Winter sports, specifically skiing and snowboarding, continue to grow in popularity. They are sports that incorporate an expansive variety of the population. The winter sports crowd is comprised of various ages, sizes, abilities, and fitness levels. Although skiing and snowboarding are often enjoyed on the same mountainous terrain the injuries sustained by these activities are different. SKIING: Koehle et al state in their 2002 article that lower leg injuries are decreasing as knee strains and sprains are increasing. This increase has been attributed to the development of new ski binding technology1. New ski bindings or “multi-release” bindings are adapted to release in at least one more direction than just a lateral motion at the toe or forward lean at the heal1. Although these new bindings are an improvement they do not specially release as needed when the below mentioned common mechanisms of knee strains occur1. LEGS (LOWER EXTREMITY) Knee sprains comprise about 30% of adult alpine ski injuries, Medial collateral ligament (MCL) injured just slightly more than anterior cruciate ligament (ACL). This percentage Koehle et al reported from a study performed at Jackson Hole ski resort from 1982-19931. Common mechanisms leading to these ligament injuries include: 1) A stress on the medial side of the knee as it is forced outward (valgus external rotation). This occurs as the person falls forward and catches the inside edge of the ski forcing the leg outward1. 2) A forward stress on the knee as the lower leg is moved forward on the upper leg (the boot induced anterior drawer mechanism1). This can happen when a person lands hitting the back of the ski to the snow first with the knee straight (extended). 3) An inward force on a fully bent knee (‘phantom-foot’). This occurs as the person falls backwards dropping hips below knees and the inside edge of the downhill ski gets caught in the snow behind the skier causing an inward (internal rotation) force while the knee is fully bent (hyper-flexed). This is the most common mechanism of lower extremity injury while skiing1. ARMS (UPPER EXTREMITY) Koehle et al report ulnar collateral ligament (UCL) tear of the first metacarpophalangeal joint (thumb) comprises 1/3 of the upper extremity injuries. This injury is also called ‘skier’s thumb’. The mechanism of this injury is falling on an outstretched hand with the pole in the palm causing an inward force (radial deviation) of the hand stressing the UCL. 11% of upper extremity injuries occur at the shoulder1. Rotator cuff followed by anterior glenohumeral dislocations/subluxations, arcomioclavicular (AC or collar bone) separations, and lastly collar bone (clavicular) fractures. These shoulder injuries are commonly caused by falling as well as improper planting of the ski pole1. SNOWBOARDING: Novice snowboarders with less than 1-year experience comprise nearly half of those that are injured2. Bladin et al state that the most common location of a snowboarding injury is the wrist. Per D. Laliotis’s study Bladin et al states that there is a 10-fold increase in wrist injuries for snowboarders verse skiers. A preventative measure for decreasing wrist injuries could be, wearing specifically designed protective wrist guards. However utilizing these wrist guards may make other areas such as the shoulder more prone to injury. Knee injuries mainly occur in the leading leg (mostly Left) for snowboarders2. This accounts for about 17% of all snowboarding injuries2. Ankle injuries during snowboarding may commonly involve a fracture of the lateral process of the talus. This may be related to an inversion (inward) and compressive force on the joint while landing a jump2. Spinal cord injuries comprise about 3.3% of all snowboarding injuries per Yamakawa et al’s study in 20012. A majority of these spinal injuries are comprised of fractures to the transverse process and involve jumping2. SKIING COMPARED TO SNOWBOARDING: Bladin et al state that snowboarders are three times more likely to be injured from jumping then skiers. Due to the fact that the person is fixed to the board (biomechanics) during snowboarding they are less likely to incur a knee injury2. This is because the snowboard cannot act as a lever and exert a force (torque) on the knee. Hagel et al found snowboarders more likely to sustain head/neck, trunk, and upper extremity injuries. Per Hagel et al skiiers were more likely to sustain lower extremity injuries. Hagel et al also indicate that females are more likely than males to sustain head/neck and lower extremity injuries3. PREVENTION: Koehle et al’s study reports that ski and snowboarding experience is a highly correlated factor relating to injuries. Taking lessons would be recommended for increased experience in a more controlled environment. However studies, looking at the effect of ski instruction on prevention of injury, are unable to produce a statistically significant correlation1. Other studies that have participants watch an educational video on proper falling techniques before skiing have demonstrated a decrease in injuries verses those that don’t1. It has also been suggested that proper conditioning, incorporating both strength and endurance elements specifically for the lower extremities and back, be implemented before the ski season1. It has been suggested that poorly adjusted equipment is a significant risk factor for injuries in young skiers5. Other preventative suggestions include: 1) Properly fitting and maintained equipment, 2) Possible use of a ski helmet, 3) Utilizing poles without wrist straps, 4) Skiing/snowboarding under control and stopping before significant fatigue sets in, 5) Participation in a conditioning program1. For snowboarding, Hagel et al recommend helmets, wrist-guards, appropriate binding adjustments, and proper instruction. CHECKING YOUR FITNESS: There are a variety of ways that one can use to assess their fitness level before hitting the slopes. A VO2 Max test can be run to determine aerobic capacity4. Wingate peak test also can sub-maximally determine aerobic capacity utilizing a stationary bike4. Measuring how high you can jump (vertical jump) gives you an idea of your muscle power, it has been noted that for elite male skiers a vertical jump of 62 cm is ideal, for female 52 cm4. Utilizing a leg press machine one can estimate their leg strength by doing a 1 repetition max test or how much weight each leg can press with good form one time. It has been noted that elite male mogul athletes can single leg press 2.2 x their body weight, females 2.0 x body weight4. For a specific ski/snowboarding related exercise or fitness programs tailored to your individual needs it may be necessary to contact your physician or physical therapist. After all is considered, always judge your skill and fitness level and choose appropriate runs. Have a great winter season!!! References: 1) Koehle, M.S., Lloyd-Smith, R., & Taunton J.E. (2002). Alpine Ski Injuries and Their Prevention. Sports Med, 32, 785-792. 2) Bladin, C., McCrory, P., Pogorzelski, A. (2004). Snowboarding Injuries. Sport Med, 34, 133-139. 3) Hagel, B. E., Goulet, C., Platt, R. W., Pless, I. B. (2004). Injuries Among Skiers and Snowboarders in Quebec. Epidemiology, 15, 279-286. 4) Preparation for Skiing and Snowboarding. (2003, July). Australian Family Physician, 32, 495-498. 5) Goulet, C., Regnier, G., Grimard, G., Valois, P., Villeneuve, P. (1999). Risk Factors Associated with Alpine Skiing Injuries in Children. The American Journal of Sports Medicine, 27, 644-650.
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