Preventing Ski Injuries

Ski injuries are no more common than the injuries experienced by other people participating in any other sort or activity with similar intensity. Almost any sport bears some risk of injury, with skiing being no exception or a greater contributor to this fact. The severity of injury may be as traumatic as a head injury or paralysis or as minor as some bruising. Fatalities do occur, but not enough to be statistically different from other sports. Interestingly, some modifications to equipment have actually decreased the injury rate for many. For example, a broken tibia (one of the lower leg bones) used to be feared by most skiers, but this injury is rarely seen anymore since the ski bindings are no longer as restrictive as they once were. The use of helmets has been increasing (especially amongst people under 9 and over 65) and so non-severe head injuries have decreased. Some of the injuries that the helmet has helped prevent include cuts, bruises, and mild concussions. The helmet has yet to prevent many deaths because the severity of the accident usually overcomes any protective mechanism offered by the helmet. To some, it may come as surprise that few injuries occur because of impact with other skiers. Muscle imbalance, fatigue, and skiers overextending themselves beyond their limits are other causes of ski injuries. Common in skiing are injuries to the knees, the thumbs/hands and the shoulder region.

Of the knee injuries, Anterior Cruciate Ligament (ACL) tears are common because of the mechanism of injury. The ACL helps prevent the lower leg bones from shifting forward away from the upper leg bone. It is a deep ligament whose structure is compromised when the foot is planted and the leg is twisted. The twist and plant may occur with skiers as their ski gets stuck (planting the foot) and the upper body moves away from the planted foot. The introduction of shorter skis has helped decrease the incidence of ACL tears amongst skiers. A torn ACL may "pop" as it tears and the person usually feels pain. The leg may feel unstable at first but then swelling and muscle guarding mask the laxity. Swelling and tenderness are to be expected, as is difficulty moving. Other damage typically comes along with ACL tears including damage to the meniscus and other knee ligaments. Most ACL tears are treated surgically, but it is possible to stay active without having surgery. Treatment, with or without surgery, involves regaining full range of motion, increasing motor control of the muscles, maintaining balance capabilities and increasing the strength of all involved muscles. Return to activity may take anywhere from 6-9 months.

Tears to the Medial Collateral Ligament (MCL) happen as a result of being hit on the outside of the knee, or because of twisting while having a planted foot, (same mechanism that causes ACL tears). The MCL helps prevent the knee from 'opening up' and prevents excessive movement/gaping of the lower leg bone from the upper leg bone. The range of damage may be anywhere in the mild to complete rupturing continuum. A mechanism with enough force to tear the ACL typically does extensive damage to the MCL too. Smaller stress on the knee forces some gaping of the joint and causes minor tears in the MCL. Mild to medium MCL disruptions are tender, may swell, and the knee remains fairly stable. A grade III sprain signifies a tear and results in pain, limited range of motion, and laxity of the joint. When pressure is applied to the outer portion of the knee, it opens up on the inside. MCL tears respond well to treatments from a qualified professional. The treatment will focus on pain relieve, improving range of motion, and strengthening the muscles to help prevent continual giving way of the joint.

Between the bones of the upper and lower leg are two 'discs' of cartilage that serve as protective cushions. They help prevent the bones from rubbing on one another and they absorb shock generated from ambulation. They can be damaged by a plant and twist mechanism. In addition, the MCL and the medial (inside) meniscus are connected, so excess strain to the MCL may also damage the medial meniscus. The meniscus may be partially torn, or completely torn. It can leave floating debris in the joint causing pain and instability. Treatment as before is focused on relieving pain, decreasing swelling, increasing range of motion and improving strength. Surgery may be required to clean the area out and it has very good outcomes with quick recovery.

Direct impact and contact accounts for many injuries to the thumb, hand, wrist, and shoulder region. A ski pole may force the thumb back into past its natural end range. Hard landings may result in wrist or hand sprains and may cause a fracture of the associated bones. A FOOSH or fall on out stretched hand often results in a broken wrist bone, separated shoulder or broken clavicle. A separated shoulder is an injury that occurs between the acromimun (tip of shoulder) and the clavicle. This joint, known as the AC joint, can be sprained. The force causing a separation can be from directly landing n the shoulder or it may travel up the arm after a FOOSH. This force can also be strong enough to fracture the clavicle. These injuries are painful and require respite from activity. They may or may not be treated surgically, and return to activity can be expected with no limitations.

Some injuries may be unavoidable, but the extent of the damage may be minimized. When neither of those is true, a fit individual will be able to recover quicker. For this reason, it is important to stay in shape even when not hitting the slopes. It is also important to not overextend yourself. Always stay within your limitation and abilities, and take care of your equipment. Fully functional equipment may be a huge factor in preventing injuries. Take some lessons as a beginner, and seasoned skiers should take refresher classes to keep their skills up to speed. On the slopes, look out for other skiers and be aware of the environment. Remember to not over-ski yourself, get rest, and keep nourished and well hydrated. As people fatigue, the rate of injury increases. Get in shape, and stay in shape before, during, and after ski season.

Finally, to be a strong, healthy and effective skier, good nutrition is necessary. A strong body requires natural nutrition and whole food vitamins from natural and healthy foods. Foods rich in phytonutrients such as fruits, vegetables and additive free aloe vera juice should be the mainstay of any skier's diet. A concentration on whole grains and lean meats goes without saying. The bottom line, a physically strong and nutritionally strong body will lend themselves to a marked reduction in the probability of ski related injury.

Contributed by: Dr. Linda Kennedy MS SLP ND. From abc-of-skiing.com