December 2015

Injury Prevention and Care on the Slopes

Author: John P. Batson

This is the time of year when many Lowcountry residents migrate north or west in search of some true winter weather and fun on the mountains. This is also the time of year when we in the sports medicine community see a number of injuries from skiing and snowboarding. For many of the common medical conditions and injuries one might face on the slopes, there are some sound preventive strategies. For some of the trauma that is not preventable, we will review some helpful initial injury care.

General medical conditions
Altitude sickness is a common reason you might find yourself tired and lacking energy despite the excitement of fresh powder at your destination. Altitude sickness is due to the lower oxygen content in the air at higher altitude. Symptoms include fatigue, headache, poor energy and poor sleep. Even if you are in great shape, you need to pace yourself the first few days on the mountain. Staying hydrated is important, as is avoiding excessive caffeine or alcohol on the slopes. Some medications can help lessen altitude sickness (oral steroids, Azetazolamide) and might be worth discussing with your doctor. Ibuprofen has also been shown to help some individuals with altitude sickness symptoms. Other important general medical items include wearing protective layers to prevent cold injuries/exposure, sunscreen applied often for your face and lips, and goggles to protect your eyes.

Head injuries
Head injuries and concussions have been placed in the spotlight in sports like football and soccer, but skiing and snowboarding are common causes for head injuries as well. It is much more common these days for helmets to be worn on the slopes and for good reason. Properly fit helmets can help lessen the severity of head injuries if you were to hit the ice, a tree, someone’s skis or another skier.
Concussions are mild traumatic brain injuries. Signs of a concussion include headache, confusion, fatigue, sensitivity to light or sound, balance difficulty and nausea or vomiting. Concussions do not show up on a CT (cat) scan or MRI; rather they are a physiologic problem with the brain. These injuries should be evaluated by a physician skilled in concussion management. If you have a concussion, it is important that you not return to the slopes until all of the symptoms have resolved.

Upper extremity (arm) trauma
Arm injuries after a fall on the slopes are common. While many of these injuries may not be preventable, it is important to recognize when you should seek medical attention when they occur. It may be obvious you have broken a bone or a dislocated joint, but many injuries are subtle. If you are very tender over a bone, it is always a good idea to have it checked. If you can not raise your shoulder after a fall, you may have a fracture or a torn rotator cuff. If you can not fully bend or straighten your elbow or wrist after a fall, you should have it evaluated. Kids, in particular, are more prone to fractures rather than sprains. If they are sore on a bone, you should have it evaluated. Recognizing and treating these injuries early can lessen the related downtime and prevent a worse problem if you were to fall again on the arm. Initial treatment for most of these injuries should include PRICE (Protection with a splint or sling, Rest, Ice, Compression and Elevation). Wrist splints may prevent some wrist injuries, and these are a great idea if you are just learning to snowboard.

Knee sprains and trauma
Knee injuries such as ACL tears are one of the most common injuries for skiers, experienced or novice level. As in soccer, there are some preventive strategies for knee injuries on the slopes. Most knee injury prevention programs involve core and leg strengthening (hip abductors, quadriceps and hamstring in particular) and some balance type exercises to help with jumping and landing mechanics. Aerobic activities such as cycling, roller blading, and the elliptical machine are great ways to build leg endurance and recruit similar muscles you would use on the slopes. You can jump or run in and out of cones to help with agility. Keep your skis properly tuned so, if necessary, you will break out of the bindings and avoid stress to the knees.

Skiing and snowboarding are great activities for the entire family. If an injury does occur, remember the PRICE mnemonic to assist with initial care. Hopefully if you use some of the above strategies you can prevent some injuries from happening all together. These prevention strategies require some effort weeks prior to your trip. So hurry up and get fit, strengthen your legs and core, buy a helmet cause ski and snowboard season is upon us!

John P. Batson, MD, FACSM is the director of Lowcountry Spine & Sport, LLC and volunteer physician for the U.S. Ski and Snowboard Team.

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