5 Incredible Hawaii Medical Stories


(page 4 of 6)

A Mysterious Malady Afflicts Malihini Surfers

How a local doc identified a rare syndrome that can paralyze surfers on their first time out.

Dr. James Pearce.
Photo: Rae Huo

The patient was a 19-year-old Australian man, a rugby player in excellent shape, vacationing in Waikīkī with his family. He paid for a surfing lesson, practiced popping up to his feet as the board lay on the beach, then paddled out with an instructor to catch some waves, like countless tourists before him. While lying on the board, he felt pain in his lower back, but he stayed in the water until the lesson was over.

After returning to shore, his legs became alarmingly numb. By the time he got to Straub Clinic & Hospital, he couldn’t move his legs at all—he was paralyzed from the waist down.

The man had not suffered an obvious injury or big wipeout. He had paddled out in good health, and paddled back in to become paraplegic.

This apparent medical mystery was no mystery at all to the neurologist at Straub who treated the man. Dr. James Pearce had seen several similar cases since the early 1990s, so many, in fact, he succeeded in identifying the cause as a previously unrecognized medical condition, which he named surfer’s myelopathy.

Those who suffer from it are inevitably first-time surfers—and usually tourists. “Their stories are always exactly the same,” Pearce says. “It’s their first surfing lesson, they paddle out in the water, they experience back pain, they come back to the beach and there’s some component of numbness.”

That numbness can range from mild tingling in the legs to all loss of feeling and movement. In some cases, it resolves itself. In others, it’s permanent. As with other spinal- cord injuries, there is no cure.

Pearce believes surfer’s myelopathy is caused by repeated hyperextension of the back. For a small number of people predisposed to the condition, this puts a kink in an artery, blocking blood flow to the spine and causing a spinal stroke. But it would take an autopsy to confirm this, Pearce says, and since nobody dies from surfer’s myelopathy, the exact mechanism behind it remains a mystery.

“It doesn’t happen to established surfers,” he says. “It’s always people taking their first surf lesson.”

Surfer’s myelopathy is extremely rare. Only about 50 cases have been documented worldwide, and most of them have happened in Hawaii. Oddly, only two involved local residents learning to surf. This is another mystery: Why are tourists most affected?

Pearce has a theory: Novice local surfers follow the cues of experienced surfers, who sit on their boards while waiting for waves, relieving pressure on the lower back. Visitors taking surf lessons at Waikīkī Beach typically remain in a prone position, putting more pressure on the lower back. Why it happens so much in Hawaii is no mystery at all. “There’s no place on the face of God’s Earth that has more surfing lessons than Waikiki” Pearce says. “That’s the only reason I recognized it.”

As for the young Australian, he remained paralyzed for his first two days in the hospital, but eventually, he fully recovered. “He was a lucky one,” Pearce says.

Generally, the surfer’s myelopathy patients with the best outcomes are the ones who get out of the water as soon as they start to feel back pain. If they arrive at the hospital paralyzed, they usually remain paralyzed. Pearce’s advice for surfing newbies? “If you go out for your first surfing lesson and develop back pain, don’t stay out in the water,” he says. “Get back to the beach.”

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Honolulu Magazine September 2018
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