17 Common Surfing injuries (Prevention & Treatment)

All 17 common surfing injuries, from lacerations and cuts to sprains and strains, shoulder damage from paddling, fractures and ear injuries.

Time in the water adds sunburn, dehydration, hypothermia and sea sickness, with head and spinal injuries, marine life encounters and drowning covered as the serious risks.

Let’s paddle out together and explore the dangers lurking beneath the surface of this thrilling pastime.

Injury Rates and Numbers

The figures below come from injury surveillance data and peer reviewed studies. Each row names the population it was measured in, because rates from elite athletes and from recreational players are not comparable.

Finding	Measured in	Source
Reported surfing injury rates range from 0.74 injuries per 1,000 surfing hours in Australian recreational surfers to 6.6 per 1,000 hours in international contest surfers.	Recreational and competitive surfers in 19 studies from Australia, Brazil, UK, USA, Portugal, Japan and Norway, Systematic review of studies up to 2019, published 2020	Sports (Basel) 2020;8(2):25, Epidemiology of Acute Injuries in Surfing: A Systematic Review
Skin injuries were the most common type of acute surfing injury at 46.0 percent, and being struck by the surfer’s own board was the leading mechanism at 38.6 percent.	Recreational and competitive surfers pooled across 19 epidemiological studies, Systematic review of studies up to 2019, published 2020	Sports (Basel) 2020;8(2):25, Epidemiology of Acute Injuries in Surfing: A Systematic Review
A prospective study of 32 surfing contests recorded 13 acute injuries per 1,000 hours of competitive surfing, equal to 5.7 injuries per 1,000 athlete exposures.	Professional and amateur contest surfers at 32 surfing contests worldwide, 1999 to 2005, published 2007	American Journal of Sports Medicine 2007, Competitive Surfing Injuries: A Prospective Study
US emergency departments treated an estimated 131,494 surfing injuries from 2002 to 2013; lacerations led at 40.7 percent and 95.7 percent of patients were treated and released.	All ages presenting to US emergency departments with surfing injuries (NEISS sample, median age 27), 2002 to 2013, published 2016	American Journal of Emergency Medicine 2016, Surfing USA: surfing injuries presenting to US EDs 2002 to 2013
In a survey of 1,473 New Zealand surfers, 34 percent had sustained a major traumatic surfing injury in the previous 12 months, and 58.1 percent of injuries came from direct contact.	1,473 self-identified surfers living in New Zealand, 18.3 percent female, Survey December 2015 to July 2016, published 2021	PeerJ 2021;9:e12334, Traumatic surfing injuries in New Zealand: a descriptive epidemiology study

Overview

Injury	Body area	Typical time out
Lacerations and cuts	Skin, any body part	3 days to 4 weeks, longer if infected
Sprains and strains	Ankle, knee, and lower back	2 to 12 weeks, 3 months plus if torn
Shoulder injuries	Shoulder	4 weeks to 6 months
Sunburn	Skin	2 days to 2 weeks
Fractures	Any bone, most often ribs, nose, and hand	6 weeks to 6 months
Ear injuries	Ear	None to 3 months after surgery
Marine life injuries	Skin, foot and hand	1 day to 3 weeks, longer if deep
Head injuries	Head	1 to 4 weeks, longer if symptoms stay
Dehydration	Whole body	Hours to 3 days
Knee injuries	Knee	3 weeks to 12 months after ACL surgery
Rib injuries	Chest	3 to 12 weeks
Foot injuries	Foot and toes	1 to 4 weeks, 6 to 12 if fractured
Eye injuries	Eye	1 day to 2 weeks
Spinal injuries	Neck and back	1 week to many months
Hypothermia	Whole body	1 day to several days
Drowning	Whole body	Days to months, medical clearance first
Sea sickness	Whole body	Hours, rarely a full day
Wrist Sprain and Scaphoid Fracture	Wrist	2 to 12 weeks, longer if it fails to heal
Skier’s Thumb, a Tear of the Ulnar Collateral Ligament	Thumb	4 to 6 weeks, 3 months after surgery
Shin Contusions and Board Rash	Shin	1 to 3 weeks

Lacerations and cuts

A laceration in surfing is a split through the skin and sometimes the fat layer beneath it, usually caused by the sharp trailing edge of a fin, the nose of the board, or a reef bottom. The typical moment is the wipeout, when the board is still tethered to your ankle and the water pushes it back into you. Coral and barnacle cuts also drive fragments and bacteria into the wound, which is why they behave differently from a clean kitchen cut.

Symptoms

• A clean split or a ragged tear in the skin, often noticed only after the session.
• Bleeding that looks dramatic in water because seawater spreads it.
• Little or no pain at first, especially in cold water.
• Stinging or throbbing once you are warm again on the beach.
• Redness, spreading warmth, or pus over the following days if it is getting infected.

How serious it is: Superficial cuts that stop bleeding under pressure and stay closed at rest heal on their own. A cut that gapes open, keeps bleeding after several minutes of firm pressure, exposes fat or tendon, or was made by coral or a fin is the serious form and belongs in a clinic.

Typical time out: Three to seven days for a superficial cut, two to four weeks if it needed stitches, and longer if it becomes infected, because a reef or fin wound is dirty by nature and may need to stay open for a while.

See a doctor if: Go to a doctor if the wound gapes, keeps bleeding through pressure, was made by coral or a fin, or if redness, swelling, and fever appear over the next days.

What helps

• Firm direct pressure with a clean cloth until the bleeding stops.
• Rinsing thoroughly with clean drinking water, not seawater, to flush out sand, coral fragments, and fin wax.
• Getting reef and fin wounds seen the same day, since they often need proper cleaning and sometimes antibiotics.
• Keeping the wound covered and dry, and checking your tetanus status.
• Staying out of the water until the wound is fully closed, because warm seawater carries bacteria that thrive in open skin.

Sprains and strains

A sprain is an overstretched or torn ligament, the passive band that holds two bones together, while a strain is the same damage in a muscle or its tendon. In surfing they come from the pop up, from landing a drop with the ankle rolled over the rail, and from the twisting the lower back absorbs during a bottom turn. The ankle ligaments on the outside of the joint and the muscles along the lumbar spine take most of it.

Symptoms

• Sudden pain at the moment of the twist or the awkward landing.
• Swelling that builds over the first hours.
• Bruising appearing a day or two later, sometimes below the injured spot.
• A feeling that the joint is loose or gives way under load.
• Stiffness and pain when you first move after sitting still.

How serious it is: The usual scale runs from grade 1, an overstretch with the tissue still intact, through grade 2, a partial tear with clear loss of strength or stability, to grade 3, a complete tear where the joint feels unstable and often cannot bear weight.

Typical time out: Two to six weeks for a grade 1 sprain or strain, six to twelve weeks for a grade 2, and three months or more for a grade 3 or after surgery. The spread is wide because ligaments regain their stiffness slowly even after the pain is gone.

See a doctor if: See a doctor if you cannot put weight on the leg for more than a few steps, if the joint looks deformed, or if numbness spreads into the foot.

What helps

• Loading the joint early within a pain limit rather than resting it completely, which shortens recovery.
• Short cooling in the first hours only for pain relief, not as a treatment plan.
• Balance and single leg work for ankles, since the reflexes that protect the joint fade fast after a sprain.
• Progressive strength work for the hips and trunk when the lower back is involved.
• Physical therapy if you still limp after a week, and imaging if the joint feels unstable rather than just sore.

Shoulder injuries

Paddling is the single biggest load in surfing, and it runs through the rotator cuff, the four small muscles that hold the head of the upper arm centered in its shallow socket. Hours of overhead reaching irritate the supraspinatus tendon and the bursa above it, while a fall with the arm stretched out over the head can lever the joint out of its socket entirely. Repetition without strength is what turns a normal load into a painful one.

Symptoms

• A dull ache deep in the shoulder that starts partway through a paddle.
• Pain when reaching overhead or behind your back.
• Trouble sleeping on that side.
• Weakness when lifting the arm out to the side.
• After a dislocation, a visible dent below the tip of the shoulder and an arm you do not dare move.

How serious it is: Tendon irritation with full strength is the mild end. A partial or full rotator cuff tear brings real weakness, and a first dislocation in a young surfer carries a high chance of repeat dislocations, which changes the treatment.

Typical time out: Four to twelve weeks for rotator cuff tendinopathy, three to six months after a dislocation depending on whether the joint stays stable, and six months or more after a cuff repair. The range is wide because tendon and capsule tissue remodel far more slowly than muscle.

See a doctor if: Get it looked at the same day if the shoulder is visibly out of shape after a fall, if you cannot lift the arm at all, or if the hand feels numb.

What helps

• A progressive rotator cuff and scapular strengthening program, which is the treatment with the best track record for paddling shoulders.
• Cutting session volume for a while instead of stopping entirely, and paddling with a higher elbow and less reach.
• Adding external rotation and mid back strength work on land between sessions.
• Physical therapy early rather than after months of waiting.
• Treating a cortisone injection as an exception: it can quiet pain briefly, but for tendinopathy the longer term results tend to be worse, so it never replaces the loading program.

Sunburn

Sunburn is direct UV damage to the cells of the outer skin layer, which triggers an inflammatory reaction hours after the exposure. Surfing multiplies the dose because water and wet skin reflect light upward, the wind removes the heat that would normally warn you, and the face, neck, ears, and backs of the hands stay exposed for the whole session.

Symptoms

• Skin that turns red and feels hot several hours after you get out.
• Tightness and stinging, worst on the neck, ears, and back of the hands.
• Pain when clothing or a wetsuit rubs the area.
• Blisters in the more severe cases.
• Peeling after a few days.

How serious it is: Redness without blisters is superficial and settles within days. Blistering means damage into the deeper skin layer, which scars more easily and raises long term skin cancer risk, especially with repeated burns in childhood.

Typical time out: Two to five days out of the water for a mild burn, one to two weeks if blisters form, and longer if the blistered skin becomes infected.

See a doctor if: See a doctor if large areas blister, if you feel feverish, faint, or nauseated, or if a burn on the face involves the eyes.

What helps

• Cooling the skin with cool water and drinking more than usual for the first day.
• A plain moisturizer or aloe gel, avoiding products with anesthetic additives that often irritate.
• Zinc based or water resistant mineral sunscreen reapplied between sessions, since a single morning application does not survive an hour of paddling.
• A long sleeve rash guard, a surf hat for longboarding, and lip balm with UV protection, which outperform sunscreen alone.
• Leaving blisters intact and covered rather than opening them.

Fractures

A fracture is a break in the continuity of bone, and in surfing it usually comes from a blunt impact rather than from twisting: your own board driven back by the wave, the sea floor in shallow water, or another surfer in a crowded lineup. The nose, ribs, forearm, and hand bones take most of these hits because they are close to the surface with little muscle over them.

Symptoms

• A sharp crack or snap felt at the moment of impact.
• Immediate pain that does not settle when you stop moving.
• Rapid swelling and later deep bruising.
• A limb or a nose that looks bent or out of line.
• Inability to use the part normally, such as gripping or bearing weight.

How serious it is: An undisplaced crack, where the bone fragments stay in line, is the mild form and usually heals in a cast or brace. A displaced or open fracture, where the ends have shifted or the skin is broken over the bone, needs surgical care.

Typical time out: Six to eight weeks for the bone itself to unite in most cases, but three to six months back to full surfing, because the joint stiffness and muscle loss around the cast take longer to reverse than the bone.

See a doctor if: Go to an emergency department for any visible deformity, bone breaking the skin, numbness or a cold pale limb below the injury, or a limb you cannot use at all.

What helps

• Splinting or supporting the limb in the position it lies in rather than straightening it yourself.
• Getting an X ray the same day, since undisplaced fractures often look like a bad bruise.
• Following the immobilization time given to you, then starting guided motion work as soon as it is allowed.
• Keeping the rest of the body training during the layoff so the return is a matter of weeks and not months.
• Physical therapy after the cast comes off, especially for wrist and hand fractures where stiffness is the main problem.

Ear injuries

Surfer’s ear is the slow growth of extra bone in the walls of the ear canal, a reaction of the bone lining to repeated cold water and wind. The narrowed canal then traps water and wax, which sets up infections. A separate problem is a torn eardrum, where a flat fall or a wave slapping the side of the head drives water into the canal fast enough to burst the membrane.

Symptoms

• Water that stays in the ear for hours after a session.
• Muffled or reduced hearing on one side.
• Repeated ear infections with pain and discharge.
• Sudden sharp pain during a wipeout in the case of a burst eardrum.
• Ringing or dizziness after the impact.

How serious it is: Mild exostoses narrow the canal without symptoms and only need protection from here on. Severe narrowing causes constant trapped water and infection and is treated surgically. Most eardrum tears close on their own, but a large tear or one with vertigo needs an ear specialist.

Typical time out: No time off for early surfer’s ear, but three to six weeks out of the water after a torn eardrum, and two to three months after surgery for exostoses. Cold water surfers often lose several sessions each winter to canal infections.

See a doctor if: See a doctor for sudden hearing loss, spinning dizziness, or discharge and pain that continue for more than a day or two.

What helps

• Wearing fitted earplugs and a hood in cold water, which is the only thing that stops the bony growth from progressing.
• Drying the ears after every session, for example by tilting the head and using a drying drop your doctor approves.
• Keeping the ear dry and out of the water while a torn eardrum heals.
• An early check with an ear specialist if water keeps getting trapped, since surgery is far simpler before the canal closes down.
• Treating infections properly rather than surfing through them.

Marine life injuries

Jellyfish tentacles fire stinging cells into the skin on contact and keep firing while fragments remain attached. Sea urchin and stingray injuries are puncture wounds: brittle spines break off under the skin, and stingray barbs inject a protein venom that is inactivated by heat. Shark bites are rare but combine crush and cut injury to muscle and vessels.

Symptoms

• Instant burning or stinging in a line or a whip pattern on exposed skin.
• Raised red welts that follow the shape of the tentacle.
• A deep throbbing pain out of proportion to the small puncture in urchin and stingray wounds.
• Black dots under the skin where spines have broken off.
• Nausea, cramps, or breathing difficulty in more severe stings.

How serious it is: Most stings are local skin reactions that settle within hours. Severe forms involve whole body symptoms such as vomiting, muscle cramps, chest tightness, or collapse, and puncture wounds with retained spines that go on to infect.

Typical time out: One to several days for a simple sting, one to three weeks for a puncture wound with retained spines, and much longer for a deep bite wound that needs surgical repair.

See a doctor if: Call for emergency help if there is trouble breathing, chest pain, widespread cramps, collapse, or bleeding you cannot control with pressure.

What helps

• Rinsing a jellyfish sting with seawater, never fresh water, since fresh water makes the remaining stinging cells fire.
• Lifting off tentacle fragments with a card edge or tweezers instead of rubbing them.
• Immersing stingray and urchin wounds in water as hot as you can comfortably tolerate, which breaks down the venom proteins and relieves pain.
• Getting retained spines removed and the wound checked, because seawater bacteria infect punctures readily.
• Shuffling your feet in shallow sandy water so stingrays move off before you step on one.

Head injuries

A concussion is a functional disturbance of the brain caused by a blow or a sudden acceleration of the head, not a structural break. In surfing the usual mechanism is the board coming back at you after a wipeout or the head striking the sea floor in shallow water. The danger is doubled because the confusion and imbalance that follow happen while you are still in moving water.

Symptoms

• Headache and a feeling of pressure in the head.
• Confusion, slowed thinking, or not remembering the wipeout.
• Dizziness and unsteadiness.
• Nausea, and sensitivity to light or noise.
• Feeling unusually tired or irritable in the hours afterwards.

How serious it is: Most concussions settle over days to a few weeks. Loss of consciousness, repeated vomiting, worsening headache, a seizure, or symptoms that keep getting worse point to a more serious brain injury and are an emergency.

Typical time out: One to four weeks for a straightforward concussion, provided each step back is symptom free, and months when symptoms persist. A second impact before recovery lengthens everything, which is why the graded return matters more than the calendar.

See a doctor if: Get emergency care for any loss of consciousness, repeated vomiting, worsening headache, a seizure, unequal pupils, or someone who cannot be roused properly.

What helps

• Getting out of the water immediately and staying out for the rest of the day, no exceptions.
• A short period of relative rest for a day or two, then a gradual return to light activity rather than a dark room for a week.
• A stepwise return through walking, light cardio, and non contact skill work before paddling out again.
• Having someone stay with you for the first night after the impact.
• A medical assessment before returning to surf if symptoms last beyond a few days, and a helmet in shallow reef breaks.

Dehydration

Dehydration is a net loss of body water, and surfing hides it well: you sweat inside a wetsuit without noticing, cold water suppresses thirst, and immersion itself makes the kidneys produce more urine. The result is a falling blood volume, which reduces the blood reaching working muscles and the brain and shows up as fatigue and poor coordination before you feel thirsty.

Symptoms

• Dry mouth and a growing headache during or after a long session.
• Tiredness and heavy arms that make paddling feel harder than usual.
• Dark, concentrated urine and less of it.
• Dizziness when standing up on the beach.
• Muscle cramps, most often in the calves or feet.

How serious it is: Mild dehydration causes thirst, headache, and reduced performance and reverses within hours of drinking. Severe dehydration with confusion, fainting, a racing pulse, or no urine is a medical emergency and often overlaps with heat illness.

Typical time out: Hours to a day once you rehydrate properly, but two to three days if you were badly dry or also overheated, because the fluid balance and the fatigue both take longer than the thirst does.

See a doctor if: Get medical help for confusion, fainting, a fast weak pulse, or an inability to keep fluids down.

What helps

• Drinking before you paddle out, not just afterwards, since you cannot drink in the water.
• Adding sodium through an electrolyte drink or salty food after sessions longer than about two hours or in hot weather.
• Checking your urine color as a simple daily gauge.
• Coming in for a drink between sets on long hot days rather than pushing through.
• Recognizing that a wetsuit in warm air is a heat trap and shortening those sessions.

Knee injuries

The anterior cruciate ligament runs inside the knee and stops the shinbone sliding forward and rotating; the menisci are two crescents of cartilage that spread load between thigh and shin. Both are injured in surfing when the back foot stays fixed on the deck and the body rotates over it, typically during a hard bottom turn or a wipeout where the leash and the wave twist the leg. Kneeboarding and knee paddling add direct impact to the front of the joint.

Symptoms

• A pop or tearing sensation at the moment of the twist.
• Swelling that fills the joint within a few hours.
• A knee that feels unstable or gives way when you turn.
• Locking or catching if a meniscus fragment is caught.
• Pain when squatting or coming down into the surf stance.

How serious it is: A mild sprain of the collateral ligaments is a grade 1 injury that settles quickly. A complete ACL tear, a locked knee from a displaced meniscus tear, or a combined injury sits at the severe end and usually needs specialist assessment.

Typical time out: Three to six weeks for a mild sprain, six to twelve weeks for many meniscus injuries treated without surgery, and nine to twelve months after ACL reconstruction. The gap is large because a reconstructed ligament needs most of a year before it tolerates twisting loads.

See a doctor if: See a doctor if the knee swells within hours, locks in a bent position, or gives way when you try to walk on it.

What helps

• An early assessment when the joint swells fast, since blood in the joint usually means a structural tear.
• Guided strength work for the quadriceps and hips, which is the foundation of both non surgical and post surgical recovery.
• Landing and cutting drills on land before returning to turns in the water.
• Softening the back foot pressure and choosing smaller waves for the first sessions back.
• Imaging when the knee locks or keeps giving way rather than when it merely aches.

Rib injuries

Ribs are thin curved bones with muscle between them, and they lie directly under the skin at the side of the chest where the rail of the board hits during a wipeout. Paddling on a hard deck also bruises the cartilage where the ribs meet the breastbone. Because the rib cage moves with every breath, an injured rib is reminded of itself constantly and cannot be rested the way a limb can.

Symptoms

• Sharp pain at one exact spot on the chest wall that you can point to with a finger.
• Pain that spikes with a deep breath, a cough, a laugh, or a sneeze.
• Difficulty rolling over in bed or getting up from lying down.
• Bruising over the impact area after a day or two.
• Shallow breathing because full breaths hurt.

How serious it is: A bruise or a single undisplaced crack is painful but heals on its own. Several ribs broken in a row, a rib broken in two places, or any rib injury with shortness of breath raises the risk of lung injury and needs urgent assessment.

Typical time out: Three to six weeks for a bruise and six to twelve weeks for a fracture before paddling is comfortable, with the range driven by how much the injury restricts your breathing rather than by the bone itself.

See a doctor if: Seek urgent care for shortness of breath, coughing blood, pain that spreads into the abdomen, or feeling faint, since these suggest a lung or organ injury under the ribs.

What helps

• Adequate pain relief so that you can still take deep breaths, which prevents chest infections.
• Deliberate deep breathing and gentle coughing against a cushion several times a day.
• Avoiding chest binding or tight strapping, which restricts breathing and does more harm than good.
• Sleeping propped up in the first painful weeks.
• Returning to paddling gradually, starting with short flat water sessions.

Foot injuries

The top of the foot and the toes are the parts most exposed to the reef: coral cuts split the thin skin over the bones, and sea urchin spines break off in the sole. A separate mechanism is the toe or forefoot caught under the board or against the sand during a landing, which sprains the joints at the base of the toes or breaks a small bone. There is almost no muscle padding over these structures, so injuries reach bone quickly.

Symptoms

• Cuts on the top of the foot or the sole after walking on reef.
• A deep ache and dark dots in the sole where spines are embedded.
• Pain at the base of a toe that worsens when you push off.
• Swelling and bruising across the forefoot.
• Pain when your foot presses into the deck during the pop up.

How serious it is: Superficial cuts and a single embedded spine are the mild form. Wounds that reach a joint or tendon, spines left in place, and forefoot fractures with visible deformity are the serious end and need proper treatment.

Typical time out: One to two weeks for a shallow cut, two to four weeks for a puncture wound that stays clean, and six to twelve weeks for a fracture or a significant sprain of the toe joints.

See a doctor if: See a doctor for spreading redness and warmth, a wound over a joint, numbness in the toes, or an inability to bear weight on the foot.

What helps

• Thorough rinsing with clean water and same day removal of coral fragments and spines.
• Reef booties on sharp bottoms, which prevent most of these injuries outright.
• Stiff soled shoes for a few weeks when a forefoot bone or joint is injured.
• Early gentle movement of the toes to keep the joints from stiffening.
• An X ray if pain over one spot on the forefoot persists beyond a week or two, since small foot fractures are easily missed.

Eye injuries

A corneal abrasion is a scratch across the clear front surface of the eye, made by sand carried in a wave, a fingernail during a scramble, or the wax and grit on a board. The cornea is packed with nerve endings, which is why a scratch too small to see hurts intensely. Long term UV exposure on the water also drives pterygium, a thickened growth of surface tissue creeping in from the corner of the eye.

Symptoms

• A sudden feeling of grit or sand that does not wash out.
• Intense watering and difficulty keeping the eye open.
• Pain that worsens in bright light.
• Blurred vision on that side.
• Redness concentrated around the colored part of the eye.

How serious it is: A small surface scratch usually heals within a day or two. Deeper injuries, an object that has penetrated the eye, chemical exposure, or any change in vision are serious and need same day specialist care.

Typical time out: One to three days out of the water for a simple abrasion, one to two weeks if it becomes infected or an object had to be removed, and longer after surgery for a pterygium.

See a doctor if: Get seen the same day for reduced vision, an object stuck in the eye, or pain and redness that keep worsening after the first day.

What helps

• Rinsing gently with clean water or saline and letting the eye blink the particle out.
• Not rubbing the eye, which turns a scratch into a deeper wound.
• Removing contact lenses and leaving them out until the eye is fully settled.
• Lubricating drops, and a medical check if pain persists past a day.
• Wrap around UV sunglasses on land and a hat, which slow the development of surface growths on the eye.

Spinal injuries

Two very different things fall under this heading. The common one is soft tissue strain of the muscles and joints of the neck and lower back, from hours of extending the spine while paddling and from the whiplash of a wipeout. The rare and dangerous one is a fracture or dislocation of the vertebrae, usually from diving head first into a sandbar in shallow water, which can damage the spinal cord that runs inside them.

Symptoms

• A tight aching band across the lower back after a long session.
• Neck stiffness and headache the morning after a heavy wipeout.
• Pain that shoots down an arm or a leg.
• Pins and needles, numbness, or weakness in a limb.
• In severe cases, an inability to move a limb or loss of bladder control.

How serious it is: Muscle and joint strain is the mild form and settles with movement and time. Any nerve symptom, meaning numbness, weakness, or radiating pain, moves the injury into a category that needs assessment, and suspected vertebral injury after a head first impact is an emergency.

Typical time out: One to four weeks for a paddling related back or neck strain, six to twelve weeks when a nerve is irritated, and many months after a vertebral fracture. The spread is this wide because the same symptom can come from a muscle or from a structure near the nerve.

See a doctor if: Treat it as an emergency and keep the person still if there is numbness, weakness, loss of bladder or bowel control, or severe neck pain after a head first impact.

What helps

• Staying gently active rather than lying flat, since prolonged bed rest makes back pain worse.
• Hip flexor and thoracic mobility work, because a stiff upper back forces the lower back to do the extension during paddling.
• Trunk and gluteal strength training on land, the single best documented measure against recurring lower back pain.
• Never diving head first off the board and always landing flat with arms protecting the head.
• Medical assessment when pain radiates below the knee or into the hand, or when weakness appears.

Hypothermia

Water pulls heat from the body far faster than air of the same temperature, so a long session in cool water steadily drains core temperature even when you feel fine at first. As the core cools, blood is drawn away from the hands and feet, and the muscles lose both strength and fine control, which is what makes hypothermia dangerous in the water rather than just uncomfortable.

Symptoms

• Shivering you cannot stop, at first, followed by shivering that stops as it worsens.
• Numb, clumsy hands that cannot manage a leash or a zipper.
• Slurred speech and slowed thinking.
• Stumbling and poor coordination on the beach.
• Drowsiness and a strange lack of concern about being cold.

How serious it is: Mild hypothermia means heavy shivering with clear thinking and reverses with warmth and dry clothes. Moderate to severe hypothermia, where shivering stops and thinking is confused, is a medical emergency and must be handled gently, because rough handling of a very cold body can trigger dangerous heart rhythms.

Typical time out: The rest of the day for a mild case, one to three days of feeling drained afterwards, and a hospital stay with a longer recovery for a severe case.

See a doctor if: Call emergency services if shivering has stopped while the person is still cold, or if speech, thinking, or consciousness are affected.

What helps

• Getting out of the wind and out of the wet suit into dry layers immediately.
• Passive rewarming with blankets and warm sweet drinks for anyone who is alert, avoiding alcohol.
• Handling a severely cold person gently and not rubbing the limbs.
• A wetsuit, hood, gloves, and boots matched to the actual water temperature, plus a hard time limit on winter sessions.
• Surfing with someone else in cold conditions, since the person affected is usually the last to notice.

Drowning

Drowning is respiratory impairment from being submerged, and in surfing it usually follows a chain rather than one event: a long hold down empties the lungs, a leash wraps on a reef, or a rip carries a tired surfer beyond their paddling ability. Water entering the airway triggers a spasm of the larynx and then oxygen deprivation, and the brain is the organ that suffers first.

Symptoms

• Panic and a strong urge to breathe while still held under.
• Coughing, choking, and gasping on surfacing.
• Chest tightness and a persistent cough afterwards.
• Confusion, extreme tiredness, or blue lips.
• In a bystander: a silent, upright person in the water who is not calling out.

How serious it is: A brief submersion with coughing that clears is the mild end, though breathing problems in the hours after should still be checked. Anyone who was unresponsive, needed rescue breaths, or has ongoing breathing difficulty needs emergency treatment and hospital observation.

Typical time out: A few days after a minor event with medical clearance, and weeks to months after a serious episode depending on lung and brain recovery. Anyone who lost consciousness needs a medical clearance before surfing again.

See a doctor if: Call emergency services for anyone pulled from the water who is unresponsive, breathing abnormally, or who develops a cough, breathlessness, or confusion in the hours afterwards.

What helps

• Getting the person out of the water safely without becoming a second casualty, then checking breathing and starting rescue breaths and CPR if absent.
• Calling emergency services early, even if the person seems to recover.
• Medical assessment after any event with coughing or breathlessness, since lung symptoms can worsen over the following hours.
• Prevention that actually works: matching wave size to your own swimming ability, knowing how rips run at the break, and never surfing alone in big surf.
• Practicing relaxed breath control and knowing how to unclip or cut a trapped leash.

Sea sickness

Motion sickness arises when the balance organs of the inner ear report movement that your eyes do not confirm, which happens while you sit on a board in a rolling swell and stare at a horizon that keeps shifting. The mismatch is processed in the brainstem and triggers nausea, sweating, and a drop in appetite. Boat trips out to a reef break are the classic trigger.

Symptoms

• A vague uneasy feeling in the stomach that builds slowly.
• Cold sweat and pallor.
• Increased saliva and repeated swallowing.
• Headache and heavy tiredness.
• Nausea and vomiting in the worse cases.

How serious it is: Mild queasiness that passes once you paddle or focus on the horizon is the common form. Repeated vomiting matters mainly because it dehydrates you and drains the strength you need to get back to shore.

Typical time out: Usually none beyond the session, with symptoms fading within an hour or two on land, though a bad episode with vomiting can leave you flat for the rest of the day.

See a doctor if: Seek medical advice if severe dizziness, spinning, hearing changes, or vomiting continue on dry land, since that points to an inner ear problem rather than motion sickness.

What helps

• Fixing your eyes on the horizon or on the shoreline instead of on the board or a phone.
• Staying active and paddling rather than sitting still in the swell.
• Ginger in any form, which has reasonable evidence for mild nausea.
• Over the counter antihistamine motion sickness tablets taken before the boat trip rather than after symptoms begin, keeping in mind they cause drowsiness.
• Eating something light beforehand and staying hydrated, since an empty stomach makes it worse.

Wrist Sprain and Scaphoid Fracture

Falling with an outstretched hand drives the wrist backwards past its normal range, which overstretches the ligaments between the small carpal bones and can crack the scaphoid, the boat shaped bone at the base of the thumb. Surfers also load the wrist hard during the pop up, when the whole body weight passes through both hands on the deck. The scaphoid matters because its blood supply enters from one end, so a missed fracture there often fails to heal.

Symptoms

• Pain on the thumb side of the wrist after a fall onto the hand.
• Tenderness in the hollow at the base of the thumb.
• Swelling that is mild enough to be mistaken for a sprain.
• Weak grip, especially when opening a bottle or twisting.
• Pain when you push up from the board during the pop up.

How serious it is: A simple ligament sprain with full movement and no bony tenderness is mild. Persistent tenderness in the hollow at the base of the thumb suggests a scaphoid fracture, which is the serious form even when the X ray looks normal at first.

Typical time out: Two to six weeks for a sprain, but eight to twelve weeks in a cast for a scaphoid fracture and considerably longer if it fails to unite and needs surgery. This is why the wrist that still hurts after two weeks deserves a second look.

See a doctor if: See a doctor if the wrist is still tender at the base of the thumb a week after a fall, if it looks deformed, or if the fingers go numb.

What helps

• Getting an X ray after a fall onto the hand if the base of the thumb is tender, and a repeat check or scan if the pain persists despite a normal first film.
• A wrist brace for the first weeks in a simple sprain, then progressive weight bearing through the hand.
• Doing the pop up with the hands under the chest and the elbows close in, which reduces the extension angle at the wrist.
• Grip and forearm strengthening before returning to long sessions.
• Physical therapy for stiffness after immobilization, which is the main lasting problem in wrist injuries.

Skier’s Thumb, a Tear of the Ulnar Collateral Ligament

The ulnar collateral ligament sits on the inner side of the main thumb knuckle and stops the thumb being levered away from the hand. In surfing it tears when the thumb is caught on the rail, in the leash, or against the sand while the rest of the hand is pushed the other way. Because the pinch grip depends on this ligament, a full tear leaves the thumb unable to hold anything firmly.

Symptoms

• Pain and swelling on the inner side of the base of the thumb.
• Bruising in the web space between thumb and index finger.
• Weakness when pinching, for example holding a key or a zipper pull.
• A feeling that the thumb wobbles sideways.
• Pain when the thumb takes weight during the pop up.

How serious it is: A partial tear with a stable joint is treated in a splint. A complete tear can leave the torn ligament end trapped outside the covering tissue, which prevents healing and needs surgical repair, so the distinction is worth making early.

Typical time out: Four to six weeks in a thumb splint for a partial tear, and three months or more when the ligament is repaired surgically. Grip strength usually lags behind pain by several weeks.

See a doctor if: See a doctor if the thumb can be bent sideways more than the other one, if pinch grip is clearly weak, or if there is a lump at the base of the thumb.

What helps

• Early assessment, because a fully torn ligament left alone leaves a permanently weak pinch grip.
• A thumb spica splint that leaves the wrist and other fingers free.
• Graded pinch and grip strengthening once the splint period ends.
• Taping the thumb to the hand for the first sessions back.
• Keeping fingers away from the leash and the rail when you fall, and letting go of the board rather than grabbing it.

Shin Contusions and Board Rash

The front of the shin has skin and bone with almost nothing in between, so a hit from the rail or fin lands directly on the periosteum, the sensitive membrane covering the bone. The result is a deep bruise that can lift the membrane and form a lump. Repeated rubbing of the shins against a waxed deck during paddling and knee paddling adds a burn like abrasion known to surfers as board rash.

Symptoms

• Sharp pain and a lump directly over the bone after an impact.
• A dark bruise that takes days to appear and weeks to fade.
• A raw red patch on the shins and knees after long sessions.
• Pain when anything presses on the spot, including a wetsuit.
• Tenderness that lingers long after the bruise has gone.

How serious it is: Most shin contusions are painful but harmless and settle over weeks. A rapidly swelling, extremely tight shin with numbness after a hard blow is the rare serious form, because pressure can build inside the muscle compartment and cut off circulation.

Typical time out: One to three weeks for a bruise or board rash, with the lump over the bone often outlasting the pain by several more weeks. A significant impact with continuing pain over one point warrants an X ray to exclude a crack.

See a doctor if: Seek urgent care if the shin becomes very tight and swollen with severe pain out of proportion to the injury, numbness, or a foot that will not lift.

What helps

• Short cooling in the first hours for pain, then gentle movement rather than complete rest.
• A shin sleeve or neoprene pad while the area is still tender.
• Keeping board rash clean and covered, since broken skin in seawater infects easily.
• Wearing a full suit or leggings on long sessions, and rewaxing so you are not gripping with your legs.
• An X ray if a single tender point over the bone still hurts to press after two weeks.

First Aid for Soft Tissue Injuries: PEACE and LOVE

Sports medicine has moved on from RICE. The current guidance, published in the British Journal of Sports Medicine in 2019, splits care into the first days after the injury and everything that follows.

PEACE, the first two to three days

• Protect: unload the area and limit movement that hurts, but only briefly.
• Elevate: keep the limb above heart level when you can.
• Avoid anti-inflammatories: they may blunt the healing you need.
• Compress: a bandage or taping limits swelling.
• Educate: your body heals this on its own; passive treatments rarely speed it up.

LOVE, from day three onward

• Load: return to movement as pain allows, early loading builds tissue.
• Optimism: expectations shape recovery more than most people assume.
• Vascularization: easy cardio that does not hurt brings blood to the area.
• Exercise: restore strength, mobility and balance before returning to play.

Ice still helps with pain in the first hours. What changed is the evidence that long icing and routine anti-inflammatory drugs slow tissue repair.

How to Lower Your Risk in Surfing

• Build paddling volume gradually rather than jumping from occasional sessions to daily surfing on a trip, since the shoulder tendons adapt more slowly than your enthusiasm does.
• Train the rotator cuff, mid back, and grip on land between sessions, because paddling itself strengthens only one half of the shoulder.
• Learn to fall flat and shallow with your arms shielding your head, and never dive head first off the board, which is the mechanism behind most serious neck injuries in surfing.
• Keep the board away from yourself after a wipeout: come up with hands over the head, use a leash matched to the board and the wave size, and consider a nose guard or fin edge protection.
• Wear the gear the break demands, meaning reef booties over coral, earplugs and a hood in cold water, and a helmet at shallow reef breaks.
• Match wave size and crowd to your current fitness and swimming ability, and check how the rips run before you paddle out.

When to Stop and Get Medical Help

Most of the injuries on this page are treated at home. These signs are not.

• Any wipeout followed by confusion, memory loss, repeated vomiting, or loss of consciousness.
• Severe neck or back pain after a head first impact, or numbness, tingling, or weakness anywhere in the arms or legs.
• A visible deformity of a limb, bone breaking the skin, or a joint you cannot move at all.
• Bleeding that does not stop after several minutes of firm direct pressure.
• Shortness of breath, chest pain, or coughing after a hold down or a hard impact to the chest.
• Shivering that has stopped while the person is still cold, with slurred speech or confusion.

Sources

• Sports (Basel) 2020;8(2):25, Epidemiology of Acute Injuries in Surfing: A Systematic Review
• American Journal of Sports Medicine 2007, Competitive Surfing Injuries: A Prospective Study
• American Journal of Emergency Medicine 2016, Surfing USA: surfing injuries presenting to US EDs 2002 to 2013
• PeerJ 2021;9:e12334, Traumatic surfing injuries in New Zealand: a descriptive epidemiology study

This article is general information, not medical advice. If you are hurt, a doctor or physiotherapist who can examine you is worth more than any web page. Last reviewed: August 2026.

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