Surfer’s myelopathy is a rare but serious non-traumatic spinal cord injury, meaning it does not result from direct impact. Instead, it arises from prolonged or repeated postures, primarily associated with surfing. While often linked to first-time surfers, it can affect others engaged in activities involving back hyperextension.
Understanding Surfer Myelopathy
Myelopathy refers to any neurological deficit stemming from spinal cord dysfunction. Surfer’s myelopathy specifically describes a dysfunction of the spinal cord caused by a reduction in blood flow, rather than direct physical trauma. This lack of adequate blood supply, known as ischemia, can lead to cellular damage within the spinal cord.
The spinal cord regions most commonly affected are the lower thoracic and lumbar areas, extending to the conus medullaris. Although named for surfing, similar myelopathies can occur in other activities involving sustained back hyperextension, such as yoga, Pilates, gymnastics, or ballet.
How Surfing Can Lead to Myelopathy
The primary mechanism behind surfer’s myelopathy is spinal cord ischemia, a deprivation of oxygen due to reduced blood flow. This often occurs from prolonged back hyperextension, a posture frequently adopted while paddling on a surfboard. This position, sometimes called the “cobra position,” can compress spinal arteries, specifically the anterior spinal artery, which supplies a significant portion of the spinal cord.
When spinal arteries are compressed, blood supply to the spinal cord is reduced, particularly in “watershed areas.” These regions, where blood supply from different arteries meets, are more vulnerable to insufficient blood flow if a contributing artery is compromised. Prolonged pressure from the surfboard on the surfer’s trunk can also impede blood flow in the inferior vena cava, potentially worsening venous congestion and contributing to ischemia. Factors like fatigue, dehydration, and unique spinal anatomy can further increase this risk. This condition can impact otherwise healthy individuals, often appearing after extended periods of paddling without breaks.
Identifying Symptoms and Seeking Help
Symptoms of surfer’s myelopathy typically appear suddenly during or shortly after a surfing session. Initial signs often include low back pain, followed by weakness, numbness, or tingling in the legs. These symptoms can progress rapidly, sometimes within 30 minutes to 4 hours, potentially leading to partial or complete paralysis of the lower limbs.
The progression of symptoms can also involve sensory changes, such as loss of tactile perception, and issues with bladder and bowel control, including urinary retention. Given the time-sensitive nature of this injury, immediate medical attention, such as an emergency room visit, is highly recommended to prevent further neurological deterioration.
Diagnosis usually involves a neurological examination and Magnetic Resonance Imaging (MRI) of the spine. An MRI can reveal characteristic changes in the spinal cord, such as T2 hyperintensity and swelling, helping to confirm the diagnosis and rule out other potential causes of neurological deficits.
Treatment and Prevention
Immediate medical interventions for surfer’s myelopathy focus on supportive care and reducing inflammation. This can include anti-inflammatory medications, such as corticosteroids, though their standardized use for non-traumatic ischemic spinal cord injuries is still being studied. Induced hypertension, a method to increase blood pressure, may also be used to improve blood flow to the spinal cord.
Recovery varies widely among individuals, ranging from full recovery to persistent neurological deficits, including permanent paralysis in some cases. Rehabilitation, often involving physical therapy, is an important part of the recovery process to regain strength and function.
Preventative measures are important for surfers, especially beginners. Maintaining proper paddling technique, which avoids excessive and prolonged back hyperextension, is a primary recommendation. Taking frequent breaks during surfing sessions, staying well-hydrated, and incorporating stretching routines can help reduce spinal stress. Strengthening core and back muscles also helps to support the spine and distribute physical demands. Novice surfers should gradually increase their surfing duration and intensity, rather than engaging in prolonged sessions initially.