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Sports Medicine

, Volume 43, Issue 5, pp 355–366 | Cite as

What are the Exercise-Based Injury Prevention Recommendations for Recreational Alpine Skiing and Snowboarding?

A Systematic Review
  • Kim Hébert-LosierEmail author
  • Hans-Christer Holmberg
Systematic Review

Abstract

Background

Skiing and snowboarding are two activities that significantly contribute to the total number of sports-related injuries reported per year. Strength, endurance and cardiovascular fitness are central components in sports injury prevention. Providing exercises and training recommendations specific to recreational skiers and snowboarders is important in both injury prevention and reducing the prevalence and cost associated with alpine winter sports injuries.

Objective

The aim of this paper was to systematically review the literature for injury prevention recommendations specific to recreational alpine skiers and snowboarders. The focus was to discern recommendations that targeted physical fitness, exercise and/or training in the prevention of musculoskeletal injuries in these two sports.

Data Sources

Fourteen electronic databases were searched in October 2011 using relevant MeSH terms and key words.

Study Selection

Articles were included if they addressed injury prevention, recreational alpine skiing or snowboarding and musculoskeletal injuries. Only original research articles published in peer-reviewed journals, and in the English-language, were reviewed. Articles on elite athletes were excluded.

Study Appraisal and Synthesis Methods

Two independent reviewers quality assessed articles meeting inclusion criteria using a modified version of the Downs and Black Quality Assessment Checklist. Data on study population, study design, study location and injury prevention recommendation(s) were extracted from articles using a standard form and subsequently categorized to facilitate data synthesis.

Results

A total of 30 articles met the inclusion criteria and were reviewed, having an average ± standard deviation quality score of 72 % ± 17 % (range: 23–100 %). Overall, 80 recommendations for the prevention of musculoskeletal injuries in recreational alpine skiers and snowboarders were identified and classified into five main groups: equipment (n = 24), education and knowledge (n = 11), awareness and behaviour (n = 15), experience (n = 10) and third-party involvement (n = 20). No recommendations pertained to physical fitness, exercise and/or training per se, or its role in preventing injury.

Limitations

A comprehensive meta-analysis was not possible because several articles did not report data in sufficient detail.

Conclusions

The importance of targeting physical fitness in injury prevention is accepted in sports medicine and rehabilitation; yet, there was a paucity of articles included in this review that explicitly investigated this aspect with regards to recreational alpine skiing and snowboarding. The most frequent recommendations for preventing skiing and snowboarding injuries concerned equipment or the involvement of third parties. The dominance of equipment-related measures in the injury prevention literature may be rationalized from a sports biomechanics viewpoint, as these activities involve high velocities and impact forces. Nonetheless, this also indicates a need for appropriate levels of strength, endurance and conditioning to meet the technical demands of these sports. Bearing this in mind, future research is encouraged to investigate the role of physical fitness, exercise and training in decreasing the incidence and severity of skiing and snowboarding injuries in recreational athletes.

Keywords

Physical Fitness Anterior Cruciate Ligament Injury Injury Prevention Sport Injury Musculoskeletal Injury 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgments

The authors acknowledge contribution from Maria Hansson and Mette Bäckström in the systematic review process. This review was supported financially by the Swedish National Centre for Research in Sports. There are no relevant conflicts of interest to declare.

References

  1. 1.
    Burns TP, Steadman JR, Rodkey WG. Alpine skiing and the mature athlete. Clin Sports Med. 1991;10(2):327–42.PubMedGoogle Scholar
  2. 2.
    Young CC, Niedfeldt MW. Snowboarding injuries. Am Fam Physician. 1999;59(1):131–6. 141.PubMedGoogle Scholar
  3. 3.
    Bladin C, McCrory P. Snowboarding injuries: an overview. Sports Med. 1995;19(5):358–64.PubMedCrossRefGoogle Scholar
  4. 4.
    Hunter RE. Skiing injuries. Am J Sports Med. 1999;27(3):381–9.PubMedGoogle Scholar
  5. 5.
    National Ski Areas Association. Industry Stats. 2010 [online]. http://www.nsaa.org/nsaa/press/industryStats.asp. Accessed 9 Dec 2010.
  6. 6.
    Médecins de la Montagne. Accidentologie des sports d’hiver. Dossier de Presse, 2011 [online]. http://www.mdem.org. Accessed 1 Jun 2011.
  7. 7.
    Langran M. An introduction to snow sport injuries and safety. 2012 [online]. http://www.ski-injury.com/intro. Accessed 20 Jun 2012.
  8. 8.
    SMARTRISK. The economic burden of injury in Canada. 2009 [online]. http://www.smartrisk.ca/downloads/burden/Canada2009/EBI-Eng-Final.pdf. Accessed 9 Oct 2009.
  9. 9.
    National Center for Injury Prevention and Control. CDC Injury Research Agenda, 2009–2018. 2009 [online]. http://www.cdc.gov/ncipc. Accessed 24 Jun 2009.
  10. 10.
    Maffulli N, Longo UG, Gougoulias N, et al. Sport injuries: a review of outcomes. Br Med Bull. 2011;97(1):47–80.PubMedCrossRefGoogle Scholar
  11. 11.
    Garrick JG, Requa RK. Sports and fitness activities: the negative consequences. J Am Acad Orthop Surg. 2003;11(6):439–43.PubMedGoogle Scholar
  12. 12.
    Finch CF. Getting sports injury prevention on to public health agendas: addressing the shortfalls in current information sources. Br J Sports Med. 2011;46(1):70–4.PubMedCrossRefGoogle Scholar
  13. 13.
    Kallinen M, Markku A. Aging, physical activity and sports injuries: an overview of common injuries in the elderly. Sports Med. 1995;20(1):41–52.PubMedCrossRefGoogle Scholar
  14. 14.
    Emery CA, Hagel B, Morrongiello BA. Injury prevention in child and adolescent sport: whose responsibility is it? Clin J Sport Med. 2006;16(6):514–21.PubMedCrossRefGoogle Scholar
  15. 15.
    Daneshvar DH, Baugh CM, Nowinski CJ, et al. Helmets and mouth guards: the role of personal equipment in preventing sport-related concussions. Clin Sports Med. 2011;30:145–63.PubMedCrossRefGoogle Scholar
  16. 16.
    Shealy JE, Johnson RJ, Ettlinger CF. Do helmets reduce fatalities or merely alter the patterns of death? In: Moritz EF, Haake S, editors. The engineering of sport 6. New York: Springer; 2006. p. 163–7.CrossRefGoogle Scholar
  17. 17.
    Hagel BE, Pless IB, Goulet C, et al. Effectiveness of helmets in skiers and snowboarders: case-control and case crossover study. Br Med J. 2005;330(7486):281–3.CrossRefGoogle Scholar
  18. 18.
    Cusimano MD. The effectiveness of helmet wear in skiers and snowboarders: a systematic review. Br J Sports Med. 2010;44(11):781–6.PubMedCrossRefGoogle Scholar
  19. 19.
    Mueller BA, Cummings P, Rivara FP, et al. Injuries of the head, face, and neck in relation to ski helmet use. Epidemiology. 2008;19(2):270–6.PubMedCrossRefGoogle Scholar
  20. 20.
    Hagel BE, Russell K, Goulet C, et al. Helmet use and risk of neck injury in skiers and snowboarders. Am J Epidemiol. 2010;171(10):1134–43.PubMedCrossRefGoogle Scholar
  21. 21.
    Meeuwisse WH, Tyreman H, Hagel B, et al. A dynamic model of etiology in sport injury: the recursive nature of risk and causation. Clin J Sport Med. 2007;17(3):215–9.PubMedCrossRefGoogle Scholar
  22. 22.
    Bladin C, McCrory P, Pogorzelski A. Snowboarding injuries: current trends and future directions. Sports Med. 2004;34(2):133–8.PubMedCrossRefGoogle Scholar
  23. 23.
    McGill S. Core training: evidence translating to better performance and injury prevention. Strength Cond J. 2010;32(3):33–46.CrossRefGoogle Scholar
  24. 24.
    Karlsson J. Profiles of cross-country and alpine skiers. Clin Sports Med. 1984;3(1):245–71.PubMedGoogle Scholar
  25. 25.
    Howorth B. Skiing injuries. Clin Orthop Relat Res. 1965;43:171–81.PubMedCrossRefGoogle Scholar
  26. 26.
    Bouter LM, Knipschild PG. Causes and prevention of injury in downhill skiing. Phys Sportsmed. 1989;17(11):81–94.Google Scholar
  27. 27.
    Morrissey MC, Seto JL, Brewster CE, et al. Conditioning for skiing and ski injury prevention. J Orthop Sports Phys Ther. 1987;8(9):428–37.PubMedGoogle Scholar
  28. 28.
    Laskowski ER. Snow skiing. Phys Med Rehabil Clin N Am. 1999;10(1):189–211.PubMedGoogle Scholar
  29. 29.
    Steffen K, Andersen TE, Krosshaug T, et al. ECSS position statement 2009: prevention of acute sports injuries. Eur J Sport Sci. 2010;10(4):223–36.CrossRefGoogle Scholar
  30. 30.
    Torjussen J, Bahr R. Injuries among competitive snowboarders at the national elite level. Am J Sports Med. 2005;33(3):370–7.PubMedCrossRefGoogle Scholar
  31. 31.
    Goulet C, Hagel BE, Hamel D, et al. Self-reported skill level and injury severity in skiers and snowboarders. J Sci Med Sport. 2010;13(1):39–41.PubMedCrossRefGoogle Scholar
  32. 32.
    Girardi P, Braggion M, Sacco G, et al. Factors affecting injury severity among recreational skiers and snowboarders: an epidemiology study. Knee Surg Sports Traumatol Arthrosc. 2010;18(12):1804–9.CrossRefGoogle Scholar
  33. 33.
    Downs SH, Black N. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol Community Health. 1998;52(6):377–84.PubMedCrossRefGoogle Scholar
  34. 34.
    Andrew E, Anis A, Chalmers T, et al. A proposal for structured reporting of randomized controlled trials. JAMA. 1994;272(24):1926–31.CrossRefGoogle Scholar
  35. 35.
    OCEBM Levels of Evidence Working Group. The Oxford 2011 Levels of Evidence. 2011 [online]. http://www.cebm.net/index.aspx?o=5653. Accessed 21 Sep 2011.
  36. 36.
    McKenna J, Hammond C. Perspectives on injuries in snowboarders. J R Soc Promot Health. 2007;127(4):181–9.PubMedCrossRefGoogle Scholar
  37. 37.
    Langran M, Selvaraj S. Snow sports injuries in Scotland: a case-control study. Br J Sports Med. 2002;36(2):135–40.PubMedCrossRefGoogle Scholar
  38. 38.
    Corra S, Conci A, Conforti G, et al. Skiing and snowboarding injuries and their impact on the emergency care system in South Tyrol: a restrospective analysis for the winter season 2001–2002. Inj Control Saf Promot. 2004;11(4):281–5.PubMedCrossRefGoogle Scholar
  39. 39.
    Scott MD, Buller DB, Andersen PA, et al. Testing the risk compensation hypothesis for safety helmets in alpine skiing and snowboarding. Inj Prev. 2007;13(3):173–7.PubMedCrossRefGoogle Scholar
  40. 40.
    Ruedl G, Webhofer M, Linortner I, et al. ACL injury mechanisms and related factors in male and female carving skiers: a retrospective study. Int J Sports Med. 2011;32(10):801–6.PubMedCrossRefGoogle Scholar
  41. 41.
    Ruedl G, Linortner I, Schranz A, et al. Distribution of injury mechanisms and related factors in ACL-injured female carving skiers. Knee Surg Sports Traumatol Arthrosc. 2009;17(11):1393–8.PubMedCrossRefGoogle Scholar
  42. 42.
    Ettlinger CF, Johnson RJ, Shealy JE. A method to help reduce the risk of serious knee sprains incurred in alpine skiing. Am J Sports Med. 1995;23(5):531–7.PubMedCrossRefGoogle Scholar
  43. 43.
    Jørgensen U, Fredensborg T, Haraszuk JP, et al. Reduction of injuries in downhill skiing by use of an instructional ski-video: a prospective randomised intervention study. Knee Surg Sports Traumatol Arthrosc. 1998;6(3):194–200.CrossRefGoogle Scholar
  44. 44.
    Brotherhood JR. Snow, cold and energy expenditure: a basis for fatigue and skiing accidents. Aust J Sci Med Sport. 1985;17(1):3–7.Google Scholar
  45. 45.
    Koehle MS, Lloyd-Smith R, Taunton JE. Alpine ski injuries and their prevention. Sports Med. 2002;32(12):785–93.PubMedCrossRefGoogle Scholar
  46. 46.
    Natri A, Beynnon BD, Ettlinger CF, et al. Alpine ski bindings and injuries: current findings. Sports Med. 1999;28(1):35–48.PubMedCrossRefGoogle Scholar
  47. 47.
    Beynnon BD, Ettlinger CF, Johnson RJ. Epidemiology and mechanisms of ACL injury in alpine skiing. In: Hewett TE, Shultz SJ, Griffin LY, editors. Understanding and preventing noncontact ACL injuries. Champaign: Human Kinetics; 2007. p. 183–8.Google Scholar
  48. 48.
    Spörri J, Kröll J, Amesberger G, et al. Perceived key injury risk factors in World Cup alpine ski racing: an explorative qualitative study with expert stakeholders. Br J Sports Med. 2012;46(15):1059–64. doi: 10.1136/bjsports-2012-091048.Google Scholar
  49. 49.
    Neptune RR, McGowan CP, Fiandt JM. The influence of muscle physiology and advanced technology on sports performance. Annu Rev Biomed Eng. 2009;11(1):81–107.PubMedCrossRefGoogle Scholar
  50. 50.
    Hewett TE, Lindenfeld TN, Riccobene JV, et al. The effect of neuromuscular training on the incidence of knee injury in female athletes: a prospective study. Am J Sports Med. 1999;27(6):699–706.PubMedGoogle Scholar
  51. 51.
    Sugimoto D, Myer GD, McKeon JM, et al. Evaluation of the effectiveness of neuromuscular training to reduce anterior cruciate ligament injury in female athletes: a critical review of relative risk reduction and numbers-needed-to-treat analyses. Br J Sports Med. 2012;46(14):979–88. doi: 10.1136/bjsports-2011-090895.Google Scholar
  52. 52.
    Kröll J, Müller E, Seifert JG, et al. Changes in quadriceps muscle activity during sustained recreational alpine skiing. J Sports Sci Med. 2011;10(1):81–92.Google Scholar
  53. 53.
    Kröll J, Wakeling JM, Seifert JG, et al. Quadriceps muscle function during recreational alpine skiing. Med Sci Sports Exerc. 2010;42(8):1545–56.PubMedCrossRefGoogle Scholar
  54. 54.
    Kiani A, Hellquist E, Ahlqvist K, et al. Prevention of soccer-related knee injuries in teenaged girls. Arch Intern Med. 2010;170(1):43–9.PubMedCrossRefGoogle Scholar
  55. 55.
    Morrow PL, McQuillen EN, Eaton LA Jr, et al. Downhill ski fatalities: the Vermont experience. J Trauma. 1988;28(1):95–100.PubMedCrossRefGoogle Scholar
  56. 56.
    Boden BP, Prior C. Catastrophic spine injuries in sports. Curr Sports Med Rep. 2005;4(1):45–9.PubMedGoogle Scholar
  57. 57.
    Tesch P, Larsson L, Eriksson A, et al. Muscle glycogen depletion and lactate concentration during downhill skiing. Med Sci Sports. 1978;10(2):85–90.PubMedGoogle Scholar
  58. 58.
    Seifert JG, Kipp RW, Amann M, et al. Muscle damage, fluid ingestion, and energy supplementation during recreational alpine skiing. Int J Sport Nutr Ex Met. 2005;15(5):528–36.Google Scholar
  59. 59.
    Nygaard E, Andersen P, Nilsson P, et al. Glycogen depletion pattern and lactate accumulation in leg muscles during recreational downhill skiing. Eur J Appl Physiol Occup Physiol. 1978;38(4):261–9.PubMedCrossRefGoogle Scholar
  60. 60.
    Walsh NP, Gleeson M, Shephard RJ, et al. Position statement. Part one: immune function and exercise. Exerc Immunol Rev. 2011;17:6–63.PubMedGoogle Scholar
  61. 61.
    Holloszy JO, Coyle EF. Adaptations of skeletal muscle to endurance exercise and their metabolic consequences. J Appl Physiol. 1984;56(4):831–8.PubMedGoogle Scholar
  62. 62.
    Rønning R, Rønning I, Gerner T, et al. The efficacy of wrist protectors in preventing snowboarding injuries. Am J Sports Med. 2001;29(5):581–5.PubMedGoogle Scholar
  63. 63.
    Machold W, Kwasny O, Eisenhardt P, et al. Reduction of severe wrist injuries in snowboarding by an optimized wrist protection device: a prospective randomized trial. J Trauma. 2002;52(3):517–20.PubMedCrossRefGoogle Scholar
  64. 64.
    Boldrino C, Dann K. Risk factors in snowboarding. Int J Consum Prod Saf. 1998;5(1):41–51.CrossRefGoogle Scholar
  65. 65.
    Bouter LM, Knipschild PG, Volovics A. Binding function in relation to injury risk in downhill skiing. Am J Sports Med. 1989;17(2):226–33.PubMedCrossRefGoogle Scholar
  66. 66.
    Dohjima T, Sumi Y, Ohno T, et al. The dangers of snowboarding: a 9-year prospective comparison of snowboarding and skiing injuries. Acta Orthop. 2001;72(6):657–60.CrossRefGoogle Scholar
  67. 67.
    Ferrera PC, McKenna DP, Gilman EA. Injury patterns with snowboarding. Am J Emerg Med. 1999;17(6):575–7.PubMedCrossRefGoogle Scholar
  68. 68.
    Fournier J-Y, De Preux J. Severe head injuries in downhill skiing: a review of 100 cases. Neurosurg Q. 1997;7(4):255–63.CrossRefGoogle Scholar
  69. 69.
    Franz I, Hasler RM, Benneker L, et al. Severe spinal injuries in alpine skiing and snowboarding: a 6-year review of a tertiary trauma centre for the Bernese Alps ski resorts, Switzerland. Br J Sports Med. 2008;42(1):55–8.PubMedCrossRefGoogle Scholar
  70. 70.
    Hildebrandt C, Mildner E, Hotter B, et al. Accident prevention on ski slopes: perceptions of safety and knowledge of existing rules. Acc Anal Prev. 2011;43(4):1421–6.CrossRefGoogle Scholar
  71. 71.
    Kroncke EL, Niedfeldt MW, Young CC. Use of protective equipment by adolescents in inline skating, skateboarding, and snowboarding. Clin J Sport Med. 2008;18(1):38–43.PubMedCrossRefGoogle Scholar
  72. 72.
    Levy AS, Hawkes AP, Rossie GV. Helmets for skiers and snowboarders: an injury prevention program. Health Promot Pract. 2007;8(3):257–65.PubMedCrossRefGoogle Scholar
  73. 73.
    Macnab AJ, Cadman R. Demographics of alpine skiing and snowboarding injury: lessons for prevention programs. Inj Prev. 1996;2(4):286–9.PubMedCrossRefGoogle Scholar
  74. 74.
    Macnab AJ, Smith T, Gagnon FA, et al. Effect of helmet wear on the incidence of head/face and cervical spine injuries in young skiers and snowboarders. Inj Prev. 2002;8(4):324–7.PubMedCrossRefGoogle Scholar
  75. 75.
    Nakaguchi H, Fujimaki T, Ueki K, et al. Snowboard head injury: prospective study in Chino, Nagano, for two seasons from 1995 to 1997. J Trauma. 1999;46(6):1066–9.PubMedCrossRefGoogle Scholar
  76. 76.
    Ruedl G, Herzog S, Schoepf S, et al. Do ski helmets affect reaction time to peripheral stimuli? Wilderness Environ Med. 2011;22(2):148–50.PubMedCrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2013

Authors and Affiliations

  1. 1.Swedish Winter Sports Research Centre, Department of Health SciencesMid Sweden UniversityÖstersundSweden
  2. 2.Swedish Winter Sports Research CentreÖstersundSweden

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