Consumer Health Features

Top Tips for Skiing Injury Prevention

By April Neale Dec 4, 2013, 23:33 GMT

Top Tips for Skiing Injury Prevention

All winter sports enthusiasts need to read up on Dr. Hernandez\'s checklist before any skiing. EPA/ARNO BALZARINI

According to the US Consumer Product Safety Commission, there were more than 144,000 snow skiing-related injuries treated in hospitals, doctor's offices, and emergency rooms in 2010. Injuries associated with snowboarding were even greater: 148,000.

Dr. Jaime Hernandez, an orthopedic specialist, spoke to us about how to keep from becoming a statistic.

Common Ski Injuries

A wide range of injuries occur in snow skiing. Knee injuries are very common, particularly injuries of the anterior cruciate ligament. Because skiers frequently put their arms out to break a fall, shoulder injuries — such as dislocations and sprains — often occur.

Fractures around the shoulder and lower leg are also common. Head injuries also occur in skiing, and can be especially serious. Several strategies can help prevent ski injuries, such as having the appropriate equipment and choosing ski runs that match your level of experience.

Taking ski lessons is especially important for new skiers — learning how to fall correctly and safely can reduce the risk for injury. Even experienced skiers can improve by taking a lessons Proper Preparation\

The best way to stay well this skiing season, according to Dr. Hernandez:

• Maintain fitness. Be sure you are in good physical condition when you set out on a ski outing. If you are out of shape, select ski runs carefully and gradually build your way up to more challenging trails. Many ski injuries happen at the end of the day, when people overexert themselves to finish that one last run before the day's end. A majority of these injuries can easily be prevented if you prepare by keeping in good physical condition and stopping when you are tired or in pain.

• Warm up. Research studies have shown that cold muscles are more prone to injury. Warm up with jumping jacks, running or walking in place for 3 to 5 minutes. Take a couple of slow ski runs to complete your warm up.

• Hydrate. Even mild levels of dehydration can affect physical ability and endurance. Drink plenty of water before, during, and after skiing.

• Know safety rules. Understand and abide by all rules of the ski resort. Know general safety rules of skiing, such as how to safely stop, merge, and yield to other skiers. Ensure Appropriate Equipment

• Wear several layers of light, loose and water- and wind-resistant clothing for warmth and protection. Layering allows you to accommodate your body's constantly changing temperature.

• Buy or rent boots and bindings that have been set, adjusted, maintained and tested by a ski shop that follows American Society of Testing and Materials (ASTM) standard job practices.

• Check the binding of each ski before skiing. The bindings must be properly adjusted to your height and weight. • Wear appropriate protective gear, including goggles and a helmet. Helmets are sport-specific, so do not wear a bike helmet on the slopes. Ski helmets should be worn.’ Ensure a Safe Environment

• Stay on marked trails and avoid potential avalanche areas such as steep hillsides with little vegetation.

• Watch out for rocks and patches of ice on the ski trails.

• Pay attention to warnings about upcoming storms and severe drops in temperature. Make adjustments for icy conditions, deep snow powder, and wet snow. Prepare for Injuries

• Skiers should ski with partners and stay within sight of each other. If one partner loses the other, stop and wait.

• Seek shelter and medical attention immediately if you, or anyone with you, is experiencing hypothermia or frostbite. Make sure everyone is aware of proper procedures for getting help if injuries occur.

Skiing Injuries

Downhill skiing continues to increase in popularity. The skiing industry has made the sport accessible to more people. Faster ski lifts and expansion of trails at ski areas, as well as improved snow making capabilities, have increased the numbers of skiers on the slopes.

Dramatic changes have occurred in the equipment as well. Ski boots have evolved from soft leather cut boots to mid-calf plastic boots that rigidly support from the lower leg and ankle. Advancements in binding design continue to reduce the number of lower extremity injuries. The American College of Sports Medicine (ACSM) endorses the use of these more sophisticated multi-directional release bindings.

Falls are an obvious cause of injuries, accounting for approximately 75 to 85 percent of skiing injuries. Collisions with objects including other skiers, account for between 11 and 20 percent, while incidents involving ski lifts contribute between 2 and 9 percent. Studies demonstrate that the majority of injuries are sprains, followed by fractures, lacerations and dislocations.

Though changes in modern ski equipment and improvements in slope design and maintenance have contributed to a decline in injuries, there are still a significant number of skiing injuries. While fractures were more common prior to these equipment changes, it is now more common to see injuries to the ligaments of the knee.

Several studies have demonstrated that the most common injury to the knee is damage to the medial collateral ligament (MCL). This injury occurs with slow twisting falls or when beginners maintain a snowplow position for lengthy periods and stress the ligament. Virtually all degrees of MCL sprains can be managed conservatively with bracing and limited range of motion.

Another common knee injury is rupture of the anterior cruciate ligament (ACL). Many factors can attribute to this injury, such as a backward fall as the lower leg moves forward. A similar shearing force can occur when the lower leg is suddenly twisted away from the upper leg as in “catching an edge.”

These injuries often require surgical repair and extensive rehabilitation. Fractures of both the femur and tibia occur more commonly with violent twisting falls or collisions. It is common to see fractures in older skiers who have more brittle bones. High speed collisions with a stationary object can cause significant major trauma of vital organs and clearly require emergency care and evaluation. \

Injuries to upper extremities account for approximately 30 to 40 percent of all injuries. The most vulnerable joint of the upper body is the thumb. Injury to the ulnar collateral ligament of the thumb is second in frequency only to MCL injuries of the knee. These injuries occur when a skier falls on an outstretched arm that is still gripping the pole. The thumb is suddenly pulled outward, injuring this joint. ACSM supports the use of poles with straps rather than the fitted grip as these are associated with fewer injuries.

Like knee sprains, sprains of the thumb are graded first degree, second degree or third degree, depending upon the severity of damage to the ligament. Surprisingly, injuries to the thumb can be srious and, if not cared for properly, can result in long term disability. A protective cast is used in nearly all cases for lengths of time varying from three to six weeks. Infrequently surgery is required.

While fractures of the upper extremity are infrequent, dislocations of the shoulder are quite common. After rehabilitation of a dislocation, protection of the joint to prevent recurrence is important. Despite aggressive rehabilitation programs designed to strengthen the shoulder, recurrent dislocations are possible. Surgical repair is often necessary to restore the joint to a more functional state.

With any of these injuries, it is important to determine the severity of the injury. Skiing should be discontinued if it causes further pain. Wait for assistance. Initial first aid consists of “RICE” (Rest, Ice, Compression, and Elevation). ACSM recommends injuries be promptly evaluated and treated by appropriate medical personnel.

Many factors contribute to an individual’s potential for injury. Attention to preseason conditioning with an emphasis on sport specific exercises will help delay muscle fatigue which often contributes to an injury. Taking lessons is recommended to increase one’s skiing ability and appreciation of varying ski conditions.

Additionally, good equipment that is properly fitted and maintained by a certified ski shop will minimize risks. Skiers who understand the risks and attempt to control as many variables as possible can avoid many serious injuries. ACSM stands in support of safe sports participation and believes it is possible to reduce individual risk for injury while still enjoying the sport of skiing.

Snowboard Injuries

While similar in many ways, skiing and snowboarding do have their differences. These sports variety greatly when it comes to the type of injury typically sustained by participants.Conditioning for Skiing requires speed, strength, balance and flexibility. Snowboarding requires similar conditioning however, the way the body moves in both sports is fundamentally different. This difference tends to result in very different injuries in each sport.

Common Injuries

Skiing tend to result in more knee injuries. The typical skiing injury involves torque-type injuries to the knees and lower extremities. This twisting of the upper leg one way, while the lower leg rotates the opposite way, often results in tears to the anterior cruciate ligament (ACL).

In snowboarding, both feet are strapped onto the same board and always point the same direction. This protects the knee from any twisting. However, the upper-extremity is in the position to take the force of a fall. When snowboarders fall, they land on their hands, shoulders, rear-ends, or heads. The most typical snowboarding injury is a wrist fracture. There are also wrist sprains and elbow contusions and dislocations, and a lot of contusions and rotator cuff injuries in the shoulder.

Broken collarbones, concussions and other head and neck injuries are common, too. Rotator cuff injuries in the shoulder are usually treated more conservatively with strengthening programs, anti-inflammatories for contusions and swelling, and rest for the general healing process. Intermittent application of ice (10 minutes three or four times a day) can be helpful in reducing pain, swelling, and inflammation. If a snowboarder attempts dangerous maneuvers — in the trees, going off jumps, and doing tricks — helmets are worth considering.

Injury Prevention

Snowboarders, especially those just starting out, would be wise to stock up on some Safety Gear. Wrist and elbow guards can ease the force of falls on the joints of the upper body. Knee pads help prevent contusions, a pad for the tailbone is also a good idea, as new snowboarders spend a lot of time on their backside. To protect the shoulders from falls, it isn't a bad idea to learn a bit about its' anatomy and function (for more information, read Shoulder Saving Tips).

Finally, although both skiing and snowboarding happen in the snow on a mountain they are very different in terms of technique. Keep in mind that just because you are a good skier, you may be a novice on a snowboard. Taking a lesson from a qualified instructor or an experienced snowboarder is a good idea for the beginning snowboarder. It will make your time on the mountain much more enjoyable.

Jaime Hernandez, M.D., is a Los Angeles-based orthopedic surgeon with a specialty in sports injuries - especially knee injuries that are the bane of long-distance runners and skiing ethusiasts.Dr. Hernandez is UCLA and Harvard educated and is on the cutting edge of robotic-assisted orthopedic surgical procedures.


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