Clinical Review

Lower Extremity Injuries in Snowboarders

Am J Orthop. 2014 November;43(11):502-505

References

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The mechanism of injury differs in snowboarding, in which both feet remain attached to the board. Davies and colleagues¹⁵ examined 35 snowboarders who sustained ACL injuries after a flat landing from a jump and concluded that snowboarders preparing for a landing exhibit more quadriceps contraction, which increases the loading force on the ACL during landing. Furthermore, the snowboarder’s stance on the board, with the front foot slightly rotated relative to the board, results in a slight internal tibial rotation of the knee and establishes a posture that makes the snowboarder susceptible to injury. However, the lower incidence of knee injuries among snowboarders compared with skiers may be attributable to the fact that there is a limited amount of torque that can be generated on either knee as both feet are fixed to the board.¹⁶

The increased quadriceps force in anticipation of a landing, combined with the internal tibial rotation of the knee caused by the snowboarder’s stance, may be the primary mechanism of ACL rupture in snowboarders.¹⁵

Injury Prevention Strategies

Prevention strategies require an identification of injury risk factors for snowboarders. Hasler and colleagues⁷ conducted a study with 306 patients to identify variables that presented a risk for snowboarders. Low readiness for speed, bad weather, and bad visibility, as well as snow conditions, were found to be significant risk factors.

Skiers’ overall injury rate has decreased over the past 60 years, and this decrease has been attributed in part to improved ski technique and instruction.^17,18 Improperly adjusted ski bindings are the culprit in many equipment-related lower extremity injuries, and beginners are at much higher risk for such injuries. Lessons and comprehensive safety training could reduce this injury rate.^17,19 Several awareness video and training programs focusing on injury prevention have reduced knee sprains in ski patrollers compared with controls by 62% in 1 study; a similar program reduced injury by 30% in nonprofessional skiers.¹⁷ A study of injured snowboarders during a winter in Scotland found that 37% of the patients had no formal instruction or training in correct snowboarding and falling technique.²⁰Training programs for snowboarders could yield meaningful results in injury prevention and avoidance of risk-taking behavior among snowboarders.

Advances in equipment have also had an impact on the incidence of skiing injuries. Ski bindings protect skiers in 2 ways. First, the binding keeps the boot attached to the ski and prevents unintended release on difficult terrain. Second, the binding releases the boot from the ski during extreme conditions to prevent the skier from experiencing extreme forces or moments that could result in injury. Functional failure in ski bindings has been implicated in increased incidence of knee injuries and ligament rupture. In a study of injuries sustained by recreational alpine skiers in Japan, Urabe and colleagues²¹ found that 96% of those injured stated that the ski bindings had not released at time of incident. The effects of binding adjustment and maintenance among snowboarders have not been fully investigated, and there are no set guidelines for individual snowboarders on appropriate binding level. However, as there is a range of binding adjustment options available, snowboarders may have an optimum level that maximizes both mobility and protection from injury.²²

Soft-shelled boots may also increase injury risk for snowboarders. Such boots allow for a wider range of ankle motion and offer little protection from extreme joint movements. Soft boots are generally preferred among snowboarders because they allow for increased mobility for sharp turns and maneuvers. However, modification of the stiffness of boots that limit ankle and foot joint mobility could reduce the incidence of ankle fractures and sprains among snowboarders.²²

Summary

Snowboarding has become increasingly popular worldwide. It attracts a loyal group of amateur athletes and has developed into a billion-dollar industry with a growing rank of professionals. Although most snowboarding injuries are upper extremity injuries, the foot, ankle, and knee represent commonly injured areas among recreational and experienced snowboarders. Advances in ski equipment have significantly reduced the incidence of ankle injuries, but rising knee ligament injuries continue to pose a challenge. Foot and ankle injuries remain an issue in snowboarders despite advances in equipment and safety. New snowboard designs and boot and binding modifications may hold promise in decreasing the risk for injury in these athletes.