Surf paddlingMany competitive surfers present at the clinic with recurrent neck spasm and pain. The symptoms generally occur during or after their surf session and can last for a few days. This article will explain what the most likely factors are that contribute to these complaints, review spinal mechanics, and describe how it can be prevented with simple exercises.

Structure of the cervical spine: Between adjacent vertebrae are a pair of facet joints. They are small synovial joints and like many joints in the body, are comprised of a closed capsule with synovial fluid and are innervated by nerves, which makes them sensitive to inflammation.  As they articulate with each other, these facet joints allow the spinal motion segment to extend, flex and rotate the head and neck.

What happens when you paddle in the surf?  As you lie on your belly to paddle to the peak or to catch a wave your neck is in full extension and sometimes rotates, as you need to look towards where you are going. As this extended position is often sustained for a long period of time the facet joints can be compressed, and irritated. This initiates localized inflammation of the facets followed by an adjacent muscle spasm.  This is very similar to what happens when you sleep with a pillow that is either too thin or too thick or when you turn your head too quickly and it suddenly seizes up. Most of us have experienced this, as it is relatively common.

Most of the time these symptoms settle within a few days, helped by a treatment (one consultation is often enough), heat, rest and sometimes an anti-inflammatory medication. Unfortunately these complaints may become recurrent and a strategy needs to be adopted to reduce the risk of further episodes. Although it is a benign condition it can be debilitating if close to a competition or an important training session.

How can this be avoided? It is important to understand that the cervical spine needs to be strong as well as flexible. As we do not have ribs to provide rigidity in this area of the spine, we predominantly rely on muscles and ligaments to stabilize the neck. Similar to the core stabilizer muscles that support our lower back, we have deep postural muscles in the neck to provide support. When these muscles are tired or weak, spine stability is reduced, the neck posture is altered and we are at risk of facet joint inflammation. As a reaction to this irritation our more superficial muscles (initially only used for gross movements) compensate for the lack of stability and seize up. A muscle spasm ensues and your neck feels stiff and painful. This is a protective mechanism.

In order to avoid this cascade of events it is advised to train the deep neck muscles (similarly to training our core) so they are able to sustain optimal posture. Here are a few exercises that can be easily performed daily.  Once you feel that your neck has acquired a certain strength you can eventually drop to a maintenance routine that can be performed every 2-3 days.

1) Prone cobra: Place your arms by the side, palms facing the floor. Pinch the shoulder blades together and lift the hands off the floor. Slowly lift your forehead about 2cm from the towel keeping eyes looking straight at the floor (do not tip your head back and look forward). Hold for 10 seconds and repeat 3 times.

2) Supine head lift: Lying flat on your back with both knees bent, slowly lift your head off of the floor while slightly tucking your chin in. Hold for 10 seconds and repeat 3 times.

It is also important to understand that the tighter your neck muscles are, the more pressure is put on the facet joints. That is why stretching exercises are paramount. As the neck is often in an extended position (especially with surfing), you can stretch your neck extensor muscles by putting the head into gentle flexion, helped or not by your hands. You can do these stretches after surfing, or regularly during the day, especially if you work at a desk in an office or at school, as your neck tends to adopt a similar extension with poor postural habits. Hold the position for 15 seconds without forcing as your neck is a sensitive area.

1) Upper trapezius and neck extensors stretch: Gently hold your head tilted with the tips of your fingers until you feel a mild stretch on the side of your neck. Increase the stretch by pushing the opposite shoulder (right shoulder on the picture) downwards. Hold for 10 seconds and repeat on the other side.

2) Chin tuck: Begin this exercise sitting or standing tall with your shoulders slightly pulled back. Tuck your chin in until you feel a mild to moderate stretch. Keep your eyes and nose facing forwards. Hold for 10 seconds and repeat 3 times.

As always, these are only guideline and you should consult your health practitioner for a more tailored program. Everyone’s neck is different and requires specific care, but this is a start to help you surf longer and better.

François Naef, Osteopath


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