The holidays are over, but many of us here in the Northeast, or out in the West, are just beginning to hit the slopes. Whether you are a traditional skier, or a “shredder” snowboarder like me, safety is always of the utmost concern. While these two sports tend to be leisurely for many, the possibility of serious and debilitating musculoskeletal injuries should be recognized and prevented as best as possible.
In general, prevention of all winter injuries always begins with preparedness. If it’s the first outing of the season, a warm-up lesson is something to take seriously, no matter what the level of skill, especially as many resorts offer sessions and training for all levels. Unless you are an avid year-round athlete, many of the muscle groups active in skiing and snowboarding are not commonly utilized in everyday life. For snowboarding in particular, 25% of all injuries occur on the first session. As always, stretching and appropriate warm up and cool down are important to prevent any strains and sprains.
Compared to other sports, proper fitting equipment, particularly boots, is also tantamount to a successful, injury-free day. In fact, loose-fitting boots account for more than 1/3 of lower extremity injuries. Snowboarding boots are particularly important. Soft boots double the risk of ankle injury when compared to hard, but the opposite is true with regard to knees. Snowboarder’s ankle is a specific condition that is often missed; if you have suffered a high ankle sprain while snowboarding or skiing, and it is not improving with therapy, a fracture of the outside (lateral side) of the ankle may be present and not evident on regular X-rays. However, most fractures are easily diagnosed based on the injury and X-rays.
Skiing tends to result in frequent injuries related to the knee. The most common injuries involve MCL sprains and tears, and ACL tears. Typically they happen with a sudden change in direction, wherein your lower leg travels in an opposite direction to your upper. MCL injuries will result in localized pain on the inner part of your knee, and associated swelling. ACL injuries typically are more painful with deep, generalized knee pain and an overall swollen joint. If ACL tear is significant, this may require surgery for correction.
Snowboarding tends to result in less knee injuries (16% vs 38%), but more upper extremity injuries, such as wrist fractures (23% vs 4%). This usually occurs with falling on an outstretched hand. From personal experience, whether you are novice or expert, continue to wear the wrist guards as it will prevent many of the lower wrist and upper hand injuries with snowboarding. The most effective have been ones used with in-line skating.
Skiers thumb is an injury related to ligaments torn at the base of the thumb, typically when a ski pole gets caught in snow, and forces the thumb into a sudden hyperextension. Pain will be felt pressing at the base of the thumb with swelling, and difficulty with grip. Minor strains/sprains will improve through Pain Management, while more severe injuries will require surgical correction.
Acromioclavicular joint (AC) sprains are also common to skiers, usually from a fall directly on to the front part of the shoulder. Pain is typically felt along the front upper part and top of shoulder and the far end of the clavicle, also while lying on the affected side and reaching movements across the chest. Immobilization, anti-inflammatory medications and initial rest are usually the treatment.
Helmets are now also becoming a standard part of safety equipment as the rate of concussion, and more serious head injuries have escalated over the last decade. They design them to be pretty stylish now, so no excuses! Whether you ski or ride, prevention and knowing your limits will help keep a safe and fun day on the slopes.
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Jeffrey M. Ciccone, MD, specialized in various forms and techniques of anesthesia and pain management. Learn about Mount Sinai’s Pain Management and Integrative Medicine at www.mountsinai.org/painmgmt.