September 25, 2017

Come Off The Mountain In One Piece

The right prep and gear—along with some quick thinking—will help keep you injury-free all season

By John MacGillivray, M.D.

Winter is approaching—it’s time to dust off the skis and snowboards and jump on those lifts. In fact, a record 60.54 million thrill-seekers did just that last season, according to the National Ski Association. With so many athletes hitting the slopes, knee twists and hand injury remain frequent sights in my office. While skiers can’t prevent all spills, they can reduce the incidence of injury by keeping in shape and also by knowing when to address aches and pains.

Skiing and snowboarding require a lot of strength and good balance. As an avid skier for over 40 years, I firmly believe in a pre-season strength and conditioning program that concentrates on the quadriceps, hamstrings and the core, and also includes endurance exercises such as plyometrics, elliptical training, and lunges. Many injuries on the slopes occur after fatigue sets in, so being strong and in shape can help prevent harmful falls.

When you gear up for your season, pay particular attention to protecting your head and neck—these receive the most hazardous snow injuries. Helmet use for snow sports is a controversial topic, and the conversation was initially sparked by the ski-related deaths of Michael Kennedy in 1998 and actress Natasha Richardson in 2009. There’s ample evidence suggesting that a helmet will protect you against most of the head injuries experienced on the slopes. They offer the most protection for low speed impacts and for falls involving head contact on the snow (rather than on a tree or other object). Experts also agree that helmet use in children is strongly recommended as they are at higher risk of injury. Don’t mess around: wear a helmet.

Traveling south from your noggin, pay attention to your thumbs. The inside, or ulnar collateral ligament (UCL), is the most commonly injured, causing pain that is known as “skier’s thumb.” The injury occurs when the skier falls and is unable to let go of the pole, causing a bending stress to the thumb. A partial tear can usually be treated with a cast or splint, whereas a complete tear requires surgery. Want to reduce your chances of coming home with skier’s thumb? Let go of those poles when you fall!

If you’re a boarder, your wrists are the most vulnerable. When snowboarders fall, they instinctively extend their hands in an attempt to soften their landings, which can lead to a wrist sprain or fracture. Studies have shown that wearing wrist guards, particularly by beginning snowboarders, decreases the incidence of wrist injuries. Think about it: you wouldn’t rollerblade without wrist protection, would you? (No, you wouldn’t!) Nor should you board without it. Check out the Dakine Nova Wristguard gloves ($50; dakine.com).

Alpine skiers need to protect their knees. Anterior cruciate ligament (ACL) tears are very common—the number of ACL reconstructions I perform per week doubles during the ski season. They are frequently caused by the “phantom foot” phenomenon, which happens when the skier is off-balance, sitting with their hips down below the knees, and their weight focused on the inside edge of their downhill ski. In these cases, they often feel a “pop” in the knee, likely signifying a torn ACL. To help avoid an ACL tear, avoid fully straightening your leg when you fall. Keep your knees flexed instead. If you think you’ve torn your ACL, don’t get up. Wait for the ski patrol to transport you to the base clinic for further evaluation.

Now, here’s by far the most important way to prevent ski or snowboarding injuries: keep your sticks or your board under control, and be aware of others around you. Many injuries I see at are from collisions that could have been avoided. So enjoy the upcoming season, but don’t take risks you aren’t prepared for. Stay safe!

Dr. John MacGillivray, an orthopedic surgeon at Hospital for Special Surgery (HSS) in New York, has served as a team physician to the U.S. Ski Team, orthopedic consultant for the National Hockey League Players’ Association, and team physician for the U.S. Snow Boarding Team. He is also a volunteer and on the Board of Directors at the Carlos Otis Stratton Mountain Clinic in Vermont.


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