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Skiing and Snowboarding - Injuries and Prevention

 

Introduction:

As the mercury begins to drop and the snow starts to fly many athletes head to the slopes. Participation in alpine sports has risen in recent years. This increase is related to many factors, including a growth in popularity of snowboarding and an increased interest in The Winter-X Games. While both skiing and snowboarding can be extremely entertaining, they have the potential to be dangerous.

According to the U.S. Consumer Product Safety Commission the leading cause of winter sports injuries was snowboarding. In 2008 there were 150,065 snowboard related injuries. Alpine(downhill) skiing ranked second with 148,555 injuries that year. Epidemiological studies have identified some common injury trends that occur in these sports. For example, beginners are more likely to be injured than experienced riders/skiers. Lessons provided by a professional instructor are therefore highly recommended for beginners. Another common injury trend is that serious injuries, such as fractures, are associated with high speed falls and failure to land jumping tricks.

The American Academy of Orthopedic Surgeons (AAOS) released in 2010 some generalized injury prevention tips. Their recommendations included the following:

  1. Cold muscles, tendon and ligaments are more susceptible to injury - therefore perform light exercise for 3-5 minutes and then stretch prior to participation.
  2. Prevent dehydration while on the slopes.
  3. Never participate when experiencing pain or when exhausted.
  4. Never ski or board alone.
  5. Wear protective gear.
  6. Know your surroundings.
  7. Prevent cold-related injuries by wearing several layers- light, loose, water and wind resistant clothing.
  8. When falling try to land on your buttock or side to minimize risk of injuries.
Cold Exposure Injuries:

Winter sports place athletes at risk for cold exposure injuries. Common cold-related injuries include frostnip, frostbite and hypothermia. It is important to realize these injuries can occur even when the ambient temperature is above freezing (32 degrees F). Cold exposure injuries are significantly more likely to occur with high winds and if clothing, gloves, socks or boots are wet. Proper cold protection is the key to injury prevention. The young and elderly are especially vulnerable to these injuries.

Frostbite occurs when tissues freeze which leads to ice crystals forming and ultimately cell death. The most common areas to be affected by frostbite include the hands, feet, nose and earlobes. Exposure to the cold leads to a diminished blood flow in the affected area. If the exposure to the cold persists, then the area can freeze. Signs of frostbite include the following:

  1. Pain and burning that can progress to numbness and eventually complete loss of sensation.
  2. Skin color changes that begin with paleness or redness and can progress to blue/ gray and ultimately black.
  3. Blistering of the affected area may also occur.

Prevention of frostbite begins with an awareness of ambient temperature and wind speeds. Furthermore, dressing warm and limiting exposure to the face and extremities is important. Pack extra dry clothes, socks and gloves. Avoid tight fitting clothes, gloves, socks or boots that could decrease blood flow. If hands/feet become wet or conditions worsen, then come indoors as soon as possible.

The treatment for frostbite is to rapidly re-warm the affect area by emersion in warm-hot water (104 degrees F). Dry heat should not be used and techniques employing massage or friction must be avoided. They can lead to greater tissue damage. If you have frostbite you need to seek professional medical attention as soon as possible. Also, do not re-warm the affected part if there is a chance of re-freezing.

Frostnip is a milder form of injury relate to cold exposure. Like frostbite it tends to affect the hands, feet, nose and earlobes. Unlike frostbite, however, with frostnip no freezing of the tissues occurs. As such, permanent tissue damage does not result. In the affected area the skin becomes pale and there may be associated numbness. The treatment is to re-warm the area. As with frostbite never rub the affected area to re-warm.

Hypothermia refers to a lowering of the core body temperature. As with other cold exposure injuries, hypothermia occurs more readily when a person is wet and/or when the wind chill factor is low. Signs of hypothermia include shivering, blotchy skin, blue extremities and numbness/tingling. As the core body temperature decreases respiration and heart rate decrease. If the hypothermia becomes severe, then death can occur. Treatment includes the following: remove wet clothes and dry the patient, cover with warm clothes and blankets, seek shelter from the wind and water, administer warm fluids and seek medical attention.

Skiing Injuries:

While skiing and snowboarding are similar activities, they are associated with different injury patterns. The most common injuries in skiing involve the lower extremities. Contusions, sprains and strains are among the most frequent injuries that involve the lower extremities. When compared to the 1970s, lower extremity injuries have decreased and the pattern of injuries has changed. This is due primarily to improvements in equipment. Tibia and ankle fractures were once among the most common injuries sustained by skiers. However, with the advent of higher/stiffer boots and improved bindings, these injuries are no longer as common.

The knee is now the most frequently injured body part with skiing. Approximately 20-35% of all skiing injuries involve the knee. With the improvement in boot and binding designs came an increase in anterior cruciate ligament (ACL) injuries. The three different mechanisms of injury believed to be responsible for the ACL injuries in skiers are as follows:

  1. A fall where the skier catches the inside ski edge and falls forward between the ski which causes an external rotational twist to the knee.
  2. A fall where the skier lands on the back of the ski with the knee extended and the boot pushes forward loading the ACL.
  3. A fall where the skier lands backward between the skis and catches the inside edge on the downhill ski which causes an internal rotational twist to the knee.

Another knee injury that is being seen with increased frequency among skiers are fractures of the lateral tibial plateau. The tibial plateau is the wider portion of the tibial that makes the surface of the knee joint.

Among the more common upper extremity injuries associated with skiing are shoulder and thumb trauma. “Skier’s Thumb” refers to an acute tear of one of the main stabilizing ligament of the thumb (the ulnar collateral ligament of the MCP joint). This ligament tear accounts for 8-10% of all skiing injuries. It occurs when the skier falls with the ski pole in their hand. The force gets concentrated on the ligament and it can rupture. Orthopedic evaluation is required to determine if the ligament is partially or completely torn. If left untreated these ligament injuries can cause significant disability due to the fact that the person will lose the ability to pinch.

Snowboarding Injuries:

Unlike skiing, the majority of snowboarding injuries involve the upper extremities. (Knee injuries are not as common in snowboarders because the feet are rigidly fixed to the board and do not release during a fall.) Studies have shown that approximately 50% of all upper extremity injuries in snowboarders are wrist fractures. These fractures occur when the rider reaches out either forward or backward when they fall. Due to the speeds travelled and the fact that many of these fractures occur from failing to land a jump, the wrist fractures associated with snowboarding tend to be high-energy injuries. Recent studies have determined that greater than 60% of the wrist fractures occur on the side opposite of the sliding direction.

Shoulder dislocations account for near 12% of all snowboarding-related upper extremity injuries. The most common dislocation in an anterior-inferior dislocation. These injuries occur when the upper arm and shoulder is forcible brought away from the body (i.e., abducted) and externally rotated. When the dislocation occurs it tears the labrum and shoulder ligaments. The majority (>65%) of shoulder dislocations occur on the same side as the sliding direction of the rider.

Other common upper extremity injuries associated with snowboarding include acromioclavicular joint separations, clavicle fractures, humerus fractures and elbow dislocations.

Helmet Use:

Overall injury rate in skiing has decreased in recent years. However, serious injuries related to skiing and snowboarding have increased. There are 20-30 death each year in the U.S. related to these winter sports. Male skiers have a 50% higher rate of head injuries when compared to females. While injuries in general are more common with beginners, fatalities associated with skiing and snowboarding are more likely in experienced skiers/boarders. The cause of most head injuries and fatalities is a collision with a fixed object. As such, the AAOS position statement recommends protective helmets and headgear.

by James Dennison MD  - Sports Medicine Specialist
Genesee Orthopedic and Hand Surgery Associates

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