Michael L Gross, MD  
Male, 64
Hackensack,Westwood, NJ

Specialties: orthopedic surgery, sports medicine

Interests: Orthopedics, Knee and Shoulder Arthroscopy
Active Orthopedics & Sports Medicine
Hackensack, NJ
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10 Tips to Avoid Ski Injuries this Winter

Mar 02, 2011 - 1 comments

Winter is still with us, just look out the window and there is certainly no doubt of that.  While you may have already hit the slopes, it is never too late to think about safety.  Skiing is a high speed sport that requires strength, endurance, balance, skill, and co-ordination. Muscles involved are the quadriceps, hamstrings, gluteals, abdominals, upper body and especially the core.
At highest risk for injury, are the joints of the lower limbs, which bear the brunt of the forces passing through the body while skiing. The knee joint is the most vulnerable joint while skiing, with the ankle joint, the wrist, thumb and shoulder being the other joints commonly injured. Improvement in ski boots and bindings protect the foot, ankle and the tibia from injury. Unfortunately, this results in the even greater ground forces being transmitted to the semi-flexed knee. While overall injury rates for skiing continue to drop, knee injuries, particularly to the anterior cruciate ligament (ACL) are on the rise.
Skiing is generally considered to be a sport with a high injury risk. Although, recent advances in design of equipment, as well as technique, has resulted in a drastic reduction of risk. However, injuries to the anterior cruciate ligament of the knee, and spinal injuries, continue to occur at an alarming rate. Thumb injuries are also a common occurrence.  When you are injured, seek medical attention; but the best treatment is to avoid injury altogether.
Presented here are 10 easy ways to prevent injuries while you’re out on the mountain:
1. Prepare for a ski trip with a conditioning program
A physical conditioning program is very important for avoiding injuries on the ski slopes. Physical conditioning is vital for improved muscular strength, endurance, co-ordination, and reflexes. Skiers should start doing exercises about a month and a half to two months prior to heading for the ski resorts. Some good exercises, to help prepare for the slopes include those which use similar motions. Swimming, bicycling and rowing use similar muscles and build endurance, as well as strength. Exercises which strengthen the thigh muscles are also helpful,.  Most important are exercises to build core strength and balance.  Don’t try to ski yourself into shape
2. Stretching is important
Stretching improves your flexibility, another key ingredient in avoiding a ski injury. When you stretch, combine both dry land stretching and ski stretches with your skis and boots on once you are out on the mountain.  Concentrate on stretching your legs and core, but don’t forget your upper body as well. Don’t forget to stretch when you get off the lift and are at the top of the mountain.  A few minutes of stretching before you turn back down the mountain, could be the best investment you make all season!
3. Choose the proper Equipment
Skiers using incorrectly adjusted skis and bindings are eight times more likely to sustain an injury.  Consider ski conditions, your ability, and your experience when choosing which skis to buy.  Buy skis and ski bindings together to ensure a proper fit. Choose skis based on your ability, the type of skiing you plan to do and your weight. Get measured by a professional to ensure a good fit.  Skis now are shorter and more shaped like an hourglass than in the past. If you’re still hanging on to your sentimental favorites, this is the year to update.  Choose poles that fit your height. To find the right size pole, stand in your ski boots and hold the pole upside down to the ground. Place your hand under the basket (the round piece at the bottom of the pole) and touch your thumb to the basket. Your arm and the pole should create a 90 degree angle. If the angle is more than 90 degrees, you need a longer pole. If the angle measures less than 90 degrees, your pole should be shorter.  Purchase boots for skiing that fit snugly and offer proper support based on your skiing ability. Novice skiers generally wear "soft" boots that allow for slower skiing while advanced skiers choose stiffer boots that offer agility and work well with speed.  Find ski goggles that provide protection from ultraviolet rays, wind and sun glare.  If you already have all the equipment you need, make sure it is well maintained, and in even better shape than you are!
4. Take a rest  
The highest risk of accident is after 3pm on the third day of your ski trip. This is because muscle fatigue reaches its peak 48 hours after you start your vacation.  In general, recreational skiers on a skiing holiday should follow the rule of three: after two days of skiing, the muscles of the lower limb are fatigued and therefore less able to protect against injuries. The rule of three thus recommends a stop no later than 3 pm each day, skiing not more than 3000m each day, and taking the third day off.
Don’t just rely on the rule of three. If you do feel tired while skiing or snowboarding, it’s important to listen to your body and take breaks as necessary. If you’re on the trail, pull off to the side—never stop in the middle, below a jump or blind rollover. If you can, head to the closest lodge for water and a snack, and rest for a little while before heading back out.
If you’ve really overdone it on the slopes in the morning, don’t overdo it and push yourself to ski all day. There’s nothing wrong with quitting a little early if it helps prevent a serious injury. Go get a massage or use the hot tub to soothe those tired muscles instead. Besides, there are fewer people in the resort hot tub in the mid-afternoon anyway.

5. Take a lesson
From the novice to the most experienced expert, an hour with an instructor at the start of your trip can be a good idea, and a great way to prevent injuries.  A qualified ski instructor can help you improve your skills, so that you can safely ski more challenging terrain.  Bad habits learned early on, are difficult to resolve on your own, and a good instructor can identify them and help correct them.  Proper form and technique are essential to avoid injuries.  It is important to choose ski runs that you can ski on successfully. If you select a run that is too difficult for your level of expertise, you are more likely to suffer an accident. Ask the ski instructor to describe the various runs so that you have a clear idea of what to expect, and what level of expertise is required. If you are skiing in unfamiliar terrain, an instructor can help identify the runs that are most appropriate for you, and also point out potential rough spots.
6. Don’t Drink and Ski
Don't drink alcohol at lunch or on the slopes. Most ski accidents happen in the afternoon. The effects of muscle fatigue—less strength and control—are increased by the consumption of alcohol. Contrary to popular belief, more relaxation is not always a benefit to your skiing.  Avoid alcohol while on the slopes.  Save the drink for après ski by a fire in the lodge
7. Dress well
When buying skiwear, look for fabric that is water and wind-resistant. Look for wind flaps to shield zippers, snug cuffs at wrists and ankles, collars that can be snuggled up to the chin and drawstrings that can be adjusted for comfort and keep wind out. Be sure to buy quality clothing and products. Dress in layers. Layering allows you to accommodate your body's constantly changing temperature. For example, dress in polypropylene underwear (top and bottoms), which feels good next to the skin, dries quickly, absorbs sweat and keeps you warm. Wear a turtleneck, sweater and jacket. Be prepared. Mother Nature has a mind of her own. Bring a headband or hat with you to the slopes, 60 percent of heat-loss is through the head. Wear gloves or mittens (mittens are usually better for those susceptible to cold hands).
8. Wear a Helmet.
Recent research has shown that the use of helmet reduces the incidence of any head injury by 30 to 50 percent, but that the decrease in head injuries is generally limited to the less serious injuries such as scalp lacerations, mild concussions (Grade I) and contusions to the head, as opposed to more serious injuries such as concussions greater than Grade II, skull fractures, closed head injuries and the like. There has been no significant reduction in fatalities over the past nine seasons even as the use of helmets overall has increased to 57 percent overall usage among skiers and snowboarders, and to as much as 43 percent within the population at greatest risk—experienced young adult male skiers and snowboarders. This trend emphasizes the importance of not increasing risk-taking behavior simply because you are wearing a helmet.   It is important that any helmet be properly fitted and that it not uncomfortably restrict your vision or hearing. Read the helmet manufacturer's information and learn about what level of protection a particular helmet will provide. All models are not the same and do not provide the same level of protection.
9. Fall Correctly
You are going to fall; falling while skiing is inevitable.  Since you are going to fall eventually, learn to fall correctly.  In a fall, keep your arms forward and your hands over your skis if possible. Keep your arms away from your body, don’t keep them tucked in.  Don’t fully straighten your legs when you fall - try and keep them bent.  After a fall, don’t try to get up until you have stopped moving.  
10. Ski Smart, Be Aware.
Observe the National Ski Areas Association Code listed below and share with other skiers the responsibility for a great skiing experience.
Always stay in control.
People ahead of you have the right of way.
Stop in a safe place for you and others.
Whenever starting downhill or merging, look uphill and yield.
Use devices to help prevent runaway equipment.
Observe signs and warnings, and keep off closed trails.
Know how to use the lifts safely.

Skiing can be a fun and healthy pastime.  Taking the time and making the effort to prepare, trying to observe a few simple rules, and being smart enough to know when you’ve done enough, can make all the difference.  Some injuries are unavoidable, but most can be prevented.  Hopefully, your next itinerary won’t include a visit to the ER.  But if you do have bad luck, follow up and get the proper care when you return home.  

Dr. Michael Gross, the founder and director of Active Orthopedics and Sports Medicine P.A., www.activeorthopedics.com , is the section chief for sports medicine and the orthopedic director for the center for sports medicine at Hackensack University Medical Center.  Dr. Gross is the co-founder and medical director of the Active Center for Health and Wellness, a unique facility promoting health through a combination of services including personal training, nutrition counseling, massage therapy, acupuncture, and Bio-identical Hormone Replacement Therapy www.activecenterforhealthandwellness.com

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by ChitChatNine, Mar 03, 2011
Last March my pre-teen son suffered a stress fracture of his growth plate while skiing and was in a cast for a few weeks -- this year, so far, has been uneventful in the way of injuries.  He wore a helmet while snowboarding and protective gear w/o putting up his usual "fuss" -- it's a shame that so many feel "they" will never get injured --- it's always "someone else", until they experience it first hand.

Thanks for writing this great blog!


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