Self-reported skill level and injury severity in skiers and snowboarders

There is evidence to suggest that the rate of injury is lower for expert skiers and snowboarders than for beginners. A better understanding of the relation between injury severity and skill level is also needed for planning injury prevention strategies. Our objective was to examine the severity and location of injuries sustained by self-reported expert and beginner skiers and snowboarders. A case-control study design was used. Injured skiers and snowboarders had to report their skill level on a 5 point scale (1: “beginner”; 5: “expert”). Two sets of severely injured cases were defined based on the type of injury and ambulance evacuation. Controls were those who did not sustain severe injuries. Logistic regression analyses were performed to relate injury severity to skill level. Subjects were 22 078 injured skiers and snowboarders who reported to the ski patrol with an injury sustained on the slopes of an alpine ski centre of the Canadian province of Québec during the seasons 2001–2002 to 2004–2005. Compared with beginners, experts had an increased risk of suffering from a severe injury (adjusted odds ratio [AOR]: 1.88; 95% CI: 1.58–2.23). Expert snowboarders were also more likely to suffer from a severe injury or be evacuated by ambulance (AOR: 1.18; 95% CI: 1.02–1.38). Results suggest that the type of activities or manoeuvres performed by expert skiers and snowboarders may increase the risk of sustaining a severe injury compared with beginner participants.     

Spinal injuries in skiers and snowboarders

Spinal injuries are among the most devastating injuries associated with recreational sports. Snowboarding spinal injury patterns have not been described. During two seasons (1994 to 1995 and 1995 to 1996), 34 skiers and 22 snowboarders suffered serious spinal injuries (fracture or neurologic deficit or both) at two ski areas in British Columbia, Canada. Ski patrol records, the Provincial Trauma Database, and hospital records were reviewed. Injury rates were based on computerized lift-ticket data and a population estimate of 15% snowboarders (ski patrol observation). The incidence of spinal injury among skiers was 0.01 per 1000 skier-days, and among snowboarders was 0.04 per 1000 snowboarder-days. Mean age was 34.5 years for skiers and 22.4 years for snowboarders. Seventy percent of the skiers were men, whereas all of the snowboarders were men. Jumping (intentional jump > 2 meters) was the cause of injury in 20% of skiers and 77% of snowboarders. Neither age nor sex accounted for any significant portion of this difference. The rate of spinal injuries among snowboarders is fourfold that among skiers. Although jumping is the primary cause of injury, it is an intrinsic element of snowboarding. Until research defines effective injury-prevention strategies, knowledge of the risk of snowboarding should be disseminated and techniques for safe jumping should be taught.     

Self-estimation of ability among skiers and snowboarders in alpine skiing resorts

Skiing ability is thought to be an important risk factor for injuries, but the best method to classify skiing ability is not known. The objective of this study was to validate five different questions designed to self-report skiing ability for ski injury surveillance. To this end 512 alpine skiers, Telemark skiers, snowboarders and skiboarders were asked to selfestimate their skiing ability using five different questions based on skiing skill, piste difficulty, turning technique, skiing experience and falling frequency, each with four categories. The participants then made a test run to test their skiing ability. Observed and self-reported skiing ability were compared using kappa statistics. The correlation between observed and self-reported skiing ability was low to fair, with kappa values of 0.34 for skiing skill), 0.33 for piste difficulty, 0.38 for turning technique, 0.26 for experience and 0.16 for falling frequency. However, the sensitivity and specificity for each of the questionnaires in discriminating between individuals in the poorest skiing ability category on the test and the rest of the group was relatively good (skiing skill: sensitivity 75%, specificity 91%; piste difficulty 68, 96%; turning technique 75, 91%; experience 75, 90%; falling frequency 61, 97%). The results show that the capacity to self-assess skiing ability is limited, but estimation based upon turning technique or skiing skill seem to be best methods for epidemiological studies on injuries in snow sports.     

Snowblading injuries in Eastern Canada

OBJECTIVES: To evaluate injury patterns of snowbladers and compare them with those of skiers and snowboarders. To determine possible effects of helmet use in these sports on injury to the head and neck. METHODS: This prospective case series observational study was conducted by collecting the injury reports from the ski patrol during the 1999-2000 season at Mont Tremblant ski resort, Quebec. All participants in downhill winter sports who presented themselves to the ski patrol with traumatic injury related to their sport were included. A concussion was defined as any loss of consciousness, amnesia, confusion, disorientation, vertigo, or headache that resulted from injury. The ski patroller reported helmet use on the accident report at the time of injury. RESULTS: Snowbladers present with a unique pattern of injury compared with skiers and snowboarders. The incidence of leg, knee, and ankle/foot injuries were 20.5%, 25.6%, and 10.3% respectively. Concussions represented 11% of all injuries. There was no increase in other injury, including neck injury, related to helmet use. CONCLUSIONS: Unique injury patterns in snowbladers warrant reconsideration of equipment design. Concussion is a common injury on the ski slope. Although the effects of helmet use on concussion rate are inconclusive based on this study, helmet use did not increase the rate of neck injury, even when adjusted for age.     

Risk of injury during alpine and telemark skiing and snowboarding. The equipment-specific distance-correlated injury index

Estimation of injury risk in alpine sports is difficult. We present a new method of calculating an injury index related to the distance traveled on ski or snowboard. The distance-correlated injury index equals the number of injuries per 100,000 km traveled distance. This injury index can also be correlated to the type of equipment used. The equipment-specific distance-correlated injury index is the same as the distance-correlated injury index, but it is sport-specific. We found the distance-correlated injury index for alpine skiing to be 3.9 (95% Cl = 2.8 to 5.4); for snowboarding, 13.5 (95% Cl = 8.3 to 22.0); and for telemark skiing, 3.0 (95% Cl = 1.0 to 9.4), suggesting a three- to four-times higher incidence of injuries requiring hospital treatment among snowboarders than among alpine and telemark skiers.     

Increased injury risk among first-day skiers, snowboarders, and skiboarders

BACKGROUND: Inexperience predisposes skiers, snowboarders, and skiboarders to a higher risk of injury. HYPOTHESIS: Individuals on their very 1st day's experience of skiing, snowboarding, or skiboarding are at greater risk of injury. STUDY DESIGN: Case control study. METHODS: All individuals injured at the three largest ski areas in Scotland during the three winter seasons 1999-2000 through 2001-2002 were included. First-day participants were identified. Individual demographic details and snow sports-related parameters were recorded. Control data were collected from uninjured individuals. Factors associated with injury were explored in univariate and multivariate analyses. RESULTS: First-day participants were overrepresented in the injured population by a factor of 2.2. Participant age younger than 17 years or older than 26 years, snowboarding, taking professional instruction, and the use of rented or borrowed gear were all independently associated with increased injury risk among 1st-day participants. CONCLUSIONS: First-day participants are at increased risk of injury. Several independent risk factors for injury have been identified. CLINICAL RELEVANCE: First-day participants should be targeted in any future educational programs with emphasis on gear selection, use of protective gear, and the risks of exceeding the limits of their ability.     

A comparison of recreational skiing- and snowboarding-related injuries at a Colorado ski resort, 2012/13-2016/17

ABSTRACT

The purpose of this study was to compare injury patterns between recreational skiers and snowboarders. Injured skiers (n = 3,961) and snowboarders (n = 2,428) presented to a mountainside medical clinic, 2012/13-2016/17. Variables investigated for analysis included demographics/characteristics, injury event information, and injury information. Skiers were older than snowboarders (34.3 ± 19.3 vs. 23.2 ± 10.5 years, p < 0.001); a greater proportion of skiers were female (46.3% vs. 27.8%, p < 0.001). Most skiers (84.4%) and snowboarders (84.5%) were helmeted at the time of injury (p = 0.93). Snowboarders were most frequently beginners (38.9%), skiers were intermediates (37.8%). Falls to snow (skiers = 72.3%, snowboarders = 84.8%) and collisions with natural objects (skiers = 9.7%, snowboarders = 7.4%) were common injury mechanisms. Common skiing injuries were knee sprains (20.5%) and head trauma (8.9%); common snowboarding injuries were wrist fractures (25.7%), shoulder separations (9.1%), and head trauma (9.0%). Given that injury patterns significantly differ between sports, it is important for clinicians, ski patrollers, and resorts to develop and deliver sport-specific injury prevention interventions to most effectively decrease injury burden.     

A 10-year study of snowboard injuries in Lapland Sweden

Snowboard injuries in a Swedish ski area were evaluated from 1989 to 1999. All injured skiers (alpine, telemark, snowboarders) who sought medical attention at the local Medical Center within 48 h of the accident, were asked to answer an injury form. Physicians assessed and treated the injured skiers. There were a total of 1775 injured skiers; 568 injured snowboarders mean age 19 years. The female/male ratio was 34/66%, the injury rate 3/1000 skier days, three times higher than that of alpine skiers. The skill level of the injured snowboard riders improved during the period. The fall/run ratio of the beginners was higher (1.0) and their risk behavior lower (3.9 on visual analogue scale 1-10) in comparison to the advanced riders (0.4 and 6.6, respectively). Injuries were in 54% located to the upper extremity, 35% were wrist/lower arm injuries. Beginners had significantly higher frequency of lower arm/wrist injuries (46%), than average (32%) and advanced riders (20%). The most frequent single diagnosis was wrist/lower arm fracture (20%). Advanced riders tend to have more head/neck injuries than beginners, 17% vs. 13% (NS). Thus, with elevated skill level the injury pattern changed. For injury prevention, wrist guards and helmets are recommended for snowboard riders.     

The association between removing and reintroducing man-made jumps in terrain parks and severe alpine skiing and snowboarding injuries

ObjectivesTo explore the effect of removing and reintroducing man-made jumps in terrain parks (TPs), on the proportion of severe injuries among alpine skiers and snowboarders in Québec, Canada.DesignQuasi-experimental study.MethodsInjuries were identified via injury report forms completed by ski patrollers during seasons 2000–2001 to 2016–2017 in Québec ski areas. Severe injuries were defined based on the type of injury or ambulance evacuation. Logistic regression analysis was used to provide adjusted odds ratios (AOR) for the comparison of the time periods before jump removal (PRE) and after jump reintroduction (POST) with the jump removal interval (INT).ResultsCompared with INT, the proportion of severe injuries in PRE was not significantly different (AOR: 1.05; 95% CI: 0.85–1.30), but was higher in POST (AOR: 1.76; 95% CI: 1.24–2.51) for ski areas with jump removal. In ski areas without jump removal, there was no change in PRE (AOR: 0.96; 95% CI: 0.87–1.07) and increased odds of severe injuries in POST (AOR: 1.20; 95% CI: 1.07–1.35). A supplementary analysis suggested that removing jumps from TPs has contributed significantly to a reduction in the proportion of severe injuries. This protective effect appears to decline over time.ConclusionsThese results do not suggest that removing jumps from TPs as an effective long-term injury prevention strategy in skiing and snowboarding. Collecting data on exposure could improve our understanding of how removing, introducing or reintroducing man-made jumps in TPs is associated with the risk of minor and severe injuries in TPs and on regular trails.     

Head injuries in snowboarders compared with head injuries in skiers. A prospective analysis of 1076 patients from 1994 to 1999 in Niigata, Japan

We investigated snowboarding-related head injury cases and skiing-related head injury cases during five ski seasons at one resort area. There were 634 snowboarding-related head injuries and 442 skiing-related head injuries. The number of snowboarding head injuries increased rapidly over the study period. More male snowboarders than female snowboarders suffered head injuries. For both snowboarders and skiers, head injuries frequently occurred on the easy and middle slopes. Falls were the most frequent causes of injury in both groups. Jumping was a more frequent cause of injury in the snowboarders (30%) than in the skiers (2.5%). Injury to the occipital region predominated in the snowboarders as compared with the skiers. There were 49 organic lesions in 37 snowboarders and 46 organic lesions in 33 skiers. Subdural hematoma was frequent in the snowboarding head injury group, and fracture was frequent in the skiing head injury group compared with the snowboarding group (not significant). Subdural hematoma was likely to be caused by a fall rather than by a collision, and bone fracture was likely to be caused by a collision rather than by a fall. Four snowboarders and one skier died as a result of their head injuries. Our data suggest that snowboarding head injuries may be prevented by protection of the occipital region and refraining from jumping by beginners.     

MRI of snow skiing and snowboarding injuries

Snow skiing has been called "the world's oldest sport," "the fastest non-motorized sport on Earth," and "the riskiest sport undertaken by adults on a routine basis." This article discusses the common mechanisms for orthopedic injuries occurring in two of the most popular winter sports in the world that have a reputation for an inherently high risk of injury: alpine skiing and snowboarding. The emphasis herein is on magnetic resonance imaging of characteristic injuries in skiers (knee, thumb, shoulder) and in snowboarders (wrist, forearm, ankle). Spine injuries in snowboarders and skiers are also discussed.     

Injuries among World Cup ski and snowboard athletes

There is little information available on injuries to World Cup skiers and snowboarders. The aim of this study was to describe and compare the injury risk to World Cup athletes in alpine skiing, freestyle skiing, snowboarding, ski jumping, Nordic combined and cross country skiing. We performed retrospective interviews with the International Ski Federation (FIS) World Cup athletes from selected nations during the 2006–2007 and 2007–2008 winter seasons and recorded all acute injuries occurring during the seasons. We interviewed 2121 athletes and recorded 705 injuries. There were 520 (72%) time‐loss injuries and 196 (28%) severe injuries (absence >28 days). In freestyle skiing, alpine skiing and snowboarding, there were 27.6, 29.8 and 37.8 time‐loss and 14.4, 11.3 and 13.8 severe injuries per 100 athletes per season, respectively. In Nordic combined, ski jumping and cross country skiing, there were 15.8, 13.6 and 6.3 time‐loss and 3.3, 5.6 and 0.7 severe injuries per 100 athletes per season, respectively. In conclusion about 1/3 of the World Cup alpine, freestyle and snowboard athletes sustain a time‐loss injury each season, while the risk is low in the Nordic disciplines. A particular concern was the high proportion of severe injuries observed among alpine, freestyle and snowboard athletes, which is in contrast to most other sports.     

Occurrence and trends in ski injuries in Norway

OBJECTIVES: To provide an overview of ski injuries in Norway and to describe the changes between 1990 and 1996. METHODS: All ski injuries (7966) treated at four hospitals providing health care to a defined population of about 11% of the Norwegian population were registered prospectively from 1990 to 1996. For this study, 6462 injuries sustained in cross country skiing, downhill skiing, telemark skiing, and snowboarding were selected for further analysis. RESULTS: The relative distribution of ski injuries by type of skiing changed significantly from 1990 to 1996 (p<0.001). Injuries from snowboarding showed the highest relative increase, and those sustained during downhill skiing showed a decline. The proportion of fractures in all types of skiing increased during the study period (p=0.001). The proportion of injuries to knee/lower leg decreased and the proportion to the forearm/wrist/hand increased during the study period (p=0.03). The mean age of the injured skiers differed significantly among the different types of skiing activity (p<0.001): cross country skiers were the oldest followed by telemark skiers, downhill skiers, and snowboarders. CONCLUSIONS: Ski injury surveillance results in early detection of changes in temporal injury trends, allowing timely adjustment of injury prevention strategies. Injuries from snowboarding are on the increase in Norway, warranting more effective injury prevention measures.


     

Are self‐reported risk‐taking behavior and helmet use associated with injury causes among skiers and snowboarders?

Over the last 10 years, ski helmet use has steadily increased worldwide. According to the “risk compensation theory,” however, studies found that up to one third of skiers and snowboarders self‐reported to engage in more risk taking when wearing a ski helmet. Therefore, to evaluate whether self‐reported risk taking and ski helmet use affect accident causes on ski slopes, more than 2000 injured skiers and snowboarders were interviewed during the 2011/2012 winter season about accident causes and potential intrinsic and extrinsic risk factors. Chi‐square tests revealed that ski helmet use did not significantly differ between self‐reported risky and cautious people (81% vs 83%). Multivariate regression analysis revealed younger age groups [odds ratios (ORs) 1.8–1.9, P < 005], male sex (OR 2.4, P < 0.001), Austrian nationality (2.2, P < 0.001), higher skill level (1.7, P < 0.001), and off‐slope skiing (OR 2.2, P = 0.060) to be predictive for a risky behavior on ski slopes. Neither the use of skis or snowboards nor accident causes were significantly associated with a riskier behavior on ski slopes. In conclusion, self‐reported risk‐taking behavior and ski helmet use seem not to be associated with accident causes leading to an injury among recreational skiers and snowboarders.     

Acute spine injuries in skiers and snowboarders

Skiing and snowboarding are popular winter sports associated with significant traumatic spinal injuries. Despite a decline in most injuries related to these sports over the years, acute injury rates of the spine have remained stable and even increased. Vertebral fractures and spinal cord injuries are the most common serious acute injuries of the spine in skiers and snowboarders. Due to the unique characteristics of each sport, different injury mechanisms are responsible for the majority of injuries. This article reviews injury patterns, injury types, mechanisms of injury, and strategies for prevention of spine injuries in skiers and snowboarders.     

Cross-country skiing injuries and biomechanics

Cross-country skiing exercises most of the joints, muscles and tendons in the body giving the skier an all around workout. This, in combination with a low incidence of injury, makes cross-country skiing an ideal recreational and competitive sport. The new skating techniques developed during the last decade have resulted in greater velocity. The maximum speed during the diagonal stride technique is 6 m/sec compared to 8 to 9 m/sec when skating and double poling. Top-level skiers today use strong and ultra light skis of fiberglass and graphite. The ski weight is less than 500g. Today's skating technique does not require any waxing and only the cambered portion of the ski is waxed when performing the diagonal stride. The preparation of the ski course has improved with the development of special track machines. This allows top-level skiers to reach 60 to 80 km/h on downhill slopes, which has resulted in an increased risk of injury. Because cross-country skiing takes place wherever snow is available, it is difficult to establish accurate injury rates in comparison to alpine skiing which is performed on very specialised terrain at ski areas. Studies estimate the cross-country ski injury rate in Sweden to be around 0.2 to 0.5 per thousand skier days. A prospective study of cross-country ski injuries conducted in Vermont revealed an injury rate of 0.72 per thousand skier days. 75% of the injuries sustained by members of the Swedish national cross-country ski team during 1983 and 1984 were overuse injuries while 25% resulted from trauma. The most common overuse injuries included medial-tibial stress syndrome, Achilles tendon problems and lower back pain. Most common among traumatic injuries were ankle ligament sprains and fractures, muscle ruptures, and knee ligament sprains. Shoulder dislocation, acromioclavicular separation and rotator cuff tears are not infrequent in cross-country skiing. Injuries to the ulnar collateral ligament of the metacarpal phalangeal joint of the thumb (Stener's lesion) is the most common ski injury involving the upper extremity. Cross-country skiers 16 to 21 years of age complained more frequently of mild lower back pain than similarly aged non-skiers. This may result from repetitive hyperextension motions during the kick phase and the recurring spinal flexion and extension during the double poling phase. Repeated slipping on hard and icy tracks infrequently produce partial tears or microtrauma in the muscle tendinous units of the groin.(ABSTRACT TRUNCATED AT 400 WORDS)     

Factors affecting injury severity among recreational skiers and snowboarders: an epidemiology study

Different results have been reported for skiing and snowboarding injuries worldwide. Few studies consider the injury severity score (ISS) for the evaluation of differences among injured skiers–snowboarders. The aim of this study is to identify possible risk factors that affect the severity of skiing and snowboarding injuries in three winter seasons (2002–2005) in South Tyrol. For every injured skier or snowboarder referred to our emergency department in three consecutive seasons, the following data were collected: date of birth, gender, self-declared technical skills level, place of residence (local/non-local), as well as the date, time, and place of the accident. Type of injury and ISS were retrospectively assigned. Data concerning the snowfall in the last 24 h, average snow level, and outdoor air temperature values were obtained from four weather stations that were located inside the ski resorts. A multiple linear regression model was used to evaluate the association between ISS and potential determinants. In the analyzed seasons, 2,511 injured skiers and 843 injured snowboarders were evaluated at our emergency department. There was a significant change in the ISS value for subjects with different self-reported skills levels (P < 0.001). Men and non-local residents experienced more severe injuries than women and local residents, respectively (P < 0.013, P < 0.001). The ISS was higher for people aged over 60 (P < 0.001). Snowfalls brought about a decrease in accident severity (P = 0.009). The severity of the injuries increases with age. Prevention and information programs should be targeted to people who are at high risk of severe injury. A 24-h fresh snowfall seems to reduce the severity of injuries. Very little is known about snow conditions and winter sports injury. Further studies are needed to explore this field.     

Ski boot canting adjustments affect kinematic,kinetic, and postural control measures associated with fall and injury risk

ObjectivesThe aim of this study was to investigate if and to what extent small lateral wedges inserted under the ski boot, known as canting, could impact knee kinematics/kinetics, balance, and neuromuscular activity in recreational alpine skiers in the laboratory setting.DesignExperimental, crossover study with repeated-measures analysisMethodsThirty-eight recreational skiers completed a single-leg postural balance test while wearing standardized ski boots in their unmodified state (control), and with medial and lateral canting wedges applied. Kinematics, kinetics, postural control measures, and neuromuscular activity of the lower extremity were assessed using optical motion capture, instrumented force plates, and electromyography.ResultsCanting modifications had significant impact on lower extremity kinematics and kinetics: canting wedges on the medial side of the foot significantly decreased knee valgus moments, hip internal rotation, and hip adduction. Medial canting also improved some postural control measures associated with balance quality, and reduced activation levels of the Vastus Lateralis, Biceps Femoris, and Tibialis Anterior.ConclusionsIn the laboratory setting, canting appears to be an appropriate option for improving balance in alpine skiers. Medial canting can alter skier kinematics and kinetics in ways which are consistent with mechanisms of ACL injury. Canting may also result in reduced neuromuscular effort. These changes in movement have potential to prevent lower limb injuries in alpine skiers. The findings of this study motivate future research to predict individual responses to canting treatment in a study setting more closely resembling the sports environment.