On the striking downward trend in injuries associated with alpine skiing

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Martin Burtscher is Professor at the Department of Sport Science, Medical Section, at the University of Innsbruck, Austria

Gerhard Ruedl is Assistant Professor at the Department of Sport Science at the University of Innsbruck, Austria

 

Daily news reports on skiing injuries during the winter season may convey the impression of downhill skiing as being a most dangerous activity. In fact, these reports have to be interpreted in the light of the very large participation rates. Worldwide, there are more than 2,000 downhill ski areas spread across 80 countries with an estimated 400 million skier days annually.

Assuming a death rate of 1 per 1 million skier days and an injury rate of 1-2 per 1,000 skier days a total of 400 fatalities and 400,000 to 800,000 injured skiers would result. That may be enough to fill newspapers daily but they actually represent a relatively low death and injury risk.

Put another way, for the individual who skis for 20 days per winter season on average, 1 death would occur within 50,000 years and 1 injury within 25 to 50 years. Of course, each individual fatality and each individual injury is one too many, but let's not disregard potential health benefits resulting from 400 million days of physical activity of the overall skier population.

The death rate of about 1 per 1 million skier days (which includes both traumatic and non-traumatic deaths) has remained relatively stable over time. The vast majority of fatalities are due to a collision with a solid object like a tree or rocks and would be mostly avoidable by choosing a skiing velocity appropriate to individual skiing skills.

In contrast, the injury risk in downhill skiers has changed dramatically over the last six decades. For example, a study performed in 1961 at Mount Snow in Vermont found an overall injury rate of 5.9 per 1,000 skier days, and a similar study conducted thirty years later at Blackcomb Mountain in British Columbia reported an injury rate of 2.9 per 1,000 skier days. Newest data collected in large Alpine ski regions revealed a further drop of this rate to about 0.6 to 1.0.  but an injury rate of about 2.0 was reported from other regions.

The risk reduction during the first 3 decades (1960 – 1990) has primarily been attributed to the development of release bindings and appropriate ski boots while the drop within the last 3 decades seems to be closely linked with the introduction of shorter skis (carving skis) and steadily improvements of additional skiing equipment and ski slope preparation.

Lower leg injuries decreased by about 90% since the introduction of release bindings in the 1960s,  accounting nowadays for only 5-7% in adult skiers but still exceeding 20% in children up to 12 years. However, knee injuries have become the most prevalent skiing injuries accounting for about 30 % in males and more than 50 % in females. These injuries are typically caused by a critical load to the knee during falling.

The steady downward trend in injury rates over the last 3 decades is clearly against the trend towards increased injury risk in alpine skiing associated with the introduction of carving skis that had been anticipated. However, less aggressive short carving skis with a broader tip are much easier to drive than the conventional long skis leading to rapid improvement of skiing skills associated with a lower falling and injury risk. Of course, this might be not the only reason for the drop in skiing injury rates. Also, ski boots have become more comfortable, use of protective gear like helmets has increased, and the preparation of ski slopes has been optimized. The latter is of particular importance since this may be one source explaining the relatively broad range of injury rates observed between individual ski regions. Not surprising that the injury risk increases with the proportion of steep and ungroomed slopes, and it is the decision of the individual skier to be prepared to use these slopes. Furthermore, injury rates also vary largely with age, sex, and skiing ability as already demonstrated by the authors of the early Mount Snow Study. Thus, differences between skier populations and variable slope conditions may explain different injury rates reported from different ski areas.

For all the reasons given, alpine skiing has become relatively safe. The numerous annual media reports on ski injuries have to be interpreted in light of the tremendous numbers of skiers. In our opinion, the associated health benefits from skiing, especially arising from its association with a healthier life style, clearly outweigh the health hazards. Technical improvements will likely help  with further reducing the injury risk. Probably even more important, each individual skier can help to prevent injuries by the development of appropriate physical fitness for the sport, responsible behaviour on ski slopes and appropriate choice of slope.

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