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Bill Klaproth (Host): Skiing is a popular winter recreation sport, however, people with skiing-related injuries populate hospitals, doctor’s offices and emergency rooms every year. Here to talk with us about skiing injuries is Dr. Monika Radloff, a sports medicine physician at Cayuga Medical Center. Dr. Radloff, thank you for your time. So, what type of skiing are we going to be talking about today?

Monika Radloff, MD (Guest): Well, when I talk about skiing, most people really are thinking about downhill skiing, but there’s actually a lot of different things that you can do once you have a pair of skis on your feet. So, there’s cross country skiing, which is also known as Nordic skiing where you can either ski in a straight line and we call that classic skiing, or you can also do skate skiing where you are moving your legs in a skating motion. Most of these are done on groomed trails, but it seems like here around Ithaca, a lot of people are getting out in the forests or on golf clubs or in the parks and just going out and skiing and having a fun time doing that.

There’s downhill skiing as well. Or it is also known as Alpine skiing which essentially, we ride a chairlift that goes up to the top of the mountain and once you get up there, you point your skis downhill and you get to the bottom. And then there are some people who also do what’s called back country skiing, so you are getting off of the designated ski trails and you are going off different sides of the mountains. You can either do that in a ski area where you ride the ski lift up and then you get off the lift and you either ski or hike to a different area where you ski down, or you can do it completely out in the backcountry where it’s not around a ski area at all.

Interestingly now a lot of ski areas are starting to allow uphill skiing. Essentially, what you are doing is putting some skins on the bottom of your skis and then you can ski up the hill with those skins on the bottom. There are some really cool binding systems that will allow you to release the heel and so you are almost like walking up the mountain. So, the great thing about those is that you are getting this very good workout in going up, but once you get to the top, you clip in your heel and you can ski down to the bottom of the mountain. So, you have the fun of skiing down, but you get a little bit of that aerobic workout going uphill.

But each of these has different physical demands and different injury risks. In cross country skiing, you really need much more of that cardiovascular fitness and most of the injuries that we see there are from overuse. In downhill skiing, you need a little bit more muscular endurance and strength in your legs and there’s more of an incidence of acute injuries, more so from some falls. And then back country skiing you actually have to have a combination really of good cardiovascular fitness and strength, but then in addition to that, you have the environmental factors, where you have to be very wary of the weather, and you have to watch out for that avalanche risk as well.

Host: Right. So, you have to prepare for the type of skiing that you are doing. I’ve never heard of uphill skiing, but that does sound like an intense cardiovascular workout, trying to basically walk or ski up the mountain. So, what types of injuries do you see then in skiing?

Dr. Radloff: So, I’m going to focus the most on downhill skiing primarily because that’s where we really see the majority of the injuries. And most are really traumatic, so it’s people who are falling and hitting the hard slopes, collisions with either other skiers or trees or then the lift accidents. So, when you think about lower body, the majority of injuries there really are to the ligaments in the knee. And so, anatomy wise, you have got the medial collateral ligament which runs along that inside, interior aspect of the knee. You have the anterior cruciate ligament which is one of those big ligaments that sit deeper inside the knee. And really when anytime that your knee twists with a ski attached to the end; it’s typically not a good thing for that knee. So, if you catch an edge, if you hit a piece of ice and that ski all of the sudden twists, you can get a sprain or a tear of either your MCL or your ACL. Most of the MCL injuries will fortunately heal with time and with bracing. The ACL tears and injuries, most of those will need some type of surgical repair in terms of getting those better.

If you think about upper extremity type of injuries, those occur when either people are putting out their arms to try and stop themselves or if they land directly onto the shoulder. So, there we look at either fractures. You can get fractures in your wrist. You can get fractures of your collar bone, the clavicle. Sometimes they will get fractures of your humerus. The other thing that we commonly see is a shoulder dislocation, especially when you are trying to reach out and catch yourself, that shoulder will dislocate. The other thing that we see there are AC sprains and if you – there’s one problem that we can see with the thumb as well that’s called a skier’s thumb, so if you are holding onto the ski pole and all of the sudden the thumb gets twisted or pulled out; you can sprain the little ligament that helps to hold it in place and that requires either a period of immobilization and putting it into a splint or actually surgery for that as well.

And then the other thing that we really worry about with skiing are head injuries. So, if you imagine if you either run into a stationary object, such as a tree or if you fall and then you hit your head onto that icy surface of the ski slope; you can sustain anything from a concussion to getting some bleeding inside the brain to even having a skull fracture.

Host: Yeah. Wow, that – and that’s exactly what you don’t want. There’s a whole lot of possible injuries with skiing Dr. Radloff, so what can be done to prevent injuries?

Dr. Radloff: So, the big thing that you want to do is make sure that you are maintaining your fitness throughout the year before you get on that ski slope. So, a week before is not really the time that you want to start thinking about your fitness. You need to be doing it really, throughout the summer. Skiers need to have good cardiovascular fitness, especially if you are going to be doing something like cross country skiing. So, if you are doing an activity like running or getting on your bike; those are all good ways just to get that preseason fitness up and ready to go. You also need to have really good muscular endurance and strength in order to make it through a day of skiing. So, you should be doing things like lifting weights, working out with a trainer, participating in some type of exercise class that focuses on strength.

Most of the ski injuries on the ski slope tend to occur when you are fatigued and tired. So, you need to make sure that you are taking breaks throughout the day and if you feel like my legs are feeling a little bit tired; that’s the time where you just want to go in and take a little rest in the lodge. That’s one of the biggest things that I hear from people when they come in with an injury. They tell me well I was on my last run of the day when I fell, and this is when this injury happened. So, if you are thinking about taking that last run; maybe hold off on that and just call it a day a little bit earlier.

Then the other thing you really need to think about is before you get on the slopes, make sure that your equipment is all ready to go. So, your bindings should be properly set because you really want to make sure that those bindings are releasing so that when you do fall, so it doesn’t twist and torque your leg and your knee. The skis should be tuned up regularly. You need to make sure that you have appropriate clothing to protect yourself against the cold weather. That means wearing multiple layers. You should have a good base wicking layer either made of a synthetic or wool type of material. You need to have a mid-layer for warmth and then you need to have an outer layer that is both wind and waterproof.

And then most importantly, make sure that you have a helmet. I know that when I was growing up, actually we really didn’t use helmets when we were out skiing, you just had your hat or your ear muffs on. So, now I think helmets are fortunately becoming much more common and the majority of people are really starting to wear them. But they are actually, if you have never worn one, they are actually really quite comfortable. They keep your head nice and warm. They keep your ears warm. It’s a good way to kind of keep those goggles in place and they just help prevent those head injuries and that’s definitely a thing that you should be doing now to protect that head.

If you are just starting to learn how to ski; it’s always good to make sure that you are taking a lesson. So, you want to learn proper technique. You want to know how to get on and off of the ski lift. The instructors will really tell you how to be safe on the mountain in terms of watching out for other skiers. It’s really collisions with other skiers that are a common way to get injured. So, you might be skiing in control yourself, but it’s certainly possible that someone around you is not skiing in control. So, you need to be wary of who is around you, realize that the people who are downslope of you are the skiers that have the right of way. If you get off to the side of the ski slope, then you need to make sure that you are looking uphill to make sure that no one is coming before you start going downhill. So, similar to being out on the roads and driving in traffic. You always have to be aware of what’s going on around you.

And then make sure that you are staying on those marked trails. So, going off trail is where you have a higher incidence then of running into problems. And if you are purposely going off trail in terms of if you want to do some back-country skiing; then definitely making sure you have the appropriate gear and especially all your avalanche safety equipment as well.

Host: Well, that makes sense and great tips Dr. Radloff and on that same thought line, probably good idea to stay within your ability level too, right? Instead of yeah, I can go up to the diamond, you better know you are ready for that before you hit that slope is that right?

Dr. Radloff: Absolutely. The way to not learn how to ski is to all of the sudden go up the mountain and instead of going down the green slope to go down the black diamond slopes. So, yes, in order to get better, you have to sometimes push your limits, but definitely know what you can ski and what you can’t ski and what you feel comfortable on. Because that’s how those injuries occur when people are up on those runs where they really shouldn’t be.

Host: Well, Dr. Radloff, great information and I love how you talk about cardiovascular health too. We think of strains and sprains and other injuries but not cardiovascular health. So, that’s a major component to prepare for as well before you hit the slopes. Dr. Radloff, thank you again for your time. For more information please visit www.cayugamed.org, that’s www.cayugamed.org. This is To Your Health from Cayuga Medical Center. I’m Bill Klaproth. Thanks for listening.