Thursday, 21 January 2016

Injury trends

Did you know that the weather and the snow type both affect injury trends in alpine sports?  At Bonne Santé we audit the injuries that we see.  Along with literature reviews and up to date research, this allows us to keep track of the trends that are occurring and helps us plan injury prevention strategies. Through informative seminars, biomechanical analysis and patient education we strive to use our knowledge and awareness to decrease injury risk in skiers.

When possible, it is important for us to learn how injuries occur.  It helps us to assess the likely damage, identify the primary structure affected and ascertain if there are any other structures involved.  It helps us to decide if you may also need an x-ray, a brace or further opinion.

Many ski injuries are avoidable by being fit to ski, having the correct equipment set up and avoiding fatigue, however all sports carry a risk of injury, and alpine sports especially due to the environment and equipment involved.  The aim of this blog is not to put you off skiing, but to increase your awareness of how and why injuries occur.   This blog talks about some of the injury types that we have seen recently. Our aim, when possible and safe to do so, is to accelerate the healing process and to return our clients back to the pistes as quickly as we can.


During the first few weeks of December, the snow was icy and hard packed.  Interestingly, we had a surge of people needing treatment for pre-existing niggles that had flared up on the hard, unforgiving terrain.  This was especially true in people who had pre-existing lower back pain. Typically, the bullet proof pistes were contributing to significant myofascial spasm, especially to the quadratus lumborum muscles (found in your lower back and sides) and the hip flexors.  In the majority of cases, we were able to treat these injuries and return our clients to the slopes.

Although we saw a lot of people suffering from knee pain, this was mostly due to the hard packed pistes and thigh muscles over working. Even well conditioned ski instructors reported feeling the strain on their knees.  We did not see a lot of knee ligament injuries during this time.  The handful of anterior cruciate ligament (ACL) injuries that we did see early in the season, mostly occurred in skiers that were landing from jumps (boot-induced mechanism) or through bent knee twisting injuries (the phantom foot mechanism).

The boot-induced mechanism usually occurs after going off a jump. Instinctively, the skiers legs fully extend and the tails of the skis contact the snow first on landing.  This forces the back of the ski boot against the calf, driving the tibia (shin bone) out from under the femur (thigh bone) resulting in an ACL injury.  
In the phantom foot mechanism, the skier loses balance to the rear and 'sits back' on the skis.  The hips end up below the knees and the skiers weight is shifted on to the downhill ski, which then rotates inwards on the hyper flexed knee. The downhill ski is fixed, while the rest of the body continues forward and if the bindings do not release, the ACL takes the strain.  This typically happens when a skier is attempting to get up whilst still moving after a fall or attempting to recover from an off balance position.

When the snow was hard packed we also saw more compressive meniscal injuries than usual.  The menisci are the cartilage discs that are located in the knee joint.  These act as shock absorbers. With the repetitive forces through the legs when skiing on bullet proof pistes, the meniscus start to take the strain.  The other time we see meniscal strains is when skiers are training in the bumps.  Again, the repetitive loading puts huge forces through the knee joints and as the mensici act to absorb these forces time and time again, eventually they react.  This is especially true in skiers that may not have optimum alignment and positioning through their lower limbs, such as A-frame skiers.


Since the snow has come (and keeps coming), we have seen an increase in knee ligament injuries, especially to the ACL and the medial collateral ligament (MCL).  When there is powder on the pistes, skiers are a lot more likely to catch an edge and fall.  If the ski binding doesn't release, the knee ligaments usually take the strain. Commonly, this occurs through a 'valgus and internal rotation strain' as well as through the phantom foot mechanism mentioned above.  When the former occurs,  the skier falls forwards and the inner edge of their ski tip catches on the snow.  This causes an immediate abduction (outwards) and external rotation of the tibia. As the skier is carried forward by their momentum, a valgus (inwards) strain occurs at the knee.

Another huge factor that has been contributing to current injuries is the visibility, or lack of!  All the recent snow has meant cloudy days, flat light and white out conditions.  If you can't see well, it is difficult to read the terrain and the contours in the pistes.  Lumps and bumps can sneak up unawares and falls are more likely.  Having good balance and righting reactions can significantly help to reduce the chance of falling.   Practicing both static and dynamic balance drills is a good idea on the lead up to your skiing holiday, as is practicing your balance with your eyes closed. If you take away your visual stimulus, you have to rely on your other balance systems to keep you upright (your vestibular system and your proprioceptive system).  It therefore makes sense to train these off the hill, by doing balance drills with your eyes closed.  I will come onto balance drills in a future blog, in the meantime contact for further information.

Knee injuries are common in both recreational and professional skiers. If you are unfortunate enough to sustain a knee injury on your skiing holiday, you can call us for phone advice or an appointment on 00 33 (0) 4 79 06 07 27.  We are recognised by most UK insurance companies.


       Bonne Santé         0033 (0) 4 79 06 07 27

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Factors associated with self-reported failure of binding release among ACL injured male and female recreational skiers: a catalyst to change ISO binding standards?
  British Journal of Sports Medicine 

January 1, 2016 5037-

Knee Injuries in Downhill Skiers.  A 6-year Survery Study.   Shea et al,
Orthopaedic Journal of Sports Medicinevol. 2 no. 12325967113519741   40

Mechanisms of Anterior Cruciate Ligament Injury in World Cup Alpine Skiing.  A Systematic Video Analysis of 20 Cases. Bere et al.  Am J Sports Medvol. 39 no. 7  1421-1429

Myths Concerning Alpine Skiing Injuries, Johnson et al,  Sports Health: A Multidisciplinary Approach vol. 1 no. 6 

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