Recreational Snow-Sports Injury Risk Factors and Countermeasures: A Meta-Analysis Review and Haddon Matrix Evaluation

Individual behavioral and sporting risk factors affecting injuries in recreational skiers and snowboarders: a case-control study

This case-control study aimed to analysis of the relationship between individual behaviours and sports risk factors and injuries among skiers and snowboarders. During the 2021-2022 winter season, 1132 injured and 1069 non-injured skiers and snowboarders were surveyed regarding demographic, self-reported individual behavioural and sporting characteristics. Multivariate regression analysis revealed previous snow-sports injury (OR: 26.39, 95% CI: 13.32-52.31, P < 0.001), nervousness (OR: 3.78, 95% CI: 2.91-4.90, P < 0.001), calm (OR: 1.90, 95% CI: 1.46-2.48, P < 0.001) and fearful (OR: 20.60, 95% CI: 11.45-37.04, P < 0.001) emotional states, and higher risk-taking behaviours (OR: 3.72, 95% CI: 2.87-4.83, P < 0.001) were important risk factors associated with injuries to all skiers and snowboarders. Compared to snowboarders, the risk of injury to skiers was more likely to increase as the length of their skiing experience increases. Emotional and cognitive levels appear to be important conditions that influence injuries to skiers and snowboarders, a proper understanding of the potential interactions between cognition and behaviour appears to be important for public ski safety management.

Effectiveness of an injury prevention video on risky behaviours in youth snow sports: A randomized controlled trial

Objectives

Ski and snowboard-related injuries are common among Canadian youth. Analyzing the role of risky behaviours that contribute to injury risk is essential for gaining an understanding of injury prevention opportunities. The objective was to determine if rates of risky behaviour seen at the ski hill were lower for children and adolescents exposed to an educational injury prevention video.

Methods

This single-blinded cluster randomized controlled trial included students (ages 7-16) from 18 Calgary schools who were enrolled in novice levelled school-sanctioned ski and snowboard programs. Consenting schools were randomly assigned to the intervention or control. The control group followed standard preparation including watching a general ski hill orientation video that was created by the ski hill. The intervention group viewed the intervention video focussed on injury prevention. The Risky Behaviour and Actions Assessment Tool was used by blinded research assistants to observe and record students' risky behaviours at an Alberta ski hill.

Results

In total, 407 observations estimated the rate of risky behaviour. The overall rate of risky behaviour was 23.31/100 person runs in the control group and 22.95/100 person runs in the intervention group. The most commonly observed risky behaviours in both groups were skiing too close to other skiers/snowboarders and near collision with an object/person.

Conclusions

Both groups showed similar rates of risky behaviour and demonstrated the same most common type of behaviour. Practical applications: future work should focus on mitigating common risky behaviours.

Muscular Fatigue and Quadriceps-to-Hamstring Ratio in Alpine Skiing in Women over 40 Years

(1) Background: In alpine skiing, senior athletes and especially women have a high risk of knee injury. This may also be related to muscular fatigue (MF) of the knee-stabilizing thigh muscles. This study investigates both the evolution of muscle activity (MA) and of MF of the thighs throughout an entire skiing day. (2) Methods: n = 38 female recreational skiers over 40 years of age performed four specific skiing tasks (plough turns, V-steps uphill, turns with short, and middle radii) at specific times, while freely skiing the rest of the day. Surface EMG of the thigh muscle groups (quadriceps and hamstrings) was measured using special wearables (EMG pants). Apart from standard muscle activity parameters, the EMG data were also processed in the frequency domain to calculate the mean frequency and its shift over the day as a metric of muscle fatigue. (3) Results: The EMG pants showed reliable signal quality over the entire day, with BMI not impacting this. MF increased during skiing before and for both muscle groups significantly (p < 0.006) during lunch. MF, however, was not reflected in the quadriceps-hamstrings ratio. The plough manoeuvre seems to require significantly (p < 0.003) more muscle dynamics than the three other tasks. (4) Conclusion: MF may be quantified over an entire skiing day and thus fatigue information could be given to the skier. This is of major importance for skiers at the beginner level dominantly performing plough turns. Crucial for all skiers: There is no regenerative effect of a 45-min lunch break.

Skill-Specific Differences in Equipment-Related Risk Factors for ACL Injury in Male and Female Recreational Skiers

Background

In recreational alpine skiing, the anterior cruciate ligament (ACL) is affected in approximately 50% of serious knee injuries. There are established sex-based and skill-based differences in ACL injury risk, but the potential impact of equipment used (eg, skis, bindings, and boots) has not been evaluated.

Purpose

To evaluate individual and equipment-related risk factors for an ACL injury depending on sex and skill level.

Study Design

Case-control study; Level of evidence, 3.

Methods

This was a retrospective questionnaire-based, case-control study of female and male skiers with and without ACL injuries during 6 winter seasons (from 2014-2015 to 2019-2020). Demographic data, skill level, equipment specifications, risk-taking behavior, and ownership of ski equipment were recorded. Ski geometry (ski length; sidecut radius; and widths of the tip, waist, and tail) was taken from each participant's ski. The standing heights of the front and back part of the ski binding were measured using a digital sliding caliper, and the standing height ratio was calculated. Abrasion of the ski boot sole was also measured at the toe and heel. Participants were divided by sex into less and more skilled skiers.

Results

A total of 1817 recreational skiers participated in this study, of whom 392 (21.6%) sustained an ACL injury. A greater standing height ratio and more abrasion at the toe of the boot sole were associated with increased ACL injury risk in both sexes, independent of the skill level. Riskier behavior increased the injury risk only in male skiers, independent of the skill level, and longer skis increased the injury risk only in less skilled female skiers. Older age, the use of rented/borrowed skis, and more abrasion at the heel of the boot sole were independent risk factors for ACL injury in the more skilled skiers of both sexes.

Conclusion

Individual and equipment-related risk factors for an ACL injury partly differed according to skill level and sex. Consideration of the demonstrated equipment-related factors should be implemented in order to reduce ACL injuries in recreational skiers.

A Comparison of ACL Injury Risk, Ski Geometry and Standing Height Parameters between Skiers with Rented and with Owned Skis

to evaluate if ACL injuries are associated with recreational skiers using rented skis and whether individual factors, ski geometry parameters and standing heights differ between skiers who rented or owned skis. A retrospective questionnaire-based, case-control study of ACL-injured and uninjured recreational skiers was conducted during six winter seasons. Age, sex, body height, body weight, nationality, ownership of skis, skill level, risk-taking behavior, ski length, side-cut radius, widths of the tip, waist, and tail, and the standing heights at the front and rear components of the ski binding were assessed. Additionally, ratios between ski widths and a standing height ratio were calculated. Altogether, 1780 skiers (48.9% females) with a mean age of 39.2 ± 13.0 years participated, of whom 22.0% sustained an ACL injury and 32.3% rented skis. ACL injury risk was significantly associated with rented skis (OR 3.2, 95% CI 2.5-4.0). Compared to skiers using own skis, participants who rented skis were more likely female, smaller and lighter, tourists, less skilled and more cautious. In comparison to owned skis, rented skis showed significantly lower mean values in ski length, side-cut radius, ski widths, and for the three ski widths ratios. Additionally, standing heights were significantly lower while standing height ratio was higher for rented skis. Beside individual factors, equipment-related factors should be considered when renting skis in order to reduce ACL injury risk.

Helmet Use in Preventing Head Injuries in Bicycling, Snow Sports, and Other Recreational Activities and Sports

Bicycling, snow sports, and other recreational activities and sports are important activities to keep children and youth active as part of a healthy lifestyle. These activities can be associated with serious and fatal head and facial injuries. Helmets, when worn correctly, are effective in decreasing head injuries and fatalities related to these activities. Legislation for helmet use is effective in increasing helmet use in children and, ultimately, in decreasing deaths and head and facial injuries. A multipronged strategy employing legislation, enforcement of laws, and medical clinicians and community programs is important for increasing helmet use to decrease deaths and injuries from recreational sports.

Helmet Use in Preventing Head Injuries in Bicycling, Snow Sports, and Other Recreational Activities and Sports

Recreational activities and sports are a common and popular way for youth to enjoy physical activity; however, there are risks related to physical injury. Injuries can potentially result in death and long-term disability, especially from traumatic brain injury. Helmet use can significantly decrease the risk of fatal and nonfatal head injury, including severe traumatic brain injury and facial injuries when participating in recreational sports. The most robust evidence of helmet effectiveness has been demonstrated with bicycling and snow sports (eg, skiing, snowboarding). Despite this evidence, helmets are not worn consistently with all recreational sports. A multipronged approach is necessary to increase helmet use by children and youth participating in recreational sports. This approach includes legislation and enforcement, public educational campaigns, child education programs, and anticipatory guidance from clinicians. This policy statement guides clinicians, public health advocates, and policymakers on best practices for increasing helmet use in recreational sports, including bicycling and snow sports.

Research on Application Experience Design of Ice and Snow Sports Equipment Based on Bee Colony Model

Sports equipment is the key to the smooth development of ice and snow sports. With the rapid development of social economy and the improvement of people's living standards, the demand for ice and snow sports equipment is increasing day by day. This article presents an improved method based on the chaos theory and the bee colony algorithm to quantify the application experience design of ice and snow sports equipment and reduce the influence of uncertain factors on the design results. First, the chaos theory can establish the dataset of application experience design and analyze the discreteness of the set. According to the bee colony algorithm, the dataset is divided into several groups, and each group obtains the best application experience design by using the design optimization strategy. Finally, the results are mixed to obtain the final experience design results. Through MATLAB simulation analysis and verification, the improved bee colony model can improve the accuracy of application experience design of ice and snow sports equipment in an uncertain environment, shorten the overall design time, and meet the requirements of application experience design of different ice and snow sports equipment. Therefore, the model proposed in this paper is suitable for the application experience design of ice and snow sports equipment.

Incidence of injuries in professional snow sports: A systematic review and meta-analysis

PURPOSE

The study aimed to conduct a comprehensive systematic review and meta-analysis of injury incidence in professional skiers and snowboarders.

METHODS

We systematically searched PubMed, Web of Science, and MEDLINE for studies on injury incidence published from inception to April 2020. Injury data were extracted, alongside information on injury location, severity, type, cause, and sport discipline. Incidence of injuries was presented per 1000 athlete-days, with 95% confidence intervals (95%CIs).

RESULTS

The search identified 462 articles, and 22 were included in our review. The overall incidence of injuries among professional skiers and snowboarders was 3.49 per 1000 athlete-days (95%CI: 2.97-4.01). Lower extremity had the highest injury incidence (1.54 per 1000 athlete-days, 95%CI: 1.24-1.84). Incidence rates of slight, mild, moderate, and severe injuries were 0.26, 0.31, 0.57, and 0.59 per 1000 athlete-days, respectively. Contusion had the highest incidence rate (1.82 per 1000 athlete-days, 95%CI: 1.01-2.63). The most common cause of injury was contact trauma (3.20 per 1000 athlete-days, 95%CI: 1.32-5.08). Freestyle skiing had the highest incidence rate (6.83 per 1000 athlete-days, 95%CI: 4.00-9.66), and Nordic skiing had the lowest rate (2.70 per 1000 athlete-days, 95%CI: 1.94-3.46).

CONCLUSION

Professional skiers and snowboarders have a substantial risk of sustaining injuries. Our findings can be used to inform the planning and provision of healthcare for elite participants in different snow sports.

Managing risk in ski resorts: Environmental factors affecting actual and estimated speed on signposted groomed slopes in a cohort of adult recreational alpine skiers

Background

Certain weather conditions are clearly harmful, increasing the risk of injury of winter sports participants substantially. The objective of this study was to investigate actual speeds of skiers on signposted groomed slopes and to measure their skill to accurately estimate them with regard to environmental conditions such as visibility, sky cover, snow quality, wind and temperature.

Methods

The data were obtained from a sample of 421 adult recreational skiers taking ski courses. The Pearson correlation coefficient was used to explore the relationship between actual and estimated speed for all participants. Multiple linear regression analysis was used to measure the effect of environmental conditions on both the skiers’ actual speeds and their errors of estimation. Values of 0.05 or less were considered to indicate statistical significance.

Results

The Pearson correlation coefficient between estimated and actual speed was 0.90 (P < 0.001). Skiers underestimated their actual speed on average by 13.06 km/h or 24.1%. Visibility, quality of snow and wind speed were shown to significantly affect both actual maximum speed and estimated speed. Good visibility, grippy snow and calm wind were associated with both the highest actual maximum speed and the lowest ability to estimate it.

Conclusion

Certain environmental conditions are associated with the actual speed at which skiers travel and with their ability to estimate it. Visibility, quality of snow and wind speed seem to influence both actual speed and the ability to estimate it while sky cover and temperature do not. A reinforced understanding of skiing speed on signposted groomed slopes is useful to gain insight into crashes and the mechanisms of resulting injuries, to evaluate means of protection and to devise successful prevention policies in ski resorts.

Phonogenic Voice Problems among Speech-Language Pathologists in Synchronous Telepractice: An Overview and Recommendations

Many speech-language pathologists (SLPs) recently adopted a live, synchronous online distribution of clinical services due to physical distancing measures aimed at bringing the coronavirus disease 2019 (COVID-19) outbreak under control. Few SLPs had received training in telepractice to prepare them for changes from an in-person service delivery model to synchronous telepractice. The new telepractice environment may alter vocal behaviors and communication interactions in such a way that negatively impacts voice production. Thus, delivering synchronous online clinical services may require that SLPs adopt novel prevention strategies for avoiding phonogenic voice problems. Guided by two complementary injury frameworks, the Haddon Matrix and the Haddon Countermeasures, this article provides an overview of potential factors associated with phonogenic voice problems among SLPs in telepractice and proposes possible prevention strategies to maintain optimal vocal health and function with synchronous modes of online clinical practice.

Contributing Factors Affecting the Severity of Metro Escalator Injuries in the Guangzhou Metro, China

Urban rail transit has become one of the indispensable modes of public transportation in large cities. Escalators are ubiquitous in metro stations, as passengers typically use escalators when entering or leaving a metro station. Thus, escalators have become an accident-prone location. To develop suitable prevention strategies, it is necessary to understand the risk factors that affect the severity of escalator accidents. This study analyzed 967 escalator passenger accidents that occurred in the Guangzhou Metro from 2013 to 2015. The Haddon matrix was used to evaluate the interaction of humans, escalators, and environmental factors before, during, and after accidents. Then, the contributing factors associated with the severity levels were determined based on chi-square tests. Passengers aged 66 years and older are more vulnerable to serious injuries (p < 0.001), and previous health conditions are significantly related to the severity of the passenger’s injuries (p = 0.002). The weather conditions (rainy days) are also significantly related to the severity of escalator accident injuries (p = 0.039), and injured people with head injuries are at greater risk of being severely injured (p < 0.001). The analysis results of these risk factors can provide theoretical support for the metro operators to develop reasonable and effective preventive measures to reduce the escalator risk.

Geriatric Skiers: Active But Still at Risk, a National Trauma Data Bank Study

BACKGROUND

Downhill skiing accounts for a large portion of geriatric sport-related trauma. We assessed the national burden of geriatric versus nongeriatric ski trauma.

MATERIALS AND METHODS

Adults presenting to level 1/2 trauma centers after ski-associated injuries from 2011 to 2015 were identified from the National Trauma Data Bank by ICD-9 code. We compared demographics, injury patterns, and outcomes between geriatric (age ≥65 y) and nongeriatric adult skiers (age 18-64 y). A multiple regression analysis assessed for risk factors associated with severe injury (Injury Severity Score >15).

RESULTS

We identified 3255 adult ski trauma patients, and 16.7% (543) were geriatric. Mean ages for nongeriatric versus geriatric skiers were 40.8 and 72.1 y, respectively. Geriatric skiers more often suffered head (36.7 versus 24.3%, P < 0.0001), severe head (abbreviated injury scale score >3, 49.0 versus 31.5%, P < 0.0001) and thorax injuries (22.2 versus 18.1%, P = 0.03) as compared with nongeriatric skiers. Geriatric skiers were also more often admitted to the ICU (26.5 versus 14.9%, P < 0.0001), discharged to a facility (26.7 versus 11.6%, P < 0.0001), and suffered higher mortality rates (1.3 versus 0.4%, P = 0.004). Independent risk factors for severe injury included being male (OR: 1.68, CI: 1.22-2.31), helmeted (OR: 1.41, CI: 1.07-1.85), and having comorbidities (OR: 1.37, CI: 1.05-1.80). Geriatric age was not independently associated with severe injury.

CONCLUSIONS

At level 1/2 trauma centers, geriatric age in ski trauma victims was associated with unique injury patterns, higher acuity, increased rates of facility care at discharge, and higher mortality as compared with nongeriatric skiers. Our findings indicate the need for specialized care after high impact geriatric ski trauma.

Understanding youths' attitudes and practices regarding listening to music, video recording and terrain park use while skiing and snowboarding

BACKGROUND

Skiing and snowboarding are popular activities among Canadian youth and these sports have evolved to include certain risk behaviours such as listening to music, using terrain parks, and video recording yourself or others. The objective of this study was to determine the prevalence of these risk behaviours and identify factors that are associated with the risk behaviours.

METHODS

Using focus group methodology, a questionnaire was developed to capture aspects of the Theory of Planned Behaviour. A cross-sectional study was conducted where the questionnaire was administered to youth aged 13-18 during two winter seasons at two ski hills in Manitoba, Canada.

RESULTS

The sample was comprised of 735 youth (mean age 14.9; 82.1% male, 83.6% snowboarding). The most common behavior was using the TP (83.1%), followed by listening to music that day (36.9%), and video recording that day (34.5%). Youth had significantly higher odds of listening to music that day if they planned to next time (OR 19.13; 95% CI: 10.62, 34.44), were skiing or snowboarding alone (OR 2.33; 95% CI: 1.10, 4.95), or thought listening to music makes skiing or snowboarding more exciting or fun or makes them feel more confident (OR 2.30; 95% CI: 1.31, 4.05). They were less likely to if they believed that music made it more difficult to hear or talk to others (OR: 0.35; 95% CI: 0.18, 0.65). Youth had significantly higher odds of using the terrain park if they believed that terrain parks were cool, challenging, or fun (OR: 5.84; 95% CI: 2.85, 11.96) or if their siblings used terrain parks (OR: 4.94; OR: 2.84, 9.85). Those who believed that terrain parks were too busy or crowded (OR: 0.31; 95% CI: 0.16, 0.62) were less likely to use them. Youth had significantly higher odds of video recording that day if they reported that they plan to video record next time (OR: 8.09, 95% CI: 4.67, 14.01) or if they were skiing or snowboarding with friends (OR: 3.65, 95% CI: 1.45, 9.18). Youth had significantly higher odds of video recording that day if they agreed that recording makes them try harder and improved their tricks (OR: 3.34, 95% CI: 1.38, 8.08) compared to those who neither agreed nor disagreed. Youth were less likely to record themselves that day if their friends did not do so (OR: 0.36; 95% CI: 0.16, 0.80).

CONCLUSION

Common predictors of engaging in risk behaviours suggest that injury prevention programs may not have to be specific to each behaviour. Some strategies for injury prevention are suggested.

Knee injury prevention in alpine skiing. A technological paradigm shift towards a mechatronic ski binding

BACKGROUND

Skiing can be beneficial for the sense of delight and wellbeing. Nonetheless, the risk of injury should not be ignored. The traditional ski binding, working solely on a mechanical principle, performs well with regards to a prevention of mid-shaft tibia fracture. However, with respect to knee injuries, it is not able to provide protection. Future concepts, such as mechatronic binding designs have the potential to decrease knee injuries that traditional bindings cannot prevent. In addition to mechanical loads, this kind of binding design uses additional parameters, e.g. knee kinematics and the skier's muscle state, to control the binding release.

METHODS

This paper provides a review about our knowledge of injury mechanisms in recreational alpine skiing and previous work regarding mechatronic ski binding concepts. Also, our own biomechanical approach towards a mechatronic ski binding is described. Four input variables for an algorithm are discussed with respect to existing sensor solutions and designs of our own. A concept for an algorithm, based on our current knowledge in injury mechanisms is presented.

CONCLUSIONS

Though first designs were described in the 80s, for decades the idea of a mechatronic ski binding was not further pursued by research. Technological improvements in the field of micro-electronics and wearable sensors, as well as decreasing costs of these devices, make a mechatronic concept feasible. Main challenge is still the missing knowledge about injury mechanisms in alpine skiing and hence the quantification of the influence of possible input variables for the mechatronic system on those injuries.

The Demographics of Fractures and Dislocations Across the Entire United States due to Common Sports and Recreational Activities

BACKGROUND

There exists little nationwide data regarding fracture and dislocation patterns across a wide variety of sporting activities for all ages and sexes.

HYPOTHESIS

Participant demographics (age and sex) will vary with regard to fracture and joint dislocation sustained during sport-related activities.

STUDY DESIGN

Descriptive epidemiology study.

LEVEL OF EVIDENCE

Level 3.

METHODS

The National Electronic Injury Surveillance System All Injury Program data 2005 through 2013 were accessed; 18 common sports and recreational activities in the United States were selected. Statistical software was used to calculate the numbers of fractures and dislocations, and incidence was calculated using US Census Bureau data. Multivariate logistic regression analysis determined the odds ratios (ORs) for the occurrence of a fracture or dislocation.

RESULTS

A fracture occurred in 20.6% and a joint dislocation in 3.6% of the emergency department visits for sports-related injuries; annual emergency department visit incidence was 1.51 for fractures and 0.27 for dislocations (per 1000 people). Most of the fractures occurred in football (22.5%). The OR for fracture was highest for inline skating (OR, 6.03), males (OR, 1.21), Asians, whites, and Amerindians compared with blacks (OR, 1.46, 1.25, and 1.18, respectively), and those older than 84 years (OR, 4.77). Most of the dislocations occurred in basketball (25.7%). The OR for dislocation was highest in gymnastics (OR, 4.08), males (OR, 1.50), Asians (OR, 1.75), and in those aged 20 to 24 years (OR, 9.04). The most common fracture involved the finger, and the most common dislocation involved the shoulder.

CONCLUSION

Inline skating had the greatest risk for fracture, and gymnastics had the greatest risk for joint dislocation.

CLINICAL RELEVANCE

This comprehensive study of the risks of sustaining a fracture or dislocation from common sports activities across all age groups can aid sports health providers in a better understanding of those sports at high risk and be proactive in prevention mechanisms (protective gear, body training).

Stimulating injury-preventive behaviour in sports: the systematic development of two interventions

Background

In addition to the beneficial health effects of being active, sports are also associated with a risk of sustaining injuries. To avoid the occurrence of sports injuries, preventive measures can be applied. The aim of the current article is to provide insight into the systematic developmental process of two evidence-based interventions designed to stimulate injury-preventive behaviour in runners and skiers, in which Intervention Mapping (IM) and Knowledge Transfer Scheme (KTS) are used as developmental protocols. However, the ultimate steps in the process are adjusted to meet requirements of the intervention and the target group.

Methods

Using a three-step process, we developed two interventions to stimulate injury-preventive behaviour in runners and skiers. Sports participants, sports experts and behaviour experts contributed throughout steps two and three of the developmental process.

Results

In step one we started with a problem statement in which we used information about the number and the burden of running-related and skiing-related injuries in the Netherlands. In step two, in-depth research was performed using four research strategies. During this step we tried to answer the following question: Which preventive measures or actions should be executed to prevent what injuries by whom, and how should we do that? A desk research/systematic review of the literature, expert meetings, target user surveys, and target user focus group meetings were conducted. In step three of product development, both interventions were developed. During the developmental process, co-creation sessions with target users were held. Before finalizing the interventions, pre-tests of the interventions were performed with target users.

Conclusions

Through a three-step approach, we developed two interventions to stimulate injury-preventive behaviour in runners and skiers. To develop an intervention that fits the needs of the target population, and will be used by them, it is necessary to involve this population as soon and as much as possible. Several steps in the IM and KTS protocols have thus been adjusted in order to establish an optimal fit between intervention and target group.

Injury patterns after skiing and snowboarding sports accidents

BACKGROUND

Alpine sports are associated with risk of serious injuries. To gain insight into factors that may help reduce injury severity, accident characteristics and injury patterns were analyzed in a cohort of injured skiers and snowboarders.

METHODS

All patients with Alpine sports-related injuries, reporting the injury to a leading medical assistance organization in the Netherlands in the period of 2013-2016, were contacted. Medical data were collected from the patients' files. Only ski and snowboard incidents were included. Injuries were classified according to the Abbreviated Injury Scale (AIS) and Injury Severity Scale (ISS). Data on the accident conditions, i.e. risk factors, were collected using retrospective patient-reported questionnaires. Risk factors for injuries with ISS≥9 were analysed by multivariate modelling.

RESULTS

Of the 1588 included patients, 421 patients filled out the questionnaire. Skiers (N.=1370) had more knee injuries (20.4% vs. 7.4%, P<0.001), femur fractures (5.3% vs. 0.5%, P=0.002) and lower leg fractures (27.5% vs. 11.5%, P<0.001) compared to snowboarders (N.=218). Skiers were also more seriously injured (ISS>9) (P=0.01). Injured snowboarders sustained more brain concussions (8.8% vs. 15.7%, P=0.003) and lower arm fractures (5.4% vs. 16.1%, P<0.001). Only 'a higher skills level' was borderline significant for predicting serious injury (OR: 4.0 95% CI: 0.86-18.50; P=0.08). No additional risk factors were identified.

CONCLUSIONS

Injury patterns after skiing and snowboarding accidents differ, injury severity differed not. Preventive measures should therefore aim to protect specific body parts depending on the type of Alpine sport. Experienced skiers and snowboarders may be more at risk for serious injuries.

Effect of environmental conditions on injury rates at a Colorado ski resort

OBJECTIVE

To determine the effect of daily environmental conditions on skiing and snowboarding-related injury rates.

METHODS

Injury information was collected from a mountainside clinic at a large Colorado ski resort for the 2012/2013 through 2016/2017 seasons. Daily environmental conditions including snowfall, snow base depth, temperature, open terrain and participant visits were obtained from historical resort records. Snowpack and visibility information were obtained for the 2013/2014 through 2014/2015 seasons and included in a subanalysis. Negative binomial regression was used to estimate injury rate ratios (IRRs) and 95% CIs.

RESULTS

The overall injury rate among skiers and snowboarders was 1.37 per 1000 participant visits during 2012/2013 through 2016/2017. After adjustment for other environmental covariates, injury rates were 22% higher (IRR=1.22, 95% CI 1.14 to 1.29) on days with <2.5 compared with ≥2.5 cm of snowfall, and 14% higher on days with average temperature in the highest quartile (≥-3.1°C) compared with the lowest (<-10.6°C; IRR=1.14, 95% CI 1.03 to 1.26). Rates decreased by 8% for every 25 cm increase in snow base depth (IRR=0.92, 95% CI 0.88 to 0.95). In a subanalysis of the 2013/2014 and 2014/2015 seasons including the same covariates plus snowpack and visibility, only snowpack remained significantly associated with injury rates. Rates were 71% higher on hardpack compared with powder days (IRR=1.71, 95% CI 1.18 to 2.49) and 36% higher on packed powder compared with powder days (IRR 1.36, 95% CI 1.12 to 1.64).

CONCLUSIONS

Environmental conditions, particularly snowfall and snowpack, have a significant impact on injury rates. Injury prevention efforts should consider environmental factors to decrease injury rates in skiers and snowboarders.

The (In)visibility of Groomed Ski Runs

I analyse the visibility of "groomed" ski runs under different lighting conditions. A model of human contrast sensitivity predicts that the spatial period of groomed snow may render it invisible in the shade or on overcast days. I confirm this prediction with visual demonstrations and make a suggestion to improve visibility.

Intervention Strategies Used in Sport Injury Prevention Studies: A Systematic Review Identifying Studies Applying the Haddon Matrix

BACKGROUND

Prevention of sport injuries is crucial to maximise the health and societal benefits of a physically active lifestyle. To strengthen the translation and implementation of the available evidence base on effective preventive measures, a range of potentially relevant strategies should be considered.

OBJECTIVE

Our aim was to identify and categorise intervention strategies for the prevention of acute sport injuries evaluated in the scientific literature, applying the Haddon matrix, and identify potential knowledge gaps.

METHODS

Five electronic databases were searched (PubMed, EMBASE, SPORTDiscus, CINAHL, Cochrane) for studies that evaluated the effect of interventions on the occurrence of acute sport injuries. Studies were required to include a control group/condition, prospective data collection, and a quantitative injury outcome measure.

RESULTS

A total of 155 studies were included, mostly randomised controlled trials (43%). The majority of studies (55%) focussed on strategies requiring a behavioural change on the part of athletes. Studies predominantly evaluated the preventive effect of various training programmes targeted at the 'pre-event' phase (n = 73) and the use of equipment to avoid injury in the 'event phase' (n = 29). A limited number of studies evaluated the preventive effect of strategies geared at rules and regulations (n = 14), and contextual modifications (n = 18). Studies specifically aimed at preventing re-injuries were a minority (n = 8), and were mostly related to ankle sprains (n = 5).

CONCLUSIONS

Valuable insight into the extent of the evidence base of sport injury prevention studies was obtained for 20 potential intervention strategies. This approach can be used to monitor potential gaps in the knowledge base on sport injury prevention.

What are the risk factors for injuries and injury prevention strategies for skiers and snowboarders in terrain parks and half-pipes? A systematic review

OBJECTIVE

To synthesise the current evidence regarding the risk factors, the injury prevention strategies and the profile of injured skiers and snowboarders in terrain parks (TPs) and half-pipes (HPs).

DESIGN

Systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines.

DATA SOURCES

Literature searches from six electronic databases and manual searches were performed.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Inclusion criteria were: (1) publication based on original data; (2) injuries sustained in TPs or HPs; (3) recreational skiing or snowboarding injuries; (4) observational or experimental study design with a comparison group.

RESULTS

No study explored the risk factors in HPs or the prevention strategies in TPs or HPs. From the literature retrieved, there is strong evidence that skiing or snowboarding in a TP is a risk factor for head, neck, back and severe injuries. Two papers assessed the risk factors for injuries in TPs, mainly demonstrating that features promoting aerial manoeuvres or a large drop to the ground were associated with higher feature-specific injury rates. The profile of injured skiers and snowboarders in TPs described in the literature suggested some evidence of associations between factors including activity, sex, skill level, helmet use, age and TP injuries.

SUMMARY/CONCLUSIONS

This systematic review demonstrates the need for studies identifying the risk factors for injuries to skiers and snowboarders and on interventions to reduce the risk of injury in TPs and HPs. Studies addressing the issue of TP design should be considered.

PROSPERO REGISTRATION NUMBER

CRD42016045206.

Training Load and Fatigue Marker Associations with Injury and Illness: A Systematic Review of Longitudinal Studies

Background

Coaches, sport scientists, clinicians and medical personnel face a constant challenge to prescribe sufficient training load to produce training adaption while minimising fatigue, performance inhibition and risk of injury/illness.

Objective

The aim of this review was to investigate the relationship between injury and illness and longitudinal training load and fatigue markers in sporting populations.

Methods

Systematic searches of the Web of Science and PubMed online databases to August 2015 were conducted for articles reporting relationships between training load/fatigue measures and injury/illness in athlete populations.

Results

From the initial 5943 articles identified, 2863 duplicates were removed, followed by a further 2833 articles from title and abstract selection. Manual searching of the reference lists of the remaining 247 articles, together with use of the Google Scholar ‘cited by’ tool, yielded 205 extra articles deemed worthy of assessment. Sixty-eight studies were subsequently selected for inclusion in this study, of which 45 investigated injury only, 17 investigated illness only, and 6 investigated both injury and illness. This systematic review highlighted a number of key findings, including disparity within the literature regarding the use of various terminologies such as training load, fatigue, injury and illness. Athletes are at an increased risk of injury/illness at key stages in their training and competition, including periods of training load intensification and periods of accumulated training loads.

Conclusions

Further investigation of individual athlete characteristics is required due to their impact on internal training load and, therefore, susceptibility to injury/illness.

A Tailored Web-based Advice Tool for Skiers and Snowboarders: Protocol for a Randomized Controlled Trial

BACKGROUND

Being active in sports has many positive health effects. The direct effects of engaging in regular physical activity are particularly apparent in the prevention of several chronic diseases, including cardiovascular disease, diabetes, cancer, hypertension, obesity, depression, and osteoporosis. Besides the beneficial health effects of being active, sports participation is unfortunately also associated with a risk of injuries. In the case of many sports injuries (eg, winter sports) preventive measures are not compulsory, which means that a behavioral change in sports participants is necessary to increase the use of effective measures, and subsequently prevent or reduce injuries in sports.

OBJECTIVE

The evidence-based Wintersportklaar online intervention has been developed to stimulate injury preventive behavior among skiers and snowboarders. In this article, the design of the effectiveness study will be described.

METHODS

A randomized controlled trial with a follow-up period of four months during the winter sport season will be conducted. The participants consist of inexperienced skiers and snowboarders. At baseline, skiers and snowboarders in the intervention and control groups are asked to report the injury preventive measures they usually take during their preparation for their winter sport holiday. One and three months after baseline, skiers and snowboarders are asked to report retrospectively in detail what measures they took regarding injury prevention during their current winter sport preparation and winter sport holiday. Descriptive analyses (mean, standard deviation, frequency, range) are conducted for the different baseline variables in both study groups. To evaluate the success of the randomization, baseline values are analyzed for differences between the intervention and control groups (chi square, independent T tests and/or Mann-Whitney test). Chi square tests and/or logistic regression analyses are used to analyze behavioral change according to the intention to treat principle (as initially assigned).

RESULTS

The project was funded in 2016 and enrolment was completed in 2017. Data analysis is currently under way and the first results are expected to be submitted for publication in 2018.

CONCLUSIONS

To combat the negative side effects of sports participation, the use of injury preventive measures is desirable. As the use of injury prevention is usually not compulsory in skiing and snowboarding, a behavioral change is necessary to increase the use of effective injury preventive measures in winter sports.

TRIAL REGISTRATION

Dutch Trial Registry NTR6233; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=6233 (Archived by WebCite at  http://www.webcitation.org/6wXZPzjUi).

Adventure and Extreme Sports

Adventure and extreme sports often involve unpredictable and inhospitable environments, high velocities, and stunts. These activities vary widely and include sports like BASE jumping, snowboarding, kayaking, and surfing. Increasing interest and participation in adventure and extreme sports warrants understanding by clinicians to facilitate prevention, identification, and treatment of injuries unique to each sport. This article covers alpine skiing and snowboarding, skateboarding, surfing, bungee jumping, BASE jumping, and whitewater sports with emphasis on epidemiology, demographics, general injury mechanisms, specific injuries, chronic injuries, fatality data, and prevention. Overall, most injuries are related to overuse, trauma, and environmental or microbial exposure.