This post is a Part 2 of 2 – Following on from Ski Injury for desk workers – Part 1 | Photo by asoggetti 

Our top 5 Snow Injuries

Following Caitlin’s last blog on injury prevention in the snow fields, this month’s blog is a focus on the most common injuries we see from skiing and snowboarding. These injuries in particular are common among desk workers who hit the slopes eager but not always fully prepared. 

No. 1 – MCL (Medial Collateral Ligament) Knee Injuries

Having spent 3 years working as physio in London where everyone makes dashing over to Europe for a quick weekend ski a winter ritual, there would be days in the clinic where the majority of my book would be taken up by MCL injuries. MCL injuries are more common in skiers than snowboarders as the foot is fixed in the boot. With snowboarding, as there is a bit of flexibility in the way the ankle is held in the boot, any force to the lower limb is distributed across the two joints, whereas with skiing, as the foot is fixed, any twisting or sideways force is concentrated on the knee.

The medial ligament sits on the inside of the knee joint and stops inward and twisting forces which are the two main ways this ligament can be injured.  Pain will be felt immediately on the inside of the knee and we grade the injury to describe the amount of damage that has occurred. Where Grade 1 refers to about 25% of the tissue injured which generally translates to a couple of weeks of rest, Grade 2 refers to 50-75% of the tissue torn which probably means a brace and 4-6 weeks out and Grade 3 meaning a complete rupture. Be careful with Grade 2 and 3 injuries to have them properly diagnosed as it is not uncommon to have ACL and meniscus injuries to go along with the MCL injury. If you are unsure, a physio or doctor can easily test and grade MCL injuries on the bed, but move quickly on those injuries at higher force as it’s tricky to confirm ACL injuries after the first 24 hours.

Tips to prevent MCL injuries in skiers are to ensure your bindings are adjusted correctly for your weight and ability. It’s really important that the skis click off at the right time in case of accident as this will significant reduce excess stress to the knee. Also consider that the snow plough position places quite a lot of stress on the ligament so talk to your instructor if you’re concerned.


No. 2 – Ankle Fractures and Ligament Injuries

Where knee injuries are super common in skiers, snowboarders are more prone to ankle injuries for the reasons mentioned above. Often ankle injuries in snowboarders occur at high force as it takes less hours on the snow to develop a good competency so boarders quickly become confident with speed and jumping.

Of course, if the injury occurs at high speed there is a much greater chance for a fracture to occur however some of the more significant ligament injuries can also put you out for a good period of time. The ankle can either roll in our out which results in ATFL and CF ligament injuries or deltoid ligament injuries respectively. It’s not uncommon for this to be combined with a twisting force which may result in damage to the syndesmosis or a “high ankle sprain” which is the tissue that attaches the two leg bones (tibia and fibular) together. Greater amounts of force can result in fractures of the tib and fib, and another common ankle fracture in snowboarders is on the calcaneus or the talus (the heel bones from the impact of landing heavy from a jump.

Get your ankle injuries assessed particularly if they occur at high force to exclude the presence of a fracture. Depending on the structures involved an ankle injury could involve a couple of days with your foot on ice watching the slopes from the chalet, to a moon boot right through to surgery. The physios and doctors on the mountain would be able to help you with getting the diagnosis and management right straight away to prevent an excessive healing period.

One really good way of preventing ankle injuries is to ensure your boots are well fitted. There is often a lot of room in snowboarding boots so invest in a pair of foot beds or orthotics to make sure the boot fits properly. Also know your skill level and limit when it comes to jumping and speed and keep your fastest and most risky runs for the late morning once you’re warmed up, but before your body is tired and the snow is starting to deteriorate.


No. 3 – Wrist Fractures

Wrist injuries and fractures are more common in snowboarders than skiers, particularly beginner snowboarders as you get less time to react to falls and often it’s the hand that is placed down first, whereas in skiing the squatting position lends itself more to the hips, knees and body taking the fall.

Reaching the outstretched hand to the ground, when falling particularly when the snow is icy or compacted results in a significant force and speed concentrated on a small area of the body. The most common fractures to occur are Colles fractures (the radius bone at the wrist joint) and scaphoid fractures which is the bone that sits at the base of the thumb. Colles fractures can be treated with plaster or surgery where surgery will often result in faster recovery. The treatment of scaphoid fractures can be varied depending on where the fracture is and whether the bone has separated but for most normal scaphoid fractures the person in instructed to wear a brace and rest. If you’ve suffered a scaphoid fracture however, be sure though to make sure you get your follow up appointment with the doctor as these are notoriously bad healers and need to be checked at around 6-8 weeks.

Tip: Consider wearing flexible wrist guards which extend half to three-quarters of the way up the forearm if you’re a beginner snowboarder to reduce the chance of having a wrist fracture and try to keep your weight forward to prevent falling backwards onto your hand (but not too far forward!!)

Ski Injuries Viva Physio

 

 

 

 

 

 

 

 

 

Photo by Fanny Rascle 


No. 4 – Skiers Thumb 

You would think by the name that skiers thumb was unique to skiers however it can also be seen in snowboarders as well. The name refers to injury of the ulna collateral ligament of the thumb and is coined as it’s a classic mechanism where a skier who has their wrists through the loops on the stocks or poles catches the snow as they’re going down.

The ligament injury can be easily tested for by a doctor of physio and is graded the same as described above for MCL injuries referring to the percentage of fibres that have been torn. Management can vary from a bit of ice and a thumb stabiliser and straight back out on the snow with caution for a grade 1, right through to 4-6 weeks of immobilisation or even surgery for grades 2 and 3. A big risk with a grade 3 injury is that a little piece of bone is taken with the ligament which is described as an avulsion injury so be careful to ensure you have had the injury correctly diagnosed to ensure it’s been managed in a way that ensures the fastest recovery.

You could consider wearing a thumb stabiliser (brace) if you’ve had a history of skiers thumb or are concerned about thumb injury (for example if thumbs are your livelihood like they are for physios!) Also consider holding your stocks by the handle rather than looping your wrists through them. It can be a pain trudging up the mountain if you have a crash and have to walk back up to get them but less painful than a skiers thumb! Or of course you can wait until the kindness of strangers to bring the pole down to you.


No. 5 – Head Injuries 

Due to the high pace and high risk of snow sports, concussion is really common and you don’t have to knock yourself out to be causing damage to your brain. You can read more about concussion in the blog Laura wrote a few years ago – Staying Safe and Preventing Head Injuries on the Ski Fields vivaphysiotherapy.com/stay-safe-ski-fields/ and Caitlin’s more recent general injury prevention blog – Ski Injury Prevention for Desk Workers vivaphysiotherapy.com/ski-injury-prevention-for-desk-workers/

Don’t forget that wearing a helmet significantly decreases the chance of having a head injury so it’s probably one of the most important things you’ll pack in your ski bag this winter.


General tips: 

Of course none of us envisage an injury when we are getting in the car to head up to Hotham on a cold August morning but there are a few things you can do to minimise the chance of being picked up by Ski Patrol.

  1. Get prepared! Particularly if you haven’t been on the skis or board for a year. Fatigue is one of the biggest things that will impede your judgement so getting your muscles conditioned for your chosen winter sport is really important. Caitlin is running snow sports classes in our Pilates studio every Tuesday evening until the end of September so get on board to keep yourself injury-free.
  2. Know your Limits. It’s often when we push ourselves beyond our skill level that we wind up in the doctors rooms. It’s fun to have a few fast runs but stay on-piste and make smart decisions about which days and which jumps are right for you.
  3. Always keep improving. Get a lesson as regularly as you can afford it to ensure your skill level is tip top.
  4. Consider wearing braces. On areas such as thumbs, wrists and of course on your head.

Enjoy your snow sports this year and we hope not to see you in the clinic! However if you’d like any general advice, we are always available to field any questions you may have on [email protected]

Signing off,
Kathryn.