Subject: A plan to help reduce the risk of the most common skiing related injuries.

The resources exist to make a substantial reduction in the risk of the most common types of alpine skiing injury. Carl Ettlinger* and Jasper Shealy.**

Background: Skiing is a lot safer than it was in the early 1970s. The overall injury rate is down by nearly 2/3 and injuries below the knee down the most at almost 85%. These figures would be a lot better but there has been no improvement in the rate of these lower leg injuries for the past several years.

In a trend running counter to lower leg injuries, serious knee sprains, usually involving the ACL (anterior cruciate ligament), are up almost three-fold from the late 70s. It has only been over the last decade there has been about a 50% decline in ACL injuries in the United States, even though the incidence of ACL sprains has continued to rise in other countries.

We know for a scientific certainty how to help reduce the risk of lower leg injury. Most are related to the quality or condition of the release system. The technology for injury reduction was developed and proven in the 1970s and forms the basis of the standard practices promulgated in the late 1980s. Today, most alpine equipment suppliers provide products and technical information compatible with those standards and most repair and rental facilities possess the tools necessary to implement those standardized procedures. In our opinion, the reason the injury reduction trend stagnated is that both the public and the trade have become complacent and confused the existence of an effective vaccine with the eradication of the disease. For the trend toward fewer lower leg injuries to be re-established, there will have to be an improvement in the maintenance, repair, and timely replacement of ski equipment in compliance with the existing standards.

We also know for certain how to help reduce the risk of ACL sprains. These injuries are not related to the quality or condition of the release system but to a subtle chain of events which can put even the most experienced skier in jeopardy. Ski areas and equipment suppliers helped fund a key study, which proved education is effective. The study reported that ACL sprains among participating ski patrollers (the group most like the general skiing public in terms of their on-slope activities) were reduced by more than 75% following training. The lessons learned from this study have gone into programs, which have the potential to benefit all skiers and would-be skiers. However, our surveys show that the skiing public is largely unaware of the message.

The principal remaining safety issue is helmet use. Today we know that the use of a helmet is quite effective in reducing the severity and incidence of typical skiing and boarding head injuries. In our study, we found a 62% reduction in potentially serious head injuries (concussions of all sorts, skull fracture, and closed head injury). On the other hand, it is equally clear that helmets are not associated with any decline in skiing and boarding fatalities. The reason is quite clear as well. The events leading up to each situation are quite different. The typical head injury involves falling to the snow surface. The actual horizontal speed has little to do with the head injury as the effective impact speed to the snow surface is a function of the vertical distance the head travels from an upright posture to the snow surface; usually abut 6 feet or less. Thus the impact speed is on the order of 10 to 12 mph onto a snow-covered surface. Helmets that meet national and international standards can effectively limit the potential for injury under those circumstances. On the other hand, the most common fatality scenario involves a male going in excess of 27 mph and a direct impact of the head or torso with a fixed object (usually a tree). Under those circumstances, the severity of the impact simply overwhelms whatever protection a helmet can offer. Wearing a helmet should not confer invincibility or invulnerability to the user. A helmet is not a panacea for all head injuries in alpine winter sports. Any program which encourages the use of helmets by skiers and snowboarders, ought to stress that they are, at best, only a partial solution. In addition, all skier/rider education programs should convey the concept of a fall zone, the area through which the snowsport participant will slide following a fall. In a larger sense, we need to teach all participants how to recover from a loss of control and when recovery is inappropriate, how to make a controlled landing.

An Inspection Could Make the Difference:
Get the most out of your equipment by visiting a professionally equipped shop before each season and after every 15 to 30 days of skiing. If your equipment has already been giving you trouble consult HARDWARE versus SOFTWARE PROBLEMS before you go. When you drop your equipment off for inspection, make sure you bring the whole package including your poles. Tell the technician you want a “complete equipment inspection” the staff will probably do a quick visual check on the spot, but may ask you to authorize certain routine tests and maintenance. If repairs or component replacement are required and the work is extensive, you’ll probably have to leave your equipment for a short time until they can fit your work into their scheduled. If you already suspect that it may be time to retire some of your equipment, check out USED EQUIPMENT before your visit. If you need help in finding a qualified shop in your area, go to PICKING A QUALIFIED SHOP. If you need more information on selecting equipment or other information to help you get more out of your on-slope experience, go to EIGHT STEPS TO SAFER SKIING or visit Gearing To Go.

ACL Awareness Training:
Equipment has not as yet been proven to reduce the risk of ACL injury. But there is something you can do to help yourself. A free pamphlet is available at the cash register of participating shops and wherever trail maps are dispensed at participating ski areas. A 3-minute supporting video by the same name is often available for viewing at these same shops and on resort TV networks. A 19 minute video for home viewing is also available. To download a copy of the pamphlet or order the video, go to TIPS FOR KNEE-FRIENDLY SKIING.

Subject: Skiboards and other skis without release bindings.

Any ski, short or long, without a release system is potentially dangerous.
Carl Ettlinger* and Jasper Shealy.**

A practice with the potential to dramatically increase the incidence of lower leg injury is the use of short skis with non-releasable bindings. A recent study demonstrated that lower leg injuries were four times more likely when using such products, than with conventional rental equipment incorporating releasable bindings. Since short skis are also available in combination with releasable bindings, there seems to be no reason to sell or rent such a product. Any ski, short or long, without a release system should be considered potentially dangerous and should not be sold or rented without both parties recognizing the increased risk of lower leg injury associated with its use.

*Carl Ettlinger – Adjunct Asst. Professor, College of Medicine, University of Vermont, Burlington, VT 05405, and President, Vermont Safety Research, Underhill Ctr., VT 05490

**Dr. Jasper Shealy – Professor, Department of Industrial and Manufacturing Engineering, Rochester Institute of Technology, Rochester, NY 14623