Physical therapy recommendations for injury prevention in alpine skiing
Keywords: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. https://doi.org/10.1136/bjsports-2018-099166
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. https://doi.org/10.1249/mss.0000000000001078
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. https://doi.org/10.1097/00007632-198403000-00002
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. https://doi.org/10.1136/bjsm.2009.070573
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. https://doi.org/10.1080/17457300.2011.648677
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. https://doi.org/10.1177/036354659502300503
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. https://doi.org/10.1177/0363546514556737
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. http://dx.doi.org/10.1136/bjsports-2015-095467
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. https://doi.org/10.1007/s40279-013-0032-2
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. https://doi.org/10.1177/03635465990270060301
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. https://doi.org/10.1007/s001670050098
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. https://doi.org/10.1001/archinternmed.2009.289
Koehle, M. S., Lloyd-Smith, R. & Taunton, J. E. (2002). Alpine ski injuries and their prevention. Sports Medicine, 32(12), 785–793. https://doi.org/10.2165/00007256-200232120-00003
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. https://doi.org/10.1249/mss.0b013e3181d299cf
Langran, M., & Selvaraj, S. (2002). Snow sports injuries in Scotland: a case-control study. British Journal of Sports Medicine, 36(2), 135-140. https://doi.org/10.1136/bjsm.36.2.135
McGill, S. (2010). Core training: Evidence translating to better performance and injury prevention. Strength & Conditioning Journal, 32(3), 33-46. https://doi.org/10.1519/SSC.0b013e3181df4521
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. https://doi.org/10.1177/1466424007079489
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. https://doi.org/10.2519/jospt.1918.104.22.1688
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. https://doi.org/10.2165/00007256-199928010-00004
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. https://doi.org/10.2106/JBJS.E.00616
Pfister, G. (2001). Sport, technology and society: from snow shoes to racing skis. Culture, Sport, Society, 4(1), 73-98. https://doi.org/10.1080/713999811
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. https://doi.org/10.1007/s00167-009-0860-7
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. https://doi.org/10.1055/s-0031-1279719
Schoenhuber, H., Panzeri, A., & Porcelli, S. (Eds.). (2018). Alpine Skiing Injuries: Prevention and Management. Springer. https://doi.org/10.1007/978-3-319-61355-0
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. https://doi.org/10.1007/s40279-016-0601-2
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. https://doi.org/10.4085/1062-6050-47.6.10
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. https://doi.org/10.1136/bjsports-2011-090895
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. https://doi.org/10.1007/s40279-013-0135-9
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. https://doi.org/10.1136/bjsports-2015-095798
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. https://doi.org/10.1177/1941738119825842
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 http://eir-isei.de/2011/EIR_17_2011.pdf#page=4
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. https://doi.org/10.2519/jospt.2012.3741
How to Cite
Copyright (c) 2022 Friderika Kresal, Špela Bračun, Laura Tönig, assist. prof. dr. Mojca Amon
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Open Access Policy and Copyright
This journal provides immediate open access to its content on the principle that making research freely available to the public supports a greater global exchange of knowledge. Users are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under the terms of the Creative Commons Attribution-Non-Commercial-NoDerivs license (CC BY-NC-ND) that allows others to share the work with an acknowledgement of the work’s authorship and initial publication in this journal.
- Authors grant the publisher commercial rights to produce hardcopy volumes of the journal for sale to libraries and individuals.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal’s published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.