Snowboarding and skiing injuries
Preventing and treating winter sport injuries
Who, how and what gets injured?
SnowboardingForward falls commonly result in shoulder-girdle injuries: anything from rotator cuff (shoulder) strains to collar bone fractures. Falls backwards more commonly produce wrist fractures or strains, spinal injuries (low back and/or neck area) and head injuries, usually from a direct blow to the back of the skull during a fall. All can happen at any ability level.
The types of injury are more linked to ability level than in snowboarding. Beginners spend their time in the snowplough position, in which you have to keep your legs turned inwards with knees bent, to maintain your skis in a V point in front of you. This fixed position imposes strain on the medial collateral ligament (MCL). The MCL comes under further strain as the snowplough width increases (when, for instance, ski tips cross and lock).
As the skier learns to adopt the parallel position (both skis pointing forwards) you get faster and tend to move in and out of deeper knee bends. On steeper slopes (especially with more expert skiers – and indeed, snowboarders) the knees can have to endure extreme bending under load, placing stress on the kneecap. At greater speeds and with acute turns, falls will have more twisting force, resulting in anterior cruciate ligament (ACL) or combined knee injuries involving the menisci (cartilage) and/or side ligaments. Meniscal injuries happen most often as a result of twisting stress on the bent, loaded knee.
Falls: The most common cause of injury. The snow surface is unique and varied and a minor loss of balance can result in a dramatic fall. Snowboarders usually fall forwards or backwards, putting shoulders, wrist, cervical (neck area) and lumbar (lower) spine at risk. Skiers tend to fall sideways and backwards, and when they do the design of ski, boot and binding mechanism all increase the twisting stress on the knee. Ski poles are often hazardous for thumbs during a fall.
Collisions: High-impact collisions in either discipline can lead to head injuries. Low-impact ones can cause skiers anterior cruciate ligament injuries to the knee.
Fatigue: The vast majority of snow-sport injuries happen at specific times: most occur towards the end of the day but a high proportion happen just before the lunch break.
Poor technique: Increases the chance of a fall.
Loss of control: Often occurs when people ski or snowboard beyond their limits. But it may be as simple as a beginner losing control of the snowplough position.
Equipment failure: Damaged or inappropriate equipment (an enthusiastic improver buying advanced-level kit which they are not yet competent to control, for instance) may contribute directly to an injury or to the severity of one.
Precautions and training tips
- Helmets can help limit the severity of a head injury, especially for higher-level skiers and boarders travelling faster and on more unpredictable terrain;
- Wrist protectors are being modified and researched continuously, and there is strong evidence that they do prevent injury in snowboarders;
- Bindings should be checked professionally every year. Large numbers of ski injuries to the knee occur because bindings fail to release. Skiers whose fitness levels have dropped or who haven’t skied for a while should consider setting the bindings lower;
- Ski pole design is changing to improve pole grips to reduce the chance of thumb injuries, so it is a good idea to have the latest design and use the straps correctly. Novice skiers in particular need to watch out for this as they are most likely to rely on borrowed equipment.
Training and rehab focus
- Tailor your training programme to sport-specific exercises that reflect your particular level of ability (rather than that of your gym instructor);
- Fatigue is a big injury factor, so cardiovascular (cv) training is important to enable you to hold your concentration and read the snow conditions. As well as building cv for endurance, include higher-intensity interval training;
- More advanced skiers and boarders should do some anaerobic cardiovascular work, to equip you for brief sprints or bursts when tackling more challenging terrain;
- Because skiing requires a lot of lower-limb work, the cv element needs to include activities such as cross-training or cycling. Snowboarders need more upper-body strength and endurance, so consider swimming, too;
- Strength training needs to combine eccentric, concentric and plyometric muscle work. Skiers and boarders (especially intermediate and higher levels) repeatedly overload and stretch the quadriceps (front of thigh) muscles. Plyometric training should help to prepare the knees by giving them more ‘spring’;
- Novices need good ‘holding’ or eccentric strength in the quadriceps. Isometric holds on the leg press in differing degrees of bend are good, as is the classic ‘sitting wall squat’. Try to mimic the stance adopted by a skier or boarder, with a forward lean, rather than planting the back fully against the wall;
- For advanced skiers and boarders, dynamic sliding wall squats are more useful (maintain squat while flexing and extending the legs); or use a conventional full leg press;
- Snowboarders can mimic their action by facing the wall, using it for touch-balance with their hands while performing squats on the balls of their feet;
- Include strengthening for the lower quad muscles. Step exercises are simple and effective;
- Undertake plyometric training with caution;
- Good core stability and postural alignment are essential;
- Try to do some training to improve your reaction to a ‘falling back’ loss of control, eg practise lying on your back over a swiss ball, back extended and head low, and curl up to horizontal;
- Boarders should practise push-ups, paying particular attention to full arm extension under control (avoiding fierce elbow lock-out). Standing facing a wall and ‘falling’ on to it with outstretched arms (an explosive form of a wall-squat) will improve the neuromuscular reaction required to ‘catch’ a fall;
- Boarders need strong rotational control of the trunk, so, for example, add trunk rotation with medicine ball to a free-standing squat. The swiss ball is also very useful for rotation exercises;
- Work on uneven surfaces and practise control in off-balance conditions, eg two-handed throwing and catching of a ball while balancing on one leg on a trampette;
- Stretch exercises are especially important for quadriceps, hamstrings, calves, adductors, gluteals and hip flexors. Pay particular attention to achieving good length in soleus (lower calf) and gastrocnemius (main calf), because of the position of the ankle in the boot in both sports;
- Novice skiers need good adductor flexibility to cope with the snowplough, as well as a good range of internal hip rotation. Snowboarders must have good low back flexibility in all ranges.
Sean Fyfe is a physiotherapist working with Metis Physio Centres in London, a multi-disciplinary clinic. He works with elite dancers and theatre performers
Cate Streeten is a senior physiotherapist at Portland Physio Ltd, specialising in lower limb biomechanics and injuries
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