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Frequencies of injuries and causes of accidents during ski touring on ski slopes - A pilot study
Abstract
Introduction:
Ski touring along ski slopes (slope touring) increased in recent years on Austrian ski slopes. However, ascending on the border of the slope and skiing downhill on the slope might be associated with a certain injury risk. Thus, the aim of this pilot study was to evaluate frequencies of injuries, causes of accidents and potential risk factors during slope touring.
Methods:
Slope-tourers were interviewed from March to April 2014 at the bottom of 4 Austrian ski areas. Interviews were conducted during the week and at the weekend from 7.30 a. m. to 8.45 p. m.
Results:
A total of 451 slope-tourers (60.1 % males) with a mean age of 39.3 ± 14.4 years were interviewed. Interviewed persons reported that they perform about 20.6 ± 16.0 slope tours per season mainly with a partner (48 %) and during the day (51 %). Ski helmet use was 60 %. A total of 57 persons (12.6 %) reported that they suffered at least once from an injury during slope touring needing medical care. This corresponds to a rate of 6 injuries per 1000 slope tours. Main injury causes were a fall (78 %) and a collision with another person (15 %) and the main injured body part was the knee (36 %). Slope-tourers with an injury were wearing more often back protectors, and were falling more often during downhill skiing, and were abstaining less often from alcohol and were listening more often to music during downhill skiing compared to slope-tourers without an injury.
Conclusion:
Based on the findings of this pilot study we recommend abstaining from alcohol and not listening to music during downhill skiing to reduce the injury risk during slope touring.
... 23 Little is known about injury rates and causes in ski touring, and presently, only 1 cross-sectional questionnairebased study about frequencies and causes of injuries in frontcountry ski touring is available. 34 In that retrospective study, among a cohort of 451 so-called slope tourers, an injury rate of about 13% was calculated, with selfinflicted falls being the most common reported injury cause. Hence, the current study sought to determine common injury rates, patterns, causes, and risk factors in all ski touring disciplines. ...
... The injury rate was calculated per 1000 hours of sports exposure. 13,14,34,38 The term exposure comprised everything between the start and the very end of a ski tour. 11,12 An injury-event was defined as an incidence with possibly >1 injury type or affected anatomic location involved. ...
... The overall observed injury rate can also be calculated as 6.7 injuries per 1000 ski tours, which seems comparable with 6 injuries per 1000 ski tours in a previously published cross-sectional study on frontcountry ski touring. 34 The reported injury rate in cross-country skiing was 0.5 per 1000 skiing days in the recreational field and between 0.02 and 0.1 per 1000 skiing days in professional crosscountry skiing. 2,19 The majority of the injuries described by previous cross-country skiing studies were also mild and limited to the soft tissue. ...
Outdoor sports, especially those that are performed in the mountains, such as ski touring, have experienced an enormous growth in popularity over the last decades. Due to the environment in which these sports are often performed (backcountry, high mountains), potentially life-threatening situations may be faced. The most severe risks include avalanches, crevasses, sudden weather changes (rapid fall in temperature, blizzards) and falls from high rocks, steep ice or snowfields. For these reasons, meticulous planning and critical evaluation of the ski tour and the potential dangers are crucial. Medical professionals dealing with ski touring injuries should be trained not only in the usual trauma care, but also in treating hypothermia, frostbites and injuries typically occurring in avalanche victims. Apart from these potentially life-threatening events, in which the environmental conditions usually play a critical role, ski touring can also be performed in a relatively safe environment. As such, there are similarities to injuries observed in alpine skiing. The majority of injuries are considered mild and limited to the soft-tissue. The most commonly involved anatomic regions are the hands and the knees. Main causes for non-fatal accidents are poor weather and snow conditions, and inattentiveness. Significantly more injuries happen during a ski tour descent than during the ascent, and sidecountry (off-piste) ski touring was reported as an independent risk factor. The reported injury rate is higher than in recreational alpine skiing on-piste and higher than in cross-country skiing.
... 23 Little is known about injury rates and causes in ski touring, and presently, only 1 cross-sectional questionnairebased study about frequencies and causes of injuries in frontcountry ski touring is available. 34 In that retrospective study, among a cohort of 451 so-called slope tourers, an injury rate of about 13% was calculated, with selfinflicted falls being the most common reported injury cause. Hence, the current study sought to determine common injury rates, patterns, causes, and risk factors in all ski touring disciplines. ...
... The injury rate was calculated per 1000 hours of sports exposure. 13,14,34,38 The term exposure comprised everything between the start and the very end of a ski tour. 11,12 An injury-event was defined as an incidence with possibly >1 injury type or affected anatomic location involved. ...
... The overall observed injury rate can also be calculated as 6.7 injuries per 1000 ski tours, which seems comparable with 6 injuries per 1000 ski tours in a previously published cross-sectional study on frontcountry ski touring. 34 The reported injury rate in cross-country skiing was 0.5 per 1000 skiing days in the recreational field and between 0.02 and 0.1 per 1000 skiing days in professional crosscountry skiing. 2,19 The majority of the injuries described by previous cross-country skiing studies were also mild and limited to the soft tissue. ...
Background
Ski touring is an outdoor sport with growing popularity in alpine countries. Information about injuries in ski touring is limited.
Purpose
To determine injury rates, mechanisms, causes, and risk factors in ski touring.
Study Design
Descriptive epidemiology study.
Methods
Between November 2015 and May 2016, a total of 191 participants from the Alps region were prospectively tracked via personalized online questionnaires. Injury rates were calculated per 1000 hours of sports exposure. Risk factors were assessed per multivariate logistic regression analysis.
Results
A total of 3900 ski tours were performed, with 10,955 hours and 4,108,503 m in height ascension (uphill) recorded. The overall injury rate was 2.5 injuries per 1000 hours of ski touring. A total of 27 injury-events were reported, of which 18 (67%) were classified as mild, 7 (26%) as moderate, and 2 (7%) as severe. Hands (28%) and knees (16%) were the most commonly involved anatomic regions. Most injuries were limited to the soft tissue, such as bruises (31%) and abrasions (18%). Significantly more injuries happened during the descent (n = 17; 63%) than during the ascent (n = 6; 22%) (odds ratio, 5.96; P = .004), while poor weather conditions, icy surface, and inattentiveness were the most often reported reasons for injury. Sidecountry ski touring was identified as the only significant independent risk factor for injury ( P < .001).
Conclusion
In this prospective injury surveillance study, the majority of ski touring injuries were mild and limited to the soft tissue. Ski touring injuries were more likely to happen during the descent of a tour, and sidecountry ski touring was the only significant independent risk factor for injury. Bad weather, icy surface, and inattentiveness were found to be the leading causes for an injury-event in this study.
... Behaviours such as speed reduction, avoidance of technically challenging tricks, use of appropriately fitted equipment should be encouraged. Listening to music whilst downhill skiing should be avoided [28]. Slope design should incorporate injury prevention as a priority with the aim of reducing overcrowding, clear demarcation of obstacles, and creation of dedicated terrain parks with instruction of safe jumping techniques [4]. ...
... Among slope tourers, Ruedl et al. reported an injury rate of 6 per 1000 tours. The average age of skiiers in this category was 38.8 years [28]. With telemark skiers, injuries were more likely to occur in ski resorts than in backcountry areas [36]. ...
... Backcountry skiers are inherently at increased risk of injury from avalanches, crevasse falls and falls from a height. Regarding slope-tourers, falling was the most common mechanism of injury [28]. In snowkiting, speeds of over 100 km/h and jump heights of up to 10 m above ground are reported, which predisposes participants to high-energy injuries [37]. ...
Introduction:
Alpine winter sports have become increasingly popular over recent decades, with a similar increase in accident incidence. This review provides an overview of the most recent literature concerning spinal injury epidemiology, mechanisms, patterns and prevention strategies in the context of alpine winter sports.
Material and methods:
The PubMed, Cochrane Library, and EMBASE databases were searched using the keywords spine injury, alpine injury, spine fracture, skiing injuries, snowboard injuries. 64 published studies in English and German met a priori inclusion criteria and were reviewed in detail by the authors.
Results:
There are various mechanisms of injury in alpine winter sports (high speed falls in skiing, jumping failure in snowboarding) whilst regionality and injury severity are broadly similar. The thoracolumbar spine is the most common region for spinal injury. Spinal cord injury is relatively rare, usually accompanying distraction and rotation type fractures and is most commonly localised to the cervical spine. Disc injuries seem to occur more commonly in alpine winter sport athletes than in the general population.
Discussion:
Despite awareness of increasing rates and risks of spinal injuries in alpine winter sports, there has been little success in injury prevention.
... In the Austrian mountainous regions alone, there is an estimated number of eight million ski visitors per year [1]. Slope touring (= the ascending of a ski slope with ski touring equipment and following downhill skiing on the slope) has increased throughout the years with an estimated number of 80,000 slope tourers on Austrian ski slopes per year [2]. The region around the city of Innsbruck hosts approximately 30,000 slope tourers per year [3]. ...
... Reasons given for the growing number of slope tourers include the easy ascent, physical activity-related health promotion, no risk of avalanches on slopes, and social aspects [3]. This progress, however, often causes troubles with the lift companies because of safety risks through ascending slope tourers during daytime hours and descending slope tourers during nighttime hours [2]. Overall, little is known about injuries and risk factors in slope touring. ...
... Overall, little is known about injuries and risk factors in slope touring. In a preliminary study, Ruedl et al. investigated potential factors associated with injuries in slope touring [2]. More than 450 slope tourers (60.1% males) with a mean age of 39.3 ± 14.4 years reported that they perform about 20.6 ± 16.0 slope tours per season mainly with a partner (48%) and during the day (51%) [2]. ...
Introduction: Ski touring along ski slopes (slope touring) has increased in recent years on Austrian ski slopes. Alcohol consumption is proposed to be a risk factor in winter sports-related accidents. The aim of this study was to evaluate factors associated with alcohol intake among uninjured slope tourers. Methods: A total of 328 slope tourers (45% females) with a mean age of 43.8 ± 11.8 years were questioned in February and March 2014 in two huts at the top of two Austrian ski areas. Questionnaires were conducted during daytime (9.00 a.m.–4.00 p.m.) and nighttime hours (5.00 p.m.–9.45 p.m.) with a following breath alcohol test. Slope tourers filled in on demographics, skill level, risk-taking behavior, ski helmet use, and alcohol consumption. In addition, slope tourers who had consumed alcohol were asked to estimate their individual breath alcohol level. Results: In total, 187 (57%) of the slope tourers reported that they had consumed alcohol at the hut. Male sex, a higher BMI, more ski touring experience, and less ski helmet use were significantly associated with alcohol intake among slope tourers. Mean-tested breath alcohol level was 0.24 ± 0.17‰; this significantly differed from the mean estimated breath alcohol level of 0.18 ± 0.12‰. Male slope tourers had a significantly higher breath alcohol level than female slope tourers (0.26 ± 0.17 vs. 0.22 ± 0.15‰, p = 0.014). Conclusion: Approximately 60% of interviewed slope tourers, predominantly males, consumed alcohol in the huts. In addition, male slope tourers had a significantly higher breath alcohol level compared to female slope tourers and mean-tested breath alcohol level was underestimated by approximately 25% on average.
... The increase of ski helmet adoption in adults (no mandatory) is still inconsistent in other European nations also, and probably is the result of public discussion and not completely efficacious information campaign (25,26). The national datum on ski helmet usage seems higher than that one reported in other European counties (27). It is worth also recalling the level of diffusion of accident insurance programs. ...
... According to epidemiological data, alcohol abuse was often discovered in ski injured persons; alcoholic intoxication leads to reduced perception of danger, increasing the likelihood for serious damage (28,29). Based on an Austrian pilot study, alcohol consumption and behaviours reducing attention (like listening to music during downhill skiing) are more frequent in injured skiers (27). Considering that several skiers display insufficient safety knowledge in given situations, the decree of law 40/2021 reinforces the importance of a good information on the appropriate behaviour to be maintained on the ski slope. ...
Background:
Italy is one of the main destinations for winter tourism. Specifically, the country can currently count on more than 5.700 km of ski runs, served by more than 1.700 lift facilities Objective. The purpose of this study has been the analysis of injuries in ski resorts in a continuous period spanning over several seasons (17 years). In addition, the possible effect of safety law enforcements, introduced in the selected period, were considered.
Material and methods:
A ski injuries database, prepared as a duty of policemen involved in rescue activity and consisting of 246616 records of injuries for the period from 7th December 2002 to 31st December 2019, has been analysed for qualitative and quantitative variables.
Results:
The majority of injuries (58%) occurred on slopes with medium difficulties. After the introduction of national ski safety law (Law 363/2003), a strong diffusion of protective helmet has been noticed. The adoption of the helmet has significantly reduced cranio-facial injuries both in children and in adults. Moreover, no death events were recorded in the database after the introduction of Law 363/2003. The diffusion of ski accident insurance programs is slowly increasing, even if in the year 2019 approximately 38% of skiers still didn't have an insurance program.
Discussion and conclusions:
It is possible to speculate that the introduction of a national ski safety law had a positive effect on injuries reduction. At the same time, collected data underlined several critical points that seem, at least in part, addressed by the law revision performed in 2021.
... The risk of injury and mortality varies dramatically depending on the terrain (secured ski slopes, off-piste slopes, glaciers, and rock and ice slopes) where alpine ski touring is performed [42][43][44][45][46]. Studies from the Austrian Alps reported an annual death rate of 1.83 per 100,000 alpine ski tourers [47]. ...
... Particularly the death risk due to avalanche burial was higher in members, whereas that due to falling and cardiac arrest was lower. When ski tourers use secured ski slopes, the death risk from snow avalanches is virtually zero, and falls or collisions with firm obstacles or other skiers [44] or cardiovascular events [9] are main causes of fatality. By contrast, in unsecured mountainous terrain (snow covered backcountry area), burial by snow avalanches represents the primary cause of death in the Alps, in Canada, and in the US (Table 2) [29,[48][49][50]. ...
Annually, millions of people engage in mountain sports activities all over the world. These activities are associated with health benefits, but concurrently with a risk for injury and death. Knowledge on death rates is considered important for the categorization of high-risk sports in literature and for the development of effective preventive measures. The death risk has been reported to vary across different mountain sports primarily practiced in the summer season. To complete the spectrum, the aim of the present review is to compare mortality rates across different mountain sports activities primarily practiced in winter. A comprehensive literature search was performed on the death risk (mortality) during such activities, i.e., alpine (downhill) skiing, snowboarding, cross-country skiing, ski touring, and sledging. With the exception of ski touring (4.4 deaths per 1 million exposure days), the mortality risk was low across different winter sports, with small activity-specific variation (0.3–0.8 deaths per 1 million exposure days). Traumatic (e.g., falls) and non-traumatic (e.g., cardiac death) incidents and avalanche burial in ski tourers were the predominant causes of death. Preventive measures include the improvement of sport-specific skills and fitness, the use of protective gear, well-targeted and intensive training programs concerning avalanche hazards, and sports-medical counseling for elderly and those with pre-existing diseases.
... The percentage of females in those who listened to music was 10% and those who did not was 11% [12]. Injured slope tourers reported that they were listening to music during downhill skiing more often compared to non-injured slope tourers [13]. However, listening to music did not result in an increased reaction time to peripheral signals [14]. ...
... One might conclude that this means a higher level of arousal in females, which-according to the Yerkes-Dodson Law [19]-might lead to a better performance in females. Although listening to music has been connected to injuries in skiing and snowboarding [12,13], it has to be mentioned that several authors discussed listening to music as potentially having a positive influence on motor performance abilities either through the rhythmical elements of the music [20] or by influencing the arousal [21]. The secondary analysis indicated that it is unlikely that the habituation effect of listening to music in general during exercise has to be considered as a confounding variable in the present study. ...
Injuries in skiing show sex-specific differences, especially when visual perception is reduced. Reduced visual perception impairs balance, which plays an important role in avoiding skiing injuries. However, males and females might cope differently with reduced visual perception. Thus, the aim of this study was to evaluate sex-related effects of environmental perturbations (reduced visual perception and listening to music) on ski-specific balance. Using a crossover design, ski-specific balance was tested in 50 young adults (50% female) in four conditions: with and without listening to music and/or with and without reduced visual perception (ski goggles with occlusion foil). A four × two (condition by sex) mixed ANOVA revealed a significant condition by sex interaction, partial η² = 0.06. Females showed an increase in balance from the condition without music/with normal visual perception to the condition with music/with normal visual perception, while males showed a decrease. Balance was significantly higher in females compared to males, partial η² = 0.31. The findings suggest that balance is affected differently by environmental perturbations in females and males. However, the differences observed were not in line with our initial hypotheses, which might be because the model was too simplistic for how visual/auditory perturbations may affect balance.
... Looking at recreational motives, one can see that sports and exercise is the most important motive, along with promoting health and being active in the mountains. Pröbstl-Haider and Lampl (2017) and Ruedl, Pocecco, Kopp, and Burtscher (2015) have already identified comparable motives. However, what must be considered in this study is that (1) the SST trend has grown enormously in the last five years (>50% of slope ski tourers started touring only in the last five years) and (2) the COVID-19 pandemic has strongly influenced consumers' sporting behavior, which resulted in a boom of outdoor sports (Schöttl et al., 2022). ...
Winter sports tourism in the Alps remains competitive and challenges destinations to develop and offer new tourism products. Slope ski touring (SST) is an excellent example. In the Alps, this winter sport has been experiencing a tremendous boom. However, SST has been poorly examined in academia. Thus, we aimed to gain in-depth understanding of the SST phenomenon from both a supply and demand perspective by conducting two studies. In Study 1, we interviewed 26 experts to assess the relevance of SST and identify types of slope ski tourers as potential tourist segments. In Study 2, we questioned 6880 slope ski tourers and applied the motivation-opportunity-ability framework to understand why consumers engage in SST and what facilitators are important to them. This article contributes to existing knowledge by (1) analyzing potential SST target groups and their needs and (2) shedding light on the underlying typology and tourism potential of SST.
... While the area of ski touring has scarcely been examined by academia a few studies call for further research, such as those of Mueller et al. [2] investigating ski touring in general, or Happ & Schnitzer [7] examining slope ski touring. Especially in terms of safety, researchers have shown that injuries are an issue both in ski touring in general (e.g., hands and knees) [2,8] and in BCST [2]. The aim of this research is to understand the risk-taking and risk-avoidance behavior of this growing segment (BCST) and to assess expertise to increase safety by implementing tailored prevention measures like education programs and/or awareness-raising campaigns. ...
Ski touring is an emerging trend in the Alps, defined as ascending and descending a slope/backcountry with ski-touring equipment. The aim of this research is to understand risk-taking behavior, risk-avoidance behavior and assessed expertise (ascending/descending) of backcountry ski tourers. A cross-sectional survey design was chosen (N ¼ 300). Results show that e.g. genderwise, the difference is statistically significant in terms of 'I consciously expose myself to danger' t(158) ¼ 2.94, and e.g. skillwise, for 'I check every piece of equipment before use' t(152) ¼ À2.98-providing insights into the risk behavior of BCSTers in terms of gender and skills.
... Looking at recreational motives, one can see that sports and exercise is the most important motive, along with promoting health and being active in the mountains. Pröbstl-Haider and Lampl (2017) and Ruedl, Pocecco, Kopp, and Burtscher (2015) have already identified comparable motives. However, what must be considered in this study is that (1) the SST trend has grown enormously in the last five years (>50% of slope ski tourers started touring only in the last five years) and (2) the COVID-19 pandemic has strongly influenced consumers' sporting behavior, which resulted in a boom of outdoor sports (Schöttl et al., 2022). ...
The aim of the study is to analyze causes, level and structure of traumatism and exacerbation of diseases among tourists at ski resorts in Russia and abroad; to consider problems of providing first and medical aid to injured and sick people and of conducting their medical evacuation at ski resorts in Russia. Materials and research methods. Normative and empirical base of the scientific research consisted of analytical materials of Russian and foreign scientists, devoted to traumatism and non-traumatic accidents in tourists, as well as of materials on the organization of first and medical care to the injured and sick at ski resorts. In addition, normative legal acts on rendering first and medical aid to the injured and sick, contained in two departmental orders, were analyzed. Research methods: literary-analytical and statistical methods, method of direct observation. Their use allowed a comprehensive analysis of the subject of research, also it allowed to make theoretical generalizations and to formulate conclusions. Results of the study and their analysis. The results of the study have shown the need for further study of the specific conditions of first aid and medical assistance to injured and sick in the conditions of ski resorts, as well as the need to improve organizational measures to provide injured and sick with first aid and medical evacuation.
Alpine racing and recreational skiing have gained increasing popularity in recent years. With growing commercialization and professionalization, there are new challenges for athletes and the care environment. In addition to the treatment of injuries and illnesses, the prevention of medical problems is becoming increasingly important.KeywordsAlpine skiingSki racingACL injuryRehabilitationPrevention
Ski touring on groomed slopes is a relatively new outdoor sport that has steadily been gaining interest. So far, little scientific attention has been given to this outdoor activity. Thus, few questions have been asked about the motivation for practising this sport, and even fewer about whether the current COVID-19 pandemic has had an impact on the frequency of and motivation for ski touring. For this reason, we conducted a large-scale study (n = 6802) in the Austrian Alps. Results revealed that the COVID-19 pandemic has not changed the motive structure for ski touring; however, the findings showed that many people have even started to practice this sport. This research note contributes to the existing knowledge by (a) documenting ski tourers’ motives using a large sample, (b) giving insights into the effects of the COVID-19 pandemic on this specific outdoor sport, and (c) showing COVID-19-related impacts on practicing ski touring.
Management implications
•No changes in motivational reasons for ski touring due to COVID-19 pandemic.
•Trend towards outdoor sports, especially ski tours on groomed slopes in the alpine region of central Europe. Amplification of the trend due to the pandemic and the associated restrictions.
•As an outdoor sport, ski touring on groomed slopes offers versatile added value for ski tourers, but also huge potential for ropeway operators.
•This soft slope tourism can also show alternatives to temporary ropeway closures in times of the COVID-19 pandemic and could also promote tourism (especially day tourism) in small circles at the regional level.
•The increase in beginners naturally raises the question of whether this group needs special offers or how to deal with beginners on the slopes. On the other hand, this also raises the question of how to deal with the increase in ski slope users in general.
Sports injuries occur frequently in athletes. Understanding what professionals who work with patients with sports injuries think about prevention has been suggested as an important aspect to improve the effectiveness of programs to prevent sports injuries. Recent studies have shown that the main factors affecting the appearance of lesions are overtraining, incorrect sports technique, inadequate nutrition, and factors related to the athlete’s behavior, whereas the main injury prevention strategies are muscle strengthening, nutritional counseling, guidance, and good diagnostic.
Pre-seasonal screening of athletes includes ‘contract screening’ and the ‘periodic health and performance evaluation (PHPE)’ of athletes—two completely different processes that are often confused. Contract screening is a controversial process of assessing the medical viability of professional sporting contracts, which has many potential ethical pitfalls. The PHPE, on the other hand, is a far less risky process offering the team physician the opportunity to assess the health and well-being of the athletes in their care. It also provides an excellent framework for maximizing performance by encouraging physicians to offer advice on topics as diverse as recovery techniques, environmental acclimatization and jet lag.
The practice of recreational sports has increased in recent years in proportion to the perception of well-being and health applied to the desired quality of life model in different countries across the continents, but injuries and their mechanisms are different in different World places. The most common generally speaking, injury mechanism regardless of the country, except for overtraining, (more common in elite athletes) in the general population this phenomenon happens due to lack of preparation or little physical conditioning and the poor performance of the sport movements conditioned by poor technique in addition to morpho-structural and biomechanical alterations. The purpose of this study is to show how recreational sport mechanisms of injuries are different depending on a World region and how different the injury could be connected with specific sports activities.
Injuries especially in equestrian sport occur frequently in amateur and professional riders. Understanding the epidemiology and characteristics of major injuries related to a work with an animal, can create prevention programs and develop the training. Recent studies have shown that the main factors affecting the appearance of injuries are over-training, incorrect sports technique, inadequate behavior and lack of good guidelines from a trainer, and animal choosing. The main injury prevention strategies should be education, animal training and choosing, good equipment, and warming up technic, before training- make more sense.
Behavioral variables might play an important role in explaining the differences in injury rates across winter sport disciplines and injury prevention programs might be more specifically designed based on this knowledge. On ski slopes, alpine skiing, snowboarding, and ski touring are the predominant winter sport disciplines. Therefore, the aim of the present study was to investigate possible differences in injury-related behavioral variables between practitioners of these disciplines. Using a matched re-analysis approach of a cross-sectional survey, 414 winter sport participants (alpine skiers, snowboarders, ski tourers, each n = 138) were analyzed on the differences in sensation seeking, treated injuries, and injury-related behavioral variables. Cochran–Mantel–Haenszel and Friedman tests revealed significantly higher sensation seeking, p < 0.001, and a significantly higher percentage of participants reporting to have consumed alcohol in the past five skiing days, p = 0.006, in snowboarders compared to alpine skiers. The participants with treated injuries showed higher sensation seeking, p < 0.050, and a higher percentage of snowboarders, p = 0.020, compared to participants without treated injuries. Injury prevention programs for snowboarders, who remain an important risk group for injury prevention, might benefit from considering a possibly higher percentage of alcohol-consuming participants and from providing information on injury-related risks of sensation seeking.
This book is open access under a CC BY-NC 2.5 license.
This book covers the latest in snow sport epidemiology, snow sport injuries and treatment, and biomechanical/mechanical engineering related to snow sports injuries (mechanisms of injury, injury prevention by equipment design, injury prevention by design of resort features, and more). It brings together a collection of papers from the International Congress on Ski Trauma and Safety (the biennal meeting of the International Society for Skiing Safety) and presents the latest research on the effectiveness of winter sports equipment, the behavior of winter sports participants, and the epidemiology and biomechanics of winter sports injuries. This is an ideal book for researchers and professionals working in the field of sports medicine and safety.
This book also:
Covers the latest body of literature dealing with safety in winter sports as well as the prevention and treatment of injuries sustained by participants in these activities
Broadens readers’ understanding of snow sport injury prevention research
Illustrates ways safety standards for snow sports can be improved based on evidence-based research.
Downhill skiing is part of active life style in many residents of Alpine regions. However, only very little information is available whether downhill skiing on a regular basis is associated with a healthier life style resulting in the reduction of major risk factors for cardiovascular diseases and memory deficits when compared to the general population. Thus, the aim of the study was to compare life-style characteristics and cardiovascular risk factors between regular downhill skiers and the general population.
Self-reported health and life-style data were collected by questionnaire from 1259 long-term downhill skiers (971 males, aged 57.3 +/- 14.6 years; 288 females, aged 47.7 +/- 16.4 years) and compared with data from the general population.
Long-term skiers showed more favourable life-style characteristics and a better health status than the general population. Prevalences of hypercholesterolemia, systemic hypertension, diabetes, the frequency of mental stress and the occurrence of memory deficits declined with increasing yearly skiing frequency.
Long-term alpine skiing on a regular basis may contribute to healthy aging by its association with a healthier life style.
Analysis of changes in the behaviour of wearing protective equipment by alpine skiers and snowboarders after injury, performed at a level I trauma centre in Switzerland.
We present a study, using a standardised questionnaire, assessing behaviour on ski slopes by adult patients admitted between Oct 2007 and April 2008. Patients were re-interviewed after the 2008/2009 season. McNemar tests were used to analyse differences in protective clothing wearing rates between the two seasons. Multiple logistic regression with age, gender and injury severity score (ISS) as predictors, was used to compare findings in those who started wearing protective equipment and those who did not.
A total of 104/132 patients from the 2007/2008 season were questioned about wearing protective equipment in 2008/2009. 20 patients could not be reassessed (7 declined, 13 had abandoned winter sports). A total of 84 patients were reassessed (61 alpine skiers and 23 snowboarders). The median age of participants was 39 years and 70.2% were male. Helmet and back protector wearing rates increased from 40.5% to 78.6% (p <0.001) and from 14.3% to 23.8% (p = 0.021), respectively. Snowboarders more than doubled their helmet wearing rate (39.1% to 82.6%, p = 0.002). Skiers showed a trend towards doubling their back protector wearing rate (6.6% to 14.8%, p = 0.063). Younger skiers started wearing back protectors more often than older skiers.
Sustained injury might provide skiers and snowboards with a potent trigger to change their attitude towards the use of protective equipment. The psychological processes influencing the use of protective equipment require further investigation.
Different results have been reported for skiing and snowboarding injuries worldwide. Few studies consider the injury severity score (ISS) for the evaluation of differences among injured skiers-snowboarders. The aim of this study is to identify possible risk factors that affect the severity of skiing and snowboarding injuries in three winter seasons (2002-2005) in South Tyrol. For every injured skier or snowboarder referred to our emergency department in three consecutive seasons, the following data were collected: date of birth, gender, self-declared technical skills level, place of residence (local/non-local), as well as the date, time, and place of the accident. Type of injury and ISS were retrospectively assigned. Data concerning the snowfall in the last 24 h, average snow level, and outdoor air temperature values were obtained from four weather stations that were located inside the ski resorts. A multiple linear regression model was used to evaluate the association between ISS and potential determinants. In the analyzed seasons, 2,511 injured skiers and 843 injured snowboarders were evaluated at our emergency department. There was a significant change in the ISS value for subjects with different self-reported skills levels (P < 0.001). Men and non-local residents experienced more severe injuries than women and local residents, respectively (P < 0.013, P < 0.001). The ISS was higher for people aged over 60 (P < 0.001). Snowfalls brought about a decrease in accident severity (P = 0.009). The severity of the injuries increases with age. Prevention and information programs should be targeted to people who are at high risk of severe injury. A 24-h fresh snowfall seems to reduce the severity of injuries. Very little is known about snow conditions and winter sports injury. Further studies are needed to explore this field.
The prevention of head injuries in alpine activities has focused on helmets. However, no systematic review has examined the effect of helmets on head and neck injuries among skiers and snowboarders.
We searched electronic databases, conference proceedings and reference lists using a combination of the key words "head injury or head trauma," "helmet" and "skiing or snowboarding." We included studies that used a control group; compared skiers or snowboarders with and without helmets; and measured at least one objectively quantified outcome (e.g., head injury, and neck or cervical injury).
We included 10 case-control, 1 case-control/case-crossover and 1 cohort study in our analysis. The pooled odds ratio (OR) indicated that skiers and snowboarders with a helmet were significantly less likely than those without a helmet to have a head injury (OR 0.65, 95% confidence interval [CI] 0.55-0.79). The result was similar for studies that used controls without an injury (OR 0.61, 95% CI 0.36-0.92), those that used controls with an injury other than a head or neck injury (OR 0.63, 95% CI 0.52-0.80) and studies that included children under the age of 13 years (OR 0.41, 95% CI 0.27-0.59). Helmets were not associated with an increased risk of neck injury (OR 0.89, 95% CI 0.72-1.09).
Our findings show that helmets reduce the risk of head injury among skiers and snowboarders with no evidence of an increased risk of neck injury.
To evaluate the incidence and the pattern of skiing and snowboarding injuries in South Tyrol and their impact on the emergency medical system in the winter season 2001--2002 in an attempt to rationalize and improve the emergency care and assist in prevention strategies.
All medical records of patients referred to our emergency department (ED) that sustained a skiing or snow-boarding injury during the study period were retrospectively reviewed. Age, sex, local or non-local residency, type of injury, data and time of accident, type of transport to the hospital, hospital admission or ED discharge, Injury Severity Score, outcome (including mortality) were evaluated. On site mortality data were obtained from the emergency call-center registry. Ski resorts utilization was estimated from the data published by the Regional Office of Cable Transport.
For the period analyzed approximately 2,500,000 skier and snowboarder days were recorded in the whole region of which about 500,000 were attributed to the four nearby ski resorts that refer to our hospital. Of the 1087 patients, 794 were skiers and 294 were snowboarders. Snow-boarders were younger than skiers (mean age 20 and 36 respectively, p = 0.001). Females were equally represented in the two groups. Male patients, children, senior skiers and non-local residents suffered from more severe injuries than their corresponding classes (p < 0.01, p = 0.002, p = 0.02, p = 0.000 respectively). Critical injuries (ISS > or = 25) were homogeneously spread in the groups, with the exception of the non-local resident patients that showed a higher incidence (p < 0.02). No difference in severity was found between skiers and snowboarders. The incidence was 2.05 per 1,000 skier-days. Mortality rate was 1.6 per 1,000,000 skier-days. The pattern of injury was different: snowboarders showed more forearm and wrist trauma and skiers more lower extremity injuries. 208 patients were hospitalized and the mean length of stay was 4.5 days. Head trauma and fractures were the most common diagnosis of admission. The lack of field triage led to 12% of unjustified helicopter transfer and 9.6% of avoidable ambulance transport.
Incidence, pattern of injuries and mortality from skiing and snowboarding accidents in South Tyrol resemble those reported in other part of the world. Nevertheless, strategies for prevention are needed. The routine use of helmets should be enforced by law. Dangerous behaviors should be prosecuted. Skiers and snowboarders should be made aware that skiing beyond their technical ability can be life-threatening.
The use of alcohol is often intimately associated with sport. As well as providing a source of energy, alcohol (ethanol) has metabolic, cardiovascular, thermoregulatory, and neuromuscular actions that may affect exercise performance. Strength is minimally affected, and performance impairments depend on the dose of alcohol and subject habituation to alcohol intake, exercise duration, environmental conditions, and other factors. Central nervous system function is impaired at high doses, resulting in decrements in cognitive function and motor skill, as well as behavioral changes that may have adverse effects on performance. Effects may persist for hours after intoxication.
Hintergrund: Verletzungen beim Skifahren sind verständlicherweise überwiegend auf Stürze zurückzuführen. Um Kenntnis über Sturzursachen als Basis für Präventivmaßnahmen zu erhalten, wurde eine erste „Skisturz-Studie“ bereits vor 10 Jahren (2002) durchgeführt. Da es seit 2002 zu erheblichen Veränderungen in der Ski- und Snowboardausrüstung, der Schutzausrüstung und bei der Pistenpräparierung gekommen ist, kann man davon ausgehen, dass diese Veränderungen sich auch auf die Sturzhäufigkeit ausgewirkt haben.
Methoden: Von Februar bis April 2012 wurden in 6 Tiroler Skigebieten 1436 Ski- und Snowboardfahrer aller Altersklassen und beider Geschlechter interviewt. Es wurde ein Fragebogen verwendet, der jenem von 2002 sehr ähnlich war. Dieser beinhaltete u. a. Fragen zur Person, zur Sturzhäufigkeit am Befragungstag, zur Ausrüstung und zum Risikoverhalten.
Ergebnisse: Die Sturzhäufigkeit bei den SkifahrerInnen lag bei 0,076 ± 0,21 Stürzen pro Stunde und bei den SnowboarderInnen bei 0,429 ± 0,70 Stürzen pro Stunde. Prädiktiv für Stürze bei SkifahrerInnen waren das Alter (OR: 0,96; CI: 0,95 – 0,97), weiche Skipisten (OR: 4,1; CI: 1,9 – 8,8) und ein geringes Fahrkönnen (Anfänger) (OR: 2,6; CI: 1,2 – 8,1). Bei den SnowboarderInnen waren geringes Fahrkönnen (Anfänger und leicht Fortgeschrittene) (OR: 8,3; CI: 3,1 – 27,4), das Tragen eines Helms (OR: 0,47; CI: 0,23 – 0,94) und Alkoholkonsum (OR: 2,1; CI: 1,2 – 3,9) prädiktiv für Stürze.
Schlussfolgerung: Im Vergleich zu 2002 kam es zu einer erheblichen Abnahme der Sturzhäufigkeit bei SkifahrerInnen und SnowboarderInnen. Dies kann auf Verbesserungen im Materialsektor und der Pistenpräparierung zurückgeführt werden. Die verringerte Sturzhäufigkeit sollte auch einen positiven Einfluss auf die Verletzungshäufigkeit haben.
Background:
Injuries in alpine skiing and snowboarding are mainly caused by falls. In 2002, a study was conducted to gain insight into the risk factors for falls when skiing or snowboarding. Since then, the evolution of skiing, snowboarding and safety equipment, as well as slope preparation, may have altered the frequency of falls while skiing or snowboarding.
Methods:
In total, 1436 male and female skiers and snowboarders from all age groups were interviewed from February until April 2012, in 6 Tyrolean ski resorts. The questionnaire was nearly identical to that used in 2002. It contained questions concerning personal characteristics, falls, equipment and risk taking behaviour.
Results:
The incidence of falls among skiers was 0.076 ± 0.21 per hour and that among snowboarders was 0.429 ± 0.70 per hour. Age (OR: 0.96; CI: 0.95 - 0.97), soft snow conditions (OR: 4.1; CI: 1.9 - 8.8) and poor skiing skills (beginners and intermediates) (OR: 2.6; CI: 1.2 - 8.1) were predictive for falls during skiing. Poor snowboarding skills (beginners and intermediates) (OR: 8.3; CI: 3.1 - 27.4), wearing a helmet (OR: 2.3; CI: 1.2 - 4.6) and alcohol consumption (OR: 2.1; CI: 1.2 - 3.9) were predictive for falls during snowboarding.
Conclusions:
The incidence of falls among skiers and snowboarders was substantially lower when compared to that in 2002. Improvements in skiing and snowboarding equipment as well as slope preparation may have contributed to this favourable development. We strongly assume that the lowering in fall incidence may positively affect the injury incidence.
Background:
Alpine skiing and snowboarding are the most popular winter sports. These sports are also associated with a certain injury risk which, however, has steadily decreased during the past decades. During the winter season 2002/2003 the last large survey on ski injuries in Austria was performed. Among others, modern skiing equipment and optimized slope preparation may impact on the injury risk. We hypothesise that these changes may have led to a further decrease in ski injuries during the past decade.
Methods:
In the winter season 2012/2013, skiing injuries were recorded in 26 Austrian ski areas. Data were collected from rescue personnel on ski slopes and by physicians in the hospital or doctors practice with the help of a questionnaire.
Results:
A total of 7325 injured skiers and snowboarders (age: 34.8 ± 17.8 years) were recorded (49 % males and 51 % females; 80 % skiers, 14 % snowboarders, 6 % others). The most frequent causes of injury were self-inflicted falls (87 %) and collisions with other skiers/snowboarders (8 %). Most affected injury locations among skiers were the knee (41 %; predominantly in female skiers, > 50 %), shoulder/back (18 %) and arms (10 %). Most affected injury locations among snowboarders were arms (38 %) and shoulder/back (23 %). Head injuries were found at the same frequency (8 %) in skiers and snowboarders. The calculated injury rate was about 0.6 injuries per 1000 skier days and has decreased by more than 50 % during the past decade.
Conclusions:
Modern skiing equipment and optimised slope preparation may be at least partly responsible for the decreased injury risk on ski slopes which is supported by the observation of a reduced falling frequency. Future preventive measures should focus on a reduction of knee injuries in female skiers.
Background Some snowboarders listen to music on a personal music player and the objective was to determine if listening to music was associated with injury in a terrain park.
Methods A case–control study was conducted at a terrain park in Alberta, Canada during the 2008–2009 and 2009–2010 winter seasons. Cases were snowboarders who were injured in the terrain park and presented to either the ski patrol and/or a nearby emergency department (ED). Demographic, environmental and injury characteristics were collected from standardised ski patrol Accident Report Forms, ED medical records and telephone interviews. Controls were uninjured snowboarders using the same terrain park and were interviewed as they approached the lift-line on randomly selected days and times. Multivariable logistic regression determined if listening to music was associated with the odds of snowboard injury.
Results Overall, 333 injured cases and 1261 non-injured controls were enrolled; 69 (21%) cases and 425 (34%) controls were listening to music. Snowboarders listening to music had significantly lower odds of injury compared with those not listening to music (adjusted odds ratio (OR) 0.68; 95% CI 0.48 to 0.98). Snowboarders listening to music had significantly higher odds of presenting to the ED versus ski patrol only compared with those not listening to music (adjusted OR 2.09; 95% CI 1.07 to 4.05).
Conclusions While listening to music decreased the odds of any injury in the terrain park, it increased the odds of an injury resulting in ED presentation.
Backcountry recreationists account for a high percentage of avalanche fatalities, but the total number of recreationists and relative percentage of different recreation types are unknown. The aim of this study was to collect the first comprehensive survey of backcountry skiers and snowshoers in a region in the European Alps to quantify adherence to basic prevention and safety practices. Over a 1-week period in February 2011 in South Tyrol, Italy, 5576 individuals (77.7% skiers, 22.3% snowshoers) in 1927 groups were surveyed. Significantly more skiers than snowshoers could report the avalanche danger level (52.5% vs 28.0% of groups) and carried standard rescue equipment (transceiver, probe, and shovel) (80.6% vs 13.7% of individuals). Complete adherence to minimum advisable practices (i.e., an individual being in a group with one member correctly informed about the danger level and carrying personal standard rescue equipment) was 41.5%, but was significantly higher in skiers (51.1% vs 8.7% snowshoers) and in individuals who were younger, reported more tours per season, traveled in larger groups, and started earlier. A transnational survey over a complete winter season would be required to obtain total participation prevalence, detect regional differences, and assess the influence of prevention and safety practices on relative reduction in mortality.
Background:
Annually, in Austria more than 10 million people participate in winter sport activities such as alpine skiing, snowboarding, cross country skiing and ski touring. About 80 - 90 % of all accidents are caused by a fall without other people involved and about 10 % are caused by collisions between people.
Methods:
In the winter season 2011/2012, skiers and snowboarders injured due to a fall or a collision on a ski slope have been interviewed about potential intrinsic and extrinsic risk factors in the Austrian province Vorarlberg.
Results:
In total, 1741 people injured by a self-inflicted fall and 137 people injured due to a collision have been interviewed. People injured due to a collision showed more often a head injury (15 vs. 8 %) and more often a concussion (15 vs. 6 %). Furthermore, people injured due to a collision were significantly older (41 vs. 33 years) and showed a higher proportion of skiers (86 vs. 79 %) as well as of higher skilled people (83 vs. 74 %) compared to those injured by a self-inflicted fall. Collisions between sport participants incurred significantly more often on slope intersections (11 vs. 4 %), when more people were on ski slopes (30 vs. 12 %) and when the sun was shining (85 vs. 69 %).
Conclusion:
According to the results of this study, preventive recommendations to reduce the risk of a collision include an adaptation of the individual skiing or snowboarding behaviour and the actual speed on skill level, weather conditions and number of other skiers and snowboarders on ski slopes. In addition, influences of adaptive visual information and supervision systems at slope intersections and in relation to weather and traffic conditions should be evaluated.
In alpine skiing, a controversial discussion has been taking place regarding the potential influence of wearing a ski helmet on the individual level of risk taking behaviour. The aim of this study was to evaluate whether self reported risk taking behaviour and self reported risk compensation are associated with the personality trait sensation seeking (SS) in alpine skiing and snowboarding. In total, 683 persons (36% males and 64% females) completed an online-survey about attitudes and use of protective gear in winter sports including the German version of the sensation seeking scale form V. A logistic regression analysis including gender, age, nationality, preferred winter sport, self reported skiing ability, mean skiing time per season, use of ski helmets, and SS total score was used to estimated adjusted odds ratios (ORs) and their 95% confidence intervals (95 CI) for self reported risk taking behaviour. Regression analysis revealed that a more risky behaviour increased with male gender (OR: 2.7), with an age<25 years (OR: 1.6), with skiing (OR: 1.3), higher skill level (OR: 5.7), and a mean skiing time>28 days per season (OR: 2.2). In addition, SS total score was significantly higher in more risky compared to more cautious people (23.8 vs. 20.3, p<.001). Ski helmet use was not found to be predictive for a more risky behaviour (p>.05). Also, skiers and snowboarders with self reported risk compensation while wearing a ski helmet had higher SS total scores compared to those who did not report risk compensation (23.8 vs. 20.9, p=.001). In addition, self reported risk compensation in helmet wearers increased with an age<25 years (OR: 2.2), a higher skill level (OR: 2.5) and a mean skiing time>28 days per season (OR: 2.1). In conclusion, self reported risk taking and self reported risk compensation are associated with higher sensation seeking total scores. The personality trait sensation seeking, not wearing of a ski helmet, appears to be associated with riskier behaviour on the ski slopes.
The use of alcohol is often intimately associated with sport. As well as providing a source of energy, alcohol (ethanol) has metabolic, cardiovascular, thermoregulatory, and neuromuscular actions that may affect exercise performance. Strength is minimally affected, and performance impairments depend on the dose of alcohol and subject habituation to alcohol intake, exercise duration, environmental conditions, and other factors. Central nervous system function is impaired at high doses, resulting in decrements in cognitive function and motor skill, as well as behavioral changes that may have adverse effects on performance. Effects may persist for hours after intoxication.
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