Most common injuries in skiing and snowboarding and how to prevent them with the right clothing

Skiing and snowboarding as winter sports have increased significantly over the last decade. In 2010,it was estimated 11.5 million people in the United States skied and 8.2 million people participated in skiing and snowboarding, respectively (Kim et al., 2012). However, both sports are responsible for a considerable number of musculoskeletal injuries treated annually by orthopaedic surgeons. In these sports, the mechanisms underlying injuries are often related to the position of the limbs during the injury, that of the athlete, the level of experience and the design of equipment (Owens et al., 2018).

Head accidents

Head injuries account for about 15% of the injuries recorded in the two sports and are the most common cause of death for these athletes. Traumatic brain injury is fatal among snowboarders and skiers of all ages and is a factor that leads to death for 88% (Haider et al., 2012). Research published by Levy and Smith (2000) has shown that this type of injury affects about 28% of all ski injuries and 33% of all snowboard injuries.

Overall, 22% of head injuries are serious enough to cause clinical signs of concussion. In snowboarding, the use of the board implies a fixed position of the feet, which causes greater ventrodorsal instability compared to skis. In addition, this type of athlete is particularly prone to falls backwards and therefore to occipital trauma.

Back accidents

Traumas involving the spine are among the most common injuries in winter sports, in fact they include from 1% to 17% of all injuries in skiers and snowboarders. The technique of jumping and landing should be taught and emphasized in the young athlete, as it is precisely in these situations that most of these injuries occur, which mainly affect the thoracic and lumbar tract of the spine.

Shoulder accidents

Buckles injuries, together with spinal injuries, are among the most common injuries in winter sports. Kim et al. (2000) studied the snowboard and ski injuries that occurred in a resort in Vermont from 1988 to 2006 and showed that shoulder injuries and collarbone fractures in adult snowboarders accounted for approximately 11.7% and 4% of all injuries reported, respectively.

Shoulder injuries associated with skiing are mainly the result of four mechanisms:

• direct impact
• extended axial load on the arm
• forced arm abduction
• external rotational forces resulting from the well-placed ski pole during the fall.

In skiers, glenohumeral dislocations accounted for 5.5% of all injuries. Of the dislocation sites, the glenohumeral joint is the most frequent at 49.3%, followed by the elbow at 23.4% and the acromioclavicular joint at 17.9%.

Hand accidents

Hand injuries are common traumas in skiing and snowboarding. The most frequent injury is to soft tissues and concerns the ulnar collateral ligament. In fact, the chronic laxity of this ligament has made the term "skier's thumb" popular to describe this injury. The typical mechanism behind this injury is the fall in which the skier continues forward while the pole remains firmly planted on the ground.

Knee accidents

Knee injuries account for about one third of all snow injuries. As with other sports, non-contact anterior cruciate ligament (ACL) injuries occur more frequently in females than in males. In addition, femur fractures associated with alpine skiing and tibial plate fractures in adults are not uncommon in children.

Foot accidents

Due to the evolution in the design of ski boots and bindings, there has been a reduction in foot and ankle accidents in skiers over the years. In study conducted in two sports areas from 1972 to 1994, Deibert et al. (1998) recorded an overall 43% reduction in the number of ankle problems sustained at the start of the study compared to the number recorded at the end. Ankle fractures and sprains make up the majority of these wounds in both sports.

The fracture of the lateral process of the astragalus, which is commonly referred to as a snowboarder fracture, is a relatively minor and unique in snowboarding. In contrast, Leach and Lower (1985) reported that dislocation of the peroneal tendon and Achilles tendon, which mainly result from forward falls, are more frequent in skiers.

Accident prevention in skiing and snowboarding

In a recent study on ski and snowboard injuries treated in a paediatric trauma centre in Colorado from January 1999 until December 2014, it was found that 57% of injured children wore helmets (Milan et al., 2017). In patients admitted to intensive care, the average severity score was significantly lower for those wearing protection than for those without helmets. Although the authors of the study showed a high tendency to wear a helmet, a substantial number of patients (about 40%) were without it.

Among the precautions that can be taken, the use of the cuff can also significantly reduce the risk of wrist accidents, including sprains and fractures. In a study by Idzikowski et al. (2000), women who used wrist protection during a ski competition recorded an accidentrate for this joint that was reduced by 50%. However, there are no particular indications as to the type of design or technology most appropriate for this particular equipment.

Few sources in the literature report data on the use of knee pads and their ability to prevent knee problems on skiing and snowboarding. Kocher et al. (2003) examined a sample of 180 professional alpine skiers with ACL accidents and found that subjects using knee pads had a 6-fold lower probability of knee accidents than those not using pads.

Clothing to reduce the risk of accidents in the snow

Several studies have shown that 50% of the injuries in snowboarding affecting the lower end are related to the type of binding and boot used. Snowboard bindings, unlike those used in recreational skiing, are not releasable. An exception is telemark skiing, where there is no heel binding and the boots used are lighter and more flexible overall. In addition, boots with "open" heels can reduce the risk of fractures due to forward falls. Three different types of snowboard boots are available: soft, hybrid and hard.

The soft boot, used by amateur sportsmen, is traditionally made of leather or synthetic material and allows a comfortable ride, especially in maneuvers. On the other hand, hard snowboard boots are mainly worn by runners. Runners may, however, expose the athlete to a higher probability of knee injuries than soft boots, which are instead more protective of the ankle joint.

Finally, programs aimed at improving stability, characteristic of core training, should be part of the prevention programs offered by doctors and personal trainers.

• Kim S, Endres NK, Johnson RJ, Ettlinger CF, Shealy JE: Snowboarding injuries: Trends over time and comparisons with alpine skiing injuries. Am J Sports Med 2012;40(4):770-776.
• Owens BD, Nacca C, Harris AP, Feller RJ. Comprehensive Review of Skiing and Snowboarding Injuries. J Am Acad Orthop Surg. 2018;26(1): e1-e10.
• Levy AS, Smith RH: Neurologic injuries in skiers and snowboarders. Semin Neurol 2000;20(2):233-245.
• Haider AH, Saleem T, Bilaniuk JW, Barraco RD; Eastern Association for the Surgery of Trauma Injury Control/ViolencePrevention Committee: An evidence-basedreview: Efficacy of safety helmets in the reduction of head injuries in recreational skiers and snowboarders. J Trauma Acute Care Surg 2012;73(5):1340-1347.
• Deibert MC, Aronsson DD, Johnson RJ, Ettlinger CF, Shealy JE: Skiing injuries in children, adolescents, and adults. J Bone Joint Surg Am 1998;80(1):25-32.
• Leach RE, Lower G: Ankle injuries in skiing. Clin Orthop Relat Res 1985;198: 127-133.
• Milan M, Jhajj S, Stewart C, Pyle L, Moulton S: Helmet use and injury severity among pediatric skiers and snowboarders in Colorado. J Pediatr Surg 2017;52(2): 349-353.
• Idzikowski JR, Janes PC, Abbott PJ: Upper extremity snowboarding injuries: Ten-year results from the Colorado snowboard injury survey. Am J Sports Med 2000;28(6): 825-832.
• Kocher MS, Sterett WI, Briggs KK, Zurakowski D, Steadman JR: Effect of functional bracing on subsequent knee injury in ACL-deficient professional skiers. J Knee Surg 2003;16(2):87-92.