Skiing and Injuries; a retrospective of how equipment affects a skier
Skiing has come a long way over the years, and the technological changes that have helped us enjoy sliding over snow have affected the types of injuries we see when things go awry.Using boards to maneuver on snow has a long history dating back to well over 4,000 years ago. Initially, skis were simple one-piece wooden affairs with little more than a leather strap to bind one’s forefoot to them. Having heels free allowed one to take the ups and downs of the terrain in stride, and this mobility put little stress on the skier from the equipment.As time went on, the limitations of such a loose configuration became evident as far as performance was concerned. Around the turn of the century, stiffer bindings were becoming favored as they provided more control. With the advent of ski lifts in the 1930s, the heel could now be well-secured to the ski, as there was no longer a need for a free heel to travel uphill … at least as long as you were skiing where there was a lift. This development allowed the divergence of alpine and Nordic skiing into separate pursuits.As equipment became more restrictive in an attempt to provide improved control, mobility was sacrificed. With the long lever arm of a ski firmly attached to a stiff boot that rose up above the ankle, the need for a releasable binding became apparent. Boot-top fractures were the bane of skiers even after releasables became commonplace, as the top of the boot became a fulcrum point during a fall. Releasing the heel in all directions, and the toe to either side helped reduce injuries, but the inability for the toe-piece to release in an upward fashion set the stage for the next trend. The introduction of the fiberglass ski and all-plastic Lange boots in the early 60s were favorable products of a revolution in materials technology. It didn’t take long to see the development of a higher cuff up the leg with forward lean giving more control and the ability to pressure and steer the ski with more subtle movements of the knee. With more control up the lower leg, boot-top fractures gave way to the next weakest structure in the link … the ACL, or Anterior Cruciate Ligament. The combination of high stiff cuff, forward lean and a toe binding that does not release upward, transfers forces in backward twisting falls directly to the ACL. The quadriceps muscle can complicate matters, as it contracts strongly to try to control the fall, and provides an additional force pulling the tibia forward, thus compromising the ACL. There are other ways to break the ACL, but this has been found by the Vermont Research Group to be one of the most common.More recently, injuries have started to reveal another trend. While we continue to see plentiful ACL injuries, we are also seeing a rise in high force injuries with multiple ligaments and even the tibial plateau involved. The introduction of the shaped ski, which allows skiers a monumental increase in the ability to hold an edge firmly on the snow, is thought to be a contributing factor. The increased sense of control results in faster speeds. With a ski that is not skidding, higher forces can build up. When something in this system gives out, there is more force involved, and thus we see multiple injuries in that tenuous connection in the middle of the leg.The other development having a large impact on skiing injury trends has been the acceptance and proliferation of terrain parks. High force landings from gaining huge air put an enormous impact on knees, ankles, shoulders, ribs and heads if things did not go well in the sky. Hopefully, as terrain park operators become more proficient, training programs and snow-feature design will help minimize this trend. The temptation to go big and risks associated with it will probably be with us for some time. Risk is a part of getting up off the couch, but with a little knowledge about how our equipment affects our bodies we can make informed decisions that minimize risk reasonably without sacrificing our fun.
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