Snow Sport Injury Prevention Program
Benjamin Franklin famously advised fire-threatened Philadelphians in 1736 that “An ounce of prevention is worth a pound of cure.” This is surely true in skiing and snowboarding injuries. Dr. Kevin Mangum strongly encourages snow sport athletes to stay fit and healthy. He has put together a snow sport ski and snowboard injury prevention program for his patients to use. This program is designed to strengthen the core and legs, so they can remain active all season long.
Alpine skiing injuries are common. The most common lower extremity injury has changed from the ankle and leg to the knee. This is thought to be from improved boots and release bindings.
Injuries to the medial collateral ligament (MCL) are the most commonly reported, but anterior cruciate ligament (ACL) injuries have dramatically increased and now account for almost 20% of all skiing injuries.
Common mechanisms for knee ligament injuries are listed below.
The Valgus external rotation: occurs when ski edge catches, forcing the leg into abduction and external rotation; this is the most common mechanism for MCL injuries.
The boot-induced anterior drawer occurs when the rear of the ski contacts the snow first after jump. The ski then levers the boot forward, creating the anterior drawer movement.
The phantom foot: occurs when the skier’s weight is posterior, and the skier’s hips drop below the level of the flexed knees; weight is on the downhill ski and, as the skier attempts to recover, increased force to the downhill ski results in greater edge pressure. This causes an abrupt internal rotation force on the downhill knee.
Prevention is focused on education, avoidance of high-risk positions, and equipment adjustment. A small-scale study demonstrated a decrease in knee injuries with education on not trying to recover from a fall into the hill (phantom foot).
The shoulder accounts for the largest overall number of upper extremity injuries in skiing. Here is the break down. Rotator cuff injuries account for 24% of shoulder injuries, anterior dislocation and subluxations are 22%, acromioclavicular separations are 20%, and clavicle fractures are 11%.
Skier’s thumb, also known as gamekeeper’s thumb, is the most common single injury of the upper extremity, accounting for 8% of all injuries. Sprains of the ulnar collateral ligament (UCL) occur with a fall onto an outstretched hand with a pole in the palm.
Treatment involves protection and occasionally surgical fixation. The risk of UCL injuries may be reduced by having poles with breakaway straps or using a pole without straps. A modified thumb spica splint molded to a ski pole can allow continued skiing participation.
Falls are the most common mechanism of injury, followed by jumps/landings and collisions in snowboarding. Wrist injuries are 10 times more common in snowboarders than in skiers because of frequent falls backward onto an outstretched arm and hyperextended wrist. Head injury rates are three times higher in snowboarders than in skiers. Head and spinal injuries are common and are related to the popularity of aerial acrobatics and jumping. Snowboarders are 2.5 times more likely to sustain a fracture than skiers.
Snowboarders are also at a risk of malleolar bursitis and pseudotumor of the ankle. Malleolar bursitis develops as a result of repetitive friction from stiff snowboard boots, while pseudotumors occur due to compression of soft tissues between the lateral malleolus and snowboard boot.
Fracture of Lateral Process of Talus (LPT): This particular injury is often referred to as “snowboarder’s ankle” because it is relatively unique to snowboarding. This fracture occurs 15 times more frequently in snowboarders than in the general population. The LPT is a large, wedge-shaped prominence that articulates with both the distal fibula and the posterior calcaneal facet. It is important for hinge and rotatory movements and has multiple ligamentous attachments. LPT fractures usually occur as a result of sudden dorsiflexion and hindfoot inversion with axial loading, although external rotation is thought to be a key component. Axial loading in this position, along with shearing forces transferred from the calcaneus, often occurs with landing after jumps.
The management of LPT fractures is often challenging. Type 1 fractures and nondisplaced type 2 fractures (<2 mm or extra-articular) are generally treated nonsurgically with 4–6 weeks of nonweight-bearing cast immobilization. After 2 additional weeks of a weight-bearing cast boot, patients should begin physical therapy to prevent stiff subtalar and tibiotalar joints. More severe injuries will likely require surgical intervention.
Injury prevention is paramount in snow sports, especially in snowboarding. Snowboarders should wear helmets and wrist guards. Wrist guards are beneficial in preventing serious wrist injuries, particularly in children and beginner riders; unfortunately, only <20% of riders wear them.
Cross-country or nordic skiing is multifaceted and can be pursued either as a simple recreational outdoor activity or a vigorous competitive endurance sport. Cross-country skiing serves as an excellent means to develop and maintain cardiovascular fitness; most large muscle groups of the upper and lower body are used in a smooth, rhythmic, low-impact manner.
Most injuries that occur in cross-country skiing are overuse injuries, although acute injuries are common as discussed above. Common upper limb injuries to all skiing styles include de Quervain’s tendonitis; wrist extensor tenosynovitis; rotator cuff, bicipital, and triceps tendonitis; and medial and lateral epicondylitis. The longer poles used in skating predispose skiers to triceps tendonitis. In the lower limb strains to the hip adductors, internal rotators, and flexors are common, with adductor strain being particularly predisposed by skating technique. Injuries common to running sports are similarly found in Nordic athletes and include patellofemoral pain, patellar tendonitis, medial tibial stress syndrome, stress fracture, Achilles tendonitis, plantar fasciitis and rupture, sesamoiditis, and hallux rigidus (skier’s toe).
First Time Skier or Snowboarder
If you are a first-time skier or snowboarder watch this cheesy old-time video to help with making your first day a little more enjoyable and safe!
Alpine Responsibility Code
Become familiar with and adhere to the Alpine Responsibility Code.
- Always stay in control, and be able to stop or avoid other people or objects.
- People ahead of you have the right of way. It is your responsibility to avoid them.
- You must not stop where you obstruct a trail, or are not visible from above.
- Whenever starting downhill or merging into a trail, look uphill and yield to others.
- Always use devices to help prevent runaway equipment.
- Observe all posted signs and warnings. Keep off closed trails and out of closed areas.
- Prior to using any lift, you must have the knowledge and ability to load, ride and unload safely
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