Stand up paddle board training – A balancing act

Anyone who has gone near a stand up paddle board will know that you require a good sense of balance to get going – that is blatantly obvious to both amateur’s and pro’s. In this blog I’m going to explain why balance is the key to faster paddling from a physiotherapy perspective, but first of all, we need to understand what balance actually is!

Balance is ‘made up of’ the following systems:

• Vestibular (inner ear)
• Visual (vision)    
• Somatosensory (muscle, joint and sensation feedback)

If any of these systems are not working well, or are challenged, so too is your balance. If you are unbalanced on your board, there is no way you are a fast paddler because you’re losing energy through your stroke by using inefficient patterns of movement.

Let’s think about SUP – you’re on a very unstable surface that is in a constant state of change. Therefore your somatosensory system is being flogged because your muscles are working hard to control your position and feeding back information to your brain! Again, you’re on a constantly changing surface with a relatively fixed background (which is why people get sea sickness) and therefore your visual system is getting flogged! Finally, even on the board your head and body is constantly moving in different ways relative to the surface you’re trying to stand on and so your vestibular system is constantly trying to work out where the most neutral position is for your body.

These three systems are responsible for telling your brain how to move your centre of gravity (COG) over your base of support (BOS) which is demonstrated below:

In the most basic example of how to improve balance, we usually do two things that are demonstrated in the above picture and that is to lower your COG or increase your BOS – or both at the same time. Now whilst this works well on a stable surface, we know that water is constantly in a state of change. This means that even though you might lower your COG and widen your BOS, you still are unstable on a SUP. Then think about the limitations on a racing board - if you’re on a racing board, the widest your feet are able to be will be roughly 28 inches apart…

So if the most basic strategies to improve balance aren’t going to cut it on a SUP and all three systems that are responsible for balance are challenged, how can we improve our balance?

Neuromuscular training.

Physiotherapists are experts in prescribing this type of exercise that improves the ability of your muscles to provide feedback to your brain about the position of your body, whilst undergoing a challenging task. At the clinic I have a range of equipment designed to challenge all three systems mentioned above and consequently train them in isolation to improve your balance. Your balance is the foundation upon which effective stroke mechanics are built. If you want to get faster, improve your balance.

Josh Carter

Doctor of Physiotherapy

BExSSc (Clinical Exercise Physiology), DPhty, APAM, ESSAM

Stand Up Paddle Boarding - A Hip Sport

It was a hard slog today at the clinic after spending the last couple of days on the beach covering the 2014 Australian SUP Titles. However, I wanted to share some of my thoughts on the mechanics in this unique sport, which relate to one of the biggest complaints I was approached with over the four days of competition.

Lower back pain was the most prevalent complaint at the titles, especially in the surfing events for both men and women. Now anyone who has seen SUP would know that there is a lot of bending and twisting going on – and in the physio world we know that bending + twisting can = lumbar disc herniation. Yet after the marathon event (~20km of bending and twisting) there still were more sore shoulders than lower backs. So, let’s take a look at the hips and mechanics of surfing a stand up paddleboard just out of curiosity.

We know that in SUP surfing, the boards are more ‘voluptuous’ – wider and have more volume making sharp turns more of an effort compared to a short board. We also know that to perform a nice turn a number of movements come into play such as compression (essentially squatting), driving the back foot through the turn (internal and external rotation) and weight shift across the pelvis for rail to rail transitions – all of these usually occurring at the same time.

The Pelvis

Your hips are two balls sitting in a deep socket. It’s at these two joints, along with the muscles around the hips, that squatting, internal and external rotation of the leg and weight shift occur. Now let’s say for whatever reason; tight muscles, poor joint mobility, decreased strength – the list goes on, that you’re hips aren’t performing their duty to allow these movements. Somewhere else has to make up for that lack of range and the next best place is – you guessed it, the lumbar spine!

I’d liken it to asking Pavarotti to sing Justin Beiber. It really isn’t made to do that job and so something is going to give out – most likely the heart if we’re still talking Pavarotti…

Justin who?

Give me a yell if you think your hip mobility needs a leg up!

Josh Carter

Doctor of Physiotherapy

BExSSc (Clinical Exercise Physiology), DPhty, APAM, ESSAM 

Surf Life Physio explains "Swimmers Shoulder'

Swimmers Shoulder

Swimmers shoulder is merely an umbrella term for any range of aches and pains that can occur around the shoulder joint. Many pathologies can constitute ‘swimmers shoulder’ such as sub acromial impingement, tendinopathy, rotator cuff tears and bursitis.

Each of these presentations requires a unique approach with a physiotherapy management plan in place, especially if an athlete is currently training for an event.

As previously mentioned, depending on what is actually causing the ‘swimmers shoulder’, treatment will vary specific to the needs of that pathology. However, the general path a Surf Life Physio would take would be as follows:

Pain management –

Pain is obviously undesirable – even more so because we know that pain can drive or create a number of other issues which can be demonstrated in the pain cycle below.

We will work with athletes to change their pain in consultation with a GP or pharmacist for pain relieving medication and also use specialist physiotherapy techniques to reduce pain and inflammation. As physio’s we tend to only recommend cortisone injections in the most severe or unrelenting cases – as the research on cortisone and its effectiveness is not strong enough for us to suggest that everyone should just get a jab! There is emerging research on cortisone to suggest that it may have a detrimental effect on tendon strength which may predispose to further injury in the future. We know that if we can get rid of pain quickly, we can slow the process of the pain cycle and even hopefully break it early. This may also involve a discussion with the athlete about load modification – to keep swimming but reduce the load through painful structures in a number of ways such as using fins, changing the stroke, and changing the intensity, time or type of training.

Shoulder joint specific –

We then often look at the shoulder joint – a golf ball sitting in a golf tee. Because the tee is quite shallow, any level of muscle imbalance can cause this position to change leading to undesirable movement and pain at the shoulder. Whilst this is not always the case, most times physio specific manual therapy techniques can improve the position of this joint, improving mobility about the shoulder and reducing the risk of perpetuating the above pain cycle.

Rotator Cuff control –

I use the word control over strength in this situation – too often the focus is on strengthening the rotator cuff muscles. The rotator cuff is four small muscles whose main role is to suck the golf ball of the shoulder into the golf tee and hold it there all day long. The mind boggles when I walk into the gym and see large humans performing rotator cuff strengthening with weights up to 40kg! There needs to be a focus on endurance of these muscles and more importantly the control – or what physio’s call ‘proprioception’. We use our very own invention – the ‘slosh’ pipe, to train the rotator cuff muscles of our clients for control and stability.

Integration into functional activities –

Once we’ve improved the pain, improved the position of the shoulder joint and gained control in the rotator cuff muscles, we then focus on challenging all of the above aspects by integrating the athlete back into positions that may have original caused issues. By progressing the athlete in this way, we ensure that they are able to adapt to the originally painful position with much better control so that it is now pain free. It is also in this stage that we focus on the bigger picture of biomechanics of the swimming stroke. This is a rabbit hole of confusing terms and physics which is best explained face to face to get the best understanding of!

To leave you with somewhat of an example to think about. Take the notion of swimming with a pool boy between your knees. You can’t kick and so your legs become more of an anchor that sinks your butt down low in the water. With a swimming stroke, we are always trying to create a forwards drive through the water obviously, but also the best swimmers create an upwards lift which makes them sit high in the water to increase the efficiency of their stroke. Keeping this in mind, your shoulders have to work much harder to create this upward lift when you have an anchor weighing the rest of your body down, don’t they?

Assistant Professor Nick Marshall

BPhty APAM

Stand Up Paddle Boarding Injuries - Part 1

Stand up paddle boarding has really boomed on the Gold Coast over the past couple of years. If you drive past Tallebudgera or Currumbin Creek’s on the weekend, you’re hard pressed to find the water for the stand-up paddlers. With the increase in the popularity of this sport so too is there a sharp increase in the number of injuries and dysfunctions related to stand up paddle boarding. This week, I’m going to start at the top and work my way down on giving you a physio perspective on the injuries encountered in this exciting sport.

Shoulders –

Just cruisin'

Ah yes, best not to give this area the cold shoulder! Shoulder pain is a very common occurrence in stand-up paddle boarding. Of course there are a plethora of reasons why an individual may have shoulder pain and I’m not going to cover all of these here, but more give you a heads up on when it might be best to pop off and see the physio.

Let’s think about when we all first started paddling – our arms got pretty sore! This is a sure fire way to know if you’re paddling technique is up to scratch or not. A SUP stroke should come from the hips and core with the arms merely an extension of this. If your arms are getting tired – you’re not driving through your body in the stroke. Quite often we see stand up paddlers, either novices or fatigued athletes, using their bottom arm to pull their paddle through the stroke. This not only is an in-efficient stroke, but loads up structures such as your forearm muscles (those commonly effected by tennis and golfers elbow) and also your biceps tendon at the front of the shoulder. If one is to keep paddling in this way, by pulling the paddle through the stroke with the bottom arm, sooner rather than later your shoulder or forearms will give out.

What to look out for –

Quite often biceps tendinopathy will present as an aching pain and stiffness in the front of the shoulder that actually improves once you warm up and get into a bit of activity. Once you stop and rest however, it will tend to return as an ache in the shoulder that may come into the upper arm. Exactly when and where you feel your pain will determine what stage of tendinopathy you’re in, but it’s best to get your biomechanics checked (technique) by someone who is familiar with SUP and also put on to a tendon loading program from the physio.

In regards to the forearm, tennis elbow (outside of the elbow) or golfers elbow (inside of the elbow) pain is associated with painful gripping, tension through the forearm muscles and tenderness over the outside bony bump or inside bony bump of the elbow. Quite often there is a dull ache in these parts of your arm during and after activity.

If you’re experiencing these symptoms or any pain in these areas, it’s a good time to pop in and see a physio who is experienced in helping stand up paddlers, to get you back on the water. Stay tuned as next week I'll take a look at some more common injuries seen in SUP!

- Josh Carter

BExSSc (Clinical Exercise Physiology), DPhty APAM