SUP Medicine

                  


Supsonic SUP surfboards have been proven at all the big wave proving grounds.
Surfer: Frank Forbes 
Photo: H. Forbes
       

                                    
 
Suzie Cooney is the fitness model for Surf Survival, the founder of Suzie Trains Maui- a SUP training site for all SUP and Maui sports enthusiasts and is a sponsored athlete and columnist for Athleta:




Stand-Up Paddling could be one of the most symmetry-intensive training programs around. It is probably one of the fastest growing sports in the world right now. As more and more people get involved, previously quiescient muscular imbalances will begin to act up, sending both novice and die-hard paddler to the sports medicine clinic. This webpage aims to shed light on some of the best training techniques and methods to avoid and rehabilitate Stand-Up Paddling related overuse injuries. For acute injury considerations from surfing on a SUP board, see the Surfing Sportsmedicine page.

The most common overuse ailments included nagging outside knee pain (iliotibial band syndrome), butt pain (piriformis syndrome), nagging shoulder pain (rotator cuff strain) and nagging outside elbow pain (tennis elbow) from paddling. 

All equipment mentioned is available through clicking the PerformBetter banner below:



Nutrition is an important factor in musculoskeletal rehabilitation.
A functional movement screen with corrective exercises may help prevent overuse injuries:


Iliotibial band (ITB) syndrome is an overuse problem that is often seen in bicyclists, runners, and long-distance walkers. Personally, it has been noted while Backcountry Skiing and Stand-Up Paddling (SUP). Many people ask me what causes pain on the outside of the knee just above the knee joint. It is ITB syndrome and it can be problematic. The discomfort may be so intense as to discourage you from participating in the often long and rewarding sessions of SUP and other endeavors. So what can be done about it?

Ice massage is one of the best initial therapies for ITB syndrome. Hold a cube of ice in a napkin and massage the inflamed area until the cube has melted. It could take up to 20 minutes. Do this 1-2 times daily. A Cho-Pat strap or similar compression tape may prevent overstretching and inflammation,  but ultimately it comes down to adjusting biomechanics and muscle balance. The following exercises should help as well:

  • Iliotibial band stretch: Standing: Cross one leg in front of the other leg and bend down and touch your toes. You can move your hands across the floor toward the front leg and you will feel more stretch on the outside of your thigh on the other side. Hold 15-30 seconds, contracting the muscle briefly for about two seconds mid-stretch to facilitate muscular biofeedback in the stretch. Return to the starting position. Reverse the positions of your legs and repeat.
  • Iliotibial band stretch: Side-leaning: Stand sideways near a wall. Place one hand on the wall for support. Cross the leg farthest from the wall over the other leg, keeping the foot closest to the wall flat on the floor. Lean your hips into the wall. Hold 15-30 seconds, contracting the muscle briefly for about two seconds mid-stretch to facilitate muscular biofeedback in the stretch and then switch legs and repeat the exercise another 3 times.
  • Standing calf stretch: Facing a wall, put your hands against the wall at about eye level. Keep one leg back with the heel on the floor, and the other leg forward. Turn your back foot slightly inward (as if you were pigeon-toed) as you slowly lean into the wall until you feel a stretch in the back of your calf. Hold 15-30 seconds, contracting the muscle briefly for about two seconds mid-stretch to facilitate muscular biofeedback in the stretch. Do this several times each day.
  • Hamstring stretch on wall: Lie on your back with your buttocks close to a doorway, and extend your legs straight out in front of you along the floor. Raise one leg and rest it against the wall next to the door frame. Your other leg should extend through the doorway. You should feel a stretch in the back of your thigh. Hold 15-30 seconds, contracting the muscle briefly for about two seconds mid-stretch to facilitate muscular biofeedback in the stretch then switch legs and do the exercise again.
  • Quadriceps stretch: Stand an arm’s length away from the wall with your injured leg farthest from the wall. Facing straight ahead, brace yourself by keeping one hand against the wall. With your other hand, grasp the ankle of your injured leg and pull your heel toward your buttocks. Don’t arch or twist your back. Keep your knees together. Hold 15-30 seconds, contracting the muscle briefly for about two seconds mid-stretch to facilitate muscular biofeedback in the stretch.
  • Wall squat with a ball: Stand with your back, shoulders, and head against a wall and look straight ahead. Keep your shoulders relaxed and your feet 2 feet away from the wall and a shoulder’s width apart. Place a soccer or basketball-sized ball behind your back. Keeping your back upright, slowly squat down to a 45-degree angle. Your thighs will not yet be parallel to the floor. Hold this position for 10 seconds and then slowly slide back up the wall. Do these as many times as possible until proper form cannot be maintained
  • Side-lying leg lift: Lying on your uninjured side, tighten the front thigh muscles on your top leg and lift that leg 8 to 10 inches away from the other leg. Keep the leg straight and lower slowly. Do these as many times as possible until proper form cannot be maintained working from fifteen repetitions per 30 seconds toward a goal of sixty repetitions per minute.  .
  • Knee stabilization: Wrap a piece of elastic tubing around the ankle of the uninjured leg. Tie a knot in the other end of the tubing and close it in a door.
    1. Stand facing the door on the leg without tubing and bend your knee slightly, keeping your thigh muscles tight. While maintaining this position, move the leg with the tubing straight back behind you. Do these as many times as possible until proper form cannot be maintained working from fifteen repetitions per 30 seconds toward a goal of sixty repetitions per minute.
    2. Turn 90 degrees so the leg without tubing is closest to the door. Move the leg with tubing away from your body. Do these as many times as possible until proper form cannot be maintained working from fifteen repetitions per 30 seconds toward a goal of sixty repetitions per minute.
    3. Turn 90 degrees again so your back is to the door. Move the leg with tubing straight out in front of you. Do these as many times as possible until proper form cannot be maintained working from fifteen repetitions per 30 seconds toward a goal of sixty repetitions per minute.
    4. Turn your body 90 degrees again so the leg with tubing is closest to the door. Move the leg with tubing across your body. Do these as many times as possible until proper form cannot be maintained working from fifteen repetitions per 30 seconds toward a goal of sixty repetitions per minute.

Hold onto a chair if you need help balancing. This exercise can be made even more challenging by standing on an Indo Board with Flo-cushion while you move the leg with tubing.

  • Iliotibial band stretch: Side-bending: Cross one leg in front of the other leg and lean in the opposite direction from the front leg. Reach the arm on the side of the back leg over your head while you do this. Hold this position for 15 to 30 seconds. Return to the starting position. Repeat 3 times and then switch legs and repeat the exercise.  This exercise can be made even more challenging by standing on an Indo Board with the IndoFlo-cushion
  • Clam exercise: Lie on your uninjured side with your hips and knees bent and feet together. Slowly raise your top leg toward the ceiling while keeping your heels touching each other. Hold for 2 seconds and lower slowly. Do these as many times as possible until proper form cannot be maintained working from fifteen repetitions per 30 seconds toward a goal of sixty repetitions per minute.This works the hip abductors that stabilize the iliotibial band.

Piriformis Syndrome

Piriformis syndrome refers to irritation of the sciatic nerve as it passes through or next to the piriformis muscle located deep in the buttock. Inflammation of the sciatic nerve, called sciatica, causes pain in the back of the hip that can often travel down into the leg. How does it occur? The piriformis muscle is located deep in the buttock and pelvis and allows you to rotate your thigh outward. The sciatic nerve travels from your back into your leg by passing through or next to the piriformis muscle. If the piriformis muscle is unusually tight or if it goes into spasm, the sciatic nerve can become inflamed or irritated. Piriformis syndrome may also be related to intense downhill running.

You may do all of these exercises right away in addition to ice massage.

  • Gluteal stretch: Lying on your back with both knees bent, rest the ankle of one leg over the knee of your other leg. Grasp the thigh of the bottom leg and pull that knee toward your chest. You will feel a stretch along the buttocks and possibly along the outside of your hip on the top leg. Hold this for 15 to 30 seconds. Repeat 3 times.
  • Standing hamstring stretch: Place the heel of your injured leg on a stool about 15 inches high. Keep your knee straight. Lean forward, bending at the hips until you feel a mild stretch in the back of your thigh. Make sure you do not roll your shoulders and bend at the waist when doing this or you will stretch your lower back instead of your leg. Hold the stretch for 15 to 30 seconds. Repeat 3 times.
  • Resisted hip abduction: Stand sideways near a doorway. Tie elastic tubing around the ankle on your leg which is away from the door. Knot the other end of the tubing and close the knot in the door. Extend your leg out to the side, keeping your knee straight. Return to the starting position. Do these as many times as possible until proper form cannot be maintained working from fifteen repetitions per 30 seconds toward a goal of sixty repetitions per minute.

    To challenge yourself, move farther away from the door.

  • Partial curl: Lie on your back with your knees bent and your feet flat on the floor. Tighten your stomach muscles. Tuck your chin to your chest. With your hands stretched out in front of you, curl your upper body forward until your shoulders clear the floor. Hold this position for 3 seconds. Don't hold your breath. It helps to breathe out as you lift your shoulders up. Relax. Do these as many times as possible until proper form cannot be maintained working from fifteen repetitions per 30 seconds toward a goal of sixty repetitions per minute.
  • Prone hip extension (bent leg): Lie on your stomach with a pillow underneath your hips. Bend one knee, tighten up your buttocks muscles, and lift your leg off the floor about 6 inches. Keep the leg on the floor straight. Hold for 5 seconds. Then lower your leg and relax. Do these as many times as possible until proper form cannot be maintained working from fifteen repetitions per 30 seconds toward a goal of sixty repetitions per minute.

    Repeat this exercise for the other leg.

  • Quadruped arm/leg raise: Get down on your hands and knees. Tighten your abdominal muscles to stiffen your spine. While keeping your abdominals tight, raise one arm and the opposite leg away from you. Hold this position for 5 seconds. Lower your arm and leg slowly and alternate sides. Do this 10 times on each side.

Rotator Cuff Strain and Impingement

A rotator cuff injury is a strain or tear in the group of tendons and muscles that hold your shoulder joint together and help move your shoulder. It is exacerbated by use of your shoulder in sports with a repetitive overhead movement, such as swimming, baseball (mainly pitchers), football, tennis and SUP, which gradually strains the tendon. Poor shoulder posture compounds this problem. Avoid flexing the shoulder overhead when initiating the SUP stroke. Make sure to be even and symmtric through the strokes. 

Ice massage and perform these exercises to rehab the shoulder:

  • Resisted shoulder external rotation: Stand sideways next to a door. Rest the hand farthest away from the door across your stomach. With that hand grasp tubing that is connected to a doorknob at waist level. Keeping your elbow in at your side, rotate your arm outward and away from your waist. Make sure you keep your elbow bent 90 degrees and your forearm parallel to the floor. Do these as many times as possible until proper form cannot be maintained working from fifteen repetitions per 30 seconds toward a goal of sixty repetitions per minute.
  • Resisted shoulder internal rotation: Holding tubing connected to a door knob at waist level, keep your elbow in at your side and rotate your arm inward across your body. Make sure you keep your forearm parallel to the floor. Do these as many times as possible until proper form cannot be maintained working from fifteen repetitions per 30 seconds toward a goal of sixty repetitions per minute.
  • Scaption: Stand with your arms at your sides and with your elbows straight. Slowly raise your arms to eye level. As you raise your arms, they should be spread apart so that they are only slightly in front of your body (at about a 30 degree angle to the front of your body). Point your thumbs toward the ceiling. Hold for 2 seconds and lower your arms slowly. You can start doing this exercise holding a light weight or standing using properly anchored elastic tubing and gradually increase the resistance as long as there is no pain. Do these as many times as possible until proper form cannot be maintained working from fifteen repetitions per 30 seconds toward a goal of sixty repetitions per minute.
  • Side-lying external rotation: Lie on your one side with your top arm at your side and your elbow bent to 90°. Keep your elbow against your side, raise your forearm and hold for 2 seconds. Slowly lower your arm. You can start doing this exercise holding a light weight or standing using properly anchored elastic tubing and gradually increase the resistance as long as there is no pain. Do these as many times as possible until proper form cannot be maintained working from fifteen repetitions per 30 seconds toward a goal of sixty repetitions per minute.
  • Horizontal abduction: Lie on a table or the edge of a bed face down with one arm hanging down straight to the floor. Raise your arm out to the side, with your thumbs pointed toward the ceiling until your arms are parallel to the floor. Hold for 2 seconds and then lower it slowly. Start this exercise with no weight. As you get stronger add a light weight. Do these as many times as possible until proper form cannot be maintained working from fifteen repetitions per 30 seconds toward a goal of sixty repetitions per minute.
  • Push-up with a plus: Begin on the floor on your hands and knees. Keep your arms a shoulder width apart and lift your feet off the floor. Arch your back as high as possible and round your shoulders (this is the "plus" part or the exercise). Bend your elbows and lower your body to the floor. Return to the starting position and arch your back again. Do these as many times as possible until proper form cannot be maintained working from fifteen repetitions per 30 seconds toward a goal of sixty repetitions per minute.

Your doctor may also prescribe an anti-inflammatory. Surgery is very rarely necessary. If you have any reservations, stick with the exercises and maintain good shoulder posture. See also: Surfline Health & Fitness.

Lateral epicondylitis (SUP or "tennis" elbow) is the name for a condition in which the bony bump at the outer side of the elbow is painful and tender. The elbow joint is made up of the bone in the upper arm (humerus) and one of the bones in the lower arm (ulna). The bony bumps at the bottom of the humerus are called epicondyles. The bump on the outer side of the elbow, to which certain forearm muscles are attached by tendons, is called the lateral epicondyle. Lateral epicondylitis is also referred to as wrist extensor tendonitis or elbow tendonitis. How does it occur?

SUP elbow results from overusing the muscles in your forearm that straighten and raise your hand and wrist. When these muscles are overused, the tendons are repeatedly tugged at the point of attachment (the lateral epicondyle). As a result, the tendons become inflamed. Repeated, tiny tears in the tendon tissue cause pain. Among the activities that can cause SUP elbow are tennis and other racket sports, carpentry, machine work, typing, and knitting. If you have had tendonitis for a long time, scar tissue can develop in the tendon. This is called tendonosis.

Ice massage and perform these exercises to rehab the elbow: Strengthening exercises include wrist flexion and extension as well as forearm internal and external rotation holding an elastic band in your hand anchored on something (possibly your foot when performing in conjunction with a hamstring stretch). With palm down, bend your wrist upward then downward and twist left and right as if opening the door. The stretch of the elastic tubing will provide the resistance. Do these as many times as possible until proper form cannot be maintained working from fifteen repetitions per 30 seconds toward a goal of sixty repetitions per minute.

Tubing exercise for external rotation involves resting the hand of your injured side against your stomach. With that hand grasp tubing that is connected to a doorknob or other object at waist level. Keeping your elbow in at your side, rotate your arm outward and away from your waist. Make sure you keep your elbow bent 90 degrees and your forearm parallel to the floor. Do these as many times as possible until proper form cannot be maintained working from fifteen repetitions per 30 seconds toward a goal of sixty repetitions per minute.  

Web Hosting Companies