A magazine for friends of the Warren Alpert Medical School of Brown University.

Hang Safely


A surfing doc helps prevent injuries in his favorite sport.

Gory tales of shark attacks may captivatethe public, but surfers needn’t be too concerned. According to Andrew Nathanson, MD, clinical professor of emergency medicine and attending physician at The Miriam and Rhode Island hospitals, surfers should worry less about sharks and more about their own boards. “A third of all injuries come from being cut by the fins on your surfboard— they’re the most dangerous teeth in the water,” he says.

Nathanson, a surfer himself, began studying surfing injuries during his EM residency at Los Angeles County, University of Southern California Medical Center. In June 2014, he presented his research on the frequency of injury types in surfing at the International Extreme Sports Medicine Congress, in Boulder, CO. Nathanson and others collected data at amateur and professional surfing competitions over six years, tallying injuries that caused surfers to miss work or school, or a day of competition.Lacerations, sprains, and fractures were all common. Just three of the 1,237 acute injuries documented were due to sharks, and only 3 percent of all injuries were due to marine animals.

But more than 60 percent of all injuries were caused by surfboards, and of those, 82 percent were caused by the rider’s own board. A typical surfboard is made of wood or fiberglass, with a sharp nose and sharp fins on its underside. A tether, or leash, secured with a Velcro ankle strap, prevents the rider from losing the board in a wipeout, when it could strike other surfers or strand them in choppy water. But the leash can pull taut and occasionally recoil, causing many of the lacerations common to surfing. In Nathanson’s data, cuts accounted for 42 percent of all acute injuries. Surfers can reduce that risk by smoothing the edges of the fins, replacing them with rubberized fins, and purchasing boards with rounded noses, all modifications that Nathanson has made. “Many of these injuries are totally preventable,” he says.

Hitting the bottom is the second most common cause of injury, accounting for 17 percent of injuries in the study. “In places like Hawaii, there’s a lot of sharp coral, so if you hit the bottom you’re likely to get sliced up,” he says. Sandy bottoms are generally safer, but surfers who land headfirst could still break their necks, he adds.

Nathanson is editor of the journal Surfing Medicine and surfs in Rhode Island year-round. “The surfing risks in Rhode Island are similar to other places,” he says. “People who surf in the wintertime here risk hypothermia, something you’re almost never in danger of in Hawaii. But on the other hand, in Rhode Island you don’t have those bone-crushing waves like on Hawaii’s North Shore.”

Despite his awareness of the risks, Nathanson’s suffered a few injuries: he’s stepped on a sea urchin, and twice his board hit him above the eyebrow during hurricane swells. “I just glued the wound together with Dermabond, a medical superglue,” the EM doctor says. He wants to help his fellow surfers be more selfsufficient, too: he co-authored a book, Surf Survival (Skyhorse Publishing, 2011), which translates his research into a how-to guide. “Surfers tend to travel to exotic and remote places because they want to be where other surfers aren’t,” he says. When it comes to medical care, “surfing is one of those sports where you’re often on your own,” he adds.

Nathanson hopes his findings don’t scare people away from his favorite sport. “Surfing is actually safer than soccer,” he says. But everyone should take common-sense precautions, he adds. “Don’t go out if the conditions are beyond your skill level. And take a first aid kit.”


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