VERONIQUE HAUSCHILD
U.S. Army Public Health Center
Aberdeen Proving Ground, Maryland

The silver lining to the shorter, colder days of winter is the snow and the outdoor sports typically reserved for this time of year. Winter activities such as skiing, snowboarding, snowmobiling, sledding and ice skating provide fun, excitement, fresh air and good exercise for all ages. Unfortunately, every year these activities also result in hundreds of thousands of injuries, as well as many deaths, in the U.S.

Injuries occur in both recreational and professional athletes alike. The growing popularity of skiing and snowboarding are now a focus of scientific study as emergency rooms see increases in the number and severity of injuries. A recent study of fall-related injuries in the active-duty Army showed snowboarding and skiing were the leading sports causing such injuries. Many of these injuries occurred during military-unit organized events. Military personnel need to be aware of the injury types, factors that increase the risk of injury and ways to reduce chances of injury.

Injury types
A particular concern is that at least 15 to 20 percent of winter sports injuries involve head trauma, including concussions and mild to severe traumatic brain injuries. Injuries to the head and spine are the ones most commonly associated with fatalities, and two-thirds of the head injuries are estimated to be mild TBIs.

Overall, though, bone fractures are the most frequently reported type of injury associated with winter sports. During skiing, injuries to the lower parts of the leg and foot — including the knee and ankle — are the most common. These include fractures as well as sprains or ligament tears in joints such as thumbs or the anterior cruciate ligament of the knee. Snowboard fractures are more often to the wrist and hand, as well as the arm and clavicle. Some data suggests possible long-term impairments from winter sports injuries.

Cold weather injuries such as frostbite and hypothermia are also reported — especially in conjunction with snowmobiling injuries when accidents can occur in unpatrolled or unmonitored areas. Other conditions considered less severe, but which can still limit further activity and require extended rest, include muscle strains and soreness, dehydration, snow blindness and sunburn.

Factors associated with injury risk
Several studies evaluated winter sports injuries for potential factors associated with higher risk of injury or greater injury severity. Because skiing and snowboarding are associated with the highest numbers of severe injuries, they are the most studied.

The numbers and severity of injuries appear higher at the start of the season. Recreational skiers and snowboarders are more likely to experience more severe injuries than those experienced by professionals. However, even professionals experience injuries requiring four to six weeks of recovery.

More males experience injuries than females, especially those in their late teens to mid-20s. Though nuances of the type of skiing or snowboarding — such as speed races, freestyle and snowboard cross — have some different patterns of injury types, increased risks appear more associated with improper use or lack of protective equipment and exceeding one's experience or skill level.

Reducing your chance of injury
Though there are risks, winter sports can be an exhilarating and fun form of healthy exercise. It is important to do what you can to reduce the risk of incurring winter sports-related injuries by following best practice guidelines below.

   • Wear a helmet. It is the primary evidence-supported means to reduce the risk of severe head injuries.

   • Wear wrist guards — especially when snowboarding — to reduce the risk of wrist fractures.

   • Wear other appropriate clothing/equipment such as boots and goggles.

   • Check that equipment works before each use; test your board or ski bindings.

   • Know your experience/skill level as well as the terrain.
      o    Seek proper training or certifications.
      o    Try more complicated slopes or techniques only after practicing.
      o    If at a new location, start slow and easy until the terrain is familiar.

   • Be wary of poor trail design and unknown, unmaintained areas.
      o    Use official designated groomed and patrolled trails and sports areas as opposed to “backyard” private lands.
      o    Be aware that even some maintained slopes or trails may have "black spots," areas known for conditions that have resulted in repeated or high numbers of injuries — merging slopes, a narrowing or sharp-turning trail, and poor grooming.

   • Physically condition your body at the start of the season or when attempting new techniques or equipment.
      o    Do exercises to prepare your body for the less stable lower body movements required of many winter sports. Examples include lower body muscle exercises — squats and lunges, balance/stability balls, wobble boards, agility moves and shuttle drills.
      o    Slowly progress in level of intensity and time and ensure rest breaks.

   • Be prepared by following the above guidance and also remember to:
      o    Wear layers of clothing to keep warm and dry, including socks and gloves. Replace wet items or layers as soon as possible.
      o    Use sun protection — UVA/UVB sunglasses and SPF15+ for exposed skin and lips.
      o    Stay hydrated.
      o    Keep a phone/radio as a means to contact help.

   • Be a good leader.
      o    Emphasize the safe practices described above.
      o    Enforce the use of proper procedures and protective gear.

For more information, contact the Army Public Health Center's Injury Prevention Program at usarmy.apg.medcom-phc.mbx.injuryprevention@mail.mil.