Recreational Injury Interventions

Snow Sports

Background

Covered in this section are skiing, snowboarding, and snowmobiling injuries. Most of the studies outlined in this review measure the effectiveness of interventions in adults or populations in general. However, data collected by Macnab & Cadman, 1996, from the Blackcomb ski patrol injury reports for 1991-1992 found that children age 7-12 and teens age 13-17 have a higher risk of skiing and snowboarding injury compared to people 18 and older. Head injuries constituted 17% (age 7-12) and 22% (age 13-17) of injuries in children and teens. Shorter et al, 1996, also reported head injuries, especially skull fractures, as the most common type of injury in children and adolescents who were hospitalized as a result of a skiing injury. Of the 38 patients (age 5-18) admitted to a pediatric trauma center after skiing related accidents 27 were head injuries, followed by 13 reported extremity injury fractures. The average cost per injury, in this study, was $22,000.

Rupture of the anterior cruciate ligament (ACL) has continued to be one of the most common serious medical problems associated with alpine skiing, Natri et al., 1999. Between, 1972 and 1994 knee sprains, usually involving the ACL, increased significantly by 228%. However, the incidence of injuries over time decreased from 3 to 4 injuries per1000 skier days in the early and mid 1980s to between 2 and 3 injuries per 1000 skier days in the late 1980s and early 1990s. This is generally attributed to advances in the ski/binding/boot system or through education programmes that have taught skiers to recognise and avoid high risk situations. Many of these developments in the ski/boot/binding system may have made skiing easier and perhaps safer when evaluating all ski-related injuries. But, Natri et al, concludes that these new ski/boot/binding systems produces an unique combination of forces and torques that frequently result in ACL injury, and might be the reason for the rise in such injuries. Two studies reviewed below focus on ski/boot/binding systems or equipment interventions and their impact on skiing-related lower extremity injuries.

Snowboarding has increased in popularity in recent years presenting its own unique set of injuries and injury prevention interventions. In 1998, in-area snowboarders number 3.6 million in the United States, Van Tilburg, 2000, 37.8% of these snowboarders were aged 12-17 years. This rise in snowboarding popularity amongst children is of particular interest to child injury; as snowboarders reported a 3 to 4 time higher incidence of injury compared to alpine and telemark skiers, Ronning et al, 2000. Regarding the type of injury experienced by young snowboarders head injuries appear to be common, Macnab & Cadman, 1996. This type of injury usually occurs when snowboarders jump, execute aerial maneuvers, or collide with trees, hard snow, of with other snowboarders. This study also reports an increase in the rate of ankle and wrist injuries in the 7-12 and 13-17 age groups, which may be related to increased snowboarding in these groups.

Van Tilburg, 2000 indicates that, while head injuries are a point of concern, snowboarders are more likely to experience upper and lower extremity injuries, with a slight favor of upper extremity injury, and most often a wrist sprain or fracture. One study below investigates injuries in snowboarders who wore protective wrist guards compared to those that did not. Regarding lower extremity injury, snowboarders primarily injure their ankle in contrast to knee injuries in skiers. One injury particular to the lower extremity of a snowboarders is fracture to the lateral process of the talus, called snowboarder's fracture. This type of injury can often mimic an ankle sprain and is often not seen on plain radiographs. Additionally, the lower frequency of knee injuries in snowboarders is most likely due to the minimization of torsional stretch to individal knees that is common in skiing. Stretch to the knees is reduced because of the following snowboard mechanics; relatively flexible snowboarding boots, fixed footing to a single board, and nonreleaseable bindings. Attempts to improve snowboarding performance by introducing stiffer boots could lead to more knee injuries and fewer ankle injuries. Equipment mechanics effect injury incidence.

Morbidity Mortality Weekly Report, 1997 (MMWR), findings indicate that most snowmobile incidents in Maine during 1991-1996 resulted from collisions caused by excessive speed and careless operation of the vehicle. Of the 903 reported injuries 31% were lower extremity, and 18% upper extremity. In thirteen percent of the incidents alcohol was determined to be a factor. MMWR further suggests that the majority of snowmobile-related deaths occur in males in their 20's. The fourth study included below assesses the role of a snowmobile surveillance program in the prevention of snowmobile-related deaths and injuries.

Review of snow sports studies:

Summary of snow sports interventions

Poorly adjusted equipment is a significant risk factor for young skiers. Additionally, bindings currently used appear to be insufficient for the multidirectional release required to reduce the risk of injury to the lower limb, especially the knee for all skiers. Summary of skiing interventions suggests a standard of manufacture of ski boots and bindings is necessary. Snowboarders who wear protective wrist guards are less likely to sustain wrist injuries compared to those who do not. Interventions involving enforcement of snowmobile trails can reduce the incidence of injuries from snowmobile-related trauma.

Recommendations on snow sports programs

Prevention programs for skiing should include promotion of well-adjusted equipment, improvement of skill level, education of parents, application of recognized standards for adjusting rented equipment and use of ski binding testing devices in ski shops. Further technical developments and innovations in binding-release functions, and skier education are needed. Successful snowmobile interventions require a coordinated and multi-level approach of surveillance and public education, centered on alcohol awareness and safety.

Recommendations for future research

Because most of these studies measure the effectiveness of interventions in adults or populations in general there is a need for research focused on children participating in these sports. Randomized controlled trials are needed to control for all the individual and situational variations and study the contribution of conditioning to injury prevention in various snow sports. Considering the high incidence of head injury there is a need for studies evaluating the efficacy of helmet use and the role the helmet in both protection and possible causation of head injuries in skiing and snowboarding. Further case-control studies to evaluate ski binding adjustment and protective wrist guards for snowboarders are needed. Additionally, studies that assess new ski and snowboard designs will be needed as manufactures attempt to improve sport performance.

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