Whether it’s taking on the backcountry at Berthoud Pass, carving between moguls at the Mary Jane or Nordic skiing at Devil’s Thumb Ranch winter sports are a way of life in Grand County. Skiers and snowboarders are dedicated and passionate, braving terrible traffic and snowstorms to get on the slopes. But at what cost?

We all know that skiing and boarding can be dangerous, with the constant risk of hitting a tree or breaking your leg, but the long term health effects of skiing can be equally daunting.

“We can see a prevalence of injury in terms of snow sports,” said Stephanie Zavilla, director of sports performance at the Winter Park Competition Center. “Most of what we see are knees and concussions. Obviously the amount of injuries can range, but like any very active sport there’s going to be wear and tear on the body. And most of us would not sacrifice the love we have for something in order to prevent injury.”

The most common long term concern for snow sport enthusiasts, predominantly skiers, is deterioration in the knee. Because of the forward lean of ski boots skiers tend to have an interior tilt in their pelvis, which loads a majority of your weight onto your knees. The tilt in the pelvis also means that skiers tend to load their knees more than necessary off the hill as well, according to Zavilla.

The increased stress on the knee over time can cause several complications long term.

“We see more ACL tears at a much later age than one would normally see in an urban setting,” said Lori Myers, physical therapist at the Denver Health Alpine Clinic in Fraser. “Obviously with skiing there’s an increased incidence of meniscus and ACL tears. And depending on how both are managed that could lead to arthritic changes in the joints, and perhaps later necessitating a partial or total knee replacement.

“We’ve seen quite a few total knee replacements in this population. You can extrapolate that it’s related to other knee injuries from years of skiing.”

The skier’s tilt also leads to lower back pain due to the hips and back being in a constant state of extension.

While it’s called “skier’s knee” for a reason, there are ways to help prevent damage to the knees, back and hips. Zavilla recommends postural restoration therapy, a variation on physical therapy that looks at your skeletal alignment and asymmetries that occur naturally in your body.

“We need to be moving in loading the hips and moving from our glutes instead of using our hamstrings and only loading the knees for the majority of our power,” said Zavilla. “What we’ve worked on a lot recently with postural restoration therapy is looking at realigning the pelvis back into a neutral position. That then frees up the hip flexor, you get less lower back pain and we start chaining properly in terms of our movements, range of motion and getting power from the correct muscles.”

Snowboarders are typically more susceptible to trauma injuries, though also risk long term injury to their backs. Boarders throw their feet around and torque the pivot point at the thoracolumbar junction between the thoracic and lumbar spine, creating stress on the back.

“There’s a lot of excessive rotation that occurs in that,” said Myers.

Another major long term health risk for both skiers and snowboarders is concussions. While research into concussions is still in its relative infancy, with much to still be uncovered, concussions can come with a myriad of vestibular, cognitive and memory symptoms which can develop into seizures, according to Zavilla.

Because concussions are an invisible injury, recreational skiers and snowboarders often return to the slopes before their bodies are ready.

“I think there’s a lot of myths surrounding concussions, where people think its been two weeks and they’re probably fine,” said Zavilla “In reality it could take months. I’m going on two years for mine. So it’s different for every person, and going back too soon can cause long term effects.”

While concussions are difficult to prepare for, aside from wearing a helmet and avoiding overly dangerous terrain, precautions can be taken to help prevent long term knee, hip and back injuries.

Conditioning is key. Building muscle around the knee will help protect the joint, and skiers and snowboarders should take lessons to ensure they’re using the proper form, or consult with a postural restoration therapist. Experts agree that you should be in good physical condition before you ski or snowboard, as opposed to conditioning yourself through the sport.

Nutrition is also an important element in injury prevention, as snow sports participants should know how to fuel their bodies for a day on the slopes, and how to recover afterwards.

Zavilla also emphasized the importance of mental preparation.

“I tell the athletes to have a present mindset. Becuase if you’re in the past thinking about the last time you crashed on a run, or something unrelated to skiing you’ve left the moment and you’re not fully engaged in what you’re doing. That’s when we see some injuries happen.”

The prospect of a total knee replacement or a concussion can be intimidating, but it shouldn’t stop you from enjoying your favorite snow sports, especially given the myriad of health benefits that also accompany skiing and snowboarding.

On top of improved physical fitness, snow sports can help improve coordination, balance and strength. Being outside and exercising in the fresh air is also great for your mental health.

“There’s a sense of well being and people tend to be happier when they stay physical,” said Myers. “Both skiing and snowboarding are excellent in terms of encouraging triplaner motion throughout the whole body, using the whole body in a three-dimensional manner. There’s really just better overall conditioning with people that ski and snowboard.”