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The Sports Medicine Doctor: Safety and Injury Prevention in Downhill Skiers, Part I

By Andrew W. Gottschalk, M.D., Director of Sports Medicine

Champion Orthopedics & Sports Medicine at Cole Memorial Hospital

In my last column, I told the story of breaking my leg while downhill skiing. Some accidents are just that: accidents. That day on the mountain, no amount of advance preparation would have saved me. Fortunately for those of us who love the slopes, many injuries are preventable.

Downhill skiing is work. When skiing, we endure tremendous physical forces in order to maintain stability and agility. Consequently, an essential step in injury prevention is keeping key muscle groups strong. Perhaps the most important muscles for skiers are the core muscles and the quadriceps.

The core muscles are those that support the trunk and abdomen. Strengthening the core muscles improves posture and balance, thereby helping prevent falls. The quadriceps are the front muscles of the thigh and are the largest muscle group in humans. Their tremendous strength helps stabilize the hips and knees. The hips, and especially the knees, are some of the joints most commonly hurt by skiers, so maintaining quadriceps strength is fundamental in injury prevention.

Heart (cardiovascular) fitness is just as important as key muscle group fitness. Even the strongest muscles rely on the heart’s ability to deliver oxygen rapidly and efficiently during periods of exercise. This ability is compromised under certain conditions like rapid changes in elevation. At higher elevations, air has less oxygen in it. When skiers who live in areas at lower elevations (say, the Twin Tiers) attempt to ski at higher elevations (say, the Rocky Mountains), they find less oxygen. This lower oxygen concentration takes its toll on unprepared bodies and may result in decreased energy, lightheadedness or even headaches. These changes in alertness and energy can result in injury. When skiing at higher elevations, skiers should be aware that performance can be affected and so should alter their intensity accordingly.

Along with healthy bodies, healthy equipment is also important in the prevention of injury. Well-fitted equipment is just as fundamental as having the right equipment.

Ski boots should be snug but not too tight. A snug boot stabilizes the ankle and prevents injury, while a too tight boot may decrease blood circulation to the foot and toes. Make sure a professional checks your equipment for proper fit especially the first time used.

Rapid release bindings have saved many bones from fracture and many knees from ligament and cartilage trauma. It’s important to know that rapid release bindings only release the boot after a sudden, forceful impact. Therefore, a low velocity fall may not have enough force to release the boot from the binding and ski. Sometimes a hard kick after a slow fall will release the ski (you can come back for it later!) and prevent injury to the lower extremity that would otherwise occur.

Shakespeare’s Hamlet tells us “the readiness is all.” He may as well have been talking about downhill skiing; being ready goes a long way towards injury prevention and safety. In the next column, we will continue our safety discussion and talk about topics including concussion prevention in skiers, and ways to prepare for the weather. A

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