# Evaluating head and neck trauma in surfing: injuries and prevention in an olympic sport

## TL;DR

This paper reviews head and neck injuries in surfing, highlighting the need for better injury tracking and protective measures as the sport grows.

## Contribution

The study provides the first synthesis of head trauma literature in surfing, revealing gaps in helmet efficacy and return-to-play guidelines.

## Key findings

- Head injuries in surfing include concussions, lacerations, and rare intracranial hemorrhages, with direct surfboard impact being the main cause.
- Helmet use is inconsistently reported and its effectiveness remains largely unproven in the reviewed literature.
- There are no validated return-to-play guidelines for head injuries in surfing, and pediatric and advanced surfers face higher injury risks.

## Abstract

Surfing's Olympic inclusion has spotlighted it as an internationally popular, high-impact sport with risks of neurosurgical-relevant trauma. However, research on these injuries remains sparse and heterogenous and no synthesis has mapped this literature. All athletic levels of surfers face unique biomechanical forces from wave impacts, board collisions, and seafloor contact, which results in a significant, yet under-quantified, neurotrauma prevalence. Despite parallels with other action sports, surfing-specific epidemiology, helmet efficacy, and standardized return-to-play guidelines remain underdeveloped, even within professional and collegiate athletic governing bodies like the World Surf League (WSL).

A scoping review screening for head trauma in surfing was conducted and yielded 25 studies published between 1976 and 2025 encompassing 72,093 patients. Epidemiologic data, injury mechanisms, reported intracranial pathology, need for neurosurgical intervention, and protective equipment use was extracted and synthesized in Table 1.

Our analysis of literature indicates an under quantified risk of neurosurgical-relevant trauma. Injuries include concussions and lacerations as the predominant mechanism of injury, and severe outcomes like skull fractures and intracranial hemorrhages, reported at 0.8–1.9% of large ED cohorts, which occasionally require neurosurgical intervention and, rarely, result in mortality. Direct surfboard impact is the predominant injury mechanism, estimated in one dataset to account for up to 55% of emergency department presentations. Higher rates of head injury were observed among pediatric surfers and those able to perform advanced maneuvers. Helmet use was inconsistently reported, noted in 11/25 studies, and its efficacy largely unevaluated. A critical finding is the complete absence of validated return-to-play guidelines in the reviewed literature. The prevalence of surfing injury is substantially underreported due to methodological limitations in existing studies.

This review underscores an urgent need for standardized injury surveillance, rigorous protective gear research, evidence-based concussion management frameworks, and heightened neurosurgical awareness of the risks inherent to this growing global sport.