ALPINE SKIING FAQs
1. What are the commonest injuries sustained by alpine skiers?
2. What about carving skis?
There were some initial concerns that carving skis might be associated with an increased risk of injury. When they were first introduced, a small increase in the rate of knee injuries was seen shortly afterwards. This has now settled down. The theory was that skiers who were used to traditional skis could be caught out by the superior turning ability of carving skis and this placed extra stress on the knee joint. This phase seems to have passed. The majority of skiers are now using carving skis and the "learning" phase for established skiers the learning phase has passed. Beginner skiers have never experienced anything else so did not need to learn to adapt to carvers. In fact, current injury data indicates that using carving skis has a protective effect against injury.
3. Why don't modern bindings protect against all lower leg injuries?
Whilst modern alpine ski bindings have come on a long way in the last twenty years, they are still not perfect. It is important to remember that ski bindings are primarily designed to protect the lower leg against bony injury (i.e. fractures) not knee injuries. In this regard they have been successful, as we see relatively few of these injuries nowadays. If you stop and think about it, bindings have to perform a difficult balancing act. On the one hand, we want them to hold onto our boots as we apply a multitude of different forces across them skiing at different speeds down a variety of pistes. On the other hand, we expect them to be able to recognise in a millisecond the application of an abnormal force and release our boot before the forces become so great that an injury occurs. No easy task.
There is a perception amongst many ski injury researchers that the current ISO binding settings are too high - especially for women and children - and the fact that the collateral ligaments of the knee remain the commonest site of injury in alpine skiers would tend to support this. Any reduction in binding settings has to be balanced against increasing the risk of injury from an "inadvertent release", when the binding releases when the skier doesn't want it to. In 2000, many resorts in France introduced a new (generally lower) setting system. Initially, a reduction in injury rates without an increase in inadvertent release injuries was seen. The possible development of "mechatronic bindings" may also be a step in the right direction. A new ski binding system that may protect the ACL in the event of a backwards fall was released at the start of the 2008/09 season - see answer 6 below. For details of a simple protective procedure that all skiers should be encouraged to do before they start skiing, click here.
4. How do ACL injuries occur and why all the fuss about them?
The injury rate to the ACL has until very recently been static for the last seven years at one injury for about every 2200 days skied. There are several accepted mechanisms responsible for injury to the ACL whilst alpine skiing:-
- Phantom Foot - the tail of the ski acts as a lever when a skier falls off balance to the rear
- Boot Induced - after landing off balance from a jump, the boot pushes on the calf leading to injury
- The classic mechanism - This mechanism is thought to occur when the skier moves forwards relative to the ski (such as when catching an edge at high speed), a severe anterior bending movement is applied as a result and the forces generated rupture the ACL.
These injuries are important - not only can they easily end a professional ski career, but for the recreational skier an ACL injury will mean many months away from the slopes and most likely a knee that will never give the same level of support as before. Surgery, intensive physio, time off work and considerable expense may all be encountered! More details on my knee page.
5. What about skiers in terrain parks?
More and more skiers are now venturing into terrain parks - traditionally the domain of snowboarders. Short, twin tip freestyle skis are ideal for performing acrobatic tricks on rails and in pipes. We now have data from several studies that have focussed on the topic of injuries in terrain parks. The data (from France, the USA and Canada) unfortunately (but perhaps not surprisingly) show similar findings - that compared to on slope injuries, injuries in terrain parks tend to be more serious (especially affecting the head and spine). You can read all the details on my terrain park page.
6. Any new developments on the horizon?
There are a few products that have either recently been released or are still in development that may have safety implications for alpine skiers.
Possibly the most important innovation in recent times which is now commercially avaiable is the Knee Binding. This is a new alpine ski binding designed to protect against one cause of ACL injury - the so called Phantom Foot scenario (explained in detail here). Featuring lateral heel release below the elastic limit of the ACL, this binding has been in development for several years. Whilst in theory it should protect the knee, importantly it does not seem to lead to an increase in inadvertent (i.e. accidental) release compared to any other binding. For more details, visit my page describing this binding or go to the manufacturers page at www.kneebinding.com
Still largely under development are mechatronic ski bindings. As the name implies, these are a combination of mechanical and electronic ski binding components. By recording and analysing the forces applied through the boot-binding interface during normal and abnormal skiing events, these bindings may ultimately operate using new and unique release algorithms that improve the safety characteristics of the binding and therefore lead to a reduction in lower leg and soft tissue knee injuries.
Expect to see some exciting developments in goggles in the next few years as well. Goggles with integrated GPS, cameras, heads up displays and WiFi may sound like something out of a James Bond film but they're going to be in the shops soon enough. There is the potential to provide safety features through these - imagine you're caught in a white out on a run and can't see where you're going. Turn on the GPS head up display and maybe it can guide you safely down the centre of the slope avoiding any drop offs or unexpected surprises. Maybe, just maybe, you can link to another skier's goggles and arrange a rendezvous. Could be very useful (and expensive, at least initially). Watch this space and remember where you read about it first.
Snow sports manufacturers in general have been in overdrive on the development front for the last few years Ski design has altered radically and now we have twin tips, split skis, amazing sidecuts and even Intellifibres in Head skis. These piezoelectric fibres generate an electrical charge when flexed and react to the voltage by growing stiffer. This means that as you ski harder, the ski edge bites harder which is a great feature on icy slopes or hardpacked terrain. As with the Skibo Edge system mentiond elsewhere, they have yet to be proven to improve safety. On one front it might seem logical that they will, as they should offer better grip but the flip side is that by skiing harder the risk of injury might be increased - we simply don't know at this point in time. Expect other manufacturers to follow with their own designs in the near future. Soft ski boots are becoming increasingly popular too - on the face of it a pretty decent compromise between performance and comfort. Again, we don't yet have hard data on these and so cannot comment on any potential safety issues with these boots as yet.
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