Monday, November 18, 2013

Ski and Snowboard Related Injuries

As the winter months and holiday season approaches, many of us begin to think about skiing or snow boarding season that lies ahead.  However, many of us do little preparation for the season which ends up setting us up for a potential for injuries.  According to Damon Petty, MD, Sports Medicine physician in Nashville, TN, “Every year, from December to March, I have 8-10 patients a month come into my office who have been injured during skiing or snowboarding”.  Many of these injuries could be avoided all together with the proper preparation and safety equipment.  Here we will discuss some of the most common ski and snow boarding related injuries and how to avoid them. 

Snow Skiing/Snow Boarding
Skiing and snow boarding are two of the common sports that people think of when the snow starts to fall.  Each of these sports brings its own inherent set of injuries, many of which can be avoided.  Some of the most common injuries include:
  1. Concussion/closed head injury:  According to the National Ski Areas Association (NSAA), during the past 10 years, about 38 people have died skiing/snowboarding per year on average. During the 2004/2005 season, 45 fatalities occurred out of the 56.9 million skier/snowboarder days reported for the season. Thirty of the fatalities were skiers (39 male, 6 female) and 15 of the fatalities were snowboarders (14 male, 1 female). With the introduction of helmets, there has been an associated 50% reduction in head injuries for those wearing helmets.  However, only 35% of males, 30% of females and 66% of children currently wear a helmet while skiing or snowboarding.
  1. Knee injuries:  This joint and the associated ligaments, menisci and bony structures accounts for 30-40% of all ski related injuries and ~50% of these occurring later in the day.  “The most common injury I see in my practice associated with skiing is anterior cruciate ligament tears and ruptures” says Dr. Petty, “Most of these end up as surgical patients and require 4-6 months of post-operative rehabilitation”. With the introduction of quick release bindings and carving “super sidecut” skis, there has been a dramatic reduction of injuries to this joint. 
  1. Wrist fracture or injury:  With falls more common in snowboarding vs. skiing, snowboarding accounts for a higher percentage of wrist fractures.  The natural reaction in response to falls is to stretch out your hand to break the fall.  This results in a fall onto an outstretched hand or FOOSH which leads to scaphoid and colles fractures.  It is for this reason that these falls account for 100,000 wrist fractures world wide among snowboards each year.  The introduction of wrist supports has reduced these by 50% for those who wear them. 
  1. Low back pain:  Although little data is reported to the incidence of low back pain, some authors report frequency of back pain among skiers was 64% in those 16-24 years of age and even higher in snow boarders.  Low back pain was more common in men than women and was highly dependent on ski style and for snow boarders dependent on level of experience (with less experienced having more associated with increased incidence of falls).  
Most skiing and snow boarding injuries are avoidable and we can do things now in order reduce our risk for those that can not be prevented with protective equipment.  Some of the preventive techniques:
  1. Use protective equipment.  As reported in the statistics above, use of protective equipment can drastically reduce your risk for season ending or life threatening injury.  Some suggestions include:
    1. Wear a helmet.  This reduces the risk for closed head injury or concussion by greater than 50%.  Whether you are snowboarding or skiing, a helmet should be an essential part of your attire.  This is especially important for children.
    2. Check your bindings.  Make sure your bindings are quick release and not too stiff.  This reduces stress to the lower leg and knee when you fall.
    3. Use carving skis or super side-cut skis.  This reduces stress to the meniscus and knee with cutting and maneuvering.
    4. Wear wrist splints with snow boarding.  Much like the use of these with roller blading, this should be an essential part of your snowboarding attire.
  2. Pre-season conditioning.  Because both of these sports are so physical, you should prepare your body for this level of physical exertion.  The fact that the frequency of falls increases as the day progresses is a direct reflection on strength and endurance.  The more strength and endurance you have, the less falls you have.  Keeping that in mind, you preseason training should include (you should be cleared by you physician prior to starting any exercise routine):
    1. Cardiovascular training – should be 30- 60 minutes or greater at 60-80% of heart rate max.  Sample workout:
Workout 1: Interval training, 20 to 30 minutes
Workout 2: Medium-pace workout, 40 minutes
Workout 3: Short, intense workout, 20 minutes
Workout 4: Medium-pace workout, 45 minutes
Workout 5: Long, slow workout, 60 minutes
    1. Flexibility training – should include stretching for the quadriceps, hamstrings, low back, and shoulders.  For some good stretches log onto
    2. Strength and endurance training – should include strength training for the entire body with large focus on the lower quarter (core and legs).  As season gets closer, doing less rest time and higher repetitions brings in more of an endurance component.  For a well rounded ski specific program refer to
    3. Balance training – should include some single balance activities and dynamic balance activities.  With the introduction of the Wii Fit, there are numerous balance exercises on here that would be beneficial for skiing.
    4. Plyometric training – should only be done for the more advanced training and skier.  Examples of plyometrics include:
Squat jumps
Two legged jumps
Jumping side to side
  1. Prepare for the day of.  All the proper equipment and pre-season conditioning aids you tremendously in preventing injury but what you do the day of can also have a huge impact on your potential for injury.
    1. Get plenty of sleep the night before
    2. Proper nutrition and hydration the day of.  A well rounded diet with complex carbs (granola), protein and water plays a big role in your endurance throughout the day.  Avoiding high sugary foods, alcohol and high levels of caffeine will assist in preventing from your energy “crashing” half way through the day.
    3. Listen to your body.  When you are tired, rest.  Most injuries occur when you are fatigued.
Hopefully by following the suggestions above, you to can enjoy a great ski/snow boarding season without injury. 
Eriksson, K; Nemeth, G; Erickson, E.  Low back pain in elite skiers.  Scan Jour Med and Science in Sports 2007 Jan:6(1): 31-35
Idzikowski JR, Janes PC, Abbott PJ. Upper extremity snowboarding injuries. Ten-year results from he Colorado Snowboard Injury Survey. Am J Sports Med. 28(6): 825-832, 2001
Levy AS, Hawkes AP, Hemminger LM, Knight S.  An analysis of head injuries among skiers and snowboarders.  J Trauma 2002 Oct; 53(4): 695-704.

Rossi MJ, Lubowitz JH, Guttmann D. The skier's knee. Arthroscopy 2003 Jan;19(1):75-84


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