of the tongue, muscles positioning the head, and the autonomic functioning of all organs all the way down to the lower 1/3 of your colon, exit through this junction. The major arterial supply to your brain, the internal carotid and vertebral arteries, and the venous return from your brain via the jugular veins cross here. Can you just imagine what the effects might be if the very tight space that holds these incredibly important structures is made tighter by injury or by a habit of pulling your head down and back. The effects can be far-reaching and catastrophic. Alteration of the control of your breathing and heart-rate, diminished coordination of movement, abnormal muscle tone throughout your body, digestive and other vegetative problems, and lack of blood flow to and from your brain. NOT GOOD! I would definitely prefer as much coordination of my muscles and blood flow to my brain as possible when duck diving an outside set wave or taking off on a ledgey bomb.
Most of us never think of that area and very few people have a sensory appreciation of the head-neck relationship. Alexander devised a way of learning this sensory appreciation through conscious control by inhibition and direction. Osteopathic treatment can provide mechanical assistance in restoring a torqued head neck relationship.
There are many causes of this head-neck relationship being distorted and they are unique to each individual. If not from traumatic injury then it can generally be related to the startle response which creates the habitual downward pull described by Alexander. The version of this early in life used in pediatrics to help assess an infant’s nervous system development is the Moro, or startle reflex, in which there is a typical pattern of visible movement in response to a sudden stimulus. In adults the startle reflex has also been well described, photographed, studied, and related in significance to the Alexander Technique.* The startle response is meant to be a short duration response for protection of the organism. If it is necessary for that response to persist longer than mere seconds because of an ongoing threat to survival it is then most often referred to as the fight or flight response (sometimes fight, flight, or freeze). The fight or flight response is wired into our physiology and is thought to be protective. When the protective response persists beyond when there is an actual threat to the organism’s survival it is called the General Adaptation Syndrome.** We have discussed some of the outward physical manifestations of these survival responses, but there are many physiologic variables that change when there is a perceived threat to a person. The more reactions associated with this response you recognize the more you can be aware of the reactions in your own body and be able to examine whether the response is necessary and appropriate, or if it is unnecessary and can be inhibited to allow yourself to change, to live more freely, to be more healthy, and to Surf Stronger and Paddle Longer. See Table 4.1 for a list of these responses.
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* The most extensive exposition on this is Frank Pierce Jones, PhD’s book Freedom to Change.
** An excellent book written by stress physiologist Robert M. Sapolsky Why Zebras Don‘t Get Ulcers describes the General Adaptation Syndrome and how it is linked to most of the major chronic illnesses of modern society. The book is replete with interesting scientific studies supporting the thesis.
Table 4.1: Physiologic changes in response to a perceived threat.
- Increased respiratory rate, but more shallow breathing
- Increased blood pressure
- Increased heart rate
- Eyes blink, blink rate increases
- Increase perspiration
- Shaking/trembling
- Neck muscles contract
- Shoulders elevate
- Abdominal muscles tighten
- Knees flex
- Pupils dilate
- Peripheral vision decreases (tunnel vision)
- Hearing decreases (auditory exclusion)
- Digestion decreases
- Skin turns pale, or flushes bright red
- Decreased salivation (dry mouth)
- Release of stress hormones adrenaline (epinephrine), cortisol (endogenous steroid), and nor-adrenaline (nor epinephrine)
- Increased blood sugar
- Immune system suppression
The startle response/fight or flight reflex is wired into us from before birth. Different species of animals have different sets of triggers and responses present in each and every individual of that species. Within a species individuals can also acquire unique triggers that will initiate the startle reflex/fight or flight response. The components of the response listed in table 4.1 can vary in proportion and intensity from one stimulus to another. Also, the proportions may be very different from one individual to another in response to the same stimulus. People develop these individualized triggers and responses early and throughout life.
The stimulus that triggers the startle/fight or flight may be a physical or an emotional injury that causes a particular protective response. Initially, the response was perfect and protected the person and may even have saved the person’s life. However, when the response becomes habitual and the same exact response to a different stimulus is used in another situation it is most likely not perfect, and may even be completely inappropriate for, and out of proportion to, the actual situation. This causes an excess expenditure of energy, strain on the muscles and tendons, and compression across the joints. All physiologic systems are involved in the response. The musculoskeletal system becomes more dominant in its energy consumption than when we are in the rest and digest mode (which we should be in a majority of the time). The musculoskeletal system is then being overused at the expense of all of your body’s other systems. Sometimes this inappropriate response is sustained and leads to chronic pain and other severely debilitating conditions.
The stimulus that initiates this habitual downward pull and disrupts the head-neck relationship can be obvious such as a car accident or physical abuse and all of the associated triggers. It can also be subtle such as a surfer or stand-up paddleboarder cringing when entering cold water or the anxiety of surfing or paddling a new spot. Alexander discovered that a habitual response to any stimulus can be prevented by making conscious choices. We can make choices about the activities we do, movements we make, things we ingest, the thoughts we think, and the bodily reactions we have. Downward pull can be avoided to maintain a proper head-neck relationship. This can in turn positively influence all of the body’s physiologic activities.
Organisms other than humans also exhibit a startle reflex or protective response. Look at these pictures of an earthworm in 4.2 a) fully lengthened, going about his business carefree on a rainy day, until 4.2 b) a stick is struck on the ground in front of him. Notice the shortening of his whole body and the twisting. There can be many iterations and shapes of the type of shortening unique to each earthworm and each individual human. There can also be multi-layered patterns of this posturing. The earthworm quickly sensed there was no real danger, lengthened itself again, then crawled away. However, sometimes humans perceive a threat as ongoing even after the actual threat is gone. The crunched and contorted state in their body is maintained.
Figure 4.2 (a): Earthworm fully lengthened.
Figure 4.2 (b): Earthworm startled exhibiting downward pull (horizontal pull because earthworms do not walk upright) with twists and turns.
It is easy to understand how a disturbed head-neck relationship could lead to neck pain, headaches, and other local problems. Let us look at a biomechanical problem you might not initially think of as starting from a disruption of the head-neck relationship – a problem that plagues surfers and standup paddleboarders – shoulder pain.
(Coming in the next issue of Surf Medicine, Part 2 in which the specific problem of shoulder pain is discussed and how the Surf Stronger, Paddle Longer approach is applied to both prevent and treat shoulder problems.)
Feel free to contact the author for more information or to provide constructive feedback at belugaboards@hotmail.com.
If anyone knows a publisher that might be interested in representing this book, any assistance would be greatly appreciated. Below is a table of contents of the entire manuscript to give you an idea of the overall concept and the layout of the book.
Thanks. I hope you enjoyed reading.
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References for this article:
1Damadian, R.V., Chu, D. The possible role of Cranio-Cervical Trauma and Abnormal CSF Hydrodynamics in the Genesis of Multiple Sclerosis. (2011) Physiological chemistry and physics and medical NMR. 20 September 2011, 41: 1-17.
2Freeman, M., Rosa, S., Harshfield, D., Smith, F., Bennett, R., Centeno, C., Kornel, E., Nystrom, A., Heffez, D., Kohles, S. A case-control study of cerebellar tonsillar ectopia (Chiari) and head/neck trauma (whiplash). Brain Injury. (2010) 24(7-8): 988-994.
3Zamboni, P., Galeotti, R., Menegatti, E., Malagoni, A.M., Gianesini, S., Bartolomei, I., Mascoli, F., Salvi, F. Journal of Vascular Surgery. (2009) December, Volume 50, Issue 6, Pages 1348-1358.
4Zamboni, P., Galeotti, R., Menegatti, E., Malagoni, A.M., Tacconi, G., Dall’Ara, S., Bartolomei, I., Salvi, F. Chronic cerebrospinal venous insufficiency in patients with multiple sclerosis. Journal of Neurology, Neurosurgery, and Psychiatry. (2009) 80: 392-399.
Table of Contents for the Surf Stronger, Paddle Longer book:
I. Introduction
- Chapter 1. Introduction to the Surf Stronger, Paddle Longer Approach
- Chapter 2. Introduction to Osteopathic Medicine’s influence on the Approach
- Chapter 3. Introduction to the Alexander Technique’s influence on the Approach
- Chapter 4. Introduction to the combined methods of Surf Stronger, Paddle Longer – Focus on shoulder pain and other tendon problems
- Chapter 5. Practical Exercises to begin with on land
II. Practical Applications to Surfing and Standup Paddleboarding
- A. Surfing
- Chapter 6. Prone Paddling
- Chapter 7. Duck Diving
- Chapter 8. Sitting on the Surfboard
- Chapter 9. The Pop-up
- Chapter 10. Riding the Wave
- B. Transitional topic from Surfing to Standup Paddleboarding
- Chapter 11. Entering the water
- C. Standup Paddleboarding
- Chapter 12. Introduction to Standup Paddleboarding
- Chapter 13. Moving from prone to kneeling on a Standup Paddleboard
- Chapter 14. Standing from Kneeling
- Chapter 15. Standup Paddling
- Chapter 16. Turning on a Standup Paddleboard
III. Further Considerations
- Chapter 17. Exercise
- Chapter 18. Nutrition
- Chapter 19. Driving
- Chapter 20. Computers
- Chapter 21. Navigating the healthcare system if you have an injury or medical problems with the Surf Stronger, Paddle Longer concepts, Focus on low back and neck pain
- Chapter 22. Conclusion
IV. Resources – Helpful Websites, Phone Numbers, Addresses
V. References
VI. List of Photos