As reported by the New Haven Register, October 13, 2008.

The Downside of Skiing: Slopes Invite Scars, But Safety Precautions Are Simple

By Abram Katz

You're accelerating down a snow-covered mountain with two synthetic planks locked onto your ankles and feet. This is skiing, and millions of men, women and children do it every winter.

What could go wrong?

While most skiers avoid mishaps, physicians are familiar with some unique downhill injuries. "Snowboarder's fracture" and "skier's thumb" are but two of the typical breaks, sprains and tears that doctors see when the powder is thick and trails are fresh.

A few simple precautions can make a day of schussing enjoyable, rather than a prelude to visiting an orthopedist.

According to the University of Washington in Seattle, there are 8.7 injuries per 1,000 skiers skiing for one day. Many of these injuries are self-reported.

Around 28 million people ski and snowboard in the United States. About 11.8 million skiers visited 139 resorts in the Northeast in 2006-2007. Participation in U.S. alpine skiing has dropped about 17 percent since 2001, but 5 million to 6 million snowboarders are sharing the slopes today.

Injuries seem to strike beginners and skiers who have become too comfortable or complacent, said Dr. Thomas Trojian, director of injury prevention and sports outreach at the New England Musculoskeletal Institute at the University of Connecticut Health Center.

Trojian said he sees many skiing-related knee injuries. Rigid plastic boots that are fixed to skis aggravate the problem, he said.

When the front of the ski gets caught, the knee has to twist. The joints also get punished when a falling skier tries to recover and his body falls below his knees.

Some orthopedists call the result "phantom foot" because the skier loses track of his limbs. What happens in the knee is that the anterior cruciate ligament, one of two ligaments holding the joint together, snaps.

The knee usually becomes too unstable to bear weight and is extremely painful. The injury is usually treated surgically.

Sometimes, as the ligament is getting stretched and torn, the head of the femur, or thigh bone, crushes cartilage in the knee, he said.

Strengthening muscles may help minimize the chances of an "ACL," Trojian said. Better still, when you start to fall, go ahead and fall, he said.

"Don't put weight on the downhill ski. When you're down, stay down, and keep your arms up and forward," Trojian said.

"Knee injuries predominate because of the boots. It's remarkable that there aren't more injuries," said Dr. John Reach, director of the Yale-New Haven Foot and Ankle Service.

"If you twist a leg, the ligament breaks or bones collide," he said, producing a "tibia plateau" fracture.

"You want the boot to detach from the ski. It needs to be precisely adjusted," Reach said.

Wrist injuries are numerous because many people tumble on the way down. There are a fair share of broken wrists.

"I see head injuries, spinal injuries, injuries of the upper extremities and injuries of the lower extremities," Reach said.

Head and neck injuries are the worst, and are less common.

Both Trojian and Reach emphasized the advantages of wearing a helmet. Most of the rare fatalities in skiing occur when people crash into trees, rocks or other obstacles. Helmets will not prevent all injuries, but they can reduce the severity of injuries and protect the skull.

Then, there is the injury unique to using ski poles, "skier's thumb."

Falling while holding a ski pole can stretch the thumb back to the point that the bones break.

Many people ski infrequently and are out of shape, Reach said. They then attempt to ski an expert slope. Their muscles, reflexes and nerves are not up to the task, causing them to fall, breaking collar bones, dislocating shoulders and tearing up ligaments.

"Ski at the appropriate level," Trojian said. "Make sure you're appropriately dressed." And, stop before you become exhausted.

Cross-country skiers experience fewer injuries, and most are the result of repeated stress. Unlike downhill skis, cross-country skis clip only to the toe. The skating motion can lead to over-use injuries of the tendons, known as tendonopathy, Trojian said.

Snowboarders are apt to experience "snowboarder's fracture." This happens when the snowboarder lands on a twisted, pulled up ankle. This can break off of the talus, an ankle bone adjacent to the heel.

Typically, the injury is treated by rejoining the bones with screws or other hardware.

Professional skiers and snowboarders may suffer repeated ACLs and fractures of the talus. The doctors said it is not uncommon for pros to undergo multiple repairs.

Nonprofessionals have more sprains — injuries to ligaments, which connect bones. Torn ligaments will generally heal by themselves, if not worsened by continued use, they said.

Dr. Kevin Plancher of Greenwich, orthopedist to the U.S. Ski and Snowboard Team, has some tips to avoid phantom foot, skier's thumb and worse:

  • Get back into the sport gradually, to give bones and ligaments time to adjust. Even if you are an advanced skier, do not start out on the most difficult slope.
  • Even at a familiar resort, review slope maps. Look at lift systems and resort policies for changes that may have taken place during the off-season. Know how to find the nearest first aid station.
  • Consider taking a lesson. "A brief 30-minute group or private lesson provides an opportunity for novices to practice in a controlled situation, and allows experts to hone skills that have been unused for more than half the year," Plancher said. Also, practice falling safely to reduce the risk of ligament damage.
  • If you do injure yourself, allow plenty of time to heal. Failing to treat minor injuries can transform them into more serious problems that require a longer recovery.