Physical therapy recommendations for injury prevention in alpine skiing


  • Friderika Kresal
  • Špela Bračun
  • Laura Tönig
  • assist. prof. dr. Mojca Amon Institution of Higher Education for Physiotherapy FIZIOTERAPEVTIKA, LJUBLJANA



sports medicine, injury prevention, physiotherapy, alpine ski


Introduction: Alpine skiers face high speeds, significant forces, natural and unnatural obstacles, and various environmental conditions on the slopes. Thus, they are highly exposed to certain injuries, amongst which the most common are those to the knee followed by injuries to the spine, shins, head, as well as arm and thumb injuries.

Purpose: The purpose was to systematically review the scientific literature on injuries, risk factors, and prevention in competitive alpine skiing and to provide recommendations for injury prevention in the field of physical preparation, kinesiotherapy, and/or specific exercises, and to determine which exercise program would be most appropriate for an alpine ski racer.

Methods: PubMed, Web of Science, and COBISS databases were used with PRISMA method to review the physical therapy recommendations for injury prevention in alpine skiing.

Results: 10 studies were included in the final systematic review. We have not found any evidence-based prevention programs that are not older than 10 years on the topic of physical preparation for alpine ski racers. We found that most often, the literature describes prevention in terms of equipment, course preparation, course safety awareness, and the experience of the skier.

Conclusions: The recommendation for the most efficient prevention according to the current literature is to follow the above preventive measures in combination with appropriate physical preparation, where we recommend relying on research evidence in other (non-contact) sports that have similar injury mechanisms as alpine ski racing.


Audet, O., Hagel, B. E., Nettel-Aguirre, A., Mitra, T., Emery, C. A., Macpherson, A., ... & Goulet, C. (2019). What are the risk factors for injuries and injury prevention strategies for skiers and snowboarders in terrain parks and half-pipes? A systematic review. British Journal of Sports Medicine, 53(1), 19-24.

Bailly, N., Afquir S., Laporte J. D., Melot A., Savary D., Seigneuret E., ... Arnoux P. J. (2017). Analysis of injury mechanisms in head injuries in skiers and snowboarders. Medicine and Science in Sports Exercise, 49(1), 1–10.

Beynnon, B. D., Ettlinger, C. F., & Johnson, R. J. (2007). Epidemiology and mechanisms of ACL injury in alpine skiing. Understanding and Preventing Noncontact ACL Injuries. Champaign, IL: American Orthopaedic Society for Sports Medicine, Human Kinetics, 183-188.

Biering-Sørensen, F. I. N. (1984). Physical measurements as risk indicators for low-back trouble over a one-year period. Spine, 9(2), 106-119.

Boden, B. P., & Prior, C. (2005). Catastrophic spine injuries in sports. Current Sports Medicine Reports, 4(1), 45-49.

Coburn, J. W. & Malek, M. H. (Eds.). (2012). Nsca's essentials of personal training. United States: Human Kinetics.

Cusimano, M. D., & Kwok, J. (2010). The effectiveness of helmet wear in skiers and snowboarders: a systematic review. British Journal of Sports Medicine, 44(11), 781-786.

Cusimano, M., Luong, W. P., Faress, A., Leroux, T., & Russell, K. (2013). Evaluation of a ski and snowboard injury prevention program. International Journal of Injury Control and Safety Promotion, 20(1), 13-18.

Ettlinger, C. F., Johnson, R. J., & Shealy, J. E. (1995). A method to help reduce the risk of serious knee sprains incurred in alpine skiing. The American Journal of Sports Medicine, 23(5), 531-537.

Grimm, N. L., Jacobs Jr, J. C., Kim, J., Denney, B. S., & Shea, K. G. (2015). Anterior cruciate ligament and knee injury prevention programs for soccer players: a systematic review and meta-analysis. The American Journal of Sports Medicine, 43(8), 2049-2056.

Haaland, B., Steenstrup, S. E., Bere, T., Bahr, R., & Nordsletten, L. (2016). Injury rate and injury patterns in FIS World Cup Alpine skiing (2006–2015): have the new ski regulations made an impact? British journal of sports medicine, 50(1), 32-36.

Hébert-Losier, K., & Holmberg, H. C. (2013). What are the exercise-based injury prevention recommendations for recreational alpine skiing and snowboarding? Sports Medicine, 43(5), 355-366.

Hewett, T. E., Ford, K. R., Hoogenboom, B. J., & Myer, G. D. (2010). Understanding and preventing acl injuries: current biomechanical and epidemiologic considerations-update 2010. North American Journal of Sports Physical Therapy: NAJSPT, 5(4), 234.

Hewett, T. E., Lindenfeld, T. N., Riccobene, J. V., & Noyes, F. R. (1999). The effect of neuromuscular training on the incidence of knee injury in female athletes. The American Journal of Sports Medicine, 27(6), 699-706.

Jørgensen, U., Fredensborg, T., Haraszuk, J. P., & Crone, K. L. (1998). Reduction of injuries in downhill skiing by use of an instructional ski-video: a prospective randomised intervention study. Knee Surgery, Sports Traumatology, Arthroscopy, 6(3), 194-200.

Kiani, A., Hellquist, E., Ahlqvist, K., Gedeborg, R., & Byberg, L. (2010). Prevention of soccer-related knee injuries in teenaged girls. Archives of internal medicine, 170(1), 43-49.

Koehle, M. S., Lloyd-Smith, R. & Taunton, J. E. (2002). Alpine ski injuries and their prevention. Sports Medicine, 32(12), 785–793.

Kröll, J., Müller, E., Seifert, J. G., & Wakeling, J. M. (2011). Changes in quadriceps muscle activity during sustained recreational alpine skiing. Journal of Sports Science & Medicine, 10(1), 81-92.

Kröll, J., Wakeling, J. M., Seifert, J. G., & Mueller, E. (2010). Quadriceps muscle function during recreational alpine skiing. Medicine and Science in Sports and Exercise, 42(8), 1545-1556.

Langran, M., & Selvaraj, S. (2002). Snow sports injuries in Scotland: a case-control study. British Journal of Sports Medicine, 36(2), 135-140.

McGill, S. (2010). Core training: Evidence translating to better performance and injury prevention. Strength & Conditioning Journal, 32(3), 33-46.

McKenna, J., & Hammond, C. (2007). Perspectives on injuries in snowboarders. The Journal of the Royal Society for the Promotion of Health, 127(4), 181-189.

Morrissey, M. C., Seto, J. L., Brewster, C. E., & Kerlan, R. K. (1987). Conditioning for skiing and ski injury prevention. Journal of Orthopaedic & Sports Physical Therapy, 8(9), 428-437.

Natri, A., Beynnon, B. D., Ettlinger, C. F., Johnson, R. J., & Shealy, J. E. (1999). Alpine ski bindings and injuries. Sports Medicine, 28(1), 35-48.

Pfeiffer, R. P., Shea, K. G., Roberts, D., Grandstrand, S., & Bond, L. (2006). Lack of effect of a knee ligament injury prevention program on the incidence of noncontact anterior cruciate ligament injury. The Journal of Bone & Joint Surgery, 88(8), 1769-1774.

Pfister, G. (2001). Sport, technology and society: from snow shoes to racing skis. Culture, Sport, Society, 4(1), 73-98.

Ruedl, G., Linortner, I., Schranz, A., Fink, C., Schindelwig, K., Nachbauer, W., & Burtscher, M. (2009). Distribution of injury mechanisms and related factors in ACL-injured female carving skiers. Knee Surgery, Sports Traumatology, Arthroscopy, 17(11), 1393-1398.

Ruedl, G., Webhofer, M., Linortner, I., Schranz, A., Fink, C., Patterson, C., ... & Burtscher, M. (2011). ACL injury mechanisms and related factors in male and female carving skiers: a retrospective study. International Journal of Sports Medicine, 32(10), 801-806.

Schoenhuber, H., Panzeri, A., & Porcelli, S. (Eds.). (2018). Alpine Skiing Injuries: Prevention and Management. Springer.

Spörri, J., Kröll, J., Gilgien, M., & Müller, E. (2017). How to prevent injuries in alpine ski racing: what do we know and where do we go from here? Sports Medicine, 47(4), 599-614.

Sugimoto, D., Myer, G. D., Bush, H. M., Klugman, M. F., McKeon, J. M. M., & Hewett, T. E. (2012). Compliance with neuromuscular training and anterior cruciate ligament injury risk reduction in female athletes: a meta-analysis. Journal of Athletic Training, 47(6), 714-723.

Sugimoto, D., Myer, G. D., McKeon, J. M., & Hewett, T. E. (2012). Evaluation of the effectiveness of neuromuscular training to reduce anterior cruciate ligament injury in female athletes: a critical review of relative risk reduction and numbers-needed-to-treat analyses. British journal of sports medicine, 46(14), 979-988.

Sugimoto, D., Myer, G. D., Foss, K. D. B., & Hewett, T. E. (2014). Dosage effects of neuromuscular training intervention to reduce anterior cruciate ligament injuries in female athletes: meta-and sub-group analyses. Sports Medicine, 44(4), 551-562.

Sulheim, S., Ekeland, A., Holme, I., & Bahr, R. (2017). Helmet use and risk of head injuries in alpine skiers and snowboarders: changes after an interval of one decade. British Journal of sports medicine, 51(1), 44-50.

Tarka, M. C., Davey, A., Lonza, G. C., O’Brien, C. M., Delaney, J. P., & Endres, N. K. (2019). Alpine Ski racing injuries. Sports health, 11(3), 265-271.

Walsh, N. P., Gleeson, M., Shephard, R. J., Gleeson, M., Woods, J. A., Bishop, N., ... & Simon, P. (2011). Position statement part one: immune function and exercise. Retrieved from

Wilk, K. E., Macrina, L. C., Cain, E. L., Dugas, J. R., & Andrews, J. R. (2012). Recent advances in the rehabilitation of anterior cruciate ligament injuries. Journal of Orthopaedic & Sports Physical Therapy, 42(3), 153-171.




How to Cite

Kresal, F., Bračun, Špela, Tönig, L., & Amon, M. (2022). Physical therapy recommendations for injury prevention in alpine skiing. Annales Kinesiologiae, 12(1), 43–55.