Epidemiology of Acute Injuries in Surfing: Type, Location, Mechanism, Severity, and Incidence: A Systematic Review

Abstract

Prospective and retrospective studies have examined traumatic injuries within competitive and recreational surfers worldwide using online surveys and health care facility (HCF; e.g., hospital, emergency department, medical record) data. However, few studies have provided a synthesis of all available literature. The purpose of this study was to obtain, critique and synthesise all literature specific to acute surfing injuries, and evaluate differences in injury type, mechanism and location between HCF and survey data. A systematic literature review design was used to identify relevant articles from three major databases. Peer-reviewed epidemiological studies of musculoskeletal surfing injuries were included. A modified AXIS tool was used for critical appraisal, and objective data was extracted and synthesized by lead researchers. Overall frequencies for injury location, type and mechanism were calculated from raw injury data. A total of 19 cross-sectional articles of fair to good quality (Modified AXIS 54.2–83.3%) were included in this study; 17 were National Health and Medical Research Council (NHMRC) level III-2 (retrospective) and two were level II (prospective). Articles examined competitive, recreational and combined populations. Injury data from Australia, Brazil, UK, USA, Portugal, Japan, Norway, and worldwide were represented. Skin (46.0%; HCF 50.1%, survey 43.8%) and being struck by own surfboard (38.6%; HCF 73.4%, survey 36.7%) were the most common injury type and mechanism. Head, face and neck injuries were most common in HCF (43.1%) versus lower limb injuries (36.4%) in survey data. Incidence proportion was highest in aerialists (0.48). Incidence rate (number of injuries per 1000 h) ranged from 0.74 in Australian surfers (Melbourne) to 6.6 in international contest surfers from medical record data. This review highlights the prevalence of skin, board-related, head, face and neck, and lower limb surfing injuries across available literature. Proposed use of protective equipment and foam-based surfboards in dangerous or crowded surf locations may reduce injury risk.

Chronic and Gradual-Onset Injuries and Conditions in the Sport of Surfing: A Systematic Review

“…A modified version of the AXIS Critical Appraisal Tool [ 23 ] was adapted from the tool utilized by McArthur et al [ 24 ] and used to examine the quality of each of the included studies. The AXIS tool can be implemented to assist the inclusion of cross-sectional studies within systematic reviews [ 23 ].…”

“…Further modification of the tool was conducted to ensure all the questions were relevant to chronic and gradual-onset injuries and conditions. The exclusion of Question 12 from the tool by McArthur et al [ 24 ] was justified, as the question was not applicable to the research question being investigated. This resulted in a total of 24 questions.…”

“…For example, nil “concerns about non-response bias” or nil “funding sources or conflicts of interest” would result in ‘1’ point. The maximum attainable score was ‘25’, compared to ‘27’ in the tool modified by McArthur et al [ 24 ] and ‘20’ in the original AXIS Critical Appraisal Tool for Cross-Sectional Studies [ 23 ]. A quality grade was applied as per the Kennelly Rating System and adapted in line with the research completed by McArthur and colleagues [ 24 , 26 ].…”

“…The maximum attainable score was ‘25’, compared to ‘27’ in the tool modified by McArthur et al [ 24 ] and ‘20’ in the original AXIS Critical Appraisal Tool for Cross-Sectional Studies [ 23 ]. A quality grade was applied as per the Kennelly Rating System and adapted in line with the research completed by McArthur and colleagues [ 24 , 26 ]. The raw AXIS scores were converted into percentages, with a score equal to or greater than 74% considered ‘good’, a score between 55% and 73.9% considered ‘fair’, and a score less than 54.9% considered ‘poor’.…”

Isokinetic Dynamometry as a Tool to Predict Shoulder Injury in an Overhead Athlete Population: A Systematic Review

“…An answer of ‘Yes’ was awarded 1 point, and an answer of ‘No’ or ‘Don’t Know’ was awarded 0 points with the maximum score being 17. Modifications to critical appraisal tools such as the CASP and Axis whereby questions are assigned a point system have been previously used in other reviews [ 35 , 36 ].…”