Posts tagged skiing
Reducing Your Risk Of Alpine Skiing Injuries

Alpine skiing remains one of the most popular outdoor winter sports in Colorado. It is estimated over 6.8 million skiers participated in the sport over the 2016/2017 winter season. There are inherent risks of death and injury in both skiing and snowboarding, but thankfully due to technological updates and innovations overall injuries have fallen by half over the last 30-40 years. Although injuries on the whole have decreased some traumatic cases, such as ACL tears, remain common today. A recent article summarized the available evidence on the most common ACL tears, as well as, offered an update on injury prevention strategies in alpine or downhill skiing.

Davey and colleagues published the review article recently in the journal Sports Health (2018). Authors reviewed the available evidence on ski injury prevalence including injury location, known risk factors, and ski injury prevention. Data was available from a total of 64,667 ski injuries over a 25 year period. They reported the average age of skiers injured was 30 years old with a range of 24 to 35 years. Those found at highest risk included both the young, adolescents and children, as well as, older adults (>55 years). While males were more likely to experience lower extremity fracture, consistent with other sports females are more prone to ACL tears.

As expected, the lower extremity remains the most commonly injured area of the body accounting for up to 77% of all injuries. Further, 14% of injuries involve the thumb and shoulder and 13% involve the head and neck. The knee ligaments (ACL and MCL) remain the most common injury followed by thumb and head and facial injuries. Trend data showed a drop in tibial fracture, but an increase in ACL tears. Most common mechanisms included deep knee flexion with rotation or knee hyper extension and forward movement of the thigh over the stationary leg in the boot. In addition, despite advances in helmet use and technology, the number of traumatic skiing fatalities remained constant.

Ski technological advances, including helmets, bindings, and ski poles, deserve the most credit for the 50% reduction of ski injuries. Helmet use has increased to 80% of all skiers and has been a significant advancement in the safety of participants and reduction of head and face injuries. As expected, helmets have consistently been shown to reduce both the prevalence and severity of head injuries without a subsequent increase in “risky skiing”. The risk of death with head injury has stayed relatively constant either because the forces of impact exceed the protective capacity of the helmet or the skier sustained other bodily injury causing death despite sparing their head and face.

Ski boot binding systems have contributed to the large decrease in leg fractures and contusions due to improved release mechanisms. In addition, skiers who routinely have their bindings checked by certified ski shops sustain fewer injuries than those who ski without inspected bindings. These bindings are designed to prevent fracture and leg injuries, not knee ligaments, and bindings often do not release with common ACL injury mechanisms in skiing.

Established programs such as “lids on kids” and “heads up” remain effective at improving the awareness and utilization of helmets. ACL prevention programs (Vermont Ski Safety Equipment) have focused on educating skiers to avoid situations most associated with knee sprain, as well as, instructions in how to fall with decreased risk to your knee. These programs have been shown to reduce a skier’s risk of knee injury by 60%. Interestingly, ski lessons have not been shown to reduce the risk of knee injury among skiers. In our practice, strength also remains a key component of injury prevention programs. Skiers are recommended to work with a local Physical Therapist to design an effective ski injury prevention exercise program.

Click Here To Learn More On Ski Injury Prevention Programs

Q and A with Boulder's Alpine Training Center Owner and Head Coach Connie Sciolino
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1.  What is your fitness background and how did it lead you to opening the Alpine Training Center?

I have a Master's in Exercise Science and I am a Certified Strength & Conditioning Specialist certified through NSCA.  I think my fitness path really began as a high school athlete. I was a alpine ski racer from the age of 14. Obviously early on I never really prepared for winter sport and just did a bunch of different sports from soccer to basketball, volleyball, softball, tennis. Yeah I was an active child.  Once I got to high school I raced with my high school team and a club  team on weekends and I soon realized that I would need to "prepare" for the winter season.  I started running and doing some made up workouts at home.  After a year of high school racing I would head out Oregon for summer training which meant spring was also a prep time. These two shoulder seasons of pre-season training really hooked me on the fitness aspect of the sport while still loving the technical.  Outside of college I still skied and still needed to prep for the season but really was looking for more.  I did a lot of running and earnestly jumped into "aerobics" and began teaching classes and branching out into other areas of coaching.  Running turned into marathons and aerobics turned into programming for runners & skiers.  I had always enjoyed going to the gym and lifting weights, though now I laugh at myself for what I was trying to do, and learning. I always wanted to know more and try new things and push myself.  I came across a gym in a Jackson designed for the skier, climber type and I jumped in whole heartedly.  The training I did there is very similar to what we do at the ATC and it really help me decide that this was the direction I wanted to go.  Leaving Jackson and coming to Boulder, which really is just Jackson on a larger scale - more people, more athletes, more outdoor sport opportunities, I knew that a gym similar to the Jackson gym would do well.  And that's how the ATC came about. 

2.  There are many workout choices for Boulder County residents, what makes your facility unique?

Our main focus is outdoor performance.  So while we train inside, I am always thinking about how the training is going to transfer outside.  We work to improve outdoor performance as opposed to working to be better in the gym or to prepare for gym based competitions.

3.  As we approach the winter season, what training areas should athletes be focusing on as they prepare for their respective sports?

It's a little sport specific but let's separate athletes into strength vs endurance.  Nordic skiers ie cross-country or skate skiers and ski mountaineers are endurance athletes. Their primary goal is to boost their aerobic capacity, then add some core strength for injury prevention and then leg & upper body strength to boost performance.  Downhill skiers are strength based.  While a good aerobic base will help the athlete last all day they really need to focus on core & lower body strength not only to perform but to protect the back and the joints.

4.  How important is strength training for your endurance athletes?  What performance benefits can they expect with consistent weight training?  

The single best way to increase an endurance athletes performance is to add strength training.  First it helps prevent injuries.  Runners are susceptible to all kinds of overuse injuries, not to mention the trip on the trail type of injuries.  Strength training helps them become more durable and reduce the risk of injury.  Secondly strength training will help running economy. So not only will an athlete be able to run faster they will be able to do it longer without losing form.  Finally balance. Endurance athletes whether they are runners or cyclists are probably the most imbalanced athletes.  Strong legs but often imbalanced from one to the other due to overuse injuries and their core & upper bodies are generally weak.  Ask an utra runners to do 10 strict pushups in a row.  You'll quickly see my point.

5.  What is your favorite winter activity and location for its’ performance?

Skiing.  I started skiing at age 7 and I hope to ski to the day I die.  I alpine ski and backcountry ski and have many favorites. I spent many years skiing in Jackson Hole and its hard to beat it for both the downhill and backcountry skiing.  But in Colorado my favorite downhill resort is Steamboat.  I go there every year even if its just for a day but I always try for as many as possible.  But with good snow our "hometown" resort of Eldora is pretty darn good. I'm still discovering the backcountry skiing in Colorado and try new places every year so to pick one would be premature.  But honestly any day on skiis, wherever I am, is a good day.

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.