Damien Hobgood, one of the many victims of a damaged shoulder--an injury often caused by too many perfect barrels. Photo: Joli

A lifetime spent in the lineup doesn’t come without a price. Whether it’s a bum knee, a nagging ankle injury, or the all-too-fickle rotator cuff, if you surf long enough, your body will eventually begin to wear down. To keep you in the lineup and injury-free, we tapped the shoulder of Dr. Tim Brown, the co-medical director of the ASP and founder of IntelliSkin, for the ins and outs of treating one of surfing’s most commonly injured areas: the rotator cuff.

By in large, most rotator cuff injuries occur from paddling improperly. As surfers, we have very developed shoulder muscles. Believe it or not, that's actually throwing off our body’s alignment, which is what can lead to the injury in the first place. When we paddle, we have a tendency to stroke and then pull our arms inward and toward our body. Repeating that motion for years will actually alter the natural alignment of our shoulders. Over time, you'll gradually wear down your rotator cuff and eventually be in a lot of pain.

The key to preventing a shoulder injury—like most injuries in surfing—is keeping your body and joints in proper alignment. Think of your rotator cuff as a wheel on a bike. If your wheel is out of alignment, it'll begin rubbing up against the fork of your bike. At first, it might not be that big of a deal, but over time, that wear and tear will make riding your bike harder and harder until one day, you physically just can't do it anymore. Now compare that to a tire that's in perfect alignment. That bike will ride forever—or at least until you don't want to ride anymore. The key to preventing a rotator cuff injury is all about alignment.

Rotator cuff injuries are actually pretty common in a lot of sports, so we've gotten pretty good at treating them. You'll see a lot of these types of injuries in baseball players as well, and it goes back to that motion of swinging your shoulder over your body and forcing your arm out of alignment. When we treat the injury, we approach more than just the rotator cuff; we look at the whole body and try and strengthen other parts as well to keep everything aligned. We'll put a lot of focus on strengthening your core and getting you into a proper posture. That's a huge part of the rehab. Let's say you surf every day for an hour or two. You're constantly pulling your shoulders forward in the water and over time, if you're not actively working to correct it, your shoulders and posture will begin mimicking what you're doing in the water on land. What you do for those one or two hours in the lineup will actually end up affecting you all day. You’ll get stuck in that pose. If we can fix your posture, we can help fix the injury as well, and hopefully prevent more injuries in the future.

When we're trying to heal the specific parts of the shoulder in a rotator cuff injury, it’s important to focus on mobility in the area and work on opening up your chest and the muscles underneath your shoulders. It’s all connected. For a lot of surfers, the front of our shoulders are very over used, while the back is not. So you should focus on working on strengthening and opening up the muscles that surround the shoulder to take some of the stress off the injured area. The good news is that, if the injury isn't too severe, you can typically see a significant amount of recovery in four to eight weeks. Obviously, the younger you are and the healthier you are, the quicker the recovery.

What’s the worst injury you’ve encountered from surfing? Let us know in the comments section below.