Prevention of Skiing Injuries
Skiing at altitude is one of the most challenging and stressful environments for exercise to take place and it can have a detrimental effect on performance. Individuals not used to regularly being at these altitudes (most recreational skiers) and who have not prepared themselves for the rigors of exercising at altitude often struggle. This can have a major impact on performance and therefore injury. Skiing injuries are the result of a number of factors and as such prevention must be multifaceted.
The following issues should be addressed to help minimise the risk of injury:
Fatigue is recognised as a key factor in the occurrence of injuries in a number of sports. Once an individual becomes tired, their skill level decreases and they are more likely to find themselves in a situation where they lose control.
We would recommend seeing one of our specialist sports physiotherapists or booking into the Strength & Conditioning clinic for a specific pre-ski programme that incorporates the following aspects, tailored to your needs.
Aerobic exercise targeted at improving endurance is essential. The skier should exercise at least three times per week for 30 minutes duration at each session. Exercise should be maintained at 60-70% of maximal heart rate for the 30 minutes. Activities such as running, cycling, rowing and the cross trainer machine are recommended for improving aerobic endurance. The skier should remember that they will often be exercising at high altitude where perceived exertion for a set amount of work will be higher than at sea level.
Muscular strength and endurance
Lower limb strength is vital in minimising injury risk. Strength of the calf, quadriceps and gluteal muscles is especially important. Whenever possible, strengthening exercises for these muscle groups should be done in a functional manner to mimic the actions involved in skiing.
Trunk core stability exercises improve control of the abdominal, lumbar and pelvic regions. This allows the individual to maintain control of the body movements and efficiently transfer power between the lower limbs and the upper body. These exercises are very specific and require specific instruction.
Flexibility is very important in preventing injury. Skiers should stretch daily in the weeks leading up to skiing and should stretch pre and post skiing daily while on holiday.
Balance and agility
Balance and agility also play key roles in becoming a better skier. Incorporating drills to enhance these abilities will better prepare you for any terrain the mountains have to offer.
Exposure to altitude results in an increased carbohydrate requirement as an energy source. Therefore energy intake must be increased at altitude to compensate for the increased resting metabolic rate at altitude and the energy requirements of skiing. Fatigue from low carbohydrate intake can predispose the skier to injury as stores become more depleted. Symptoms of a low carbohydrate intake are muscle heaviness and a lack of energy to ski.
Typical Carbohydrate rich foods and snacks to eat during the day can include: Dried Fruit; Sports Bars/gels; Yoghurt; Grains (Bread, Rice, Noodles and Pasta); Cereal Bars; Breakfast cereals; Fruit – bananas; Potatoes.
Dehydration is a common issue at altitude and is compounded due to fluid losses via sweat, and through breathing the cold, dry air. Fluid requirements need to be increased at altitude to compensate for these losses and prevent dehydration. Consuming a sports drink is the most practical way to ensure adequate fluid intake and also supplies essential carbohydrates for glycogen replacement.
Having a few alcoholic drinks is a typical après ski activity! However, try and remember that: alcohol will dehydrate you; alcohol still in your body the following day can reduce reaction time, concentration and coordination (increasing injury risk!); try and eat while drinking and drink water before going to bed.
Harris & Ross Nutrition can provide you with further personalised advice for your ski trip.
For more nutrition advice, visit our Ski Nutrition page by clicking here.
Podiatry & Chiropody
Healthy feet and ankles act together as accelerators, steering, brakes and shock absorbers in skiing. Any problems can have serious repercussions for skiers. Any pre existing foot conditions such as corns, calluses or bunions should be examined by a chiropodist before a ski holiday.
Properly fitted ski boots are vital to safe and successful skiing. Discomfort or injury will quickly result if the boots are not correctly fitted. A podiatrist can ensure that boots fit correctly and are comfortable by building custom made orthotics for your boots. Orthotics can also help with biomechanical imbalances such as ‘edging’ where the ski rolls to the inside or outside edge, inhibiting control going down the slopes. Ski boots can also be ‘canted’ internally to adjust the relationship between the boot and leg.
The Podiatry and Chiropody team at Harris & Ross can provide you with further personalised assessment, advice and treatment. Our podiatrist works directly with ski shop technicians to make biomechanical adjustments to boots and skis to improve performance and safety.
It is important that the equipment that the skier uses is safe, properly adjusted and appropriate for the conditions and skiers level of ability. Inexperienced skiers should always seek advice from an appropriately qualified instructor. Bindings should be adjusted by a professional so that they release in a fall. Bindings should be tested by the skier as part of the daily routine before each days skiing.
Given the high number of head and facial injuries, helmets are advisable. Although there is not a great deal of scientific research regarding the benefits of helmets in skiing, evidence from other sports such as cycling, suggests that helmets will reduce the morbidity associated with a head injury.
The skier should have a realistic understanding of their own skill level and choose the appropriate piste. It is important not to choose terrain that is beyond your level of expertise as this exposes you to real risk. Skiers tend to take more risks when skiing in a group than by themselves. It is important that you never ski a slope that you would be unprepared to ski on your own.
Prevention of Fatigue
Fatigue is implicated as a cause of injuries in many sports, and in skiing it can play a major role. Fitness training is an important strategy for preventing fatigue. Stopping for short revival breaks is a good idea throughout the day. Supplies of high energy food and drinks is a sensible way of delaying fatigue. Don’t be too ambitious when planning a day’s skiing, ensure the terrain and duration is within your fitness limits.
Skiing is not without risks and individuals wishing to participate in skiing need to be aware of the possible risks and the methods of reducing these. Due to the seasonal nature of skiing many skiers begin the season without having performed any serious alternative exercise or training since the previous ski season. This places those individuals at increased risk of injury.
The overall rate of skiing injuries has decreased over the last 30 years, however, patterns are changing, with injuries to the lower leg decreasing and injuries to the knee, shoulder and thumb increasing.
In terms of injury, skiing is one of the highest risk sports that adults undertake on a regular basis. Males are more at risk of serious injury than female skiers. The highest risk age group is 7-17 years. The rate of injury occurrence in skiing is inversely related to the level of skiing experience, in other words, skiers with the least experience are at the highest risk.
Knee ligament injuries are very common in skiing (around 40% of all ski injuries) and can result in significant sporting downtime and also loss of work time.
The ski tends to act as long lever on the end of the lower limb, as a result, large rotational forces can be placed through the lower limb if the skier loses control of one or both skis. The knee has several major stabilising ligaments with the anterior cruciate ligament (ACL) being the most important stabilising ligament.
The ACL accounts for 10-15% of all skiing injuries. The ACL can be injured by way of a twisting mechanism and also when the skier ‘dumps’ almost falling backwards to sit on the back of the skis. The lower leg is pulled forward forcefully and can disrupt the ACL.
The medial ligament (20% of all ski injuries) can be injured by twisting or collision injuries, if the lower leg is forced outwards relative to the knee.
The posterior cruciate ligament can be damaged by a blow to the top and front of the lower leg or a hyperextension injury.
Injury to the lateral ligament is not particularly common and is normally the result of a high impact collision causing multiple pathologies.
Fractures, patellar dislocations and meniscal tears can all occur as a result of twisting or collision injuries.
Head and Facial Injuries
These account for approximately 20% of all skiing injuries and a fifth of injuries occurring in children aged 7-17 years. One fifth of these injuries are severe enough to cause a loss of consciousness or symptoms of concussion.
Shoulder injuries account for approximately 10% of all skiing injuries. Dislocations and subluxations of the shoulder and AC joints are most common followed by fractures and sprains. Shoulder injuries are most commonly caused by falls onto an outstretched arm or a fall onto the point of the shoulder.
Injury to the ulna collateral ligament (where the thumb joins onto the hand, and braces the inside of the joint) is referred to as skiers thumb. This is usually caused by incorrect technique using the ski pole. When the thumb is wrapped around the pole and the pole comes to a sudden stop, the thumb can be stretched sideways, disrupting the ligament.
Harris & Ross Physiotherapy and Sports Massage can provide you with specific assessment, advice, treatment and rehabilitation to get you back on the slopes.
It is a combination of: fitness; the correct equipment; a healthy respect for the mountain and being realistic of your ability level; good nutrition; and podiatry, to ensure comfortable boots, that all contribute to prevent fatigue, thereby reducing the chance of injury, to ensure that you have an enjoyable, injury free ski trip.
The physiotherapists, sports massage therapists, nutritionists, podiatrists and trainers at Harris & Ross can offer you specific advice on preparing yourself for the ski season and should you be unfortunate enough to get injured they can help get you back on the slopes as quickly as possible.