Skiing Injuries

In the last few decades, skiing has become an increasingly popular sport and recreational activity for adults and children. Some demographic literature from the late 90s estimated that there were over 10 million skiers in the United States alone and that the ski industry during the 90s, which included about 520 ski areas, attracted about 55 million ski visits each year.

What we now know as the sport of skiing has drastically evolved from its early Nordic history as a form of transportation. Today, there are many different skiing variations, types, styles, and terrains. While skiing isn’t considered a full-contact sport, it does pose a risk of injury. The U.S. Consumer Product Safety Commission estimated that U.S. emergency rooms treated over 130,000 skiing-related injuries in 2007.

How Do Skiing Injuries Occur?

Like most sport-related injuries, skiing injuries can be broadly divided into either trauma injuries or cumulative overuse injuries. Trauma injuries frequently occur when a skier collides with an object, such as a tree or another skier, or when a skier falls on the ground or tumbles down a slope. Overuse injuries most frequently involve the soft tissue structures, such as ligaments, tendons, and muscles, and involve an overload or repetitive use of the structure, such as the frequent bending of the knee that’s involved with skiing.

The terrain, such as whether the snow is groomed or not and how steep a slope is; skill and fitness level of the skier; type of skiing; skiing speed; quality of equipment; and so forth all play a role in the risk of sustaining a ski-related injury.

Some types of skiing, such as the alpine skiing variants, involve traveling at high rates of speed and place the skier at particular risk for a traumatic injury. The navigation of positioning and the gravitational force also place a high load on the lower extremities and leave them prone to overuse injuries if the skiing activity is too long, too hard, or too frequent. Extreme skiers, such as those involved in freestyle skiing, are also at particular risk for traumatic injury. This type of skiing involves aerial acrobatics off of jumps or rails and is practiced in both resort settings and remote backcountry settings.

Skiers of all types are also at risk of entangling their skies when the snow is loose and heavy. Icy conditions are also often a precursor of injury.

While advances in equipment, the boots and release binding systems for example, have helped to decrease the incidence of lower limb fractures to around one percent, some believe these improvements have precipitated the increase in knee injuries by over 200%.

What Are Some Common Skiing Injuries?

Knee Sprains

Some statistics show that knee injuries account for as much as 40% of all skiing-related injuries.

The most common knee injury in skiing is a knee sprain, particularly anterior cruciate ligament (ACL) and medial collateral ligament (MCL) sprains. A sprain is the abnormal stretching or tearing of a ligament.

The MCL runs along the inside of the knee from the femur to the tibia bones. It tightens as the knee is flexed and functions to stabilize the inner portion of the knee joint and keep the tibia bone in place. This ligament is commonly injured when the foot is planted firmly, such as it is inside a ski boot, and an external force is applied to the outside aspect of the knee joint. The force can stretch or tear the MCL.

The ACL is across the front middle of the knee. It prevents the tibia from sliding too far and going in front of the femur. With the posterior cruciate ligament (PCL), the ACL forms an “X” across the front of the knee and provides rotational stability to the knee joint. The ACL is commonly injured during hyperextension skiing events, such as turning too hard and catching an edge.

Sprains are classified into three grades based on the degree of injury to the ligament(s):

Grade I - some stretching or microscopic tearing of the ligament.
Grade II - moderate tearing of the ligament that causes some joint instability.
Grade III - more than 90% of the ligament is torn, causing the joint to be highly unstable and possibly immobile.

Skier’s Thumb

This injury is thought to account for around 10% to 40% of all ski-related injuries. It is actually a sprain to the ulnar collateral ligament (UCL) running along the ulnar side of the metacarpo-phalangeal joint of the thumb. The sprain occurs when the thumb is forced into hyperextension or abduction, such as when a skier outstretches their hand or their ski pole to block a fall or when the ski pole becomes caught between the thumb and index finger and abnormally leverages the thumb joint. UCL sprains are classified into three grades based on the degree of injury to the ligament, just as MCL, ACL, and all other sprains are.

Of course, the above are just two of the most common soft tissue skiing injuries. Fractures, especially tibial plateau and wrist fractures; concussions; abrasions; muscle and bone bruises; shoulder dislocation; neck and spinal injuries; groin strain; and meniscus injuries are also concerns for skiers.