Hitting The Slopes
As the winter is almost upon us, it seems appropriate to talk about hitting the slopes and all that, that involves! This week’s feature will be a look into skiing and snowboarding injuries, with the next instalment looking into how you can be fit for the slopes and avoid injury.
Although not as common as you might think, both skiing and snowboarding can cause sports injuries, but they tend to have slightly different injury patterns. The increase in popularity of snowboarding in the 1990s saw a dramatic drop in knee injuries on the slopes as these tend to be reserved more for skiers. However it has also seen a rise in ankle injuries. Something that had been minimised in skiers thanks to the improved technology and stability of ski boots.
It is not possible to tell you about every possible eventuality, but what this feature does aim to do is forewarn you about the major injuries that can at times be avoided. And help you to know what to look for if you are unfortunate enough to sustain an injury.
The risk of a lower limb injury is about twice that of an upper limb injury when skiing. Despite the incidence of injuries being different, the actual mechanism of injury involved in head, spine or shoulder injuries in skiing and snowboarding are pretty similar.
Although skiing technology has greatly improved over the years,injuries involving the knee are still the most common, with a ligament sprain the most likely. There has been much debate about whether specific bindings reduce the risk of sustaining a knee injury and the evidence is inconclusive. What does appear to have reduced the rate of ACL (anterior cruciate ligament) injuries was the introduction of carving skies.
Carvers are shorter than the old style of ski with a broader head and tail end. Due to their clever design, they require far less force to turn and the shorter length makes them easier to control. If you do catch an edge in the snow, the twisting force being transmitted to the knee is reduced due to the ski acting as a shorter lever compared to the traditional longer style of ski.
Despite much research on bindings and their impact on reducing the incidence of ACL injuries, the ligament most frequently damaged is the medial collateral ligament (MCL) of the knee. It is a relatively superficial ligament that runs down the inside of the knee connecting the femur (thigh bone) with the tibia (lower leg bone).
Injury to this ligament occurs when the lower leg twists outwards relative to the thigh, causing an over-stretch of the MCL. It can also occur from a direct blow to the outside of the knee, that pushes the knee inwards. MCL injuries tend to happen at relatively slow speed often on the beginner slopes due to the amount of time spent in a snow-plough position or when a beginner panics and puts on the breaks too quickly by adopting the newly learnt snow-plough. These ligament injuries do not tend to be severe and will recover within a few weeks with a few sessions of physiotherapy once you get home.
When an injury to the ACL does occur it tends to be far more serious and if not diagnosed correctly, can have huge repercussions on a person’s future sporting ability, particularly skiing. Damage to the ACL can occur during a fall when the binding does not release the boot and the ski becomes caught and fixed in the snow and the femur and torso continue in a different direction causing a significant twisting force on the knee.
Often with this type of traumatic fall, the meniscus (deep horse-shoe shaped cartilage in the knee) and the MCL can also be damaged at the same time. Unfortunately, other than ensuring that your bindings are working effectively, there is not a great deal you can do to prevent this type of injury. The exercises in the next instalment on preparation and injury prevention can however help to prevent an ACL injury that occurs from landing badly after a jump.
It is important to land a jump on both skies simultaneously to halve the impact on just the one knee and it makes it easier to control the alignment of your leg and knee as you land. Having adequate strength in your quadriceps and hamstring muscles will undoubtedly control the forces transmitted up to your knees from the landing.
Not all injuries involving the ACL are sustained at break-neck speed. They can be sustained in a slow fall, sometimes even whilst getting off a chair-lift. Whatever the mechanism of injury, they will all involve twisting of the knee.
The term ‘skiers thumb’ is used to describe damage to the (ulna collateral) ligament of the thumb at the metacarpalphalangeal (MCP) joint. This is the joint that connects the base of the thumb with the metacarpal bones on the hand. Ligament damage usually occurs as a result of a forced hyper-extension movement of the thumb during a fall.
The most effective way of avoiding this type of injury is by not putting your wrist through the straps of your poles to enable you to release the poles quickly in the event of a fall.Beginners are often taught to use the straps on the poles probably to save their instructor from constantly chasing run away poles.
An X-ray should be insisted upon if you do injure your thumb in order to rule out fractures, don’t be fobbed off with the diagnosis of a ligament sprain.
Injuries involving the upper limbs are far more frequently seen in snowboarding than skiing. The main reason for this is that when you have both feet in bindings on a snowboard and lose your balance, the natural act is to put your arm or hand out to save yourself. For this reason, wrist injuries (as well as a bruised bottom) do tend to be fairly common, especially with beginners.
Of these upper limb injuries wrist fractures are the most common, followed by damage to the shoulder. Wrist fractures, especially in beginners, are the most cause for concern. These usually occur when the snowboarder lands on an outstretched arm having lost their balance. A fracture resulting from this mechanism of injury will usually involve the scaphoid bone at the base of the thumb or the far end of the radius (forearm) bone.
A simple balance exercise that will be mentioned in the next instalment will prepare you for avoiding this type of fall by improving your balance. Wearing a wrist guard has conclusively been shown to greatly reduce the risk of a wrist fracture. This is certainly a must for all snowboarders but especially beginners.
The type of shoulder injuries seen with skiing and snowboarding are fairly similar. Shoulder dislocations are the most common, followed by fractures to the humerus (upper arm) bone. The same type of fall resulting in wrist injuries is also the culprit here.
The shoulder joint can be thought of as a ball and socket joint where the head of the humerus sits within a very shallow socket. The socket needs to be shallow to allow the great freedom of movement that the shoulder has, but this does make it a more unstable joint. A dislocation of the humeral head in the glenoid socket is usually the result of a fall onto an outstretched armseen with all types of winter sports.
Once a shoulder has dislocated once, there is an 85% chance of recurrence further down the line, as the ligaments supporting the joint have been overstretched making an unstable joint even more unstable. The most effective way of avoiding a nasty shoulder injury is to know how to fall. It is natural to want to reach out with your arm to help you regain your balance during a fall, but this puts your arm in a vulnerable position for the inevitable fall onto it. Curling up into a ball with your arm kept in close to your side will certainly help to protect your shoulder and wrist.
Granted, there is a chance that you could sustain a different type of upper limb injury by falling in this way, however, shoulder dislocations do tend to be amongst the nastiest of shoulder injuries and are definitely to be avoided.
How your choice of boot can affect ankle injuries
Hard boots, often worn by racers offer greater stability, ankle support and control than a soft boot but can on rare occasions, lead to a knee injury (see the section below on knee injuries).
Soft boots are often worn by beginners as they offer greater manoeuvrability. However, they do not offer the same level of protection to your ankles as the harder boot provides and are twice as likely to cause a nasty ankle injury, as any forces transmitted up from the board tend to be absorbed by this joint making it vulnerable to injuries.
This commonly happens when a snowboarder lands a jump awkwardly and twists the foot inwards (inversion) whilst compressing the ankle joint on the landing. This can lead to a nasty fracture of the outside part of the talus bone which is the keystone of the ankle joint. This is often misdiagnosed as a straight forward ankle sprain and if you are unfortunate enough to sustain an ankle injury whilst boarding, it is worth being fore-armed with this information when you go to the nearest alpine clinic and insist on an x-ray.
A good option for a boot is a hybrid boot which combines the comfort and manoeuvrability of a soft boot with the stability and protection of a hard boot.
Although wearing hard boots may make you slightly more susceptible to a knee injury, they are much less frequently seen than in skiing. The main difference between the two sports is that with skiing, both legs are free to move and twist independently of the other leg. The skier and the skies are generally facing down the mountain making it easier to potentially catch an edge and incur a nasty twisting force to the knee.
In comparison, with snowboarding, both feet are attached to the same board and any twisting forces are absorbed by the entire body rather than just the knees.
There are a few circumstances with snowboarding where your knees do become vulnerable;
- Using a surface lift (i.e. drag lift or T-bar) or dismounting from a chair lift when you have one foot out of your bindings. In this circumstance, your snowboard is acting like a huge ski with the potential to apply a massive twisting force to the knee joint. Unfortunately, until lifts become more snowboard friendly, you will have to take extreme care. It is personal preference, but some boarders do actually have both feet securely in the bindings for all types of lifts. This is where having a competent skier with you to help pull you along with a pole as you near the lift is useful.
- Direct trauma from a collision with a solid object like a tree, another person or a pylon. It would usually be the front leg that absorbs this impact and sustaining a fracture to the lower leg would be the most likely injury.
- Although it is still much more common in skiing, an ACL (anterior cruciate ligament) injury can be sustained when landing a large jump without adequate control. This will be covered in the next feature about preventing injuries.
Head injuries are often the result of a fall. Beginners will often fall backwards hitting their head on the snow. Thankfully head injuries of this nature tend to be minor. However, the greater the force of impact involved in the fall or collision, the more severe the head injury.
As the risk of sustaining a head injury is less than 1%, there are no strict guidelines published by the respected bodies about wearing a helmet. However, it is obvious that wearing a helmet will significantly reduce the risk of a head injury if you are unfortunate to have a fall or collision.
Although devastating if they happen, spinal injuries on the slopes are relatively rare. There are two main causes;
- Stopping abruptly and promptly landing on your bottom on hard snow can transmit the impact forces up your spinal column leading to a compression type injury of one of the vertebra.
- Landing awkwardly on your back or neck after a jump that has gone wrong. Always go down and assess the jump first and then climb back up before performing the jump as you do not know what will greet you on the other side.
If you witness someone falling awkwardly onto their back or neck, never try and move them. Always call for help and let the professionals get them down the mountain immobilised on a back-board.
Despite all of this worrying information about the risks of skiing and snowboarding, it must be remembered that serious injuries on the slopes remain relatively rare. Preparing your body for the rigours of the slopes is still the most effective way of preventing injuries. Wearing safety equipment such as wrist guards and helmets and learning how to ski or board correctly and safely will put the odds even further in your favour.