Surfer’s Ankle – Unstable and stiff ankle

Usually a surfer that suffers from an ankle injury or chronic ankle pain will go online and start looking for exercise tips, a really good ankle brace, or any other means to help them with either a loose ankle or an ankle that is too stiff. A surfer will then seek out medical attention when these various remedies are no longer helping them and carving, turning in, and the pop up become increasingly painful and unstable endeavors. When it because too painful or surfing begins to loose its joy, a surfer will usually visit a doctor, thinking about the possibility that they may have to give up surfing.

Many surfers have a long career of sub acute ankle injuries, this means years of wear and tear powering the board, hard and soft landings, and hyperextending their ankles have a cumulative effect that is now causing ankle instability. In addition to these injuries, many suffer from a more acute injury. Some may have an ankle break in their past or significant ligament tears from a high grade ankle sprain. One thing in common is that a lot of these injuries may not have fully healed and here these surfers are now, years and decades into your surfing with significant ankle problems.

Surfer's ankle pain

The types of surfer ankle injuries

Trail leg on landing

A paper in the Journal of sports sciences (1) examined how surfers used their lead and trail limbs when landing two variations of a simulated aerial maneuver, and whether technique affected the forces generated at landing. Fifteen competitive surfers performed a Frontside Air and Frontside Air Reverse, while information on impact forces, ankle and knee muscle activity, and kinematic data was collected.

This information reveled that the trail limb generated significantly higher relative loading rates at landing. This was likely due to the surfers “slapping” the trail limb down when landing, rather than controlling placement of the limb. Similarly, higher relative loading rates were generated when landing the Frontside Air compared to the Frontside Air Reverse due to less time over which the forces could be dissipated. Practitioners should consider the higher relative loading rates generated by a surfer’s trail limb and surfers (should consider) dry-land training to improve the aerial (maneuver).

Wear and tear powering from the back leg and fractures 

A paper in the Clinical journal of sport medicine (2) documented: “The most common orthopedic injuries in professional surfers involve the knee, ankle, shoulder, hip, and back. Surfers’ rear extremities were preferentially injured which is the extremity responsible for power and torque. Shoulder injuries increased the probability of an operative intervention. Last, overuse injuries (femoral-acetabular impingement, rotator cuffs) occurred in the older surf population compared with more acute injuries (ankle sprains/fractures, anterior cruciate ligament tears) which is also consistent with time to surgery.

Experienced surfers hurt their ankles just as much as novice surfers in male groups in a landing exercise. Females land better – less ankle dorsiflexion

A study in the journal Perceptual and motor skills (3) noted the “observed inconsistency of sex differences in drop-landing motor skills might be due to the confounding factor of prior experience. Thus, in this study, (they) explored the role of experience in shaping male and female surfboard riders’ motor skill kinematics during drop landings while surfboard riding.

(The study authors) recruited 42 participants (21 females and 21 males) from three groups of surfing experience levels (competitive surfers, recreational surfers, and nonsurfers), each equally comprising seven males and seven females.

Sagittal plane kinematics and vertical ground reaction force data were collected from all participants during a laboratory-based two foot (60 cm) drop-landing task. Knee flexion and ankle dorsiflexion at initial ground contact were greater among male participants, independent of experience level.

In both sexes, greater range of motion at these joints was related to greater experience. Recreational female surfers landed in a more upright posture with more extended ankle and knee angles and less ankle dorsiflexion at the end of landing than participants in all other groups.

The research on bone marrow derived stem cell injections for chronic ankle pain and instability

Usually by the time we see someone with chronic ankle pain and mobility issues, they are into a degenerative ankle situation or advancing osteoarthritis. These people have gone beyond simple ankle sprains.

Research in the Journal of experimental orthopaedics (4) reviewed the research in the treatment of ankle osteoarthritis with bone marrow derived stem cells.

  • The goal of this study was to review outcomes of bone marrow aspirate concentrate (bone marrow derived stem cells) for the treatment of chondral (cartilage) defects and osteoarthritis of the talus of the ankle.

The researchers noted that there is not much research (at the time of this paper’s writing). . . Nonetheless, the evidence available showed varying degrees of beneficial results of bone marrow derived stem cell therapy for the treatment of ankle cartilage defects.

  • The researchers hypothesized that bone marrow aspirate concentrate may be useful in regeneration of tissue, enhancing the quality of cartilage repair. As a result, BMAC promotes a potentially healthy environment for hyaline cartilage growth and repair.

Research cited:

  • A 2009 study published in Clinical Orthopaedics and Related Research, reported that 94 % of patients returned to low impact sports activity at an average 4.4 months after bone marrow aspirate transplantation and 77 % of patients returned to high impact sports activity at an average 11.3 months. (5)
  • The same researchers in 2013 reported that 73 % of the 36 patients playing sports before surgery were able to return to sports. They also reported that 22 % of these 36 patients were able to return to sport, but at a lower level than before surgery. (6)
  • A 2011 study reported that 95 % of patients who had undergone bone marrow concentrate treatments returned to their pre-symptom level of sporting activity at an average 13 weeks.(7)

A 2016 report in the Journal of experimental orthopaedics (8) examined ways to save the ankle from fusion and replacement. In this study, Italian researchers discussed joint saving procedures such as:

  • Surgical procedures such as Arthroscopic debridement, arthrodiastasis, and osteotomy are the current joint sparing procedures, but, in the available studies, controversial results were achieved
  • Better results for patients they speculated could be achieved with Mesenchymal stem cells (MSCs). They write that stem cells may be a good solution to prevent or reverse ankle degeneration, due to their immunomodulatory features (able to control the catabolic joint environment) and their regenerative osteochondral capabilities (able to treat the chondral defects).

Can we help with your ankle pain?

There is no narrative in this video. Generally speaking, if your ankle is not frozen or locked up with bone spurs and can rotate, even through the pain, then we can have a realistic expectation that we can provide some help. How much help? We can’t be sure until we do the examination. Below shows ankle pain treatment.

Call for a free phone consultation with our staff – 800-300-9300 or 310-231-7000

With over 25 years experience in regenerative medicine techniques and the treatment of thousands of patients, Dr. Darrow is considered a leading pioneer in the non-surgical treatment of degenerative Musculoskeletal Disorders and sports related injuries. He is one of the busiest Regenerative Medicine doctors in the world. Dr. Darrow has co-authored and continues to co-author leading edge medical research including research on bone marrow derived stem cells. He also comments and writes on research surrounding the treatment of chronic tendon injury, ankle and foot pain, elbow, hand and finger pain.




Marc Darrow MD JD


1 Forsyth JR, Richards CJ, Tsai MC, Whitting JW, Riddiford-Harland DL, Sheppard JM, Steele JR. Rate of loading, but not lower limb kinematics or muscle activity, is moderated by limb and aerial variation when surfers land aerials. Journal of Sports Sciences. 2021 Mar 29:1-9.
2 Hohn E, Robinson S, Merriman J, Parrish R, Kramer W. Orthopedic injuries in professional surfers: a retrospective study at a single orthopedic center. Clinical journal of sport medicine. 2020 Jul 1;30(4):378-82.
3 Bruton MR, Adams RD, O’Dwyer NJ. Sex differences in drop landing: More apparent in recreational surfers than in competitive surfers or nonsurfers. Perceptual and motor skills. 2017 Oct;124(5):992-1008.
4 Chahla J, Cinque ME, Schon JM, et al. Bone marrow aspirate concentrate for the treatment of osteochondral lesions of the talus: a systematic review of outcomesJournal of Experimental Orthopaedics. 2016;3:33. doi:10.1186/s40634-016-0069-x.
5 Giannini S, Buda R, Vannini F, Cavallo M, Grigolo B. One-step Bone Marrow-derived Cell Transplantation in Talar Osteochondral Lesions. Clinical Orthopaedics and Related Research. 2009;467(12):3307-3320. doi:10.1007/s11999-009-0885-8.
6 Giannini S, Buda R, Battaglia M, Cavallo M, Ruffilli A, Ramponi L, Pagliazzi G, Vannini F. One-step repair in talar osteochondral lesions: 4-year clinical results and t2-mapping capability in outcome prediction. The American journal of sports medicine. 2013 Mar;41(3):511-8.
7 Kennedy JG, Murawski CD. The Treatment of Osteochondral Lesions of the Talus with Autologous Osteochondral Transplantation and Bone Marrow Aspirate Concentrate: Surgical TechniqueCartilage. 2011 Oct;2(4):327-36. doi: 10.1177/1947603511400726. PMID: 26069591; PMCID: PMC4297142.
8 Castagnini F, Pellegrini C, Perazzo L, Vannini F, Buda R. J Exp Orthop. 2016 Dec;3(1):3. doi: 10.1186/s40634-016-0038-4. Epub 2016 Jan 15. Joint sparing treatments in early ankle osteoarthritis: current procedures and future perspectives.


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