The exhilaration of this sport can engender an exaggerated sense of confidence!! Unfortunately this can result in serious limb injuries particularly to the knee, ankle, tibia (the main load bearing bone of the lower limb) or to the fibula (lower limb, 'supporting strut' ) These are often secondary to the twisting forces encountered in falls while the foot is anchored in skis. Upper limb injuries are the consequence of attempting to moderate the impact of falls and commonly involve the scaphoid and other wrist bones. Skier's thumb is also recognised whereby there is disruption of the ligaments supporting the digit resulting in instability.
If you are unfortunate and go home with an injury from your ski holiday, on your return to England you can contact your nearest practitioner via the links above. Through the sundial site you can contact Matthew Bennett who works specifically with ski injuries.
Prevention
Don’t be tempted to skip professional instruction - injuries are more common in beginners and bad habits learnt early on are difficult to resolve later.
Have your own equipment checked regularly or use a reputable equipment hire company as advised. Don’t be tempted to overstate your level of skill – longer skis are more difficult to turn and bindings set too high for your ability are more likely to cause injury. Boots should fit snugly without your ankle moving around inside. If your skis, board, boots or bindings don’t feel right, don’t be afraid to go back to the hire shop. Staff at hire facilities should take time to fit your equipment properly - if they don't ask you any questions about your height/weight/ability then seriously consider going somewhere else to hire your gear - even if it is a bit more expensive and a bit of a hassle. Believe me, sorting out a broken leg whilst abroad is a lot more hassle....
Warm up and down properly – spend a few minutes gently stretching your hamstrings, thigh muscles, hips and calves before and after going on the slopes. More information on pre holiday program.
Recognise when you need a rest – most injuries occur after lunchtime when tiredness sets in.
Hard though it is, try and avoid being persuaded to attempt slopes or speeds beyond the level of your ability. You are more likely to be injured if you try and keep up with more experienced friends.
Wear adequate clothing, preferably in layers is a must. having had first hand experience of hypothermia I wouldn’t recomend it. Don’t forget good quality sunglasses, goggles and sunscreen.
Consider wearing a protective helmet. Whilst some consider them “untrendy” there is nothing cool about sustaining a head injury. Ideally, any helmet should comply with one of the American standards (Snell RS98 or ASTM F2040) or the European standard EN1077. This indicates that it has passed certain standards. No helmet will protect the foolhardy who ski too fast and/or out of control and then slam into a tree or other static object.
Never ski or board off-piste alone. Be aware of the prevailing avalanche risk and, if in doubt, consult a local guide or the ski patrol before setting out. Carry all the appropriate gear including an avalanche transceiver and know how to use it.
Never attempt to ski or board down a closed piste. Not only do you run the risk of serious injury, but you could be prosecuted and be held liable for the costs of any rescue. Ski patrollers are not killjoys - pistes are only closed for good reason, even if those reasons are not immediately apparent to you.
Advice on soft tissue injuries from snow sports
Sorry to hear you’ve been unlucky and ended up with a soft tissue injury – this might be bruising, a muscle strain, a ligament sprain or any combination of the three. Just because a bone is not broken though does not mean your injury isn’t important – it is! This sheet is designed to offer you good advice to help get you back to full fitness as soon as possible. It is very important to start the correct management straight away. The first 24 hours post-injury in particular are critical if your injury is to stand the best chance of healing well. By following the guidance on this sheet you should ensure that you have the best chance of a full recovery.
The priorities after a soft tissue injury are:
1) Protection
This prevents further injury to the damaged area. Obviously this means that you may not be able to continue skiing or boarding – but better to let an injury heal than end up with a chronically recurring problem that puts you off the snow for much longer.
2) Compression
This helps to minimise swelling at the site of injury. Swelling increases pressure and this causes more pain. You may have had a crepe bandage applied to the injured area by the ski patrol. This shouldn’t be so tight as to be painful but should offer adequate support.
3) Elevation
As much as possible, try to keep the injured area elevated for the first 48 hours at least. This will also help to minimise any swelling. For injuries to the shoulder, collar bone, elbow, wrist or hand you may have been placed in a broad arm sling or collar and cuff. Whilst these will help to keep your arm elevated, it is important that you don’t keep your arm in the sling or cuff all the time. To do so will lead to stiffness in the elbow and/or shoulder. Try and slip your arm out of the sling or cuff at least 4 x a day and move your shoulder and elbow gently. As the discomfort from the injury settles, you’ll be able to do this more frequently and vigorously until you don’t need the sling/cuff any more. Finally, don’t wear the sling/cuff in bed at night – might sound obvious but every season we hear of people half strangling themselves in the process! Support your arm on pillows instead.
4) Ice
Or, more specifically, cooling. This helps to reduce the amount of tissue damage that occurs at the site of injury. Never apply ice directly to an injury – wrap crushed ice in (for example) a tea towel. A bag of frozen peas moulds well to most parts of the body. Try to apply something cool to the injured area for 10-15 minutes at a time at least every 4 hours if not more. It should not be painful – if anything, it should help reduce the pain. Whatever you do, don’t apply heat to an injured area especially not in the first 72 hours – so this means no hot baths!
5) Rest
We all want to get on doing the things we love again as quickly as possible. However, it is important to allow soft tissue injuries to heal properly – the worst thing you can do is try and do too much too soon and re-injure the same area. This could mean more damage and inevitably more time away from your usual activities. We recommend that every injury is reassessed by a doctor within a week of the accident so that they can advise you further.
6) Referral
To give your injury the best chance of full recovery, we strongly recommend that you see a qualified physiotherapist as soon as possible. This can be arranged through your own doctor or you can make arrangements privately yourself.
7) Anti-inflammatories
For example ibuprofen, which you can buy without a prescription. Check with the chemist or on the label if you’re not sure if you can take them. Aim to take 400mg at least three times a day after food for 5-7 days. Although they will reduce the pain they are doing much more than this and you should complete the full course even if your injury feels much better. Taking them here and there simply as pain killers means they won’t work as well to help your injury to heal.
Skiers
The commonest injuries are knee sprains, thumb sprains and shoulder injuries.
(a) The commonest single injury to an alpine skier is a grade I-II sprain of the medial collateral ligament on the inside of the knee. Usually these result from a twisting fall when the lower leg bends outwards relative to the thigh. An additional factor may be a failure of the ski binding to release. These injuries also result from a 'snowplough gone wrong', especially when the skier has a wide, unstable stance.
ANTERIOR CRUCIATE LIGAMENT SPRAINS
Incidence: Accounts for 10-15% of all ski injuries. Often diagnosed late if at all. Often associated with injuries to other structures within the knee (e.g. MCL and/or meniscus)
Cause: Intensive American research has identified two main mechanisms that predispose to ACL damage in alpine skiers. These have been termed the “phantom-foot” and “boot-induced” scenarios.
The Phantom Foot Profile
1) Uphill arm back
2) Skier off balance to the rear
3) Hips below the knees
4) Uphill ski un-weighted
5) Weight on the inside edge of downhill ski tail
6) Upper body facing downhill ski
When all six elements of the phantom foot profile are present, injury to the ACL of the downhill leg is extremely likely. Situations that can predispose to this scenario developing are:-
a) Attempting to get up whilst still moving after a fall
b) Attempting a recovery from an off-balance position
c) Attempting to sit down after losing control
To avoid such injuries
In a fall, keep your arms forward and your hands over your skis if possible
Don’t fully straighten your legs when you fall - try and keep them bent
After a fall, don’t try to get up until you have stopped moving
The boot induced mechanism occurs when a skier becomes off balance to the rear whilst attempting a jump. Instinctively, the skiers leg fully extend. As a result the skier lands on the tails of the ski which force the back of the ski boot against the calf which drives the tibia out from under the femur and the ACL tears.
Presentation/diagnosis: Often the individual describes feeling or hearing a ‘pop’ or a ‘snap’, with the knee ‘giving way’ beneath. A haemarthrosis usually develops within one hour of injury.
Investigation: MRI scanning/plain radiographs to detect associated bony, soft tissue damage and improve diagnostic pick up.
Treatment: Controversial! In the U.K., the general trend is to aspirate the haemarthrosis and initially treat conservatively with splinting and intensive physiotherapy aiming to build up muscle strength to help stabilise the joint. In the US and Europe, early arthroscopy ligament repair and mobility is advocated. Generally agreed that if you wish to continue skiing at the level of a good intermediate or above, you will probably need to have reconstructive surgery to your ACL. If however, your knee feels stable with conservative treatment, this may be avoided. Others advocate a knee brace for additional protection (see below).
Prevention: Education to recognise potentially dangerous situations occurring. In general, always aim to keep arms forward, feet together and hands over skis.
If you have already sustained an ACL injury and/or undergone reconstructive surgery, consider wearing a hinged knee brace.
Snow boarders
The commonest injuries are to the wrist, shoulder and head. The risk of sustaining a fracture is at least twice that of skiers.
The main concern for snowboarders (especially beginners) is the risk of a wrist fracture. It is estimated that 95,000 wrist fractures occur world-wide every season amongst snowboarders, although (again) the absolute risk of an injury is still very low. The problem is that the natural reaction to falling having lost balance on a snowboard is to land on an outstretched hand. The forces of the fall are absorbed by the wrist joint and injury results. Beginners, being more likely to lose balance (and fall) are at the highest risk of injury of all.
Wrist guards have now been conclusively shown to reduce the risk of a wrist injury and ideally should be worn by all snowboarders - but beginners especially. Avoid wrist guards with no bend as the shock will simply travel up the arm to the elbow, instead try to go for ones with some flexability that support but aren’t rigid.
Always attach the board to your lead foot with a security leash. Secure this before getting into your bindings to prevent a “runaway” board which could cause injury to others as well as being an expensive loss to you!
Stop on one side of the piste and kneel or stand facing up-hill in order to see oncoming traffic rather than sitting down in the middle of the piste.
Be aware of the so called "snowboarder's ankle" - this is a fracture of the lateral process of the talus bone in the foot and is very important as it can lead to long term arthritis if undiagnosed and not treated correctly. It resembles a bad ankle sprain and one major problem is that most doctors outside of ski areas will never have heard of it!! If you have persisting pain in your ankle 7 days or more after an injury from boarding this is a possible reason! Get on to your doctor - it can need a CT scan to diagnose as plain x-rays don't show this area of the foot up very well. Be persistent or your pain will be!!!!
Physiotherapy assessment and treatment as soon as possible - part of this aims to keep the quads muscles toned. ۰Assessment of ligament stability once acute pain has settled, using the uninjured side for comparison if necessary.
Information provided by Dr Mike Langran, for more expert advice please visit www.ski-injury.com
Disclaimer
Whilst this information is presented in good faith, based on the latest available evidence on snow sports injuries - neither Physique ltd or Rhian Evans can accept any liability for any accident, injury or fatality arising as a result of following advice on this website. Skiers and snowboarders are (for the most part) human and as such everyone varies - tailor this advice to your needs as much as possible. If in doubt, try and consult an experienced ski physician locally.
The commonest injuries are knee sprains, thumb sprains and shoulder injuries.
