Patient Zero

The aerial renaissance of surfing has arrived, but at what price?

Editor’s note: A few days ago, John John Florence was forced to withdraw from competition at the Quik Pro due to an ankle injury sustained attempting a frontside air. In his piece from our February issue, Alex Wilson discovers that as our most progressive aerial surfers continue to push the limits, those limits are starting to push back.

It's usually the ankle that goes first. Sometimes it's the foot. In the air these body parts are safe. It's the landing where things tend to break. The signature injuries in most sports have a habit of evolving as eras change--and if the trend of broken aerialists that has developed over the last few years is any indication, this period of surfing will be marked by the acute toll it takes on the lower leg.

"Surfing has gone to a new plane," says Dr. Tim Brown, co-medical director of the ASP. "You're not just dealing with the surface of the board or the surface of the water any more. Now athletes are casting themselves into the air, and we know from sports medicine that whenever we leave the surface, whether its earth or water, the injury potential increases dramatically, especially to the ankle."

Brown, who has been working with professional surfers for 30 years, and who has also worked with some of the biggest athletes in leagues like the NFL and the NBA, says that the severity of the injuries he's seen lately, especially those associated with aerials, are comparable to what was previously common only in sports with significantly higher traumatic potential. And the root causes behind this uptick, as far as he and other doctors can tell, are embedded in the evolution of modern surfing.

We've reached a tipping point, and we're rushing past it. The height, the frequency, and the technicality of the airs we're seeing today dwarf anything that's come before. Dear Suburbia alone can probably serve as proof. If you include Modern Collective and Lost Atlas, the chances are good that Kai Neville has documented more aerials in the last three years than Taylor Steele did in the preceding two decades.

"It's basically a disaster waiting to happen," says Brown. "We know the water surface changes, the swell direction changes, the wave itself morphs into something that you might not have been predicting. So you can't always anticipate the landing surface that you're going to have available. Therefore you're not only trying to pull off a crazy air, but you're also landing in a position you can't prepare for until you're just about to touch down. And if the body has any type of quality of movement issues, meaning if you don't squat or lunge properly, or have good techniques in the movements you do on dry land, these issues are certainly going to be magnified in the water. And frankly, our bodies just aren't built to tolerate that."

As the difficulty and regularity of these maneuvers continue to rise, so will the risks, as well as the fallout. "I think it's relative for the airs that are being attempted these days," says Taj Burrow, who broke four metatarsals and the Lisfranc joint in his left foot while trying to land a frontside air in 2005. "Guys are doing such wild rotations that it's bound to happen, regardless of how young and limber you are."
To combat this trend, pro surfers are increasingly turning to preventative training, some of it specifically geared toward improving the quality of movement and strength in the areas of the body that are likely to fail in a landing gone wrong. C.H.E.K regimens, yoga, personal trainers, balance balls, and a system called Foundation, which corrects muscle imbalances, have all become common. And once a surfer does get injured, they're also working with multiple specialists, doctors, and trainers who are applying treatments and techniques they've developed while treating athletes in other sports.

Freakish airs have always been a part of Julian Wilson's surfing--but then so have ankle and knee issues. Photo: Gasper

Kolohe Andino saw no less than six specialists after he suffered a severe ankle injury this summer. Dr. David Kruse, a sports medicine practitioner, was part of that group. In addition to treating professional and recreational surfers at all levels, he serves as the USA Gymnastics Men's National Team physician, and was a four-time member of the team itself, which means he brings a unique perspective to the subject of what can go wrong when the human body takes flight, and how to treat associated injuries afterward.

"I think what needs to happen," he says, "is there not only needs to be a trend that addresses the general fitness and health for surfers overall, but also a trend that focuses on the aerial maneuvers specifically. I would say we've seen a pretty dramatic increase over the last few years in terms of injuries that correlate with the increased frequency and level of aerial maneuvers, and we need to catch up with that. We need to make sure our bodies are ready to handle that level of activity."

Kruse's approach to prevent damage to the body in a hard landing, or to rehabilitate an aerialist in the wake of an injury, is to draw from treatments and training practices that gymnasts rely on, using an older, and wider base of knowledge as a template. "Obviously there's a lot of dynamic activity in gymnastics," he says, "where you're flipping and twisting and landing, sometimes blindly onto a surface with a fair amount of force, so there's a lot of carryover."

While working with Andino, Kruse prescribed a lot of the same jump-balance drills and dynamic activities that gymnasts focus on from a very early stage in their careers. He modified his approach, however, to make it sport-specific. Instead of asking his patient to land on a mat or a balance beam, he used drills that incorporated wobble boards, foam blocks, and other unstable surfaces designed to mimic the constantly fluctuating face of a wave.

The goal of this type of approach, he says, is to prepare the human body for the torque and force of an awkward landing, not just at the point of impact (or at the initial juncture in the kinetic chain) but in the core as well. Beyond that, these drills also engage the mind and foster the types of muscle memories and techniques that can keep a surfer safe.

This all-inclusive method is something that's central for any athlete interested in improving or maintaining their levels of performance, not just in the air, but also in a complete sense. Tim Brown worked on the same team that rehabilitated Andino, and he says that his patient's quality of movement overall improved dramatically, partially because of simple adjustments they made to the efficiency of his technique and the alignment of his posture.

The price of a clip: Yadin Nicol spent nine months out of the water after he broke his ankle in Japan while filming for Dear Suburbia. As aerial surfing evolves, so too must training regimens designed specifically to avoid lower leg injuries. Photo: Gilley

"I feel that unless you really want to bet on luck, you have to train to surf," he says. "You can't surf to train. The best braces and the best protection that we have come from our ability to link our brains with our nervous systems, and our nervous systems with our muscles. The ability to transfer power to different body parts very efficiently is critical to becoming a three dimensionally protected athlete."
The question remains, however, whether approaches like this are enough to offset the damage that can be done over an entire career--or whether the longevity of some careers might also suffer. The most severe injuries associated with airs suggest that some of the best freesurfers in the world may already be paying the price. And while there are obviously anomalies to this rule, it isn't hard to imagine, as the height and frequency of airs increase, so will the consequences.

In sports like gymnastics (or skating, surfing's considerably-more-painful-and-high-impact cousin), it's common for athletes to peak at a younger age simply because of the demands of the activity. Whether we're moving in that direction is up for debate, but the rash of injuries associated with aerials, many of them occurring to surfers under the age of 25, is certainly cause for speculation. "As far as the aerial game goes," says Taj Burrow, "the younger the better for sure. A teenage body can handle the impact of huge rotations into the flats. Those juvenile, flexible bones are much more suited for big, progressive airs."

Burrow also points out, however, that surfing has always been this way--that the young have historically driven progression. And in terms of freesurfing, this pattern is likely to continue as performance advances.

The aerialist who burns twice as bright tends to burn for half as long. Then again, that's by no means a foregone conclusion. Doctors and trainers are just beginning to grapple with the impacts of massive and frequent aerials, so it could take some time for both the long-term effects, and the compensations that athletes will make accordingly, to develop.

For instance, it's still unclear how much knee, back, and hip injuries, which are considered chronic in most cases (as in they develop over time from repeated, forceful landings), will play into the long-range scheme of many high-performance surfers' health. It's also unclear, however, what countermeasures medical practitioners, and the athletes themselves, will employ.

"The way these shifts and trends work in all sports," says Dr. Kruse," is that the medical side of things, or the injury prevention side, always lags behind the change in technique or performance. But I think if we can make changes in terms of prevention, in the ways that surfers train, it's very possible to be able to compensate. We just need to catch up with that high level of activity and make sure out bodies are ready to handle everything that comes with it."

The idea that surfers like Julian Wilson, or Dane Reynolds, might still be at the forefront of aerial performance in 10 years seems almost ridiculous. But in 2002, so did the concept of a 40-year-old World Champion. And if we can learn anything from this type of progress, it might be that the benefits of specific and intensive conditioning, and the human body's responses, always have the potential to surprise us.

"I think this is just a trend the young guys are going through," says Mick Fanning, who famously recovered from a non-aerial-related, but potentially career-ending injury in his mid-20s. "When you're young you throw caution to the wind. But as you get older you realize that you can train for certain things and do them injury-free. Look at Kelly. He's done some of the biggest rotations into the flats and come out sweet. I think you'll see, as the younger guys get older, they'll learn how to prevent these injuries and still be doing crazy, tech stuff. Sometimes the age thing is just in people's heads. It really depends on how they move forward and look after their bodies. If the next generation wants to keep flipping and spinning, they'll just have to keep focused on prevention. That's what training's all about, really--avoiding injuries. If you think about it like that, it's all pretty simple."

Easily one of the most frequent and technical fliers to emerge in the last two years, Ryan Callinan has also become one of the most injured, paying for his rise with two broken ankles, knee problems, and a host of other injuries. Photo: Bosko