Posts in skiing injury
Concussion Rates at Altitude

Winter sports are in full spring in Colorado with many people taking their athletic pursuits outside.  Skiing and snowboarding continue to grow in popularity throughout our state among both children and adults.  Thankfully, ski helmets have become the norm at our state's ski areas.  These helmets are an essential piece of equipment to reduce the forces placed on the brain and skull during a fall.  Concussion is one of the most commonly diagnosed injuries to the head among athletes.  New research is examining the impact of altitude on concussion incidence and symptoms.   

Authors have previously reported fewer concussions are diagnosed in high school and professional athletes competing at higher altitudes (Myer et al. 2014, Smith et al. 2013).  This has led clinicians and researchers to believe high altitudes may have a protective effect on brain injuries like concussion.  These first two articles were only preliminary reports and the definition of injury and high altitudes was not clear.  A recent article in the Journal of Orthopedic and Sports Physical Therapy examined concussion rates at 21 NCAA division I football programs across the country (Lynall et al. 2016).  The article stated 169 concussions were reported by these programs medical staffs over 63 seasons (1-5 seasons for each team).  Surprisingly, these authors found higher altitudes may be associated with higher rates of concussions.  

Differences between this study and previously studies may be due to differences in research methodology including injury tracking and athlete selection.  For example, the college athletes in this study may not have enough time prior to competition for beneficial physiological adaptations to occur compared to their pro counterparts.  Usually adaptations are observed 48-72 hours after traveling to altitude.  Further research is needed to determine the impact of these physiological changes on brain health in athletes, but this research adds to existing research questioning the protective benefits of altitude competition on concussion rates. 

Can I Return To Competitive Skiing After An ACL Injury?

In previous posts on ACL injuries we have discussed the rising incidence of knee injuries across multiple sports and events.  As we enter ski and snow board season Mend will help manage an increased number of these injuries.  The lower extremity is the most commonly affected body region for ski injuries with 1 in 3 injuries occurring at the knee joint (Florenes et al. 2009).  On average, each injured skier loses 1 month of training or competition following the injury.  In the most severe cases involving rupture of the ACL ligament in the knee an athlete will require Physical Therapy for up to 9 months before returning to high levels of skiing.  Up until recently, it was not known what percentage of these injured athletes returned to prior levels of skiing.

A recent review in the American Journal of Sports Medicine followed 477 elite skiers from 1980-2013 to determine their ACL injury rates and ability to return to competitive skiing (Haida et al. 2015).  These athletes competed in both speed (Giant and Super G) and technical events (Slalom) during their careers.  Overall, 1 in 4 athletes sustained an ACL injury during their career but injuries were found equally between speed and technical disciplines.  Each athlete who sustained an ACL injury and completed Physical Therapy returned to some level of competitive skiing.  Interestingly, the career lengths of those who had sustained an ACL injury was longer than those who had not sustained an injury.  The study demonstrated these athletes were able to return to high levels of competitive skiing including podium finishes.  Athletes who sustained the injury prior to age 25 had the greatest chance of returning to high levels of competitive skiing and performance.