Traumatology in skiing and snowboarding: how can accidents be avoided?

By Dr Philippe Loriaut - orthopaedic surgery and sports traumatology

We are in the middle of the winter sports season. Preventing skiing and snowboarding accidents means knowing your own limits. But it also means following safety advice, using the right equipment and wearing a helmet, especially for children. Here are a few useful reminders:

KEEPING FIT AND MAINTAINING A HEALTHY LIFESTYLE

Keeping fit is the best way to avoid skiing accidents.

Doctors have a major role to play in prevention: advising patients on exercises suited to their lifestyle and physical condition, reminding them of the basic principles of a healthy lifestyle, etc.

Resume physical activity 2 months before the big departure.

Muscle is the only element that can protect the ligament. Getting ready therefore means improving the condition and reaction capacity of your muscles.

A number of activities are recommended to help you get into shape for the mountains and ski in complete safety: some will help you build up your thighs, others will help you work on your topographical memory, and others will help you develop your sense of balance.

1. Building muscle to prepare the body for exercise

Everyone needs to strengthen the thigh muscles that protect the knee, especially women. So, from November onwards, future female skiers are invited to adopt at least one of the following good resolutions:
- Forget the car and go for a walk: an hour's walk every day is highly recommended for building up your thigh muscles.
- Forget the lifts and take the stairs. This activity not only gives your thighs a complete workout, but also improves your body control.
- Relax while building muscle through swimming. This sport strengthens all the muscles in your body (thighs, arms, back).
- To help you prepare for skiing, we even recommend swimming with flippers to build up your thighs.
- Do a little gymnastics every day. Gymnastics is excellent for developing resistance to fatigue.
- Run to maintain your endurance: a 40-minute jog, two or three times a week, is recommended to build muscle but also to develop your respiratory capacity.

2. Staying alert and exercising your topographical memory

Cycling (with a helmet!) is ideal: it's an all-round exercise that muscles the legs, but the speed (similar to skiing) also helps to maintain control and alertness.

Cycling is also recommended for training your topographical memory, as you need to be constantly reminded of the dangers of a trail, just like in the mountains. Anyone who remembers the dangers of a trail is less likely to fall.

3. Master and develop your sense of balance

Dancing, trampolining and gymnastics are all highly recommended sports for developing a sense of balance.

SOME RECOMMENDED EXERCISES TO PREPARE PHYSICALLY FOR A SKI HOLIDAY

Exercise to develop resistance to fatigue

Stand with your back to the wall in a "seated" position, i.e. as if you were sitting in a chair, for about 10 seconds. Increase this time by five seconds each day.

Exercise to develop your muscular strength and sense of balance

Sit on the edge of the chair, with one foot on the floor and the other leg stretched out in front. Slowly raise your body vertically until your knee is fully extended, then slowly lower yourself back down to the initial sitting position. Do three series of five exercises alternately on each leg.

Exercise to work the thighs, knees, ankles and coordination

Feet together, knees slightly bent, gradually lower your knees to around 90° bend, alternating from left to right, feet flat and riveted to the floor, then raise and lower them ten or so times.

Exercise for stretching the adductors

With your legs apart, slowly lower yourself onto your right thigh, bending your knee to 90°; your left leg is straight, and your torso remains upright with your hands on your hips.

Hold this position for six seconds, then move up and down your left thigh in a symmetrical pattern. Do two sets of ten.

Balance exercise

Do a series of short lateral jumps, feet together, knees together. Do three sets of ten jumps.

Exercise to build thigh muscles

Stand with your legs straight and feet together. Drop into a forward lunge, cushioning the landing with a controlled bend of the knee, back leg straight and torso erect. Return to the starting position by dynamically re-extending the bent knee.

Returning from a ski trip can be painful and require a long recovery period. This is because of the seriousness of the potential visible or invisible injuries resulting from a skiing accident.

Being aware of the risks involved in practising any sport is already the basis for implementing a preventive strategy.

Finally, don't forget that skiing should remain a pleasure, but that it is certainly the leisure activity that causes the most injuries and serious accidents.

CHECK YOUR SKI BINDINGS TO SAVE YOUR KNEES

The original aim of ski bindings was to protect the leg from the risk of fractures. The results have been very conclusive, with a spectacular reduction in this type of injury. However, these modern bindings do not protect the knee because they cannot be released in all directions (forwards, backwards or sideways) and they react very badly to simultaneous efforts in several directions.

What's more, for the bindings to be effective, they need to be adjusted according to a few simple parameters: the skier's weight and gender, his or her skill level and basic physical condition.

The risks of incorrectly adjusted bindings

New bindings and the quality of their adjustment are the main causes of knee sprains.

Incorrectly adjusted bindings can lead to

- A risk of accident through untimely release (or unlacing) if the adjustment is too low. This can lead to falls.
- A risk of injury in the event of a fall due to failure to release if the setting is too high.

Failure to release is the main cause of knee sprains. In fact, a survey showed that 82% of skiers injured by a knee sprain did not take their boots off when they fell.

The right setting for bindings

Bindings must comply with standards if they are to work properly. Until now, the international ISO standard has been little known by the general public and sometimes by professionals. In July 2000, AFNOR2 published a new guideline (standard FD S 52-748) on the adjustment of bindings.

The new standard takes into account the essential parameters for adjusting bindings: weight, shoe size, type of skier and now the skier's gender.

This new text supplements the NF ISO 8061 standard, which stipulates that bindings must be adjusted according to very precise instructions that determine the optimum release torque to ensure maximum safety for the skier, i.e. to avoid both unnecessary release and failure to release the bindings in the event of danger.

Depending on the sex of the skier, two adjustment tables are proposed to all ski professionals (simplified tables):

* This adjustment is based on parameters communicated by the participant who may underestimate or overestimate certain values (skier's weight, height, age and above all level of practice).

How do you check that your bindings are correctly adjusted? "The click-clac test

All skiers can check for themselves that their bindings are correctly adjusted using a simple test: the "click-clac test". At a standstill, rotate your foot towards the inside of your slightly bent knee; this movement alone should be enough to trigger the opening of the bindings, which should be painless but require an effort to rotate, rather than opening on their own.

ACCIDENT PREVENTION ON THE SLOPES

Sensation-seeking without real control of speed is the cause of the increase in accidents every year during the winter season in the mountains.

A few protective reflexes:

- Choose an activity that suits you and the weather
- Choose a trail or itinerary based on your ability (don't overestimate yourself, pace your efforts, set off in a homogeneous group) and adapt it to the difficulties you encounter (changes in altitude, uneven terrain, changing weather conditions).
- Make sure that your diet and hydration are adapted to your project and its duration.

Watch out for downstream skiers

It's up to the skier upstream, given his dominant position above and his overall view of the terrain, to avoid obstacles and skiers downstream, not only by adapting the direction of his trajectory, but also by anticipating the bad reflexes of others.

Control your speed

Speed remains the key to your own safety, protecting yourself but not endangering others. There is a link with what has been said about the skier downstream, since the skier upstream can regulate his speed in order to avoid the skier downstream. However, you still need to adjust your speed according to your own skiing habits, fitness, technical ability, concentration, the quality of the snow, the quality of the slopes and visibility, as well as the different types of snow, from hard snow in the shade to softer snow in the sun.

Follow the signs

While there's no question of banning off-piste skiing, you should be aware that many more people are injured when skiing off-piste, particularly as a result of avalanches or focused snow slides. Fatalities and collisions are also more common when skiing off-piste, where controlling speed is sometimes much more difficult.

For off-piste skiing and ski touring, it is essential to have avalanche rescue equipment: avalanche transceiver (ARVA) switched on when transmitting, shovel and probe, etc. and to be trained in its use.

Ask Dr Loriaut a question: contact@chirurgienorthopedisteparis.com