Doctor's Corner: Conditioning key to preventing injury during skiing, snowboarding season Doctor's Corner: Conditioning key to preventing injury during skiing, snowboarding season (December 10, 2003)

Allan Mishra, M.D., and Terri Pavelko, PT, PAC

Menlo Medical Clinic

Skiing and snowboarding are vigorous and sometimes dangerous sports. Studies have shown that there are approximately three injuries per thousand skiers or snowboarders on a mountain per day. These injuries range from minor sprains to paralysis, and even death.

Raising awareness of common problems coupled with a pre-season conditioning program should decrease the chances of sustaining an injury while skiing or snowboarding.

Although almost any body part can be damaged while skiing or snowboarding, there are some differences in the patterns of injuries between skiers and snowboarders. Skiers are more likely to injure their knees, snowboarders their arms. This is due to differences in equipment and style.

The most common knee injury is a tear of the anterior cruciate ligament (ACL). This is one of the main stabilizers of the knee and is torn when the skier is too off-balance to the rear. With the skier's weight on the inside edge of the downhill ski and weight in the backseat, the hips shift lower than the knees, creating a severe imbalance. The uphill arm swings backward and the downhill skier gets stuck in the snow, twisting the knee violently and potentially causing an ACL tear.

A second common mechanism by which skiers tear an ACL is landing with knees fully extended after a jump.

It is also possible to injure other ligaments or cartilage in the knee when skiing. More information regarding ACL tears and other sports-related injuries may be found on the Web at emedx.com.

Snowboarders may also injure their knees, but more frequently they have shoulder, arm, wrist or hand injuries. The most common injury is a fracture of the wrist. Other injuries include shoulder dislocation, clavicle fracture, forearm/hand fracture, or an injury to a ligament, primarily at the thumb. Occasionally, boarders may also sustain an ankle fracture.

At times severe injuries can occur. Usually these injuries are associated with tree collisions, reckless skiing and man-made snow. The spectrum of head and neck injuries ranges from a mild concussion to a spine fracture with subsequent paralysis. A concussion may occur when a skier or boarder violently strikes his or her head against a solid object. Helmets, therefore, may reduce the chance of this relatively rare injury. Fortunately, fatal injuries are quite rare.

Injuries may occur in part as a result of skier error, such as skiing in an area beyond one's ability, skiing too fast or losing control, and skiing when too tired.

Other factors that could lead to injuries include equipment failure or environmental hazards. Equipment failure is often due to bindings that are set too tight, are too old, or fail to release in a compromising situation. Environmental hazards are often beyond one's control and include such things as poor snow/weather conditions, natural hazards such as rocks and trees, and avalanches.

In an attempt to ready yourself for the upcoming season it is important to stay fit. Adherence to a consistent pre-season training program that includes elements of building strength, stability and endurance is essential to help prevent injuries.

It is best to get a fitness assessment, then proceed to a personalized program based on your own goals for the season. A basic program is outlined below. It should be started six to eight weeks before the beginning of the season. Always check with your physician before beginning any fitness program.

Pictures for these exercises can be found at: emedx.com under "exercise programs" on the front page.
Conditioning program

Flexibility (every day) ** Quadriceps stretching ** Hamstring stretching Strengthening exercises (3 times per week) ** Exercise bike, 30 minutes ** Wall sits: Sit against wall with knees bent at 90 degrees for 15 seconds, 10 times ** Leg press, three sets of 10 (weight should be set so the last set is hard) Core strengthening (3 times per week) ** Abdominal crunches, 3 sets of 20 ** Consider yoga or Pilates classes -- they can be very helpful for skiing

Dr. Allan Mishra is an orthopedic surgeon specializing in sports medicine. Terri Pavelko is a certified physician's assistant and licensed physical therapist.
Health column

The Almanac's monthly Health and Fitness section features a regular column in which Menlo Medical Clinic physicians, writing in their areas of expertise, will address various health topics. If you have a question regarding a particular health issue you'd like to see addressed in a future column, write to the clinic at mmcweb@stanfordmed.org or call 497-8022.

E-mail a friend a link to this story.