An Overview of Alpine Snow Sports Injuries

Alpine snow sports remain very popular winter pastimes - it is estimated that there are currently more than 200 million skiers and 70 million snowboarders in the world today. In the UK alone, over £500m is spent every year on snow sports. The last 15 years have seen the emergence of new sports such as snowboarding and skiboarding (snowblading) which have helped to widen the appeal of snow sports - especially amongst a younger generation. As well as a successful Winter Olympics in Turin, the 2005/06 season also saw the introduction of release bindings as an option on a wider range of skiboards including (most importantly) those made by Salomon, arguably the world's largest manufacturer of skiboards. I hope this will lead to a reduction in the number of lower leg fractures we have seen amongst skiboarders in recent years. Telemark skiing, once purely the domain of hardy folk in the backcountry, has also become increasingly popular as an on-piste sport with the introduction of plastic boots, carving skis and a whole range of new binding systems. Indeed, the 2006 ISPO trade fair saw the unveiling of a totally new telemark ski binding system developed by Rottefella called the NTN system. Alpine skiing itself underwent a huge renaissance with the introduction of carving skis in the mid 1990's. Now skiers can choose from a huge range of different ski designs all basically based on the carving system. New developments continue apace in all sports - advancements in soft ski boots, integrated binding systems, electronic filaments in skis - to name but three. All in all, there are more opportunities to enjoy yourself both on and off piste now than ever before......so get out there and party! I hope the information contained within this website will help you to have fun safely.

Unfortunately, as with every other outdoor sport, snow sports are associated with a risk of injury. But that risk is much lower than most people believe - less than 0.5% in fact to give you a ballpark figure. This website is written by an active ski patrol doctor who is also a family doctor in a ski area with many years experience of not only treating these injuries both on the slopes and in the clinic but also of conducting in-depth research into their occurrence and prevention. At least every month I check the literature bases for new publications and update this website as often as possible (given my full time job allows me little spare time) so that this information is passed on to the general public in a language most people can understand. Hopefully, by following the advice on this site, you will be able to enjoy many, many fantastic seasons on the snow without ever sustaining an injury. Or, if you've been unlucky enough to pick up an injury, I hope this website will help you to understand your injury and perhaps why it occurred, aid your rehabilitation and give you some useful advice that may help prevent an injury in the future. This website is continually being updated - I've been busy lately and have added new pages focussing on injuries amongst children, a new knee alpine ski binding due for release next season and an injury advice download page. You can find links to them all from here. I have also updated several pages with the latest research information from the 17th ISSS meeting, which took place here in Aviemore in May 2007. You can find my general summary of some of the important information that was presented at this meeting by clicking here. Finally, the medical references page has also just been extensively updated.

The big news is that, due to its continued growth and popularity, this website will shortly be undergoing a complete re-design and change of server. Not only will this improve the look and functionality of the site, but it will also allow me to add some new features and a much-requested forum. More details soon.

Despite all the doom and gloom predictions of global warming, Scotland has just enjoyed one of its best ski seasons for many years! I have also been lucky enough to sample the skiing delights of the Lake Tahoe Basin and Mount Parnassus, Greece. In June 2008 I will be heading to Tromsø in Norway for the 2nd World Congress on Sports Injury Prevention. I will update this website as soon as possible after this meeting with any useful information.

Wherever you plan to ski and board in the near future, I wish you many safe and memorable days on the snow and all my best wishes for 2008.

Snow sports, you may be surprised to hear, are actually relatively safe and I personally dislike anyone describing them as "dangerous" sports, although sadly you see and hear this phrase used all too commonly, especially in the press. Some of the participants may do dangerous things, but the sports themselves are not inherently dangerous. One of the major aims of this website is to try and change people's perceptions that snow sports are associated with a high risk of injury. First, let me start by explaining how we derive figures for injury rates amongst skiers and snowboarders - this will help you to understand some of the terms that you're going to come across time and time again on these pages.

Injury rates allow us to compare different sports and different time spans. For snow sports they can be expressed in one of two ways - Injuries Per Thousand Skier Days (IPTSD) or Mean Days Between Injury (MDBI). IPTSD has been traditionally used to denote an overall injury rate. It is derived by dividing the number of injuries seen by the total number of skier/boarder days and then multiplying by 1000. Alpine skiing carries an injury risk of less than 3 injuries per 1000 skier days. In other words, for every 1000 people skiing on any particular day, less than 3 will sustain an injury that requires medical attention. For skiboarding (snowblading) and snowboarding the rate is slightly higher, just over 4 injuries per 1000 boarder days. It follows therefore that the lower the IPTSD figure, the less likely injuries are to occur. You can also look at this risk in percentage terms too - i.e. 3/1000 or less than 0.3%. Pretty low I think you'll agree. If you're still not convinced, think of an average game of soccer. How many players normally sustain an injury within the space of 90 minutes? Lets say 3 (its often more). That's 3/22 = 14% or at least 35x the injury rate of skiing and snowboarding over a much smaller time frame! Think soccer's a dangerous sport? No, of course not. Well, it's more risky than skiing or snowboarding.....

A recent study in the December 2006 New Zealand Medical Journal by Bentley et al looked at the involvement of adventure tourism and adventure sports activity in injury claims made to the Accident Compensation Corporation (ACC) during a one year period from July 2004 to June 2005. The Accident Compensation Corporation (ACC) administers New Zealand’s accident compensation scheme, which provides personal injury cover for all New Zealand citizens, residents and temporary visitors to New Zealand. In return people do not have the right to sue for personal injury, other than for exemplary damages. Nearly 19,000 incidents were included in the study. The authors found that four activities (horse riding, mountain biking, tramping/hiking, and surfing) were responsible for approximately 60% of all adventure tourism and adventure sports-related injuries. Skiing and snowboarding were responsible for only 0.7% and 1% of claims respectively. Out of 27 fatalities in the study, none were from snow sports (whereas there were 6 deaths associated with both mountaineering and fishing). Further proof that snow sports are well down the list when it comes to so-called "dangerous sports". You can read the study in full for free by clicking here.

Mean days between injury is more usually used to define the frequency of injuries. It gives a statistical value for how many days you would have to ski or snowboard in order to sustain an injury. It is derived by dividing the total number of skier/boarder days by the frequency of the particular injury. For example, the MDBI for an anterior cruciate injury whilst alpine skiing is about 2100 days. This means on average, you would have to ski for approx 2100 days before you sustained an ACL injury. This time, the higher the MDBI the less likely an injury is to occur. Again, a very small risk really. Remember though that this is all population based statistics - before those of you who popped your ACL on day 1 start sending me loads of emails!

For more information on IPTSD and MDBI and their derivation, click here for my page describing in much more detail how snow sports injury studies are performed.

Below are some charts taken from our own statistics in Scotland. Click on the thumbnail to see the full size chart in a new window.


The overall injury rate from all snow sports in Scotland from 1999-2005 expressed as injuries per 1000 skier/boarder days		A comparison of the injury rates of alpine skiing and snowboarding from 1999 to 2005 expressed as injuries per 1000 skier/boarder days

Comparison of injury rates for all snow sports in Scotland expressed as MDBI		Comparison of the injury rates for the main injury groups by snow sport expressed as MDBI

Whilst they usually receive media attention, deaths due to participating in a snow sport are thankfully very rare indeed. The most complete data series on fatalities comes from the USA. From the 1991/92 to the 2003/04 season inclusive, a total of 469 traumatic deaths have been recorded within the boundaries of ski resorts in the US. Deaths from any other cause (including heart attacks) are not included in these figures. 58 of these deaths were snowboarders and 401 were skiers. A total of 650.7 million skier days took place during these 13 seasons giving a death rate of 0.71 deaths per million skier days (or one death every 1.4 million skier days - really exceptionally low).

The very latest data available is also American and comes from the 2006/07 season when there were 22 deaths from 55.1 million skier/snowboarder days. This gives a death rate of one for every 2.5 million skier days - even lower than in the case series mentioned above (Source - NSAA, USA).

This is a reduction from the 37 skiers and snowboarders who died accidentally on U.S. slopes in 2002/03. With 57.6 million visits in 2002/2003, the death rate that season translated to 0.64 deaths per million visits (or one death every 1.6 million skier days). In 2001/02 there were 45 such deaths in the USA.

Collisions of all sorts account for 90% of all fatalities - trees are the most commonly struck object accounting for some 60% of all fatalities, as happened in the case shown to the right, reported by Sky News in January 2008 . Collisions with other persons account for about 10% of all fatalities.

A more unusual mode of death is the so called "Non-Avalanche Related Snow Immersion Death" (NARSID). Also called "tree-well deaths", these result from a fall into the (often deep) pitted area under a snow-laden tree - as the victim tries to extricate themselves, they cause more snow to cave in on top of them and die from either asphyxiation or hypothermia. Snowboarders and off-piste skiers are obviously the most at risk. An additional factor is that its often hard to make others aware of what has happened to you. A previously presented study by Bob Cadman, a ski patroller at Whistler Mountain B.C., reported that NARSIDs accounted for 25% of all deaths (8/32) in B.C. The majority occurred inside the ski area boundary and just off the designated runs....once you pop down one of those tree wells chances are no one will see or hear you and you're on your own.....scary thought eh? You can read Bob's full report on the web - click here. He has also written another article in the same journal entitled "How to stay alive in deep powder snow" - well worth a read - click here. A website on the subject is also available at www.treewelldeepsnowsafety.com. The latest figures from the US shows that NARSIDs account for less than 5% of deaths in the US, but they are still something to watch out for.

The issue of helmets continues to provoke much debate, despite the facts becoming clearer and clearer. Bahr and colleagues from Norway (amongst others) have recently published more data that supports the wearing of helmets. You can read all about it on either my head injuries or helmet page.

The following is a brief overview of each snow sport - you will find much more information on each individual sports page.