Surfers: Here's Why Your Shoulder Hurts While Paddling (And Why the Problem Usually Isn't Your Shoulder)

By Chris Ricard, DPT · Explore Physical Therapy · North Kingstown, RI

You paddle out, feel fine for the first fifteen minutes, and then something at the front or top of your shoulder starts quietly complaining every time your arm reaches forward. Maybe it's been building across a few sessions. Maybe it flared after a longer swell day and hasn't settled since. You've probably been told it's a rotator cuff issue, given some band exercises, and sent on your way, without much to show for it.

Here's the thing: the rotator cuff may be where the pain is, but it's rarely where the problem starts. In surfers, shoulder pain during paddling is most often a downstream consequence of what the ribcage, mid-back, and trunk are not doing. Once you understand that, the path forward becomes a lot clearer.

Paddling Is a Full-Body Movement Most People Do With Just Their Arms

Every paddle stroke asks your arm to reach forward overhead, catch water, and pull your body over it. Done well, that movement is supported by a mid-back that can extend and rotate, a ribcage that can open up, and hips that allow you to lie flat without fighting your own body. Done from a stiff, compressed posture, which is what many people gradually settle into during a session, the shoulder ends up taking on a job it was never supposed to do alone.

Research puts shoulder injuries at roughly 15% of all surfing injuries, with paddling as the primary mechanism. The pattern that shows up most consistently in surfers with shoulder complaints is a restriction in how the mid-back moves, which changes the position of the shoulder blade, which changes how much space the rotator cuff tendons have to work with overhead. Narrow that space and repeat the movement a few hundred times per session and you have an impingement pattern that won't resolve with shoulder exercises alone.

Three Self-Tests to Check If This Is Your Problem

Before jumping into what to do, here are three simple screens you can run yourself. None of these require equipment or a clinical background. They'll tell you a lot about whether the shoulder, the mid-back, or the hip is where your restriction lives.

Test 1: Back to wall shoulder flexion

Significant restriction at left shoulder

Stand with your back flat against a wall. Feet a few inches out, lower back gently touching the wall, head back. From here, raise both arms straight overhead and try to touch the wall above you without your lower back lifting away or your ribs flaring out.

Most people can't do this cleanly. If your arms stop well short of the wall, or if you have to arch your lower back significantly to get there, your overhead range is restricted somewhere in the chain, and the shoulder is taking the compensation. This is almost exactly what your paddle stroke demands, just repeated hundreds of times in a row.

Test 2: Standing trunk extension

Stand tall with your feet hip-width apart. Place your hands on your lower back for support and try to extend your mid and upper back backward, thinking about opening your chest toward the ceiling rather than just pushing your hips forward.

Solid improvement!

Many desk workers and regular surfers have surprisingly limited mid-back extension.

If this feels stiff, blocked, or produces discomfort between the shoulder blades, your thorax is likely contributing to your shoulder problem on the board. The prone paddle position requires sustained mid-back extension to keep the shoulder blade in a position where the shoulder can move freely overhead. Without it, the shoulder compensates on every stroke.

Test 3: Single leg bridge for hip extension

check 'em both

Lie on your back on the floor with knees bent, feet flat. Pull one knee to your chest and hold it there. Lift your hips off the floor. You should be able to get the shoulders, hips and knee of the bottom leg in line with one another. If your hips (pelvis) are below your knee, that hip is lacking in hip extension mobility.

This matters for paddling because the prone position on a board requires your hips to lie relatively flat. A restricted hip extension range often restricts your lower back and mid-back from extending fully while you're attempting to get your chest off the board, which directly limits the mid-back mobility you need for a clean overhead reach.

If you test restricted on all three: limited overhead range, stiff mid-back extension, and tight hip flexors, that's a consistent picture that points well above the shoulder as the primary problem.

What's Actually Going On

When the mid-back is stiff and the hip flexors are pulling the lower back into excessive extension, the shoulder blade loses the mobile platform it needs to function. As the arm reaches overhead during each stroke, the blade can't rotate and tilt the way it should, the space for the rotator cuff tendons narrows, and those tendons or other shoulder structures and get overloaded with every pull. Repeat that across a full session and the cumulative load adds up fast.

The ribcage is a less obvious piece of this. Your ribs attach to the thoracic spine at the back and the sternum at the front, and their ability to expand and rotate influences how much your mid-back can actually move. A compressed ribcage that doesn't open well keeps the mid-back stiff regardless of how much you stretch it. This is one reason thoracic mobility work that doesn't specifically address rib mechanics often produces limited results.

The hip extension piece closes the loop. Limited hip extension in the prone position means often forces a non-optimal paddle position at the shoulder by keeping the trunk/chest closer to the board.

None of this is the shoulder's fault. It's just the end of a chain that's been asked to pick up the slack everywhere else.

What to Actually Do About It

The order of operations matters here. Trying to strengthen a shoulder that's working from a stiff, compromised platform is like putting new tires on a car with a broken suspension; it might help a little, but it doesn't fix the actual problem. I often start at the ribcage. Focus on getting full expansion throughout the entire ribcage, then working on spinal mobility in all directions. As we achieve this, we can also focus on improving hip extension mobility but also the ability to sustain a paddle position through the hips and spine.

Once some mobility is restored, the shoulder blade control work becomes both more effective and more necessary. Exercises that challenge the mid and lower trapezius and serratus anterior through a full, overhead range, not just in the mid-range where everyone is already comfortable, are what carry the changes into your paddle stroke.

Then reintroduce overhead loading gradually, working toward the full range your self-tests showed you're lacking.

When to Get It Properly Evaluated

Shoulder soreness that eases off after a session and isn't progressively worsening can often be managed with focused mobility and loading work.

But get a proper evaluation if:

• Pain is present at rest or waking you up at night

• There's a consistent painful arc when lifting your arm that doesn't warm up

• You have any sense of weakness or giving way in the shoulder

• Symptoms have been present for more than 6-8 weeks without clear improvement

• You had an acute mechanism: a hard wipeout, an awkward duck-dive impact

  
  

Shoulder pain in surfers has a broader differential including rotator cuff tears, labral pathology, and AC joint issues that are worth ruling out before committing to a rehab program. The mid-back and ribcage approach above works very well for the most common presentation, but getting the right diagnosis first matters.

If you're surfing the Rhode Island coastline and your shoulder has been grinding through sessions, you can book a free discovery call here.

Frequently Asked Questions

Why does my shoulder only hurt during paddling and not other activities? Paddling is one of the only activities that loads the shoulder overhead, repeatedly, from a prone position that demands mid-back extension, ribcage mobility, and hip extension all at once. Most daily activities don't combine those demands at that volume. When any one of those contributing factors is restricted, paddling becomes the specific context where the shoulder gets overloaded.

Is surfer's shoulder always a rotator cuff problem? Not always, and often the rotator cuff is a symptom rather than the source. Research consistently shows the majority of surfers with shoulder pain have altered shoulder blade mechanics, which is most often driven by restricted mid-back mobility rather than a primary rotator cuff problem. Treating only the rotator cuff without addressing the thorax is why many surfers don't fully recover.

Can I keep surfing while rehabbing my shoulder? Often yes, with some modification. Shorter sessions, smaller surf with less paddling demand, and attention to posture during paddling can allow you to stay in the water while addressing the underlying restrictions. Whether to continue and at what volume depends on severity and whether symptoms are progressing.

How does mid-back stiffness cause shoulder pain? The shoulder blade sits on the back of the ribcage and thorax. Its ability to move freely as the arm reaches overhead depends entirely on the mobility of the structure underneath it. A stiff mid-back limits how the blade can rotate and tilt, which narrows the space for rotator cuff tendons to glide during each stroke. Repeat that restriction hundreds of times and the tendons become chronically irritated.

How long does it take to resolve surfer's shoulder with this approach? When the mid-back, ribcage, and hip extension are addressed rather than just the shoulder, most surfers see meaningful improvement in 4-8 weeks. Cases that have been mismanaged for longer typically take more time to unwind, but the prognosis is good once the right structures are being worked on.

Chris Ricard is a DPT and owner of Explore Physical Therapy in North Kingstown, RI. He works with surfers, trail runners, climbers, and outdoor athletes across South County and Rhode Island. If your shoulder has been limiting your time in the water, book a free discovery call.