Ian D. Archibald, M.D., F.A.C.S., CIME

Snow Sport Injuries

Despite the recent balmy weather, many of you may be ready to take a trip to the ski slopes for skiing, snowboarding, or other snow sport activities.  There are approximately 500 ski areas in the North America to choose from.  Twenty of them are in the south within an eight-hour drive of the Charlotte area.  Skiing and snow boarders make approximately 50,000,000 visits to these North American resorts each year.

Your likelihood of sustaining a snow sport injury is approximately one chance per 200 visits.  It is estimated that at least 40% of all ski injuries are not reported and so the actual injury rate is unknown.  In North America fatal injuries average approximately 34 deaths per year combining both skiing and snowboarding injuries.  The majority are males in their late teens or early twenties who are often of above average ability, skiing at high rates of speed that lose control and collide with fixed objects - usually trees.

Despite these injuries snow sports are actually considerably safer than other outdoor sporting activities including swimming, boating, bicycling, and scuba diving.

There are number of myths involving snow sport injuries.  Contrary to popular belief skiers are actually the cause of more collisions than snowboarders.  Crowded ski slopes do not necessarily increase your risk of injury but caution is advised.  The use of helmets has not reduced fatal head injuries.  Current ski binding technology does not reduce your risk of knee ligament injury and in fact in some studies the newer shaped skis may actually increase your risk of knee injury.

The good news is that skiing is actually safer than it was thirty years ago.  Injury rates are approximately 50% less than they were in the 70’s.  This decrease is due in part to better equipment, including ski bindings, which reduces ankle and tibial injuries, better grooming of slopes, better skiing and snowboard instruction, and better ski resort design.  It is well proven that the most common factors involved in snow sport injuries are: participant’s level of ability; speed, in excessive of ability, and equipment failure.

Who is at risk for ski injuries?

            Beginners to both skiing and snowboarding are more prone to injury and in fact 50% of snowboarding injuries occur during the first year of learning this sport.  Women are injured more often than men especially knee ligament injuries and snow boarders are injured more often than skiers.

What injuries are most common?

            In skier’s knee ligament injuries, especially anterior cruciate ligament injuries continue to increase while almost every other type of injury has declined.  Injuries to the hand, particularly the thumb is also common in skiers and often goes unreported.  In snowboarders, shoulder and wrist injuries are the most common, particularly in beginners.

What can you do to make your next ski trip injury free?

1.   Be prepared for the environment.  Even southern ski resorts experience cold temperatures and precipitation that includes snow, sleet, and freezing rain.  Appropriate clothing including head protection and waterproof gloves are a must.

2. Skiing and snow boarding are physical activities.  You must have reasonable level of physical fitness.  Stop when you are tired.  Most injuries occur between 12 noon and 4pm. 

3. Do not attempt to ski or snowboard slopes beyond your ability.  Do not allow friends to talk you into attempting something you are uncomfortable with.

4. Know the skier/snowboarders responsibility code (www.nsp.org. under safety information).   These set of commons sense rules govern traffic on the slopes.  In some states violation of these rules make you liable for any injury you cause including the cost of medical care and for serious infractions jail time.  Be defensive, look up hill when entering a slope system, and stay in control. People ahead of you have the right away.                            

5. Drugs and alcohol adversely affect your judgment and increase your risk of injury.  They also result in increased heat loss and exposure to cold temperature injuries.

6. Take a lesson.  Professional instruction including how to recover from a loss of control situation will help you avoid or lessen injuries.  The ACL awareness program originally designed for professional skiers is the only proven method that reduces anterior cruciate ligament tears (www.vermontskisafety.com) of the knee. 

7. New snowboarders should wear wrist guards.

8. Be sure your equipment is properly maintained.  Rent equipment only from reputable vendors whose mechanics are certified meet ski binding industry standards.  Release settings need to be checked before and during the season.  Do not attempt to make your own adjustments to ski bindings.

9. Helmets.  Lids on Kids (www.lidsonkids.org) is an educational program encouraging parents to review the current understanding of the protective value of helmets.  Again there is no data that shows that helmet usage will prevent injury or death.  Helmets, however, may very well reduce severity of injury (still unproven) but in some circumstances create the opposite effect; a false sense of security.                                                                                             

10. Jumping especially into terrain parks is fun.  It also increases the potential for serious injury.  Know your landing zone surface and slope and have spotters watching you.

11. Snow blades or ski boards often have no binding release mechanisms and have been shown to increase the risk of tibia fracture.

12. Always carry ID with you on the slope.  If you are with a group plan ahead how your group will handle communication and transportation issues if someone is injured.

I hope your ski and/or snow boarding season will be injury free and enjoyable.  If you do sustain an injury get it treated either at the resort through ski patrol or with your local health care professional who is knowledgeable in the treatment of snow sport injuries.

Dr. Archibald is the Medical Advisor to the southern division of the National Ski Patrol in North America.  He has been an active member of the ski patrol at Snowshoe Mountain for the last 12 years.