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Preventing Ski Injuries

Returning to the slopes isn’t like riding a bike, says Jordan Metzl, MD, a sports medicine specialist at the Hospital for Special Surgery. Skiers need proper conditioning and the right equipment to avoid injuries.

The most common skiing injuries involve knee sprains, skiers’ thumb, tibia fractures and ankle fractures.

Studies show knee sprains account for 30% of all ski injuries. The consequences of a bad knee sprain can be far more serious than just limping around the living room for a few weeks. A common ligament injured is the anterior cruciate ligament, called ACL. If torn, it is usually a costly injury that sometimes requires surgery, then 6-9 months of recovery time.

The skiers’ thumb is the second most common injury. Thumbs are vulnerable because they're not readily protected in a fall. The injury occurs when someone falls on the outstretched hand and bends the thumb back.

Tibia fractures usually result from a blow to the tibia (for example, a tree) or a twisting force to the leg during a fall. They are most commonly treated surgically with a device called an intramedullary rod--a long rod that goes down the middle of the tibia to hold it in line.

Ankle fractures are still common, but recently there have been fewer such injuries, thanks to better boot designs. Broken ankles and legs used to be very common for skiers, but they’ve been rare lately because of better equipment.

Metzl recommends preseason training for people who plan to go skiing this winter. "You're probably going to be sore if you haven't done anything to work your muscles," he says, recommending cardiovascular exercises and some weight training to strengthen muscles (specifically your legs, rear and abdominals).

Stretching exercises are also advised to increase flexibility of those same muscles. Check with your local gym, which might offer ski-conditioning classes. Staying in shape not only reduces chances of day-after soreness, but it also makes the body better equipped to handle falls.

The right equipment is also key to preventing injuries. There have been several technological advances in the past 10 years. A revolution in ski design offers better control, less fatigue and a safer slide down the slopes. The latest is the shaped ski--wider at the tip and tail and narrower at the waist. The "fat" ski allows faster progress in learning, easier turns, less effort.

The new bindings are adept at handling a greater variety of conditions and they compensate specifically for easier release. The most dangerous fall is a slow, twisting one, and the bindings can now deal with that.

Modern ski boots help prevent ankle and leg breaks. Decades ago, people skied in what essentially were low-cut work boots that allowed ankle and leg breaks. Now the boots ride high on the leg, are made from rigid plastic to prevent movement and are waterproof. They also force the leg slightly forward, which offers a more balanced stanceplanting the skier over the "sweet spot," the middle of the ski.

When it comes of ski poles, many have returned to the tried and true wrist strap. For years, ski poles had molded grips that partly surrounded the hands. In a fall, it was hard to release hands from the grip, and the position further isolated the thumb. These kinds of poles may have contributed to an increase in thumb sprains.

In the last few years, ski areas have seen several fatalities, mostly caused by head traumas. There's growing evidence that helmets are essential on the slopes. Last year, a study by the Consumer Product Safety Commission found that helmet use could prevent or reduce the severity of 44% of head injuries suffered by adults.

Wristguards can protect also be protective during a fall, as seen with rollerbladers.

Protective Eyewear is also important. Goggles or sunglasses protect eyes from the wind and glaring sun. Most mid- to high-end goggles offer venting features that virtually eliminae the fogging that plagued old-fashioned goggles.

Metzl recommends getting ski equipment checked each year by a good dealer. "Make sure everything is in good working order," he says. "And, it might not be a bad idea to invest in some of the new technology equipment."

For the occasional skier who rents equipment, make sure the dealer is reputable, knowledgeable and tunes the equipment to your weight and skill level. Boots should be snug and prevent moment, bindings should be adjusted just for you, and the skis should be well maintained.

Injuries on the slopes can usually be splinted, iced or protected for a trip home to obtain definitive treatment. Most people would prefer not to have surgery by a stranger in one city and have someone else follow it up in another city. Also, many managed care organizations consider knee ligament injuries elective procedures and may not honor charges for elective surgery done out of their network. It’s best to check with your health plan.

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