Background

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  Alpine skiing is a popular sport worldwide, with approximately >200 million participants per year.

  
  
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  High speeds, variable terrain, and weather conditions, combined with equipment, can create a significant opportunity for getting injured.

  
  
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  Equipment changes have changed the nature of injuries, but overall rates have not significantly decreased in the past 15–20 years.

  
  
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  Lower extremity injuries are the most common, but upper extremity injuries are also frequent.

  
  
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  Head injuries and chest wall/abdominal trauma are also of great concern because these injuries can be life threatening.

  
  
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  Medical issues include cold exposure, sun exposure, altitude issues, and general travel-related problems.

Levels of Competition

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  Alpine ski racing at its highest level is governed by Fédération Internationale de Ski (FIS).

  
  
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  The U.S. Ski Association is the governing body in the United States (US).

  
  
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  The US national team is divided into four groups: A to D. Elite skiers are in the A team, with athletes ranked according to skill into the other divisions, down to the development team, or the D team.

  
  
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  Junior levels are divided by age groups (U21, U19, U16, U14, U10, and U8).

  
  
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  Often, there is overlap between collegiate levels, high school levels, and junior race clubs.

  
  
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  Levels U14–U21 may compete locally, regionally, and nationally, with the best skiers competing internationally. U10 and younger usually compete locally and occasionally regionally.

  
  
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  There are various master’s race associations, and recreational skiers can compete in the National Standard Race (NASTAR). The NASTAR is a program wherein recreational skiers of all ages and abilities can test their skills on courses set up at resorts across the country. Times and scores are compared under a universal handicapping system similar to that used in golf.

Events

Event Coverage

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  Planning and communication are the keys. Communicate with ski patrol before the event or training to learn established protocols and establish a chain of command in the event of an injury.

  
  
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  Several ski areas are a significant distance away from medical or trauma facilities; this, along with winter weather, often mandates that stabilizing care and pain control be provided while transport is arranged.

  
  
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  Medical personnel must be proficient in alpine skiing because courses are often steep and icy and should generally station themselves high up on the course so that they have access to the entire run.

  
  
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  Radios allow communication between the medical team and spotters on the course; these should be tested ahead of the training or race because most two-way radios are site-to-site and may have trouble transmitting in certain areas. Cell phone service is also inconsistent in several mountainous areas and should be investigated before the competition.

  
  
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  Most injuries are best taken care of off the mountain; hence, if possible, a majority of the care should be delayed until the athlete can be transported to lodge or medical facilities.

Epidemiology

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  Although rates of skiing injuries have declined in the last three decades, most of this decline occurred in the late 1970s and early 1980s and rates have been stable over the past 25 years.

  
  
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  Reported injury rates vary from 2 to 5 per 1000 skier days.

  
  
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  Ratio of lower extremity to upper extremity injury is approximately 2:1.

  
  
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  Location of most common lower extremity injury has changed from ankle/tibia to knee; this is likely because of equipment changes, including stiffer boot materials and the advent of release bindings.

  
  
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  Rates and severity of injury are similar with snowboarding, although snowboarders have a higher rate of upper extremity injuries.

  
  
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  Catastrophic injuries are rare: 0.01 per 1000 skier days.

Equipment

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  Major equipment changes occurred in the late 1970s and early 1980s; this included a move from leather to plastic boots and releasable bindings. Additional equipment changes occurred in the mid 1990s with the introduction of shaped skis.

  
  
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  A common misconception is that modern equipment protects the knees when it is, in fact, designed to prevent ankle and tibia fractures. Although this appears to have been effective in reducing the number of injuries, it has caused a dramatic increase in knee injuries.

  
  
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  Standard binding release is based on the skier characteristics such as skill level, boot size, height, and weight: most commonly adjusted based on the Deutches Institu für Normung (DIN) standard.

  
  
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  Binding mechanism may not release at slow fall speeds because torque requirement is not met.

  
  
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  Expert skiers and racers will often ski at DIN settings higher than recommended to prevent prerelease.

  
  
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  Lower extremity injuries, excluding knee sprains, are often associated with inappropriate equipment adjustment.

  
  
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  Shaped skis have become the mainstay in all disciplines except downhill. These skies are shorter than the tradition ski and have increased side-cut. Although shaped skis are the most common type of ski used, it is unclear if these skies have had any effects on injuries at the recreational level. Regulation changes limiting the side-cut radius for all World Cup disciplines except slalom were instituted in the 2012/2013 season. Early data suggest a small but statistically significant decrease in overall injury rates.

Training and Physiology

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  Skiing requires a good base of lower extremity and core strengthening and aerobic fitness to tolerate training loads.

  
  
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  Large eccentric and isometric loads are placed on the lower extremity; hence, strength training should focus on these areas.

  
  
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  A majority of any ski race event occurs at the anaerobic threshold, hence, cardiovascular training regimens should focus on increasing this tolerance.

  
  
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  The competitive season of elite skiers involves altitude and significant travel; therefore, training should be frequently adjusted to maximize performance while minimizing the risk of overtraining the athlete.