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Myths Concerning Alpine Skiing Injuries

post #1 of 19
Thread Starter 

I ran across a study of the common Myths Concerning Alpine Skiing Injuries.

 

Sports Health. 2009 Nov;1(6):486-92.

Myths concerning alpine skiing injuries.

Johnson RJ, Ettlinger CF, Shealy JE.


Source

University of Vermont, Burlington, Vermont.

 

Abstract:

 

There are many commonly discussed myths about ski safety that are propagated by industry, physicians, and skiers. Through a review of the literature concerning 12 such topics, this article demonstrates that the following are untrue:

 

(1) Broken legs have been traded for blown-out knees.
(2) If you know your DIN (a slang term for release indicator value), you can adjust your own bindings.
(3) Toe and heel piece settings must be the same to function properly.
(4) Formal ski instruction will make you safer.
(5) Very short skis do not need release bindings.
(6) Spending a lot of money on children’s equipment is not worth the cost.
(7) Children need plenty of room in ski boots for their growing feet.
(8) If you think you are going to fall, just relax.
(9) Exercise can prevent skiing injuries.
(10) Lower release settings can reduce the risk of anterior cruciate ligament injury.
(11) Buying new ski equipment is safer than renting.
(12) Skiing is among the most dangerous of activities.

 

It is important for the skiing public, physicians, and all those interested in improving skiing safety to verify the measures they advocate. The statements analyzed here are simply untrue and have the potential to cause harm if taken as fact by those exposed to these unsupported opinions.

 

The full article is available here:

 

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3445144/

 

I thought it was an interesting read.

post #2 of 19

I have some issues with the wording and some of the assumptions. One, DIN is not 'slang', nor is it a word. It is an acronym. It's also an equalizing datum for creating not only forces of binding release, but for measures, tolerances, and clearances in the boot binding interface. Next time you pop your Lange boot into a Salomon binding and it releases in testing to the forces assigned to a particular number, thank the German Industrial Norm. 

 

Lack of teaching safety as part of a ski lesson. Baloney. I teach youth all mountain skiing. We spend time with ski patrol talking about specific signage, tree wells, avalanche zone identification, self arrest, terrain management and tactics, and of course the skier's safety code. This is ski school policy. 

 

Exercise doesn't prevent injury...  Yet they mention fatigue without making the connection to general conditioning. The better shape I'm in, the more precise and focused my movements, and the longer I can sustain 'work' without muscle fatigue. Good to know that I can put on 30lbs, do no exercise, and be just as safe as I am now. Pass the Bon bons!smile.gif

 

Spending lots of money on kids gear isn't worth the cost.... It seems like they're saying all gear, when in fact they are only saying boots should fit, and bindings should be on good condition. That's fine, but They neglected to talk about the condition of boot soles and the boot binding interface. See DIN above.

 

If I had the time or inclination, I'd examine their citations more carefully. It's my hunch their are some less than accurate conclusions being drawn. Not in every category, but there are certainly a few that raise some questions. Thanks for sharing!

post #3 of 19

I'll take issue with the one about conditioning not influencing injury rates.  The study that was cited to show that strong muscles don't protect stated that world cup racers, with strong muscles, had high rates of ACL injuries.  Sure, but they're skiing two to three times as fast as most of us with overtightened bindings, and spend many more hours skiing than most of us. For the time being I'll continue to believe that thigh and leg muscle strength will protect my ACL's to some extent, and that endurance training will reduce the chance of my falling and being injured later in the day. (Or perhaps poor endurance protects us--at least those of us who slow down and ski easier runs when we get tired.)

 

As far as binding adjustment goes, I'll go along with the idea that initial binding setting should be done by a shop, with release testing initially and periodically (?yearly) but in the 48 years I've been skiing not once have I ever had a shop set a binding at anything other than the calculated DIN or tell me that a binding needed repair or replacement--for me and more recently for my wife and kids as well.  Either the shops aren't actually testing the bindings or binding DIN settings are more reliable than the article implies.

post #4 of 19
Quote:
Originally Posted by markojp View Post

 

Lack of teaching safety as part of a ski lesson. Baloney. I teach youth all mountain skiing. We spend time with ski patrol talking about specific signage, tree wells, avalanche zone identification, self arrest, terrain management and tactics, and of course the skier's safety code. This is ski school policy. 

 

agreed.

 

biggest myth I run into is

 

"trees are dangerous"

post #5 of 19

These are not myths, they are short generalized statements that leave out too many details to be totally accurate but I wouldn't call them myths.

post #6 of 19
Quote:
Originally Posted by markojp View Post

Lack of teaching safety as part of a ski lesson. Baloney. I teach youth all mountain skiing. We spend time with ski patrol talking about specific signage, tree wells, avalanche zone identification, self arrest, terrain management and tactics, and of course the skier's safety code. This is ski school policy. 

They clearly meant injury protection safety not skiers safety code etc.
Quote:
Then, using a process called guided discovery, 4000 participants were asked to plan strategies to avoid ACL injury. For ski patrollers (the highest risk group among ski area employees), there was a 76% reduction in incidence of severe knee sprains, compared to a similar group who did not receive the training.

Interesting that training can help people reduce ACL injuries. Likely ski areas would be 50/50 on teaching it to skies. Afraid it would scare people off of skiing on one hand vs. making them feel safer that they can actively reduce ACL injuries.

Wonder where one can find the training materials. An online course with the videos would be a great tool. Does the fear of ACL injury keep a lot of people from taking up or continuing with skiing? Would a training course that is 75% effective in reducing ACL injury help promote the sport of scare people off it?

Industry association should create an online course and offer it o all the ski areas to put a link on their website.
post #7 of 19
Quote:
Originally Posted by Eagles Pdx View Post


Wonder where one can find the training materials. An online course with the videos would be a great tool. Does the fear of ACL injury keep a lot of people from taking up or continuing with skiing? Would a training course that is 75% effective in reducing ACL injury help promote the sport of scare people off it?

Industry association should create an online course and offer it o all the ski areas to put a link on their website.

Found Vermont Safety's DVD and course program.

http://www.vermontskisafety.com/vsrvideohome.php
post #8 of 19
Thread Starter 
Quote:
Originally Posted by Eagles Pdx View Post


Found Vermont Safety's DVD and course program.

http://www.vermontskisafety.com/vsrvideohome.php

 

Want to know where I found the pamphlet on knee friendly skiing? At the orthopedic surgeon's office!

post #9 of 19
Quote:
Originally Posted by Eagles Pdx View Post


They clearly meant injury protection safety not skiers safety code etc.
 

 

Did you miss the parts about signage, avy awareness/safety, tree wells, self arrest, etc.... That I mentioned? And these would have nothing to do with injury prevention? Right. nonono2.gif

post #10 of 19
Thread Starter 
Quote:
Originally Posted by jdog View Post

These are not myths, they are short generalized statements that leave out too many details to be totally accurate but I wouldn't call them myths.

 

That's why I included the link to the actual article. While there are references cited in the article, the audience for Sports Health is not the same audience for the Journal of Orthopedic and Sports Physical Therapy or the American Journal of Sports Medicine. I would venture to say it's for more of a lay audience. The authors of this paper are well respected in the orthopedic and ski safety communities. I feel that the study is targeted for people that don't know much about skiing such as beginners. The people of this board are are well educated in the risks of skiing.

 

The conclusion of this article is:

 

Everyone who advises skiers on methods to help reduce the risk of injury should be certain that the advice given is true and accurate. Many of the positions advocated in the preceding 12 statements are simply untrue and have the potential to cause harm.

 

The wording of some of the "Myths" is quite different in the introduction and the headings:

 

 (5) Very short skis do not need release bindings.
The shorter the ski, the less the torque applied to the leg in a fall—that is, very short skis do not need release bindings

This has to do with skiboards--those really short skis.

 

 (6) Spending a lot of money on children’s equipment is not worth the cost.
Young bones bend rather than break, so there is no point in spending a lot of money on children’s equipment

 

 (9) Exercise can prevent skiing injuries.
Exercise is the best way to avoid skiing-related injuries

 

This had the potential to be an eye-opening article for health care professionals or fitness professionals that really don't know much about skiing, but if it is just skimmed and not thoroughly read, the reader may miss the point.

post #11 of 19
Quote:
Originally Posted by markojp View Post

I have some issues with the wording and some of the assumptions. One, DIN is not 'slang', nor is it a word. It is an acronym. It's also an equalizing datum for creating not only forces of binding release, but for measures, tolerances, and clearances in the boot binding interface. Next time you pop your Lange boot into a Salomon binding and it releases in testing to the forces assigned to a particular number, thank the German Industrial Norm. 

 

Lack of teaching safety as part of a ski lesson. Baloney. I teach youth all mountain skiing. We spend time with ski patrol talking about specific signage, tree wells, avalanche zone identification, self arrest, terrain management and tactics, and of course the skier's safety code. This is ski school policy. 

 

Exercise doesn't prevent injury...  Yet they mention fatigue without making the connection to general conditioning. The better shape I'm in, the more precise and focused my movements, and the longer I can sustain 'work' without muscle fatigue. Good to know that I can put on 30lbs, do no exercise, and be just as safe as I am now. Pass the Bon bons!smile.gif

 

Spending lots of money on kids gear isn't worth the cost.... It seems like they're saying all gear, when in fact they are only saying boots should fit, and bindings should be on good condition. That's fine, but They neglected to talk about the condition of boot soles and the boot binding interface. See DIN above.

 

If I had the time or inclination, I'd examine their citations more carefully. It's my hunch their are some less than accurate conclusions being drawn. Not in every category, but there are certainly a few that raise some questions. Thanks for sharing!

Sports Health. 2009 Nov;1(6):486-92. Myths concerning alpine skiing injuries. Johnson RJ, Ettlinger CF, Shealy JE.

perpetuates as many (or more) myths than it purports to explode...

 

I'll take another on....  Myth #1

Their comparison of skiing danger compared to auto & cycling...

1.  'Death' is not a full and proper indicator of 'danger'. What degree of injury however, might be up to each's interpretation. ACL, Joint dislocation, breaks, head trauma, other injuries requiring some treatment and some period of recovery time, might also be considered in the dangerous definition.

2. From the get-go they throw a high level of bullshit into their assessment. Quote "If we assume that each skiing day is 6 hours, this results in an estimate of 0.12 deaths per million hours of exposure." Assumption does not belong in any, even psuedo-sci assessment - unless you;re Ettlinger...  For much of the skier population, a lot of skiers, 6 hrs is way too high for a ski day.

Even a 9am start (which is generous for many), then a 30min to 1 hr lunch and a finish around 3 P (easily observed on lift activity... this could be comfirmed at an area with RFID passes) means 5.5 hrs or less... Then take into account restroom breaks. Then Subtract lift and waiting time, and the actual 'ski' time - time exposed to the activity, plummets drastically to prolly less than 3 hrs...

so where are we... an incomplete assumption, using not even 'like' factors or time exposure elements to decide what is 'dangerous'.

 

So, their assumption and myth busting, quote: "The risk of death expressed as the number of fatalities per million hours of exposure seems to be on the same order of magnitude as death by car or bicycle—in the range of about 0.1 deaths per million hours of exposure."  is major manufactured bullshit.

I hold no claims for dangerous or not dangerous - skiing is a situational activity and needs to be regarded as such, and studies which purport to make science of any part of it should be quite as defined and directed as possible. Skiing the 'park, the blue groomer, the sidecountry all have their own considerations, and should be treated that way. Riding a bike, mid-afternoon on Broadway in NYC, in a crit, on a 5,000 participant century, a park trail, a velodrome are also all situational.

 

I will icon14.gif and support more efforts like the one Markojp highlights "teach ...  all mountain skiing. We (his group...)  spend time with ski patrol talking about specific signage, tree wells, avalanche zone identification, self arrest, terrain management and tactics, and of course the skier's safety code. This is ski school policy"

 

kudos to any which do this...  situational awareness and safety - different for beginners and other levels of skiing, should be a part of every lesson plan. Could be handouts as well as 'instructional' videos available at the ski school or online...  there are a lot of ways/ideas of how to get this material across and WOULD have a great impact on reducing risk.

post #12 of 19
Quote:
Originally Posted by Eagles Pdx View Post


Found Vermont Safety's DVD and course program.

http://www.vermontskisafety.com/vsrvideohome.php

for any who don;t know

 

vermont ski safety

is

*Carl Ettlinger - Adjunct Asst. Professor, College of Medicine, University of Vermont, Burlington, VT 05405, and President, Vermont Safety Research, Underhill Ctr., VT 05490

 

it's a business, and does seem to have an agenda...

read some of the material

he poopoos the importance of helmet use and downplays any of it's significance in risk reduction

 

he does encourage (as important) getting your equipment checked out start of every season, by a professionally EQUIPPED shop. (Equipment which Vermont safety sells...)

course this is a good idea, but not the only one. And helmets are a good idea, not the only one...

 

everybody gotta make a livin...

post #13 of 19
Thread Starter 
Quote:
Originally Posted by moreoutdoor View Post

for any who don;t know

 

vermont ski safety

is

*Carl Ettlinger - Adjunct Asst. Professor, College of Medicine, University of Vermont, Burlington, VT 05405, and President, Vermont Safety Research, Underhill Ctr., VT 05490

 

it's a business, and does seem to have an agenda...

read some of the material

he poopoos the importance of helmet use and downplays any of it's significance in risk reduction

 

he does encourage (as important) getting your equipment checked out start of every season, by a professionally EQUIPPED shop. (Equipment which Vermont safety sells...)

course this is a good idea, but not the only one. And helmets are a good idea, not the only one...

 

everybody gotta make a livin...

 

Carl Ettlinger, M.S. was an assistant professor at UVM--not exactly a money making proposition. He has been looking at ski safety since the 70s and has a good relationship with Sugarbush to identify trends. He's actually gotten a ski area to openly communicate injury data which is nearly impossible (see Denver Post series of articles) since most are concerned about liability issues.

 

http://www.uvm.edu/~uvmpr/?Page=article.php&id=100

 

I've always just gotten the impression that he is someone sincerely interested in preventing ski injuries.

post #14 of 19

Interesting article.

 

Disagree a bit with the points about bindings.  Calibrated release testing is tricky to do on your own, but simply inspecting the bindings for damage and adjusting the "DIN" and pressure settings yourself is straightforward.

 

Quote:
...in the 48 years I've been skiing not once have I ever had a shop set a binding at anything other than the calculated DIN or tell me that a binding needed repair or replacement--for me and more recently for my wife and kids as well.  Either the shops aren't actually testing the bindings or binding DIN settings are more reliable than the article implies.

 

A lot of shops will only do a release test when they mount a pair of bindings or if you specifically ask for it (which often costs more than a simple adjustment).  That's the only way to tell if the bindings are actually requiring as much torque to release as they should for a given numerical setting.  On rental/demo skis they usually check them at the start of the season and then periodically throughout the year, but not every time they adjust the bindings.

 

Quote:
...Ski instruction could have an impact on the risk of ACL injury if instructors teach the skiing public how to safely recover from off-balance situations—namely, by sitting down when recovery is not appropriate (see Myth 9). Unfortunately, this program has not been implemented on a large scale for the general public.
 
(Myth 9 saying, in part):
 
...Keep feet together. Keep chin against chest. Do not land on a hand, but keep arms up and forward and be prepared to use the arms to protect the face and head.17 Muscles of the extremities and trunk should strongly contract during a fall; this response will stiffen and protect bones and joints.40,41,66,67After the fall, skiers who do not immediately stop should get into a position that allows them to see where they are going. Skiers who attempt to stop themselves by engaging their skis should resist the instinct to fully straighten their legs. It is also important for skiers to not get up until they have stopped sliding and to remember “When you are down—stay down.”

 

All good advice, but there are often practical difficulties with doing this sort of thing in a lesson.  IMO you'll get more bang for your buck focusing on accident avoidance and overall situational awareness than trying to practice how to fall.

post #15 of 19
Thread Starter 
Quote:
Originally Posted by Eagles Pdx View Post

Wonder where one can find the training materials. An online course with the videos would be a great tool. Does the fear of ACL injury keep a lot of people from taking up or continuing with skiing? Would a training course that is 75% effective in reducing ACL injury help promote the sport of scare people off it?

Industry association should create an online course and offer it o all the ski areas to put a link on their website.

 

A short video on "how to fall" looping in the ski rental area would be informative. Especially if it contained some of the current skiers--a Lindsey Vonn, Sho Kashima, and others who sustained injuries. It would be like a PSA.

post #16 of 19
Quote:
Originally Posted by moreoutdoor View Post


I'll take another on....  Myth #1

Their comparison of skiing danger compared to auto & cycling...

1.  'Death' is not a full and proper indicator of 'danger'. What degree of injury however, might be up to each's interpretation. ACL, Joint dislocation, breaks, head trauma, other injuries requiring some treatment and some period of recovery time, might also be considered in the dangerous definition.

 

They do mention injuries (both ACL injuries specifically and the overall injury rate) in the last two paragraphs of that section.  They also discuss how there are not many comparable injury studies between skiing and other recreational sports.

 

Quote:

2. From the get-go they throw a high level of bullshit into their assessment. Quote "If we assume that each skiing day is 6 hours, this results in an estimate of 0.12 deaths per million hours of exposure." Assumption does not belong in any, even psuedo-sci assessment - unless you;re Ettlinger...  For much of the skier population, a lot of skiers, 6 hrs is way too high for a ski day.


...

 

So, their assumption and myth busting, quote: "The risk of death expressed as the number of fatalities per million hours of exposure seems to be on the same order of magnitude as death by car or bicycle—in the range of about 0.1 deaths per million hours of exposure."  is major manufactured bullshit.

 

FWIW, I looked into the relative danger of skiing and driving recently as part of a discussion in another thread.  I tried to take it the other way -- I took the driving injury/fatality numbers and converted them into 'driver-days'.  (Skiing statistics are almost always in skier-days, while the driving ones are per million miles driven.)

 

I came to the same conclusion they did; on the whole, skiing and driving are not that far apart in lethality, and certainly within an order of magnitude.  And you're actually significantly more likely (again, over a huge population) to get hurt in some way skiing, although injuries from 'average' traffic accidents are more severe than an 'average' ski injury.

 

Obviously risk is situational; hucking cliffs in the backcountry on a high avalanche risk day is generally going to present more danger than the bunny hill at a small resort.  These numbers are averages over enormous numbers of people.  You could do better with statistics that are broken down much more precisely, but AFAIK those are not generally available, at least at anywhere near the same scale and confidence.

post #17 of 19
Quote:
Originally Posted by rx2ski View Post

 

A short video on "how to fall" looping in the ski rental area would be informative. Especially if it contained some of the current skiers--a Lindsey Vonn, Sho Kashima, and others who sustained injuries. It would be like a PSA.

 

L.V.'s injury IMHO really isn't at all applicable to the general skiing public. She was on an injected hill going very very fast and generating forces that maybe only .5% of rec skiers will ever experience. 

post #18 of 19
Thread Starter 
Quote:
Originally Posted by markojp View Post

 

L.V.'s injury IMHO really isn't at all applicable to the general skiing public. She was on an injected hill going very very fast and generating forces that maybe only .5% of rec skiers will ever experience. 

 

I didn't say it was. It's just that people are more likely to pay attention to a PSA of a sports figure than an unknown skier/actor.

post #19 of 19
Quote:
Originally Posted by Matthias99 View Post

A lot of shops will only do a release test when they mount a pair of bindings or if you specifically ask for it (which often costs more than a simple adjustment).  That's the only way to tell if the bindings are actually requiring as much torque to release as they should for a given numerical setting.  On rental/demo skis they usually check them at the start of the season and then periodically throughout the year, but not every time they adjust the bindings.

 

Good details of release tests. I think it's important to do a release test from time to time. 

 

That said, in all of Whistler Village, there's only one shop I know of that will do a release test: the tuning shop in the basement of the carleton lodge. I ran around to dozens of shops last year and nobody else could do it. Really disappointing. 

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