Alpine skiing is one of Canada’s most popular sports, as a result of our long winters and the abundance of snow and mountains. Due to the nature of skiing, injury risk is related to the high speeds and potential for impact with immovable objects, level of ski ability (due to the typical mixed abilities of skiers on a ski slope), equipment and the environment. Downhill ski injuries tend to be related to a twisting fall, impact with an obstacle or collision with another skier. The types of injuries seen are typically lower extremity injuries with a historic trend suggesting a shift from ankle fractures and sprains to severe knee injuries because of changes in skiing equipment in the last two decades.

Lower extremity injuries tend to be the result of twisting falls, while upper extremity and head injuries are due to impact. Upper extremity injuries are estimated to account for between 13% and 36% of all downhill-related injuries. Thumb sprains account for the largest proportion of upper extremity injuries followed by fractures and dislocations of the shoulder as the result of either a fall or a pole becoming entangled in the bushes.

Skiing Injury Research

The searches of computerized databases found 1,500 downhill skiing-related studies, of which 70 were found to be potentially relevant. Twenty-one additional potentially relevant studies were identified as a result of hand searching. Eleven of the 91 potentially relevant articles (12%) met the relevance criteria.

Ski Lessons – studies on ski lessons found no overall association between risk of injury and ski lessons.

Binding Adjustment Education – education strategies designed to teach people how and why to check and adjust their ski bindings prior to skiing have had mixed results. One study that played a video on a bus trip to a ski hill found a reduction in injury at the end of the day. A second study that employed a broad-based pamphlet and cassette education program failed to find any change in behaviour.

Ski Equipment – one study found that skiers with non-release bindings were 3.3 times more likely to sustain a lower extremity injury than those with release binding, and two found that skiers who performed binding release self-tests were less likely to sustain an injury than those who did not. Two of the case-controls found that skiers with bindings at higher than recommended settings were at greater risk of injury. The need for developing standard binding settings for children and youth was identified. A second study found that the actual number of falls, injury events and lower extremity injuries were significantly lower in the group whose skis had been adjusted than among the control group. They also examined thumb injuries using a special bow grip pole in a sub-set of skiers, and found that 2.8% of those using the special pole reported thumb injuries as compared to 4% of controls.

Practice Recommendations

• Ski equipment should be appropriate to the level of ability of the skier;
• Ski bindings should be adjusted by a professional at the beginning of each ski season;
• Children and youth should be taught how to conduct a ski binding self-test and should conduct these tests at the beginning of each ski day;
• Parents should consider enrolling beginning skiers in lessons and restricting them to beginner ski hills until a reasonable number of ski hours have been completed;
• Inexperienced skiers should be supervised and should wear a helmet;
• Until such time as a rigorous evaluation of ski lessons is conducted, ski lessons should continue to be recommended by ski hill management and school boards supporting ski trips – in particular for beginning skiers;
• Until such time as rigorous evaluations of ski helmets is conducted, the use of helmets specifically designed for skiing should continue to be required by ski hill management for children taking lessons, and be required/recommended by school boards supporting ski trips (especially for beginning skiers).

This article is an excerpt from a systematic review of sport and recreation injury prevention strategies recently conducted by the BC Injury Research and Prevention Unit (BCIRPU). For further information and references relevant to this article, refer to their website.  The review examined published and unpublished Canadian and international literature related to injury prevention strategies in select sport and recreational activities. The goal of the project was to examine existing evidence on the effectiveness of current prevention strategies in selected sports and recreational activities; to determine the applicability of this evidence to children and youth and to make recommendations related to best practice (policy and programming) and future research needs in the area.

The BC Injury Research and Prevention Unit was established by the Minister of Health in August 1997. BCIRPU ‘s primary purpose includes “the reduction of unintentional injuries among children and youth in BC, through the support and evaluation of effective prevention measures, and the establishment of ongoing injury surveillance across the province.”