Health & Fitness

Snowboarding Injuries and their Prevention

by Dr. Jeffrey Gundel

In 1965, Sherman Poppen bolted two alpine skis together and snowboarding was born. The original board was called the ‘Snurfer,’ combining the thrills of skiing with the skills of surfing. Snowboarding has become increasingly popular and is one of the fastest growing winter sports, with over 5.4 million participants. Originally, the majority of boarders were young males. Now males and females of all ages participate. The rate of male to female participation has decreased from 9:1 to 3:1 over the past 10 years. Twenty percent of visitors to ski resorts are boarders. Many ski resorts have recognized the popularity of boarding and have built half-pipe ramps. Snowboarding was introduced as an official Olympic sport at the 1998 Winter Games in Nagano, Japan.

Snowboarding is a safe sport, but on any given day, 10.6 per 1,000 boarders will require medical attention for an injury. One-quarter of all injuries occur during the initial snowboard experience, as more injuries occur in the younger, less experienced boarders. Fortunately, serious injuries are uncommon and fatalities rare. One is four times more likely to die from a lightening strike than from a snowboarding accident.

Injuries commonly are a result of inexperience, lack of instruction, fatigue, poorly fitted equipment or speed and loss of control. Preventing injuries involves some common sense. Proper preparation is important. Beginners should take a lesson to learn the basics of boarding and falling techniques. Equipment needs to be in good condition and appropriately fitted to your size and skill level. Understand the snow conditions and your limitations. Don’t board in poor conditions. Keep to the groomed trails suited to your boarding abilities. Despite the best preparation and caution, injuries will occur.

Injury patterns differ between skiers and boarders
The majority of alpine and cross country ski injuries are to the lower extremities, specifically the knees. Snowboarders more frequently injure their arms, predominantly their wrists.

Half of all boarding injuries involve the arms and result from a fall. The arms are used to assist in balance and usually contact the ground first during a fall. Wrist sprains and fractures are the most common arm injuries, usually due to a fall on the outstretched arm with the wrist extended. The end of the radius and/or ulna bones fracture most frequently. Encouraging beginners to keep the hands in a clenched-fist position when falling decreases the fracture risk. Sprains result from an overstretching of the ligaments holding the wrist bones together. Wrist guards have been recommended for injury prevention but controversy surrounds their use. While it has been shown that wrist guards can lessen the severity of wrist sprains and decrease the number of wrist fractures, ski clinics have reported an increase in elbow and shoulder injuries in boarders wearing wrist guards. Wrist guards protect the wrist, but transfer the pressure and forces to the elbow and shoulder, resulting in fractures and dislocations. Dislocations require an emergency room visit for reduction.

Knee injuries are less common in snowboarders. While riding, both legs are secured to the board, decreasing the twisting forces across the knees. Injuries do occur in the lift line and when entering or exiting the lift, when only one leg is in the binding. One foot stays planted on the ground as the body rotates and falls, leading to a knee sprain. The most commonly injured or stretched ligaments are the medial collateral ligament (MCL) and the anterior cruciate ligament (ACL). Initial treatment of all knee injuries is rest, ice, compression and elevation. Minor sprains do not require any further treatment, but significant sprains should be braced until healed. Severe sprains often require physical therapy to regain strength and full range of motion. An ACL tear can be partial or complete. Both can cause pain and immediate swelling within the joint. A ‘pop’ may be felt or heard as the knee gives out. Diagnosis is made by clinical examination and may be confirmed with MRI. ACL tears often lead to buckling and instability, requiring surgical ligament reconstruction. Fractures of bones around the knee occur less frequently than in skiers, although fractures are common in the leg bones just above the tops of hard shell boots. Ninety percent of injuries are to the leading leg.

Ankles are the most frequently injured part of the leg. The ankle joint is formed where the two lower leg bones meet the talus, a foot bone. Several ligaments run between these bones, holding them together. Stretching of these ligaments result in sprains. Boot type influences injury. More advanced boarders wear soft shell boots, which allow more ankle motion, resulting in ankle sprains and fractures. Hard shell boots protect the ankle, but like wrist guards, transfer the forces to the rest of the extremity, often resulting in lower leg fractures. These fractures often require surgery. Fractures of the lateral part of the talus are unique to snowboarding. These fractures can often be treated with casting, unless the fracture fragments displace. Surgical treatment involves aligning the fractured bone and securing it with a screw.

Head and neck injuries are uncommon, but can occur during collisions and failed jumps. Helmet wear significantly decreases the chance of head, face and neck injuries. Helmets have become popular after several high profile head injury skiing deaths. Children should be encouraged to wear a properly sized helmet, just as they would when bicycling or inline skating. Remember that wearing a helmet does not make you invincible and even if you are wearing a helmet, the tree always wins.

Prevention is the best treatment, but injuries may still occur. Boarding injuries are usually minor, but can be permanently disabling if not appropriately treated. Early medical evaluation can direct a rehabilitation program to speed recovery. I wish everyone a healthy and happy snowboard season.

Jeffrey Gundel, MD, (sportsdoc64@earthlink.net) of Saratoga Springs is an orthopedic surgeon specializing in sports-related injuries and arthroscopy at North Country Sports Medicine in Queensbury. He participates in hiking, mountain biking and cross country skiing.

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