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The sport of downhill skiing, the ultimate escape for many athletes, has grown to include nearly 10 million participants. Despite its popularity, snow skiing has a reputation for injuries, and 2 or 3 out of 1,000 downhill skiers become injured. Many accidents occur on very gentle runs, where a skier may simply lose control and fall or strike a tree. These injuries often occur late in the day, when a skier's muscles are fatigued. Each year a number of deaths result from multiple head and neck injuries caused by skiers losing control.

Recently, the number of head, neck, and shoulder injuries from skiing has increased dramatically, while the number of leg injuries has declined. Thanks to improved hill grooming and slicker ski surfaces, skiers can cover more of the mountain more quickly. Better ski bindings, which release the foot more readily during a fall, have led to fewer lower-extremity injuries. Despite improvements in technology, however, bindings are not all they could be. New boots have spared the ankle only to pose a danger to the knee and leg.

There are many reasons skiing leads to injuries. It is a high-impact sport; that is, you are likely to have a high-speed impact with the ground or with a natural obstacle, such as a tree, a rock, a fence, or another skier. The leverage of the ski attached to the foot applies a high level of torque to the joints. There is also a high rate of repetitive overuse injuries due to the pounding exerted on the knees in the crouch position.

What's more, many skiers tend to ski beyond their abilities. They want to be out on the expert slopes but can't handle them. They hurt not only themselves but others when they get out of control. Fast skis, overcrowded slopes, and reckless hotdoggers also contribute to the incidence of ski injuries.


Although competitive skiers wear helmets, a recreational skier wears nothing more on his head than a fancy wool cap. A blow to the head from hitting the ground can cause a concussion, and a skull fracture can result if the ground is hard enough or if the skier hits a tree or a rock. Facial fractures are common from blows to the nose, cheek, or jaw.

These are all serious injuries and require medical attention. Even a mild concussion needs treatment. If you recover rapidly and ski down by yourself, you should stop skiing for the day and rest for one week or until you have no symptoms of dizziness or disorientation when you exercise.


A whiplash injury can sprain your neck, causing stiffness and pain when you move it. You might even break your neck due to a high-impact injury. Unless the symptoms are very mild, your neck should be x-rayed.

If the injury is extremely mild, ice your neck, 20 minutes on and 20 minutes off, and rest it for a few days. You can also wear a soft neck collar. By day 3, you can begin to stretch your neck muscles gently to restore your range of motion.


A skier who falls on a shoulder can break the collarbone. If your shoulder looks as if it has dropped down and you feel pain between the breastbone and the shoulder, you probably have broken your collarbone.

If you fall directly on your shoulder, or if you fall on the point of the elbow and drive the upper arm into the shoulder, you may separate the collarbone where it hooks into the shoulder joint.

You will feel pain at the tip of the shoulder where the collarbone attaches. You will have trouble moving your arm, particularly out to the side, although any motion can be very painful if the separation is severe.


A partial shoulder dislocation occurs when the head of the arm bone (the humerus) that fits into the shoulder socket is forced partway out of the socket by a blow to the shoulder. You may feel the shoulder snap back in spontaneously or as you move it. This injury stretches the rotator cuff muscles, which hold the shoulder joint together. To tighten the joint, you will need to carry out an exercise program to restrengthen the rotator cuff muscles.

When the head of the bone comes all the way out of the socket, the shoulder is dislocated. This injury stretches the rotator cuff muscles severely. The shoulder will not pop back in by itself, and it may be difficult for a doctor to put it back in. Rotator cuff tears are usually seen among older athletes, but a high-impact ski injury can tear a rotator cuff even in a young athlete.

A rotator cuff tear or severe stretch requires a closely supervised rehabilitation program to restrengthen these muscles, and it may require surgery.


Some of the most severe knee injuries I have seen are from skiing. I never go through a ski season without seeing a number of knee injuries that require surgery. All but the most minor knee injuries must be seen and diagnosed by a doctor.

Two-thirds of all ski injuries occur in the lower limbs, and knee ligament injuries are the most common. The increase in knee injuries has been attributed to the modern high ski boot with its forward-leaning position.

Knee injuries from skiing are usually due to severe torque to the knee when bindings fail to release the foot in a fall. When your foot is fixed to the ski, turning your body or the ski to a position the rest of the body can't follow applies a severe rotary force to the knee. The damage can vary from a simple knee sprain to a tear of the medial collateral ligament (MCL), of cartilage, or even of the anterior cruciate ligament (ACL). The ACL is most likely to tear when you land on one leg and quickly pivot in the opposite direction.

Skiing is an extremely difficult sport for people with runner's knee because it puts tremendous force on the kneecap. Crouching with the thigh muscles contracted pulls the kneecap back into the groove, causing irritation. My patients with runner's knee tell me that after two days of skiing their knees ache so much that they have to take a couple of days off before they can get back on the slopes.

The treatment is to strengthen the quadriceps muscles that support the knee and, when necessary, to use an orthotic device to control the foot. Many ski shops sell boot orthotics, but these are not designed by foot experts. These may be effective if your foot problem is mild, but if it is severe, you will need a true orthotic made by a sports podiatrist.


A skier can easily injure the thumb in a fall if it gets caught in the strap of the ski pole. This common injury tears ligaments at the base of the thumb. You will not be able to touch the thumb to the second finger, and you will have no strength at all in the thumb.

Ice the thumb and get to a doctor. Your thumb will need to be splinted for about six weeks before the doctor can tell whether it will tighten and heal by itself. If not, you will need to have the thumb ligament surgically repaired.


You can break almost any bone of the body in a high-impact injury, but the bones most likely to break are the tibia and fibula in the legthe so-called boot top fracture. If the boot is rigidly fixed to the ski and the binding does not release, both bones will snap just above the boot top if enough force is applied.

This serious injury leaves the leg unstable because both bones are broken. Also, the tibia heals very slowly in this area of the leg. Often, a surgical plate must be put in to stabilize the leg.


All of the injuries discussed so far also occur among cross country skiers, but they are usually less severe because of the slower speed and lower impact of cross-country skiing. Cross-country skiers do suffer more muscle strains because they use their arms and legs more actively than downhill skiers.

The only injury that is common to cross-country skiers and not seen among downhillers is an ankle sprain. The rigid boot used in downhill skiing doesn't allow the ankle to turn over; the forces are transmitted higher up and often result in a leg fracture. The low, soft shoe used in cross country skiing, however, allows the ankle to sprain.


More than 200,000 Americans have joined the ranks of snowboarders, who proficiently ride what amounts to a small surfboard adapted to snow. They use the same slopes as downhill skiers, and snowboarding is increasingly accepted at ski areas as the equipment improves and instructors become certified.

The injury patterns from snowboarding are similar to those from downhill skiing, with slightly fewer lower-extremity injuries and slightly more head and upper-extremity injuries. The snowboarding injury rate is estimated at 1 or 2 out of 1,000, although there actually are more injuries than this because only one-quarter to one-half of all significant injuries are reported.

How to Improve Your Skiing


Strengthening exercises should be done in the off-season. The muscles subjected to the greatest stress in skiing are the quadriceps. These leg muscles handle all of the strain in the bentknee position and absorb the shock of bumps and moguls because they control how much the knee bends.

First do the Leg Extension in Chapter 1, 10 lifts per set for five sets, with whatever weight is necessary for you to fail in the last set.

An isometric exercise to strengthen the thighs, described in Chapter 20, is 90-90 Wall Sitting; another good exercise is the One-Legged Knee Bend.

A lot of unnecessary trauma and injury could be avoided if skiers would prepare for the season by getting in shape. Many skiers do nothing to condition themselves prior to the ski season. Building strong muscles and increasing cardiovascular and muscle endurance can reduce injuries and add to the enjoyment of skiing.

If you prepare properly before the season, you will be less vulnerable to a serious injury. Work to improve your flexibility, coordination, strength, and general fitness. This will substantially reduce the chance of limb and ligament damage when you fall, as you inevitably will.

A general flexibility and stretching program will help prepare your body for the twists and turns of skiing. Before you hit the slopes, remember to warm up to increase blood flow to the muscles.

You can also work to improve your skills and correct bad habits in the off-season. With this in mind, many skiers have taken up in-line skating, or roller blading. When you are going downhill on in-line skates, you need to make tight, complete, careful turns. The turning maneuvers in downhill skiing are almost identical to those of skating, where you bow the body into the curve with your weight on one leg. The weight shifting, the sense of edging, the forward-leaning stance, and the forward and backward balance of skating are characteristics that carry over to skiing. Cross-country skiers can practice with in-line skates along with ski poles adapted for the pavement.

Your local health club may have exercise machines that mimic the motions of cross-country skiing. Similar machines for home use are also available.

Check Your Equipment

Your performance in skiing depends on the quality of your equipment. Have your equipment checked every year to ensure that the ski bindings are properly set. In practically every case I see of a bad knee injury from skiing, the patient tells me, "I fell, and my binding didn't release."

All skiers should wear goggles or sunglasses that prevent reflected sunlight from reaching the eye. Normal sunglasses reduce glare from the front but do not protect the eye from glare from the side. A maximum-protection UV sunblock cream is essential in preventing severe sunburn. Apply a sunscreen lotion with a sun protection factor of at least 15 before you ski and throughout the day.

Don't Hotdog

It makes good sense to stay within your limits when skiing. Don't overski slopes you can't handle. The reckless young men between the ages of 16 and 30 who fly down the hills are the ones who get hurt the most often. Also, I see a lot of middle-aged men trying to recall their 20s by taking runs on difficult slopes.

Fatigue is a tremendous factor in ski injuries. More tired skiers on the slopes means more accidents. Getting one last run in because you paid so much for the lift ticket can be a ticket to serious injury if you are overtired. Psychologically, you may feel that you are able to perform, but muscle fatigue affects your control. If you try to make the last run of the day the best one, you are probably overdoing it.

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