Adaptive Surfing and Surf Therapy: Using the Power of the Ocean to Heal

by Tiffany M. Lau, MD

Marine Corps veteran Sgt. Toran Gaal poses for photo with his custom surfboard which allows him to surf despite being a double amputee during the Naval Medical Center San Diego surf therapy clinic in Del Mar, CA. DoD photo by EJ Hersom.

The sounds of the waves as they crash into the beach, the ambience of the ocean air, and the taste of the salty water; these are just a few of the sensory experiences of the sport of surfing. The glide of the surf board on the wave, gives the surfer the feeling of elation and excitement. Surfing puts you in the moment. You are unable to focus on anything else but what you are doing at that time. It is easy to see where the surfer’s “stoke” comes from. For many that love this sport, surfing would be something difficult to give up. However, life is unpredictable and some individuals undergo earth- shattering injuries or events that make traditional surfing a challenge; enter Adaptive surfing. Adaptive surfing is formally recognized by the International Surfing Association (ISA) (an organization with a mission to develop the sport of surfing in all of its forms across the globe). ISA has been crowning champions with physical challenges across multiple divisions and categories since 2015. In addition to the ISA there are many organizations (e.g. Disabled Sports USA) that work to coordinate surfing events as well as promoting the well- being of people with handicaps, impairments or disabilities though surfing.

There are many stories about how surfing and/or the return to surfing after a life-altering injury or event has pulled individuals out of a deep depression, given them will power, determination or a little more acceptance of their current level of function. One example is Jesse Billauer: “Many years ago, I was one of the top 100 junior surfers in the world, weeks away from turning professional. On March 25, 1996, on a morning like any other Malibu morning, I pulled inside a barrel and got thrown headfirst into a shallow sandbar. The impact broke my sixth vertebrae and I instantly became a quadriplegic.” Jesse Billauer is founder and CEO of Life Rolls On. Life Rolls On is a nonprofit organization dedicated to improving the quality of life for people living with various disabilities. Jesse Billauer turned his own peripeteia into the epitome of altruism. This organization coordinates adaptive surf and skate events around the United States.

Another example is Elsje Neethling: “For some brief moments there is nothing in the world but you, the board under you, and the wave. You forget that you are differently abled, broken, sick or hurt. The waves cleanse your head, heart, body and mind. It’s quite a spiritual experience to lie on your board in the backline, waiting in anticipated silence and focus for that one perfect wave. Surfing has given me wings, it has shattered all the odds brain cancer and disability have stacked against me. Surfing has not only given me boundless confidence to take on life, it has given me hope. Hope that there really isn’t anything you can’t do. If you can visualize it and muster up the courage and optimism, then you definitely can do it.” She is an adaptive surfer who had choroid plexus carcinoma that caused an incomplete spinal cord injury.

Adaptive surfing is growing worldwide, more and more people with different abilities are discovering the joy of gliding on an ocean wave. There have been case reports of prostheses that have been developed specifically for the physicality of surfing. It is also gaining popularity as a competitive sport. Surfers are classified based on their ability levels. Some examples of these levels are: surfers who ride in a kneeling or standing position, surfers who ride in a seated position on a wakeski, surfers who ride prone, surfers who ride in a non-standing position and need assistance to paddle into waves, and also surfers who have a visual impairment.

The mindfulness surfing requires lends it well to be used as a meditation and a type of therapy. Surf therapy is defined as a physical activity that utilizes surfing as a vehicle to achieve positive change. Surf therapy combines therapeutic elements of the ocean with the adventure of surfing to positively impact physical and metal well-being of individuals. There is a growing body of evidence that demonstrates that surf therapy is effective in improving comparable mental health outcomes across different populations in a wide range of contexts including vulnerable young people. These studies demonstrate a strong association between surf therapy and positive mental health outcomes. However this evidence still has some limitations and further research needs to be conducted. The International Surf Therapy Organization (ISTO), a nonprofit organization dedicated to advancing the use of surf therapy, has united over 22 different organizations around the world using surfing as a form of therapy. The ISTO created and follows best practice requirements and run programs following priority areas like: mental health, disability, adverse environments, and marginalized communities.

The ocean has long been regarded by many different cultures as a place of healing with therapeutic functions and usages. Adaptive surfing and surf therapy bring home the notion of inclusivity by harnessing this healing power. Surfing is this idiosyncratic mix of serenity and adrenaline and often allows surfers to practice mindfulness. Elsje Neethling summed it up best, “It’s the best medicine for any ailment.” The waves do not discriminate, if you have mental health illness, are differently-abled, or able bodied the waves of the ocean wash over you the same.


1. Adaptive Surfing -. International Surfing Association. Published 2019. Accessed August 10, 2019.

2. Life Rolls On. Life Rolls On. Published 2019. Accessed August 10, 2019.

3. When disability fades away in the water: three women who surf in spite of the odds. Marie Claire — South Africa. Published 2019. Accessed August 10, 2019.

4. “Adaptive Surfing Is The Best Thing That’s Ever Happened To Me.” Women’s Health. Published 2019. Accessed August 10, 2019.

5. Schvirtz, E., Bensoussan, L., Tourret Couderc, B., Viton, J.-M., Delarque, A., & Kerzoncuf, M. (2018). Return to surfing using an adapted prosthesis: A case report. Prosthetics and Orthotics International, 42(4), 455–459.

6. Marshall J, Kelly P, Niven A. “When I Go There, I Feel Like I Can Be Myself.” Exploring Programme Theory within the Wave Project Surf Therapy Intervention. International Journal of Environmental Research and Public Health. 2019; 16(12):2159.

Tiffany Lau is a PGY3 in the Department of Physical Medicine and Rehabilitation at Burke Rehabilitation Hospital. Follow her on Twitter @TiffanyMLauMD



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