Skiing - Injury Reduction

Skiing season is coming up, so we are entering another season of skiing-related injuries. Why do people get injured while skiing? Even those that are in the financial position to go on a skiing holiday, the average keen British skier only spends 6 days a year on the slopes. Despite skill level, this very low frequency leaves one at risk of injury, versus a movement in which you get weekly practice, such as running or going to the gym. Skiing also presents us with much higher speeds and force going through joints, which means that there is a higher chance of sustaining significant injuries such as broken bones, ACL tears, and concussions.

In the physio field, we see a wave of these injuries every Winter, and although not completely avoidable, there are some ways that you can protect yourself and reduce your injury risk. Most advice around injuries and skiing is about ‘Injury Avoidance’, however a better way to think of this concept is ‘Increased Conditioning’. 

What are the Common Skiing Injuries?

Upper limb injuries represent about 30% of all alpine skiing injuries. Snowboarding injuries are more common in beginners, whereas skiing injuries occur more (but not completely) independently of experience. Upper limb fractures, particularly of the wrists, are both more common and more severe in snowboarders. Upper limb fractures in skiers are significantly biased towards thumb injuries.

Shoulder injuries constitute about 40% of the upper limb injuries seen in alpine sports. These include; rotator cuff tendon injuries, shoulder dislocations, acromioclavicular joint injuries, clavicle fractures and proximal humeral fractures.

90% of these injuries are caused by falling. Collisions with other skiers and pole planting injuries being the next most common causes.

How Can We Prevent These Injuries?

Behaviour

It is obvious that avoiding collision risk will reduce your injury risk. Skiing skill will get you so far, but due to other skiers it is also important to be aware at all times. Ego should be left at the door, and you should ski on a slope that is appropriate to you. Joining your friends on a Black Slope may sound like a thrill, but be aware that most people on that slope will assume that you are a skilled skier and be less cautious around you.

British people are in general at a higher risk of injury than most Mainland Europeans. A significant reason for this is that British people as a population tend to learn how to ski at a later age, potentially on a school or uni trip, whereas some French, Germans, and Swiss learn how to ski at the same time that they are learning to walk.

Equipment

There would seem to be little doubt that improvements in equipment have been a significant factor in reducing total injury rates, from 5 to 8 per 1000 skier days before the 1970’s to 2-3 per 1000 skier days today. However, the main reduction has been in lower limb injuries, which have been mainly due to improved binding and boot design. Conversely, upper limb injuries have decreased little and as such are proportionately greater now.

One development which may potentially reduce the risk of shoulder injury is that of wrist strap releases on poles. As tension increases on the strap, they become detached from the poles before potentially dangerous forces can be transmitted to the upper limb and shoulder girdle.

Conditioning

When preventing fractures to the bones, there is not a lot which can be done in terms of conditioning when considering the average healthy and active person. If there is evidence of osteoporosis (reduced bone density) which can sometimes be seen in predominantly female athletes and in the older population, this could be addressed with specific medical treatment.

Core stability and balance training may have a role in reducing shoulder injuries by reducing the risk of falls and by potentially improving shoulder stability. Shoulder stability can also be improved by a number of other strategies including postural correction and by improving muscle coordination and strength of the muscles around the shoulder joint and scapula (shoulder blade).

In simple terms, focus should be placed on pulling exercises (such as in the rowing action) in preference to pushing exercises (such as bench press). More specific exercises related to strengthening the deep tendons around the back of the shoulder (the posterior rotator cuff) are also of use in trying to optimise stability and prevent shoulder dislocation. A good warm-up immediately prior to skiing or snowboarding is very important. It is well known that warm muscles and tendons are less prone to damage as a result of abnormal tensile forces.

Being Sensible

Finally, we know that skiers and boarders are more prone to injury when tired. If you are coming towards the end of the day, are tired and thinking about one more run, you may be better off stopping, enjoying some Aprés Ski and looking forward to the next (injury free) day!

If you have any questions on whether physio is the best option for you, or you have any questions about MVMNT in general, feel free to contact via email.

- Jay Towolawi, Specialist Sports Physiotherapist and MVMNT Founder.