 Thank you for joining me today on Movement Matters. I'm Christine Linders, physical therapist, board-certified orthopedic clinical specialist, beach volleyball player, and surfer. Let me ask you, who wants to improve their surfing and prevent pain and injury? I sure do, as do many of my current patients and friends here in Hawaii, in San Diego, and even in New York. Surfing is fun. I know it's a sport that we can enjoy as we age. And here in Hawaii, there are ways for every skill level. But we need to stay pain and injury-free to enjoy them. In today's show, I will teach you a simple pre-surf warm-up to improve your performance, exercises to get rid of nagging neck pain, and exercises to keep your shoulders healthy and pain-free. You will also learn the importance of a proper undo-the-sport post-surf session routine, especially if you're riding big waves or riding waves more aggressively and more frequently. And for those with low back or hip pain on the front leg, I'll show you how to get rid of that, too, to keep you pain-free in and out of the water. Let's go to video one. Welcome to the Hawaiian Islands! I had so much fun shooting these videos this weekend. That was at Makapu'u, and I couldn't get my surfboard in the water. That's just me being a novice to the island. But one of the things that I think is so important, and I was inspired by three of my patients who were into physical therapy, getting ready for the big waves on the North Shore, is to show a pre-surf warm-up and a post-surf warm-up, especially if you're a high-performing athlete. You need that strength and power in your front leg, because you're constantly turning into those glutes, turning into that leg, rotating your back the same way, whichever leg you have forward. So let's go to video number two, where I'll show you a brief pre-surf warm-up that I do. All right, so we're going to go surfing, and we don't want to hurt our shoulders. So we want to loosen up our arms. This is what I do before I get in the water. I do some nice big slow circles. I go across my body this way. I shake them forward, backward. And I've had five shoulder surgeries, so I stretch my triceps, and I lean and look and breathe, lean and look and breathe. Stretch those arms out. You need to be able to use those to paddle, push up on the board, because you also need to stretch your hips and your back. So then you're going to stretch your hips. I like dynamic stretching. You can stretch your arms at the same time. You lean forward, stretch. Suck your stomach in to protect your back. You can do it this way, and lean. Turn, because you're going to be turning on these waves. If you go down well, and turn, make sure you stretch the other side. Stretch your hips. Turn, going to stretch your back. So you want to bend over, but you've got to pull your belly button. So you're going to bend over to stretch your back, especially if you're getting ready for big wave surfing on the North Shore. You want to be able to stretch your back so you don't have an injury while you have your surf sessions. Let's go get in the water. Great. So I tried to give you what I do. I warm up my shoulders. I warm up my hips. I warm up my back. And those are some really critical components that you need to do before you get in the water. Whether you're longboarding or you're standing up relatively straight or you're tucked down in small waves, riding a shortboard or on these big waves tucked in the tube, it's so important to do dynamic stretching to prepare those muscles to perform. Because if you've been sitting at your desk all day or you could be shaping boards all day, turned the same way, you're getting tight on one side and stiff on the other or weak on the other. And you want to get those muscles, those joints, ready to tuck quick and pop up quick without pulling something or putting repetitive strain on a tight muscle or an improperly warmed up muscle. Now, why I do the shoulder warm-ups is because everything we do is in front of us and now you're going to lay face down, pull your chest back and rotate your shoulders. You're going to have to push on your board. You're going to have to grab it. You could get pounded in waves or your arms are in all different directions and I want to make sure that your arms are flexible so you don't tear structures. So let's go to video number three. Here we are. Welcome to teach you how to pound it when I'm at the back. Especially if I just got pounded, trying to get back out after right all too often for me. So I hope that... When I first moved to Hawaii almost two years ago, I had two patients who were in their 60s who just had neck fusions and they were saying how stand-up surfing enabled them to stay in the sport from the paddling. And I remember the biggest thing that I was teaching them was what I just showed you in the video was to kind of keep your neck long, engage certain pastoral extensors so you're not just cranking your neck into extension, relaxed like that and pinching on it because you're gonna be doing that if you're paddling for the one mile out in Aina Jaina or short waves in different areas around the island but also every time you go back out, you're gonna have to be paddling through waves. So I wanna make sure that your neck stays safe. It's a very mobile and vulnerable area and so I hope that helps. I show you exercises later that will also help. So let's go to video number four. I'm the water now. You've been surfing for two hours and you really need to loosen up your chest. So you wanna stretch your neck muscles and you can do hands right here in your chest. Nice, deep breath and push to your chest. So you stretch your triceps again. It'll get your chest and your triceps, same thing. So you can bend if you wanna stretch your glass. And also I used to get on my first board and I put my hands, I'll show you that later. So stretch your stomach in, you stretch your hamstring and of course, it's what makes you do that after surfing. It is so important to work on your shoulders after your surf session. And the one reason is, is when you're paddling, you're going so far forward. So you're using a lot of the front muscles and also during the day, as I mentioned, everything we do is in front of us. So we have a tendency to get tightness in our pecs from being forward, working on a project, working on our laptop, on our phones, shaping boards. I'm a physical therapist. I'm working on patients forward all the time. So everything on the front is getting worked, getting tighter and everything on the back is getting stretched and trying to stabilize me. So now I go out and I surf and I work more and more and more of those front muscles paddling, pushing up on the board, grabbing my board to duck through waves. Everything is working in the front. So when I get out of the water, I've had five shoulder surgeries and one of them a year and a half ago that I'm still recovering from, I always do a counteractive exercise after my surfing session. I actually do it in the water. I stay in the water. I surf at Rockpiles area. I stay in the water and I wrap my leash around my board and I get off and I get in the water and I do what I just showed you. I squeeze back, I do shoulder rotations. I do that. I do it right away to counteract it. And then later I do the bands that I'll show you. So it's very important and a lot of people have asked me about shoulder surgery and how not to hurt your shoulder surfing, how to keep them healthy and how to get back in the water after you've had surgery. So a few months back, I had someone come in who had thumb pain and it was risk pain. It was kind of where the thumb meets or the joint. And it was when he was pushing up on his board and I thought, well, he's either straining it on his board or there's something weaker up his arm, up the chain, and we call it the kinetic chain, from the floor up or from your arm up if you have your hands on a surface. So he had a really weak shoulder blade and he also had a history of neck pain. So one of the things we've worked on was to prevent him from getting shoulder pain and also stop his neck from hurting. We did those exercises that I just showed you and a lot of other scapular stabilization exercises, that's the shoulder blade, to get the shoulder blade stable on the rib cage. The shoulder blade I always say is the quarterback of the shoulder and you need your shoulder blade to be stable and all the muscles around the shoulder blade to be strong so that your rotator cuff doesn't get strained. So that worked for him, that was great. And I also had someone else who had a rotator cuff repair and a labor repair about four to five months ago and how do you get back in the water after that? Number one, you need full range of motion. So you can't have compensations when you raise your arm like this. It needs to go smoothly up. Your shoulder blade needs to have proper timing when you raise your arm up and proper timing when you raise your arm down. And also you don't wanna just go get on your board after surgery and paddle out and surf. And this is something that I did when I came here. I went down and I just paddled. I got in the water and I said, I'm gonna paddle for 20 minutes. That's all I'm gonna do. I'm gonna paddle and then I'm gonna get off my board and do the shoulder exercise and get out of the water and stretch. And then I did it again and then I did it again. And then I went out and I went into some whitewash where it wasn't not big whitewash where I thought, okay, now let me paddle and try to hold onto my board and see if I can stabilize my board without it ripping back. Cause that's the thing you have to worry about is you go to stabilize your board in the whitewash and it pushes your arm back and you just had surgery but you don't have the quick strength. It hasn't really gotten back to what it was before surgery. So those are the things that you wanna do to get ready to get back in the water. But it's even better if you prevent shoulder surgery by making sure you do a pre-surf warmup, making sure you do the post-surf warmup, warm down and the post-surf exercise with bands which I'll show you in just a little bit. So let's go to video number five. If you just finished surfing the North Shore on a small day like I just did, you're gonna want to prevent shoulder injury by doing this after every surf session, especially as you get into it. You gonna rotate your arms back? Using a TheraBand is helpful. You're gonna rotate your arms this way? Using a Band is helpful. You're gonna rotate your arms this way and then you're gonna do this. That should be your post-surf routine. So that's a quick thing that you can do. You can do five to 10 reps. And no, I did not surf at a pipeline two weeks ago but I did go up there and it was the first time I'd seen a lot of guys out there. I just happened to be filming it as soon as the waves died and I thought that was funny. There was a gentleman listening to me knowing I didn't go out there and laughing. So to do it with the bands, let's look at video number six. To get yourself out of shoulder pain and keep your shoulders healthy so that you can surf those big waves on a North Shore that are coming, you're gonna need to do a post-surf, undo the sport, work out. To do that, here's what you're gonna need to do when you come out of the water. You're gonna get a TheraBand and you're gonna pull your arms down to your side and squeeze your shoulder blades back, rotating your thumbs backwards. That works the lower trapezius and you just worked the upper trapezius with all that paddling. Squeeze. Now you're gonna have to undo the paddling. Pull back. I call this a W. Pull back. So you get all the lower scapular muscles that were just being strained to undo the position of paddling and pushing up. Then you're gonna work your rotator cuff. Again, you're pulling hard into those waves so you want to rotate back. Rotate back. Rotate back. And then to prevent neck pain because you're always looking up, you want to put that same band behind your head in a nice spot, straighten out your arms, and pull back. So you're pressing your neck back into the band, almost like tucking your chin down to make a nice sexy double chin. So enjoy having healthy shoulders and enjoy the North Shore waves this winter. Those are my go-to exercises, and I do have several others that I can do a separate show on it if I get some interest in it. So I've got a question. Thank you for sending that in. Are there exercises helpful for other sports? Are these exercises helpful for other sports or activities? Absolutely. I play beach volleyball. I swim. I've done a myriad of other sports, and I have had to do these shoulder exercises for my shoulders because I had surgery in college, four of them actually. My shoulders were pretty fast. My shoulders were unstable, and they had to reconstruct the joints at a very early age. So I've needed to keep these exercises in my routine in order to play sports, and also in order to work on patients every day without minimizing the amount of pain that I have, and minimizing the wear and tear on my shoulders is the longevity of my job. Anything that you do could benefit from shoulder exercises. These are great for overhead athletes, for basketball players, for swimmers, for polar polar players. Soccer players, they don't use their arms, but they need to have good posture and good core control. So they're great for soccer players. They're great for anything that you could possibly imagine using your arms for. So I would pretty much say any sport would benefit from the exercises that I'm showing you. The hip exercises, the ones I did really quick for the pre-warm, pre-surf warmup where you're lunging and doing 3D rotation is great for golf, runners, soccer players, football athletes, surfers, everything. Any running, jumping, turning athlete where their feet are on the ground, boaters, if you're in a boat and you're having to be on your feet, anything that's rotational or three-dimensional sport. So great question. And the second question is, what are the most common surf and other water sports injuries? I would have to look that up to see the statistics if there's a research study, what I am seeing in surfing and water sport injuries is I am seeing shoulder dislocations, I'm seeing labral tears, I'm seeing rotator cuff tears, I'm seeing neck injuries, I'm seeing concussions, but that's something that is, that's a whole different topic. And I'm seeing hip injuries, lots of hip injuries, a few knee injuries, but a lot of hip injuries and labral tears and glute strains. And that's when you've got like, I'm a left foot forward surfer and I like to ride low. I don't like to stand up super tall. So I'm crouched down, whether it's small or not. And I like, I like to be down there. I like to move around and, and I feel a big amount of strain on my left hamstring. I feel a large amount of strain on my left glute. And so it's something that needs to be strengthened. I don't touch on hip strengthening in this show just because of time limits, but I have touched on it in previous shows and I can do a strengthening show as well in the future. If I get interest. So that's a great question. Thank you so much for, for sending those in. So let's talk about what I just mentioned, which is if you have your left foot forward or your right foot forward, a common thing I'm saying, and one of my patients pointed this out to me. He works, he's a surf instructor. He's a big time surfer. He shapes boards. He works in a surf shop. And what he was noticing is he had terrible left low back pain running down his leg. And I also noticed some rotation in his upper back. And he thought it was from pushing, pushing people into the water the same way over and over again. But it would have caused an opposite rotation from what I was seeing. So we worked together for, I don't think of like six to eight sessions. And he was fantastic because he's so good about doing his exercises. So he could tell me what he noticed. And he noticed that in talking to everyone at the surf shop. That everyone that was complaining about back pain. That was regular foot. It was their left side. And the goofy foot people that he knew it was their right side. And so it put a light bulb in my head to say, wow, you guys need to do an undo the sport. These are a big wave crowd that are crouched down. They're way more talented than I am. And maybe have more steel nerves than I do. So I said, wait, when you're tucked down riding those big waves, you're like how, and he showed me the position that he was in. And I said, you need to undo that because when you're tucked in that position, if you're left foot forward, you are putting so much tension on your left hip, you're rotating your spine to the right. And you need to strengthen that side. You actually have to undo that position. So I showed him how to turn and rotate, which I'll show you in a minute and go the opposite way. And I also showed him how to stretch on the wall. And he came back into me, I think two weeks later, and he said, I've been doing all those stretches. I've integrated into my day. I've never felt better. I've been in the water every single day surfing. And he also said he was also shaping a board that he's been working on for the last three weeks or so. And he said in between, he'll stop and turn and go the opposite way. No pain. So let's look at image number seven. She's up nice and tall, left foot forward. You can see her trunk turned to the left. So that front leg is going to have a lot more strain on the hip musculature. And her spine is turning to the left. So if you do that two hours a day, maybe four hours a day or two hours a day, twice a day, or even one hour a day, every day you're putting your body into a pattern that is going to be developing in that way. Just as if you sit on your sofa with your legs off to the one side, or you sit on your laptop and you're turning one way all the time, you create a movement pattern in your body where muscles on one side get shorter, muscles on the other side get worked harder. And you want to undo that rotation. Now let's look at image number eight, where we have Tara's son, and he's riding right foot forward. So you can see how his right leg, that hip is so stretched and his trunk is totally turned to the right. And that almost looks like that stretch I was showing you in your pre-surf warmup. You want to be able to do that, and you want to be able to do it fast, and you want to be able to do it on moving water. So if we go to video number nine, I show you a lot of different ways to undo what you just did during surfing so you can stay pain free, keep up your performance, improve your performance, and stay in the water. Let's go to video nine. No matter what kind of waves you like, if there's small long rides or sharp steep drops, you need to figure out how to undo the sport when you're done so you don't get back pain or other injuries. So here's an example. If you're riding left foot forward and you're turning this way all the time, it puts a lot of stress on the front leg. That's my left leg. So if you're kooky foot, that'll be your right leg. But I also had a patient, and if you're tucked in like this, let me back up, with your foot rotated in, in those big waves tucking in, that's a lot of rotation to the left. So you're going to need to rotate to the right to undo that position. And how you're going to do that is you'll go over to a wall with your right side towards the wall. Put your right leg forward. Touch your hand to the wall and push your hips away. And you stretch out this side. You can also trace the wall with your hand and open it up like a big half circle to undo that as well. And you can also rotate towards. So now I'm turning my torso to the right. Because when I'm tucked in here, I'm always tucked to the left. Now you also want to stretch out your left after you're paddling. So you get out of the car door or the trunk or this chair. You put your hands down here. Thumbs up to keep your shoulder safe. Butt up in the air, back strength like your stomach in and lean down. You can also tilt your head a little bit to the right. Tilt your head a little bit to the left to stretch and also get to your hamstrings. And then after your serve session, you definitely want to stretch your chest. So I have people sit in a chair and reach back to something high like this and breathe. That stretches out the chest muscle right here. Reach back and breathe. It's a great way to do a stretch, an anti-curve stretch, anti-pike stretch, anti-rotation stretch. And of course stretch your hip flexors. Get on a chair, bend your knees like your stomach in and stretch. Stretch, open up your chest to save your back. Stretch, stretch. There's a whole lot of other stretches you can do lying down. And I showed those in my drop the mic on back pain video if you want to use that. Okay, so I hope that's helpful. I think that it's so important. And I use that wall stretch for so many people. I use it for people with scoliosis. I use it for back pain patients. If they have one-sided back pain, a lot of older people post 60 years old do great with that. If they've got that terrible pain in their back pain, they're going to be down their leg. They've been sitting leaning off to one side in that movement pattern they've created for years and years and years. And now I'm trying to stretch that side out. It's uplifting and elongating when you do it standing up because you're reaching your arm up on the wall. You touch it to the wall and then you can bend your knees to open up the space between your rib cage and your pelvis. There's so many muscles that go through that region, but they're very deep. It's your quadratus lumborum and your psoas muscle. And your quadratus lumborum connects your rib cage to your spine, to your pelvis. And this psoas connects your spine to your hip to your pelvis. So those are major connectors from kind of the upper trunk to the lower body. It's so important to be sure that those don't get contracted or short because that can cause compression and unwanted compression on one side of your spine, and that's why you're not getting to discreditation. So you look at someone left foot forward. I apologize. That video was selfie mode. So I was saying left, even though it was showing right, but I think you can get the justice of it, whichever side you have pain on that is a side that is away from the wall. You're opening up that side. You put the side that you don't have pain on towards the wall. You reach the arm up on the side. You have pain on and then you go towards that side and you go down to stretch all your rib cage muscles, all the muscles in your torso that are contracting. That is something that I do. I have scoliosis. I've also hurt my back helping a patient and it's important. So just try it. Try these exercises. They're fantastic and they're good for so many things. Like I mentioned, now I got another question that says, I shoot archery. Could these stretches work? Absolutely. That's perfect to come in after that video because let's say you're a right-handed person and you're pulling the bow this way. So you're going to pull it back to the left and you want to rotate the right rotation. So you're constantly resisting right rotation, pulling back, back, back. So to undo that, to keep yourself symmetrical with good alignment and good stability, you want to pick a band. I should have brought one up and you want to pull it back to the left and you want to undo that position. Undo that position. You also want to work your obliques as an archer, so you're going to be able to generate the force pulling back that you need. I don't shoot a bow and arrow. I don't compete in archery. I think I did a little bit when I was a kid, but I don't know much about that sport, but I do know if you're doing one side of rotation in one way, then you're going to need to undo the sport. You're going to need to stabilize your posture. You're going to need to work on core development. And everyone, I guess archery, you're pulling back, but everyone besides you needs to stretch their pecs, but I'm sure you don't do it all day long. So let's go to video number 10 where we get a great peck stretch. Hey, so you just finished your surf session. You just finished hunkering down over your laptop and everything in the front of you is tight. And you don't want back pain and you don't want hip pain and you want to be able to go and enjoy your day. So it's very important I do this every morning and I do it at work to stretch out the stuff in the front that got tight. So you're going to stand in a doorway. I like to have my arms and what I call it is the T position. Straight at shoulder height or slightly above. You put one foot in front of the other and use your back foot. You exhale and then you press forward with your back foot and inhale and you stretch. You'll feel it get tight right across here. Then you push back and you inhale. Now you can exhale from that position and it gets very tight. Inhale again, lift your chest. You can also look a little bit to the right. Breathe in. Now you stretch more of the left side. Then you come back, look a little bit to the left. Breathe in. And then relax and enjoy a better posture. Try these stretches. Try these exercises. Add some of the things I mentioned in your pre-surf warm-up. Try the post-surf. Undo the sport routine. Strengthen your hips. Strengthen your shoulders. Work on your posture and enjoy your surf session. Enjoy not getting injured. Enjoy being pain-free. Thank you. Thank Tech of Hawaii and all sponsors and donors for joining us. Thank you for watching. If you have questions, feel free to contact me. And remember, life is better when you listen to your physical therapist. Aloha.