Avoiding Injuries on Your Ski Vacation

By Mark S. Duffield, DO

Snow skiing is a very popular winter activity. Every year nearly 15 million people ski in the U.S. alone. Most are under the age of 40 with 60% being men and 40% being women.

However, like all sports, skiing does come with some inherent risks. Based on reports from the ISS (International Ski Symposium), approximately two people per 1000 days skiied sustain a serious injury from snow skiing. So really, per person involved, skiing has a relatively low number of injuries for a sport that is so common. By comparison, soccer injury statistics reveal that in a 90 minute game, two to three players may sustain an injury, showing an injury rate of 14% for soccer vs. a low .05% for snow skiing.

Most skiing injuries are minor bruises and scrapes. When major injuries occur, they are typically caused from an isolated fall, usually due to a skier's loss of control, such as going too fast or skiing in an area that is inappropriate for their ability. Only about 10% of injuries are due to collision with other skiiers.

Head injuries account for a very small amount of injuries, particularly since the evolution of the ski helmet. There is strong evidence that ski helmets may prevent and/or significantly reduce the severity of minor to moderate head trauma. So as with any sport, it is important to use the proper saftey equipment.

Most major ski injuries are either to the knee (33%) or the shoulder (9%). Interestingly, those percentages are opposite with snowboarding. With technology advancements in equipment over the last 30-40 years, particularly bindings and boots, lower leg fractures and lacerations have significantly reduced. However, the incidence of ligamentous injuries have increased, specifically to the ACL (anterior cruciate ligament).

The good news about ACL injuries is that over the past 4-6 years, they seem to be on the decline. This may be due to the trend in shorter skis, brought on by the advent of the shaped ski. It was previously thought that the bindings were the culprit of many ligament injuries (i.e. the binding didn't release and the knee took the brunt of the load, tearing the ligaments). However, the shorter ski seems to lessen the strain on the knee ligaments, particularly with inadvertent turns or falls.

When a person does sustain a ligament injury, often they cannot continue to ski and must be helped by either a companion or the ski patrol and taken to an Aid Station. Sadly, the ski day (and likely the trip!) are over as these injuries are not compatible with further sporting activities. When evaluated by an Orthopaedic Surgeon, if the diagnosis is ACL injury, the discussion is typically centered on whether to surgically reconstruct the ligament or use a brace for definitive treatment. Typically, for patients who are very active and desire a knee similar to their pre-injury status, a reconstruction of the ligament is offered. Although considered a surgery with a very predictable outcome, it is not necessarily the best or only option for every patient. Bracing can be a good option too, and is often the option of choice for patients willing to use a brace on a consistent basis.

Shoulder injuries related to skiing typically come in one of two categories: dislocation or fractures. Dislocations occur when the forces applied across the joint are so great that the supporting structures are torn and the bones are no longer held in position. Such dislocations usually require immediate medical attention in order to be "relocated" and often later will need surgical attention to keep the shoulder stable.

When fractures occur, they are usually of the clavicle (commonly known as the collarbone) or humerus, or upper arm bone. Generally speaking, both can be treated non-operatively, though some variations do require surgical attention.

In conclusion, snow skiing is truly a sport that anyone can enjoy, regardless of ability or age. It inspires one to be in direct contact with the outdoor elements and gives us the opportunity to see many aspects of nature that we may not ordinarily experience. In general it is also a very safe sport, particularly when a skier recognizes his or her physical limitations and level of skiing ability. So if you hit the slopes this winter, be mindful of your saftey and you'll likely enjoy an injury-free vacation.