Written by the Nuvirox Research Team
Key Points
- A meta-analysis of surfing shoulder injuries found joint-origin injuries (like labral tears and instability) are over 7 times more likely in surfers reporting shoulder problems than other injury types.
- Paddling — not wave-riding — is the dominant mechanism of injury, responsible for roughly 58% of shoulder injuries and estimated to account for over half of all time spent surfing.
- Shoulder injuries tend to be chronic and overuse-related, while knee injuries tend to skew more acute, often tied to aerial maneuvers and landings.
Short answer: surfing's two signature joint injuries — shoulder and knee — come from two very different mechanisms, and the shoulder one is driven by something most non-surfers wouldn't guess: paddling, not wave-riding. Multiple epidemiology studies converge on the same finding — shoulder and knee injuries dominate surfing's joint-injury picture, and the underlying causes are largely predictable from how much time surfers actually spend doing each part of the sport.
Why the shoulder, and why paddling specifically?
A systematic review and meta-analysis focused specifically on shoulder injury in surfing found that paddling was the most commonly reported mechanism of injury, accounting for roughly 58% of cases, far ahead of wave-riding maneuvers. That tracks with how surfing sessions are actually spent: paddling is estimated to make up more than half of total time in the water, repeated in a prone position with the arms in a repetitive overhead reaching-and-pulling motion that loads the rotator cuff and shoulder labrum thousands of times per session. The same meta-analysis found that joint-origin injuries — things like labral tears and shoulder instability — were over 7 times more likely among surfers reporting shoulder problems than other injury categories, and that shoulder injuries were disproportionately chronic rather than acute, consistent with a repetitive-overuse mechanism rather than a single traumatic event.
What about the knee?
A retrospective MRI-based study out of the Hospital for Special Surgery found that among surfers who came in for imaging after an injury, the shoulder and knee were the two most commonly injured joints, with anterior shoulder dislocation and torn MCL (medial collateral ligament) of the knee as the leading specific diagnoses respectively. Knee injuries in that population skewed more acute and traumatic — consistent with a specific event like a hard landing off an aerial maneuver or a board strike — rather than the gradual overuse pattern seen in the shoulder. A separate descriptive study of surfers in New Zealand found that surfers who performed aerial maneuvers had a significantly higher rate of knee injury (9.7%) than those who didn't (3.9%), directly tying knee risk to the specific maneuver rather than surfing broadly.
Does competitive level change the picture?
Yes. The same New Zealand study found competitive surfers had significantly higher rates of neck, shoulder, lower back, and knee injuries compared to recreational surfers — likely reflecting more time in the water, more aggressive maneuvers, and more aerial attempts. Interestingly, only 17% of all surfing injuries seen at the tertiary imaging center required surgery, with the large majority treated non-operatively, suggesting most surfing joint injuries, while common, tend toward the manageable end of the severity spectrum.
What surfing joint injuries won't look like
Most surfing shoulder pain builds gradually rather than announcing itself with a single dramatic moment, which is exactly why paddling-related shoulder injuries often get ignored until they're chronic. If you notice a shoulder that clicks, feels unstable, or aches specifically during the paddling motion and doesn't resolve with rest, that's worth a physical therapy or sports medicine evaluation rather than pushing through more sessions.
What actually helps
Because paddling is the dominant mechanism, shoulder-specific strength and mobility work targeting the rotator cuff and scapular stabilizers is the most evidence-aligned prevention strategy, more so than general fitness. For knee injuries tied to aerial landings, that's more a matter of progression — not attempting advanced maneuvers before building the base strength and technique for safe landings.
A broader systematic review of chronic and gradual-onset surfing conditions, distinct from the acute-injury studies discussed above, reinforces this: it specifically calls out paddling as responsible for an estimated 54% of total time spent surfing, and notes that the shoulder represented the largest proportion of chronic, longer-duration injuries in the New Zealand cohort data (44.4% of injuries lasting more than three months were shoulder-related), while the head and face accounted for the largest share of acute, short-duration injuries. That split — acute injuries clustering at the head and face from board strikes and wipeouts, chronic injuries clustering at the shoulder from paddling — is a useful mental model for understanding why surfers so often shrug off shoulder pain as normal: it doesn't arrive as a dramatic single incident the way a board-to-the-head moment does, so it's easy to underestimate until it's already chronic.
The same review also points toward an open research question worth flagging honestly: it suggests future work should investigate whether limitations or asymmetries in shoulder range of motion or strength predict who goes on to develop a shoulder injury, and whether hip and ankle mobility might influence knee injury risk during aerial maneuvers. That's a way of saying the field knows where the injuries cluster but hasn't yet nailed down exactly who's most at risk before it happens — useful context for surfers who want to be proactive rather than just reactive about joint health, since a formal, validated screening protocol for this isn't quite established yet.
Frequently asked questions
Is surfing's shoulder injury pattern similar to swimming's? Both involve repetitive overhead shoulder motion and share some overuse mechanisms, though surfing adds the added load of pushing up off the board and paddling against resistance that swimming doesn't replicate identically.
How does this compare to stand-up paddleboarding? SUP shares the paddling-driven shoulder overuse mechanism but adds standing balance demands that shift some load to the lower back and hips as well — see our dedicated piece on paddleboarding injuries for that comparison.
Why does my shoulder hurt specifically when I lift my arm out of the water? That's a common description of impingement-type pain; our general piece on why your shoulder hurts when you lift your arm covers the broader mechanics of that symptom pattern.
Is a torn labrum from surfing different from one caused by other sports? The underlying tissue damage is the same regardless of cause, though our piece on subacromial bursitis vs. rotator cuff tear can help distinguish overuse shoulder conditions more broadly.
From Nuvirox
Why we formulated Joint+ Restore
Nuvirox is currently reformulating Joint+ Restore, so rather than list ingredients that may change, here's the short version: our research team builds each formula around the joint-support compounds that show up most consistently in published human research, at doses that reflect that research rather than marketing round numbers.
Every order is backed by our 60-day money-back guarantee — long enough to actually evaluate it the way the research on joint supplements says you should, rather than judging it after a week.
Learn more about Joint+ Restore →The bottom line
Surfing's joint-injury story is really two stories: a slow-building, paddling-driven shoulder overuse pattern that's the sport's most common complaint, and a more acute, maneuver-specific knee injury pattern concentrated among more advanced and competitive surfers attempting aerials. Recognizing which pattern your own pain fits — gradual and paddling-related versus sudden and landing-related — is a useful first step in deciding whether it's a rest-and-strengthen situation or one that needs a sports medicine evaluation.
References
- Study finds most surfing injuries involve shoulder or knee, surgery usually not required. Hospital for Special Surgery / Sports Health. 2019.
- Shoulder injury in surfing: a systematic review with meta-analysis. PMC11530224.
- Furness JW, et al. Traumatic surfing injuries in New Zealand: a descriptive epidemiology study. PeerJ. 2021. PMC8544252.
*These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease. This article is for informational purposes only and is not a substitute for professional medical advice.