ORIGINAL PAPER / SPECIAL ISSUE

Orthopaedics
Traumatology

Sports Orthop. Traumatol. 34, 261–264 (2018)
C Elsevier GmbH
www.SOTjournal.com
https://doi.org/10.1016/j.orthtr.2018.06.006

and[12_TD$IF]Summary

ORIGINAL PAPER / SPECIAL ISSUE

Background: Surfing was added as an
official event of the Tokyo Olympics in2020. There are many surfers troubled
by low back pain, but there is no scientific analysis until now. This time, wetook MRI on the lumbar vertebrae in 20
official professional surfers andexamined the relationship between
the low back pain and the rate ofthe lumbar disc degeneration.
Materials and methods: Subjects are
20 people (16 men, 4 women) of 17
Japan official professional surfers and 3
Japan official professionals bodydoaders in total, average age 29.8
years old (17–57 years), we investigated by use of the lumbar vertebrae
T2-weighted magnetic resonanceimaging.
Results: 11 people (55%) had the lowback pain, 10 people (50%)had thelumbar disc degeneration (more thanGrade III of Pfirrmann classification), 2people (10%) had the lumbar spondylolysis. There is no relationshipbetween the low back pain and therate of the disc degeneration.
Conclusions: The prevalence rate oflow back pain in the professional surfers was approximately equal toprevious report. The prevalence rateof the lumbar disc degeneration was50%, and it was not high rate particularly in comparison with baseball andthe swimming. The surfing competition
is easy to cause the low back pain, but
is not easy to cause the discdegeneration.

Lumbar intervertebral discdegeneration in professionalsurfers

Keywords
Surfing – Professional surfer – Low back pain –MRI – Lumbar disc degeneration

T. Kojima et al.

LumbaleBandscheibendegeneration
bei professionellen Surfern

Takeshi Kojima1, Shinichiro Kubo1, Naoya Tajima1, Ryuma Mitsuhashi1, Shotaro
Nozaki1, Etsuo Chosa21
Nozaki Higashi Hospital Department of Orthopaedic Surgery, Murasumi-cho,Miyazaki-City, Japan2
University of Miyazaki Department of Orthopaedic surgery[7_TD$IF], Kiyotake-cho,Miyazaki-City,[8_TD$IF] Japan
Eingegangen/submitted: 18.06.2018; akzeptiert/accepted: 18.06.2018
Online verfügbar seit/Available online: 18.07.2018

Background

Surfing is recently attracting a lotof attention as one of the Olympicgames at Tokyo 2020. However,there have been very few publishedreports which concerns sportsrelated acute injuries and chronic
disorders sustained during-surfing.
Moreover, many studies of injury
on surfing were conducted onrecreational (armature) surfers.
Those studies tend to include many
minor injuries such as skin laceration and contusions, which would beresulted from surfer’s insufficient
skills. Thus, we believe that thosestudies do not precisely reflect thespecificity of athletic surfing interms of epidemiology. The purposeof this study is to clarify therelationship between the low backpain and the rate of the lumbar discdegeneration.

Materials [24_TD$IF]and methods

Zusammenfassung
Hintergrund: Surfen (Wellenreiten)
wird als offizielle Disziplin in das Programm der olympischen Spiele 2020 in
Tokio aufgenommen. Obwohl es

Between 2015 and 2016, Subjects
are 20 people (16 men, 4 women)of 17 Japan official professionalsurfers and 3 Japan official professionals bodydoaders in total,
average age is 29.8 years old (17–T. Kojima et al.

57 years). Average surfing career
duration is 16.5 year (7–40 years).
Average height is 166.6 cm (152.2–179.9 cm), body weight is 59.7 kg(40.0–76.6 kg) and Body mass index
is 21.4 kg/m2[1_TD$IF] (17.3–26.6 kg/m2).
We investigated by use of the lumbar
vertebrae magnetic resonance imaging (MRI).
Assessment of disc degeneration
We examined T2-weighted, densityweighted, fast spin-echo sagittal
MRI scans (repetition time,5000 ms; echo time, 107 ms) of
the participant’s lumbar spine using
a 1.5 T imager (Excelart Vantage,Toshiba, Tokyo, Japan). Vertebral
discs from L1/2 to L5/S1 in the midsagittal images were assessed. The
degree of degeneration was classified into 5 grades according toPfirrmann’s classification (Fig. 1),
with grade III or more considered
degenerated. The images wereassessed by one radiologist andone orthopaedic surgeon.
Low back pain
We asked about experiences of low
back pain during their lifetime andduring surfing (yes or no).

Lumbar intervertebral disc degeneration in professional surfers

261

ORIGINAL PAPER / SPECIAL ISSUE
Sports Orthop. Traumatol. 34, 261–264 (2018)bekannt ist, dass viele Surfer unterR€uckenproblemen leiden, fehlt eine
wissenschaftliche Analyse der Situation.
[16_TD$IF]In [17_TD$IF]der vorliegenden Studie wurde bei 20
professionellen Surfen eine MRT derLendenwirbels€aule durchgef€uhrt und derZusammenhang zwischen dem tiefsitzenden R€uckenschmerz und der Auspr€agung der Degeneration der lumbalen
Bandscheiben untersucht.
Material und [18_TD$IF]Methoden: Eingeschlossen in die Studie sind 20 Profi
Surfer (16 M€anner, 4 Frauen) mit einem
Durchschnittsalter von 29.8 Jahren (17–57 Jahre). Ausgewertet wurden die T2gewichteten MRT[19_TD$IF]-Aufnahmen derLendenwirbels€aule.
Ergebnisse: 11 Surfer (55%) wiesen
lumbale R€uckenbeschwerden auf, 10Surfer (50%) pr€asentierten eine Bandscheibendegeneration (h€ohergradig als
Grad III der Pfirrmann Klassifikation). 2
Surfer (10%) zeigten eine lumbale
Spondyllolyse. Ein Zusammenhang zwischen dem lumbalen R€uckenschmerz
und dem Degenerationszustand derBandscheiben zeigte sich nicht.
Zusammenfassung: Die Pr€avalenz deslumbalen R€uckenschmerzes bei professionellen Surfern entsprach den Ergebnissen fr€uherer Studien. Die Pr€avalenz
der lumbalen [20_TD$IF]Bandscheibendegeration
betrug 50%, was keinen hohen Wert[13_TD$IF] imVergleich mit Baseball und Schwimmen[21_TD$IF]
darstellt. Professionelles Surfen ist
h€aufig mit lumbalen R€uckenschmerzen
verbunden, aber nicht[2_TD$IF] mit dem Degenerationgrad der Bandscheiben.

Results
11 people (55%) had the low backpain (surfers feel only a slight backpain after surfing, and there were nosurfers who feel pain in their dailylives.). 10 people (50%) had thelumbar disc degeneration (more thanGrade III), 2 people (10%) had the
lumbar spondylolysis. There is norelationship between the low backpain and the rate of the discdegeneration (Pearson’s chi-square
test P = 0.61) (Table 1).
But the mean age of surfers withdisc degeneration is 31.5 years

Table 1. Disc degeneration and low back pain.

* LBP: Low Back Pain.
** DD: Disc Degeneration.

Table 2. Level of disc degeneration.

€rter€sselwo
Schlu
Surfen – Profi Surfer – Lumbaler R€uckenschmerz –MRT – [23_TD$IF]Lumbale Bandscheibendegeneration

Table 3. Comparison of incidence of lumber disc degeneration between surfing andother competitions.

262

T. Kojima et al.

Lumbar intervertebral disc degeneration in professional surfers

ORIGINAL PAPER / SPECIAL ISSUE
Sports Orthop. Traumatol. 34, 261–264 (2018)

Figure 1
Pfirrmann’s classification.

and average age of surfers without
disc degeneration was 27.6years,
with a significant difference theage of disc degenerating surfers
was high (T-test P = 0.0003).
7 degeneration cases were observed
at L4/5 level, with 3 cases ofGrade III and 4 cases of grade IV,
and another 7 cases were observed
at L5/S1 level, with 2 cases ofGrade III and 3 cases of grade IV
and 2 cases of grade V. Disc degeneration was observed only at L4/5 andL5/S1 levels, in professional surfers(Table 2) (Fig. 2).

Figure 2
Disc degeneration cause only low level in surfer.
Table 4. Comparison disc degeneration level in surfing and other competitions.

Discussion

Figure 3
The shoulder joint contracture increases lumbar lordosis, which becomes a risk of low
back pain.

T. Kojima et al.

Mattew [3] investigated the timespent in each surfing activity andreported, that only 8% of total time
was spent for riding, and almost halfof the time is spent for paddling.
Paddling involves lumbar extension
and rotation, so we think long hours
paddling causes disc degeneration.
To date, the relationship between low
back pain and lumbar MRI degeneration has not been reported.
Low back pain and disc degeneration
associated with swimming motion,
which is very similar to paddling,has been reported. The shoulder joint
contracture increases lumbar lordosis, which becomes a risk of low backpain (Fig. 2) [2]. We think a similar
mechanism could occur in paddling insurfing. Either lumbar extension orrotation increases disc stress.
Particularly, nucleus pulposus isstrongly compressed in rotation,

Lumbar intervertebral disc degeneration in professional surfers

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ORIGINAL PAPER / SPECIAL ISSUE
Sports Orthop. Traumatol. 34, 261–264 (2018)

Figure 4(a) Adjust left and right difference in movement of shoulder joint/elbow joint. (b, c) Compensation movement due to lumbar left
bending and right swinging during right hand paddling. (d) MRI image shows Grade IV disc degeneration at L5/S1.

which could become a force to break
the annulus fibrosus.
The risk of disc degeneration in surfing is not very high. It seems that it
depends on the age rather than theinfluence of surfing. The incidence insurfing is not particularly higher thanthat in other sports (Table 3) [1]. If
the average age of our cases wasyounger, the incidence would be further reduced, and we hope the incidence rate will decline to the level in
non-athletes. Comparing the levelsof disc degeneration, surfing showed
lower incidence of degeneration in
the upper lumbar disc than othersports (Fig. 3, Table 4) [1]. So insurfing, burden on the upper lumbar
disc may not be high (Fig. 4).

Conclusions

References

The prevalence rate of low back painin the professional surfers was approximately equal to previous report. The
prevalence rate of the lumbar discdegeneration was 50%, and it was
not high rate particularly in comparison with baseball and the swimming.
The surfing competition is easy tocause the low back pain, but is noteasy to cause the disc degeneration.

[1] M. Hangai, et al., Lumbar intervertebral
disk degeneration inathletes, Am. J.
Sports Med. 37 (2009) 149–155.
[2] K. Kaneoka, et al., Lumbar intervertebral
disc degeneration in elite competitive
swimmers. A case-control study, Am.
J. Sports Med. 35 (2007) 1341–1345.
[3] J. Mattew, et al., The effect of wave
conditions and surfer ability on performance and the physiological response ofrecreational surfers, J. Strength Condit.
Res. 28 (10) (2014) 2946–2953.

Conflicts of interest
The authors declared that they have noconflicts of interest in the authorshipand publication of this contribution.

Corresponding author at:
Takeshi Kojima,Nozaki Higashi Hospital Departmentof Orthopaedic Surgery, 2105 Takason,
Murasumi-cho, Miyazaki-City, Miyazaki
880-0837, Japan. Tel.: +81 985 28 8555;
fax: +81 985 28 8560.
E-Mail: t-koji-1173@kaz.bbiq.jp

Available online at www.sciencedirect.com

ScienceDirect
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Lumbar intervertebral disc degeneration in professional surfers