Skiing dates back 5000 years, when hunters and fishermen used animal teeth to combat snow. The modern pioneers of skiing in Scandinavia and Siberia date back to 2000 BC. Ski poles were developed from canes (now called poles) that were used for balance.
Snowboarding was recognized as an international sport at the 1998 Japan, Nagano Winter Olympics. In order to fully understand the injury mechanisms in snowboarding, it is necessary to first focus on the differences in equipment compared to skiing. In classic skiing and snowboarding, the feet are fixed by "bindings". In fact, there are two types of snowboard boots; the commonly used soft boots (soft shell) and the hard boots (hard shell) used by slalom racers. In classical Alpine skiing, only hard boots are used. Bindings with adjustable rigidity for the fixation of the boots are used for both. Another difference in equipment is the lack of poles in snowboarding, unlike skiing.
Ski injuries are mainly caused by uncontrolled, high-torque falls and impacts with a sudden acceleration. The biomechanics of injuries are explained by the differences in the boots, boards and bindings that are used.
Skiing is an extremely risky sport even for elite competitors. Interestingly, men are more often exposed to serious injuries than women. The most frequently injured body part is the knee and it is the anterior cruciate ligament that is injured the most. Injuries in knee ligaments, particularly in the anterior cruciate ligament, are 3-8 times more common in women than in men.
Injuries in the upper extremity, i.e. the shoulder girdle - arms - forearms and hands, are twice more common in snowboarders compared to skiers.
At least half of the young athletes aged between 15 and 18 are reported to suffer an injury within two years. In addition, it is known that bending forward, bending sideways and torsional loads pose a potential risk for overuse injuries. Such physiological and psychological overloads not only cause physical injuries but also increase the risk of disease by causing immune system disorders in young athletes. What is meant by young athletes are those under the age of 15 and traumatic or overuse injuries are not more common in this age group. In conclusion, young athletes who have not yet completed the adolescence stage of their lives have a higher risk of serious injury. It is noteworthy that traumatic and overuse injuries are only half as much common in athletes who are in the early adolescence stage (aged 10-15) compared to those in the late adolescence stage (older than 15).
Alpine skiing can be simply defined as "downhill skiing". The rules and race configurations are basically the same for men and women, but the course length, steepness and the number of gates are higher for men than they are for women. For Alpine skiers, 80% of injuries occur during turns, while the rest occur during straight descents. Head traumas and upper extremity (shoulder-arm-forearm and hands) injuries are caused by impacts-collisions, while knee injuries occur as a result of the failure of the legs (knees) to adapt to the fall and rolling of the body (i.e. the inability of the skis to turn with the skier due to the inability of the bindings to release the skis) while the skier is still skiing and in motion. Head traumas and spinal injuries are much more damaging injuries.
After such destructive injuries, young alpine skiers should use protective equipment (helmets, chin pads, protective gloves, face protectors) more often compared to older skiers. In other words, injuries should be a trigger for young adults to protect themselves in the future. Epidemiological studies indicate that injuries suffered particularly by competitive Alpine skiers, have decreased, i.e. skiing has become safer for them in the last 5 decades. However, it can be said that this is not confirmed in the media and in fact, a perception to the contrary is created. The reasons for the significant reduction in both upper and lower extremity injuries (pelvis, hip, knee and ankle joints - thigh bone, tibia and foot) particularly in the last 30 years include the improvement of the design of protective equipment, and the increase in the awareness of injury patterns as well as the emphasis on protective measures.
The useful effects of skiing in terms of general physical activity and aging due to a healthy lifestyle should obviously not be overlooked. Experiencing the climate that is specific to the skiing activity, i.e. exposure to altitude, also supports the positive effects.
The most common type of injuries in winter sports are:
Concussions can occur in any type of sports activities, including winter sports. More than one third of the concussion cases are seen in children. These injuries are more likely to occur while skiing or snowboarding. Therefore, such sports carry a risk of concussion.
CNN even reported a story about concussion, which is one of the leading causes of death for professional skiers or snowboarders.
The related link https://edition.cnn.com/2013/01/14/sport/skiing-risks-deaths-injuries/index.html
The presence of the following symptoms in an athlete who fell, should be considered as a strong evidence for concussion.
-Swelling in the injury area
Fractures and/or dislocations in the shoulder girdle
Shoulder injuries are observed at a frequency rate of up to 15% in all winter sports, while this rate rises up to 40% for snowboarders. Shoulder injuries are much less common in skiers (4-11%). Rotator cuff injuries of the shoulder, shoulder dislocations, acromioclavicular separations and clavicle, i.e. collarbone fractures, are the major injuries of the shoulder girdle.
Shoulder dislocations occur when a hard surface is hit or in case of a fall on an outstretched hand. The most important reason for the dislocation of the shoulder joint to be more common than the dislocation of other joints is because the shoulder joint is more mobile than other joints. Shoulder is our body's most mobile joint, hence it is the hardest one to keep in place. When the shoulder joint is dislocated, the ligaments and bones are also damaged. The risk of shoulder dislocation is quite high for ski athletes. Skaters who fall on ice or hockey players who collide with other players are also exposed to the same risks. Leaving a shoulder dislocation untreated will cause the dislocation to occur more frequently.
Spinal injuries which are rarely fatal are more disturbing than other head traumas. Injuries in the ligaments and muscles around the spine may prevent you from doing sports for many weeks. In addition, in cases of fractures-dislocations, a prognosis leading to a complete paralysis may be encountered.
Skiers on higher slopes in particular, are more vulnerable to spine injuries. Snowboard athletes are vulnerable to back injuries. In conclusion, all winter sports pose a risk for spine injuries.
Elbow Dislocation and/or Dislocation with a Fracture
While elbow injuries are usually associated with summer sports such as baseball or tennis, they are not uncommon in winter sports. Elbow injuries can occur not only due to obvious trauma, but also due to overuse or incorrect technique. A significant portion of the elbow traumas occur when the hands are stretched out during a fall to protect the body. If the impact is severe enough, it should be noted that a dislocation and vascular-nerve injuries in addition to fractures may occur in the elbow. In case of an intra-articular swelling, bruising or deformity in the elbow, the possibility of a serious elbow injury should be considered and medical help should be sought immediately.
The only winter sport where hands and wrists are regularly used is skiing. Thumb injuries are more common in skiing, than in skating or sledding. The most common hand injury is the skier's thumb, where the important ligaments that hold the thumb in place are injured. Following knee injuries, the 2nd most common injury for skiers is the injury of the thumb which occurs as a result of bending the hand and the thumb backwards while these have a firm grip on a pole. It can result in not only the tearing of the ligament but also the fracture of the thumb bones. Such injuries can occur even during the simplest movements.
Our knees try to absorb, i.e. receive and soften the shock that our body becomes exposed to during daily activities such as walking and running. In other winter sports, particularly in skiing, we require the shock absorption quality of the knees much more. The most common knee injury among sports injuries usually involves tears in the collateral and cruciate ligaments. In very severe falls, fractures can also occur in addition to ligament injuries. Severe ligament lesions occur in injuries associated with the rotation of the knee. Injuries in ligaments, particularly in the anterior cruciate ligament, are 3-8 times more common in women than in men. Although the actual cause of this is unknown, the organization of the lower part of the body, the size of the ligaments, ligament laxity, skill level, muscle strength and coordination skills are blamed for these statistics.
The most common knee injury patterns are:
-Injury in the anterior, collateral and posterior ligaments of the knee
-Meniscus tears, injuries of the knee cartilage
- Injuries of the lower end of the thigh bone (femur) or the upper end of the leg (tibia)
- Knee dislocations (these are very serious injuries with a risk of vascular injury)
Ankle Sprains and Injuries
Ankle sprains are quite common. The fracture of the bone above the heel bone called the Talus, is known as the snowboarder's foot.
While mild sprains are resolved by applying ice, elastic bandages and resting while the ankle is in an elevated position, severe ankle injuries with fractures require treatment with a cast for at least six weeks after surgery or the non-surgical treatment. In any case, it would be necessary to avoid exercising during the treatment.
2 elastic bandages (a 10 cm and a 20 cm)
2 adhesive elastic bandages
1-2 rolls of inelastic bandage
5 antibiotic ointments
5 antiseptic wipes
2 boxes of aspirin
1 thermal blanket
1 cold compress pack
2 non-latex gloves
1 hydrocortisone ointment
A pair of scissors
5 pcs of sterile square gauze pads
An oral thermometer
A first aid instruction booklet
•What everyone needs to do first is to have on them their identity information and the information of the people who need to be contacted in case of an emergency.
•Mountain conditions are extreme and everyone is responsible for their own well-being. People should avoid being in areas with conditions that exceed their level of experience and capability without appropriate equipment.
•Individuals coming from behind are always responsible to watch out for those in front of them. “Remember, nobody has eyes at the back of their heads!”
•No one should act in a manner that is above the average speed and skiing style of the general community on the slope.
•Course officials and warning signs are there for our safety; we should take them into account.
- Taking regular breaks
Keeping children under close observation for control is very important. Children don't usually realize that they're tired. This makes them vulnerable to muscle fatigue and injuries. Small breaks involving drinking water and consuming small snacks will be useful in preventing such injuries.
Obviously, knowing when to stop requires an experience in itself. All serious injuries occur during the final descents Impulses such as "Let's ski one more round, this will be the last one, we paid for this, so we should get the most out of it" have always been harmful for people in the long run.
-Checking the weather conditions
Weather conditions can be unpredictable at times. A very clear and sunny weather can suddenly become dangerous. Injuries can be prevented by checking the weather conditions in advance and particularly avoiding stormy and foggy weather.
-Not being alone
Perhaps the most dangerous behavior in winter sports is being alone. This poses any kind of potentially life-threatening risks. Such risks can be minimized by the presence of another athlete. Staying close to the other athlete will facilitate mutual assistance in the event of an accident. The presence of fatigue or confusion in the other athlete should be observed. A first aid kit that would allow to respond to an emergency should be very useful.
In general, the most important and unfortunately, the most neglected element in sports is the warm-up and stretching exercises. No elite athlete would begin an activity without doing them first!
The preparation of our muscles and heart for a physical activity is important. When the temperature drops, the muscles are stretched and the heart vessels contract. At low temperatures, potential muscle cramps increase the likelihood of injuries. Warm-up exercises should include the following:
- Stretching exercises for arms, the back and legs
- Circular movements for the upper part of the body,
- Squatting exercises
- Rope jumping or short-distance running
It should be noted that doing these exercises at extremely cold temperatures will increase the tension of the muscles and delay their relaxation. These exercises should be performed with commonly used large muscles. They should involve simple activities such as sitting down-standing up, arm circling, and light running.
- Use of protective equipment
Severe injuries can be minimized by the use of protective equipment. The most important equipment is a helmet. Numerous studies reported that the use of helmets can prevent serious head traumas that may lead to death. Suggestions for the ideal helmet:
- The outer shell of the helmet must be hard and have layers that would absorb the shock
- If your helmet is old, it should be checked for cracks and corrosion, which is very important in case of a serious injury.
- Your helmet must have been designed specifically for the type of winter sport you are doing. For example, a bicycle helmet is not suitable for skiing or snowboarding.
- Your helmet needs to be fitted properly
- Defective equipment
Just having the proper equipment will not be able to adequately protect you and your family, regardless of the activity you do, unless it's regularly maintained. In other words, your equipment should be checked for defects, i.e. any signs of wear and tear, before and after each use.
- Use of the proper technique
Many injuries that occur during skiing or snowboarding are associated with not using the right technique. For example, leaning the head too forward or not holding the ski poles correctly may result in such injuries. You must know what you are doing before you hit the slope or ice. Regardless of the type of winter sport you do, you must definitely spend time with a qualified instructor. Your instructor will teach you how to move your body while skiing down the hill or along the course, and even how to fall. For example, your ski instructor will teach you to fall forward, not backward.
Professional lessons for children are very effective in preventing injuries. The sooner your children learn the proper technique, the better equipped they will be in winter sports and skiing will be a lot more fun for them. Simple safety tips, such as rolling out of a sled that won't stop, will prevent injury or reduce its severity.
Researching techniques that will ensure safety in winter sports on the internet or in magazines will be very useful.
- Don't force yourself to go above your level of experience
Knowing your own limits and staying within those limits is important. This is especially important when trying a new slope or a winter sport that you are not familiar with. Make sure that you stay on slopes that suit your level. Don't try snowboarding or ice skating at a level that is beyond your experience. It should be noted that many injuries occur when people are not able to control their speed or try to go beyond their experience or ability.
It's not just your personal limits that you need to know. You also need to follow the rules anywhere including the ice rink or the ski slope. Restrictive lines or ropes are used by ski patrollers to mark unsafe terrain areas. These markers are also used for skaters to protect them from thin ice.
- Wearing appropriate clothing
The clothes we wear while doing winter sports do more than just keeping us warm. They also protect us against the risks of sunburn, wind burn and frost. During such protection, they should also be able to provide flexibility, allowing us to move freely. Getting cold increases stress, and under stress, any mental-motor abilities of ours are diminished. All of these factors should be taken into consideration when choosing clothes for winter sports.
The most appropriate clothing principles for outdoor activities should be as follows:
- Long and short underwear
- A long-sleeved shirt or fleece vest
- Fleece jacket or insulated jacket
- Waterproof outerwear
- Waterproof gloves that are ideally lined
- A wool beanie or a face mask to be worn under your helmet
- Wool socks
- Waterproof boots
- Be familiar with your surroundings
Unknown, unfamiliar environments can surprise you. Many winter sports injuries occur because the person involved cannot see a tree or rock on a ski slope or notice a thin patch of ice during a hockey match. Getting to know your surroundings will help you understand which areas you need to avoid. Scan the area by selecting a familiar spot in the landscape. Some simple information to minimize the risk of injury are provided below:
- Avoiding crowded areas in terms of risk of collision,
- Do not wear headphones or listen to music.
- Stay away from rocks and trees
- Scan the area at all times
Upgrades of and/or enhancements in the equipment will significantly reduce your rates of injury. For example, "quick release" can be activated in this way. This will help reduce the number of fractures in the large bones of the lower extremity (our thigh bone and tibia). Smart ski designs have significantly reduced the risk of injury in Alpine skiers. However, the concern that extremely safe equipment such as ski body armor may lead to a false sense of security and hence, lead to attempts that exceed the skill level of the concerned individual, is being discussed today.
Take enough time to gain experience on the slopes. Receive professional training and don't be in a hurry to go above your level of experience when encouraged by your more experienced friends. It is a good idea to read the FIS rules.
The popularity of winter sports, particularly skiing which dates back to 2000 B.C. and snowboarding which is a much more recent sport, is globally on the rise. The marked increase in the number of athletes also led to an increase in the risk of injury. In the last 30-40 years, injuries were significantly reduced through the improvement of equipment, and the increasing protective behaviors and awareness. Considering these recommendations, including around 200 million skiers and 70 million snowboarders worldwide, it should become clear that there is nothing to be afraid of in winter sports compared to other sports activities…
Assoc. Prof. Dr. M. Kerem Canbora