Nordic (cross-country) skiing injuries in Australia

Musculoskeletal Injuries in Cross-Country Skiing

Cross-country skiing, one of the oldest forms of skiing, is enjoyed widely as a recreational activity and as a competitive sport. It is practiced in regions with snow-covered landscapes, particularly in the Nordic countries and with increasing popularity in non-Nordic countries of Europe as well as in the United States, Canada, Australia, and New Zealand, among others. Cross-country skiing is a fairly safe activity, and historically the risk of injury has been relatively low. However, advances in equipment development, together with increasing speeds, more demanding trails, and growing numbers of participants, have all contributed to a larger report of injuries, although still comparatively low versus other skiing modalities. Injuries in cross-country skiing can occur either after a single traumatic event or in the setting of chronic repetitive microtrauma (i.e., overuse injuries).

Hospital-Treated Snow Sport Injury in Victoria, Australia: A Summary of 2003-2012

INTRODUCTION

To determine the incidence rate and changes over time for ice and snow sports injury in Victoria, Australia, from 2003 to 2012 and describe the most common types and causes of these injuries.

METHODS

Retrospective data from the Victorian Injury Surveillance Unit describing hospital admissions and emergency department presentations were extracted for the 10-year period of 2003 to 2012 for all ice- and snow-related injury. Descriptive injury data and participation-adjusted trend analyses using log-linear regression modelling of data (statistical significance, P<0.05) from the Exercise, Recreation and Sport Survey 2003 to 2010 are presented.

RESULTS

Overall, there were 7387 ice- and snow-related injuries, with a significant increase in hospital-treated snowboard injuries and a (nonsignificant) decline in hospital-treated ski injuries over the 10 years. Skiing (39%) and snowboarding (37%) had the highest incidence of hospital-treated injury, with males aged 15 to 24 years injured most frequently in both sports. Falls were the most common cause of injury in both skiing (68%) and snowboarding (78%).

CONCLUSIONS

Patterns of snow sports injury in Australia during 2003 to 2012 remain similar to findings of national studies conducted decades earlier. More importantly, however, Australian injury patterns are comparable to international statistics and thus may be generalizable internationally. Head injuries, although infrequent, are associated with great injury severity due to a high frequency of hospitalization. Furthermore, research into the use of personal protective equipment and other injury prevention measures among Australian participants, particularly by young, male snowboarders, is required. Given the similar injury patterns, injury prevention measures implemented internationally could reasonably translate to an Australian setting.

A systematic review on ankle injury and ankle sprain in sports

This article systematically reviews epidemiological studies on sports injury from 1977 to 2005 in which ankle injury was included. A total of 227 studies reporting injury pattern in 70 sports from 38 countries were included. A total of 201,600 patients were included, with 32,509 ankle injuries. Ankle injury information was available from 14,098 patients, with 11 847 ankle sprains. Results show that the ankle was the most common injured body site in 24 of 70 included sports, especially in aeroball, wall climbing, indoor volleyball, mountaineering, netball and field events in track and field. Ankle sprain was the major ankle injury in 33 of 43 sports, especially in Australian football, field hockey, handball, orienteering, scooter and squash. In sports injuries throughout the countries studied, the ankle was the second most common injured body site after the knee, and ankle sprain was the most common type of ankle injury. The incidence of ankle injury and ankle sprain was high in court games and team sports, such as rugby, soccer, volleyball, handball and basketball. This systematic review provides a summary of the epidemiology of ankle injury in sports.

A systematic review on ankle injury and ankle sprain in sports

This article systematically reviews epidemiological studies on sports injury from 1977 to 2005 in which ankle injury was included. A total of 227 studies reporting injury pattern in 70 sports from 38 countries were included. A total of 201,600 patients were included, with 32,509 ankle injuries. Ankle injury information was available from 14,098 patients, with 11 847 ankle sprains. Results show that the ankle was the most common injured body site in 24 of 70 included sports, especially in aeroball, wall climbing, indoor volleyball, mountaineering, netball and field events in track and field. Ankle sprain was the major ankle injury in 33 of 43 sports, especially in Australian football, field hockey, handball, orienteering, scooter and squash. In sports injuries throughout the countries studied, the ankle was the second most common injured body site after the knee, and ankle sprain was the most common type of ankle injury. The incidence of ankle injury and ankle sprain was high in court games and team sports, such as rugby, soccer, volleyball, handball and basketball. This systematic review provides a summary of the epidemiology of ankle injury in sports.

Telemark skiing injuries: characteristics and risk factors

OBJECTIVE

To determine the types of injuries associated with telemark skiing and the effects of ability level, equipment, and terrain.

METHODS

A survey was mailed to a sample of North American telemark skiers.

RESULTS

Completed surveys were returned by 548 telemarkers (response rate = 74.5%). The mean age was 42.7 (+/- 9.3) years, and 69% were male. A total of 439 injury events resulted in 494 body injuries, reported by 285 skiers (52%). Lower-extremity injuries (n = 231) were more frequent than upper-extremity injuries (n = 187). Knee injuries were most common with 128 cases, followed by 80 thumb, 66 shoulder, and 44 ankle injuries. Surgery was required in 39 cases. Skiers suffering thumb injuries with sequela lasting greater than 3 months were 10.1 times less likely to have sought medical attention than skiers with other long-term injuries (p < 0.001). Injuries occurred more often at lift-served ski areas (74.2%) than in the backcountry (25.8% [p < 0.001, OR = 2.09]). There was no association between boot type and overall knee or ankle injury, but risk of severe ankle injury was increased in leather boots compared to plastic (OR = 8.0, CI = 1.05, 60.59). Release bindings were used by 27.9% of all skiers but were in use in only 18.7% of injury events, suggesting that release plates have a protective effect against injury (OR = 0.59, p < 0.001). In 66 of 82 injuries (80.5%) sustained while using release bindings, the bindings did not release.

CONCLUSIONS

The knee, thumb, shoulder, and ankle are most frequently injured telemark skiing. Injuries are more likely to occur at lift-served areas than in the backcountry. Thumb injuries are often ignored and may result in long-term sequela. Ankle injuries appear more severe in leather boots. Release bindings appear protective against injury, but they often do not release.

The epidemiology of skiing injuries in Antarctica

A retrospective analysis of all skiing injuries experienced by members of the British Antarctic Survey between 1989 and 1995 was undertaken to test the hypothesis that skiing was responsible for a disproportionate number and severity of injuries compared with other activities. Fifty-nine new consultations for skiing injuries were recorded. This represented 3.2% of all consultations (annual range 1.3-6.7%), or 9.7% of all consultations due to trauma. The mean incidence was 84.3/1000 population/year. The annual proportion and rate of consultation fluctuated but no overall trends were noted. The lower limb was the commonest site of injury (76.3%), with the ratio of lower limb: upper limb injuries being 6.4:1. The commonest single injury was an isolated medial collateral ligament knee sprain (23.7% of all consultations). Head injuries comprised 8.5% and ulnar collateral ligament thumb sprains 5.1%. Assessment of injury by the Injury Severity Score (ISS) showed that skiing injuries were significantly more likely to be non-trivial (ISS > 2) than work-related injuries [chi 2(1, N = 56) = 55.6, p < 0.001] or injuries of all causes [chi 2(1, N = 56) = 65.0, p < 0.001]. They were significantly more likely to need radiological investigation than all injuries [chi 2(1, N = 59) = 22.0, p < 0.001]. The most severe (ISS 13), survivable injury seen during the study period resulted from a skiing accident. This excess of non-trivial injury raises important management issues, particularly as the majority (81%) were recreational.

Telemark skiing injuries: a three-year study

Telemark skiing is an increasingly popular wilderness activity. Little is known, however, about the injuries incurred during modern telemark skiing. To determine the incidence and types of these injuries we carried out a prospective analysis of injured telemarkers over three ski seasons from November 1994 through May 1997 at the Mount Hood Meadows ski area medical clinic in Oregon. Injured telemark skiers presenting to the clinic were asked to fill out a one-page survey, and a diagnosis was provided by the clinic physician or nurse. During the 1995-1996 and 1996-1997 ski seasons, skiers were counted at the ski lifts to determine the proportion of telemark skiers, alpine skiers, and snowboarders using the lifts. Using these proportions and the total ticket sales for the year, the number of downhill skiers, snowboarders, and telemarkers over the season were estimated, and injury rates were calculated. During the three ski seasons, 33 injuries were identified in 28 injured telemarkers. Of the study participants, 75% (21) were male. The average age was 33.1 years. Self-described intermediate and advanced telemarkers accounted for 74% of the injured. In 96% of the injuries, the skier was performing a telemark turn. Powder snow or heavy, wet snow conditions were reported most often. Lower-extremity injuries were most common, accounting for 42.5% (14) of the total. Seven of the lower-extremity injuries were ankle injuries, and four were knee injuries. Upper-extremity injuries comprised 24.2% (8) and head and facial injuries 21.2% (7) of the total. The least number of injuries occurred in the spine, 12.1% (4). Release plates were used by 8 of 28 skiers and only released in two instances. Telemark skiers comprised 0.9% of skiers counted at the lifts during the 1995-1996 season and 1.8% in 1996-1997. Injury rates/1000 skier days in 1995-1996 were 3.3 (95% CI: 3.27, 3.35) for downhill skiers, 4.1 (95% CI: 3.32, 5.22) for telemark skiers, and 6.8 (95% CI: 6.54, 7.00) for snowboarders. Injury rates/1000 skier days in 1996-1997 were 3.1 (95% CI: 3.05, 3.15) for downhill skiers, 1.7 (95% CI: 1.44, 2.11) for telemark skiers, and 5.6 (95% CI: 5.39, 5.78) for snowboarders. We conclude that telemark skiers comprise only a small proportion of skiers at a lift-served area. Lower-extremity injuries were most common, followed by upper-extremity and head and facial injuries. Injury rates for telemarkers are comparable to those for alpine skiers.

Level of medical care required for mass gatherings: the XV Winter Olympic Games in Calgary, Canada

STUDY OBJECTIVE

To determine the level of medical care required for mass gatherings and describe the types of medical problems encountered in a major winter event.

DESIGN

Standard charts were available for 3,395 encounters. Interviews with medical staff showed that the few unrecorded encounters were for very minor medical problems. A four-tiered triage system (low, moderate, urgent, and emergent) developed before the Games was applied to each chart retrospectively by a single emergency physician. Chi-squared tests were used to test significant differences.

SETTING

This winter sporting and entertainment event had 12 urban and rural venues. Medical staff (98 physicians, 161 nurses, and 337 first-aid attendants) were based in 28 advanced life support (ALS) clinics. The medical service operated for four weeks.

TYPE OF PARTICIPANTS

There were 1.8 million spectator-days. Patients included spectators, athletes, and support staff.

INTERVENTIONS

First-aid attendants referred patients to the clinics, where nurses conducted initial assessments and referred patients to physicians at the venue, or more rarely, to local hospital emergency departments. Paramedic ambulances were stationed at the venues. The triage system was not used for patient management.

MEASUREMENTS AND MAIN RESULTS

Only 40 urgent and one emergent medical problems were encountered. The majority of patients could have been managed by trained nurses working alone under standing orders. Fifty patients were transported to the hospital by ground ambulance and three by helicopter. No significant differences were found in the low acuity levels experienced at indoor urban venues, outdoor urban venues, and the rural cross-country ski venue. The Alpine ski venue was characterized by significantly higher acuity and a long prehospital transfer phase.

CONCLUSION

Owing to the low acuity encountered and the availability of Calgary's ALS ambulance service, we concluded that physician-based ALS teams were not required for patient management at the urban venues. Such teams were found to be required at the rural Alpine ski venue. Other reasons for using physicians are discussed, as is development of a standard triage system for mass gatherings.

The incidence of ankle sprains in soccer

This study investigated the relationship between exposure time and ankle sprains in soccer. Forty-one teams (639 players) from four male senior soccer divisions at different levels of skill (divisions I-VI) were followed prospectively for 1 year. The exposure to soccer and the number of injuries per player were higher in higher divisions, but the injury incidence, percentage of ankle injuries and incidence of ankle injuries were the same at different levels of skill. Of all injuries 17 to 20% were ankle sprains and the incidence varied between 1.7 to 2.0 ankle injuries per 1,000 hours of exposure. Since players with previous ankle problems run an increased risk of reinjury we suggest that these players receive preventive advice.