Johnny Heater, MC for the national figure skating championships commented that to be a good figure skater, one must have the balance of a tightrope walker, the endurance of a marathon runner, the aggressiveness of a football player, agility of a wrestler, nerves of a golfer, flexibility of a gymnast, and grace of a ballet dancer. Figure skating certainly has its unique demands. With growing popularity, more and more children are entering the sport and training hard for it. And when the training demands increase, injuries increase as well. A review of the literature reveals the differences in injury rates and types among competitively training athletes. Some basic steps can be taken to decrease the incidence of injury. There are two categories of injuries: acute and chronic. Acute injuries are associated with a single event trauma whereas chronic injuries are attributed to repetitive stress or micro trauma at a greater rate than that which the body can repair itself. Examples of acute injuries among figure skaters include lacerations, sprains and fractures. Examples of chronic injuries include tendonitis, bursitis, and disorders of the joints. There are differences in injury patterns between recreational and competitive skaters. Among recreational skaters, upper extremity injuries predominate. Acute injuries are most common with fractures cited 20% of the time. The mechanism of injury is, not surprisingly, falling. In contrast, competitive skaters, defined as those training 6 days per week sustained 56% acute injuries and 44% chronic injuries with most to the lower extremities. Acute injuries in competitive skaters are most likely to occur during jumps. One study followed 64 nationally ranked skaters in which 45% sustained injury over a one-year period. Skaters with the highest risk of injury are female pair skaters. A 1989 study found female pair skaters to experience 1.4 injuries per year. There was good news though. The authors of the study, Smith and Ludington, called the serious injuries “preventable”. Prevention of injury is probably the key to success in any sport. The biggest component is conditioning. Regular off-ice conditioning for figure skating by professionals trained in figure skating, as well as, the various aspects of physical training is highly recommended. On and off-ice training should be periodized with special attention to stretching during growth spurts. Additionally, prevention should include regular assessment of flexibility, muscle symmetry and balance, and early intervention of injuries. Proper care and fit of equipment is also essential. Acute injury treatment generally involves some degree of RICE depending on the structure involved and the severity. RICE is an acronym for rest, ice, compression, and elevation. Depending on the severity of the injury, acute injuries may require consultation with a doctor or therapist. Goals of physical therapy during the early phases of an acute injury are to create an optimal environment for healing while maintaining or improving strength and flexibility within the confines of protecting the injury. Chronic and overuse injury is increasingly seen in children as participation in sports increases. Injuries are commonly seen during a growth spurt. Chronic injuries involve an “acute phase”. There are intrinsic and extrinsic factors contributing to chronic injuries. Extrinsic factors include training and equipment. Many studies point to boots as a contributing factor to injury. Intrinsic factors are anatomical in nature and include bony alignment, flexibility deficits, and ligamentous laxity, so-called double jointedness. Treatment of overuse injuries generally involves either a physician or physical therapist or both. We recommend evaluation of all factors contributing to the injury including a biomechanical assessment by a physical therapist. The SportExcel approach to treatment includes RICE in the early phases to address pain and inflammation followed by high technology modality care to improve speed of recovery from the acute phase. We also use orthotics/bracing and taping when applicable, manual techniques and perhaps, most importantly, therapeutic exercise prescription. When seeking treatment it is important to use a healthcare provider with an understanding of the demands of figure skating and one who will communicate directly with your coaches. In addition to injuries, asthma is found at a higher rate than with other athletes. This is attributed to conditions within the ice arena, such as pollution caused by the zambonie. Nutritional deficits are also frequently found as the aesthetics of the sport demand a slender appearance. Research indicates that injury is more likely during times of even low-level stress outside the rink. In conclusion, an acute injury requires RICE with possible need for medical intervention. Chronic injuries need medical attention with good communication and collaboration of coaches, parents, and medical team for optimal outcomes. Risk is decreased through appropriate training programs that fit the unique demands of figure skaters. The good news is that compared to sports with similar training demands such as gymnastics, figure skaters experience fewer injuries overall! References Skating injuries: A guide to prevention and management, boot adjustments and physical fitness solve many problems, Angela D. Smith, MD, The Journal of Musculoskeletal Medicine, December 1997 The relationship of strength and jump height in figure skaters, Anatol Podolsky, MD, Kenton R Kaufman, PhD, Thomas Cahalan, PT, Sergei Aleshinsky, PhD, Edmund Chao, PhD, The Americal Journal of Sports Medicine, V 18, No. 4, 1990 Ankle and Foot Injuries in the Pediatric Athlete, J Andy Sullilvan, MD, Pediatric Orthopedics, Chapter 53 Ice Skating: Figure, Speed, Long Distance, and In-Line, David Muller, Per AFH Rentrom, and John Pyne, Sports Injuries: Mechanisms, Prevention, Treatment, Williams and Wilkins, 1994, 445-453 Conditioning program for competitive figure skating, McMAster, Liddle, Walsh, The American Journal of Sports Medicine Vol 7 no. 1, 1979 Anatomical factors associated with overuse sports injuries, Krivickas, Sports Med, Aug 1997 Injuries in elite pair skaters and ice dancers, Smith, Ludington, The American Journal of Sports Med, Vol 17, no 4, 1989
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