Neck and Spinal Injuries After a Surfing Wipeout in Arugam Bay: Red Flags and What Not to Do

Most of what we see after a bad wipeout is a stiff neck or a sore back that settles in a day or two. Every so often, though, someone goes over the falls at Main Point or gets driven headfirst into a shallow sandbar at Peanut Farm, and the injury is to the neck or spine itself. These are rare, but they’re the one category of surf injury where getting the first few minutes wrong can turn a recoverable injury into a permanent one. This article is about telling the two apart, and what to do while help is on the way.

Why the neck and spine are at risk in surf

Arugam Bay’s breaks are shallow by design — that’s what makes the waves so good, and it’s also what makes a bad wipeout here different from one in deep water. A wave that holds you down over a sandbar, a header into the reef, or being driven down by your own board on a short leash can all compress or twist the neck in a way deep-water wipeouts usually don’t. Bodyboarders and surfers learning to duck-dive are especially exposed, because the instinct to dive headfirst under a wave is exactly the wrong move in shallow water.

The spinal cord runs through the bones of the neck and back. A hard enough impact can bruise, compress, or in the worst cases damage it directly. That damage is sometimes immediate and obvious. Sometimes it isn’t, which is why red flags matter more than how the person looks.

Red flags: treat these as a spinal injury until proven otherwise

Get the person out of the water carefully (see below) and call 1990 if, after a hard hit to the head, neck, or back, any of the following are present:

• Neck or back pain, especially pain down the middle of the spine rather than to one side
• Numbness, tingling, or “pins and needles” anywhere in the arms, hands, legs, or feet
• Weakness in an arm or leg, or legs that won’t hold weight
• Loss of bladder or bowel control
• A visible deformity, or the neck held at an odd angle
• Loss of consciousness, even briefly, combined with any neck or back pain on waking
• Someone who says they “can’t feel” or “can’t move” part of their body
• A high-energy mechanism — a hard header into the reef or sandbar, a heavy board strike to the neck, or being held down and tumbled by a big set — even if the person seems okay immediately afterward

Any one of these is enough. You don’t need all of them, and you don’t need to be certain — treating a possible spinal injury as a real one costs nothing. Assuming it’s “just a knock” when it isn’t is the mistake that causes lasting harm.

What NOT to do

This is the part that matters most, and it runs against instinct:

• Don’t bend, twist, or try to straighten the neck or back, even if it looks like it’s at an odd angle.
• Don’t sit the person up or let them try to stand if any red flag is present.
• Don’t remove a helmet if one is being worn — leave it on and get help.
• Don’t drag the person out by the arms or shoulders. This twists the spine.
• Don’t let them “walk it off” or get back on the board to paddle in themselves.
• Don’t leave them face-down in shallow water while you go for help — but also don’t roll or move them more than absolutely necessary to keep the airway clear.

The goal, until trained help arrives, is to keep the head, neck, and back in as straight a line as possible and stop any further movement.

What to do while you wait for help

1. Call for help immediately. Shout for other surfers or people on the beach — you will likely need more than one person. Call 1990 for a free ambulance, or come to us and we will coordinate transfer.
2. If they’re floating face-down in the water, support the head and neck in line with the body with both hands while gently turning them face-up, using help from others if you have it. This is the one situation where you move someone with a suspected spinal injury — a person face-down and not breathing will drown long before an ambulance arrives, and airway comes first.
3. If they’re on the sand or in shallow water and breathing normally, leave them exactly where they are. Support the head with your hands on either side to stop it moving, and tell them clearly not to move.
4. Keep them calm and still. Reassure them, keep talking to them, and keep them in the shade if possible without moving their body.
5. Watch their breathing and level of alertness until help arrives.

Trained paramedics carry neck collars and backboards for exactly this reason — moving someone with a spinal injury safely takes equipment and training that a beach rescue doesn’t have.

When it’s probably not a spinal injury

Most sore necks and backs after surfing are muscular — from paddling, from an awkward landing, or from whiplash-type strain without any of the red flags above. If there’s no numbness, no weakness, no loss of control, and the pain is a dull ache that eases with rest rather than a sharp, central pain, it’s very likely a strain or sprain. These still deserve a check with us, especially if the pain isn’t easing after a few days, but they don’t need the precautions above.

If you’re ever unsure which category you’re in, treat it as the serious one and come in, or call us first for advice.

After a real scare

Even when a neck or back injury turns out to be a strain and not something more serious, it’s worth being seen. We can examine range of motion, check for any signs we’d want to monitor, and give you a realistic timeline for getting back in the water — usually rest, anti-inflammatories if appropriate, and staying out of the lineup until movement is pain-free and full.

Reducing the risk

Know the sandbar and reef depth at the spot you’re surfing, especially on a break you don’t know well, and especially at low tide. Don’t duck-dive in water shallow enough to hit the bottom — take the wave on the head instead, or paddle wide. On bigger or unfamiliar swell, protect your head and neck with your arms on the way to the surface after a wipeout, the same habit that helps with head injuries. And if you’re bodyboarding or just learning, ask at the surf shop or your instructor which breaks around Arugam Bay are genuinely beginner-friendly rather than guessing.

Related reading

• Head Injuries and Concussion After a Surfing Wipeout in Arugam Bay
• Suspected Fractures and Broken Bones in Arugam Bay
• Emergency Numbers in Sri Lanka

---

This article is general health information and not a substitute for medical advice. If you or a surf buddy has any red-flag symptom after a hit to the neck or back, call 1990 for a free ambulance immediately, or walk in and we will arrange transfer.