Biomechanical quantification of deadbug bridging performance in competitive alpine skiers: Reliability, reference values, and associations with skiing performance and back overuse complaints

"Health is Just the Basic Requirement for Optimal Performance and Winning": Stakeholders' Perceptions on Testing and Training in Competitive Alpine Skiing, Snowboarding and Freestyle Skiing

BACKGROUND AND OBJECTIVE

Competitive alpine skiing, snowboarding and freestyle skiing, all different in nature and risks, are known for their high injury and illness burden. Testing measures and training methods may be considered for athletes' preparation to support performance enhancement while safeguarding their health. We explored the perspectives and perceptions of competitive alpine skiing, snowboarding and freestyle skiing stakeholders regarding testing and training practices in their competitive snow sports.

METHODS

We conducted an exploratory qualitative study based on grounded theory principles through 13 semi-structured interviews about testing and training practices with athletes, on-snow and off-snow coaches, managers and healthcare providers from different national teams. The interviews were inductively analysed through a constant comparative data analysis.

RESULTS

Participants described winning as the end goal of testing and training practices, which requires athletes to perform in their best condition. To do so, they mentioned two main targets: performance enhancement and health protection. Participants acknowledged health as a premise to perform optimally, considering testing and monitoring approaches, goal setting, and training to support and protect athlete performance. This continuous cyclic process is driven by communication and shared decision making among all stakeholders, using testing and monitoring outputs to inform goal setting, training (e.g. on-snow and off-snow) and injury prevention. Such an approach helps athletes achieve their goal of winning while being fit and healthy throughout their short-term and long-term athletic career development.

CONCLUSIONS

The ultimate goal of testing measures and training methods in such competitive snow sports is winning. Performance enhancement and health protection act as pillars in systematic, tailored and flexible processes to guarantee athletes' best preparation to perform. Moreover, athletes' assessments, goal setting, monitoring tools, open communication and shared decision making strongly guide this cyclic process.

We know a lot about little and little about a lot: A contextualized scoping review on injury prevention in alpine ski racing

BACKGROUND

Our goal was to summarize and contextualize the available literature on alpine ski racing injury epidemiology, injury etiology, injury prevention measures, injury prevention context, and implementation issues.

MATERIALS AND METHODS

We searched four electronic databases using predetermined search terms. We included original studies that assessed injury, injury risk factors, and injury mechanisms, and assessed and reported the effect of an injury prevention measure in alpine ski racing. Two authors independently conducted title-abstract screening, and one performed the full-text review. For data synthesis and categorization, we used the Translating Research into the Injury Prevention Practice framework and a modified and adapted version of the Haddon matrix.

RESULTS

Of the 157 included studies, most corresponded to injury epidemiology and etiology, whereas few studies encompassed injury prevention measure development, implementation and evaluation. Preventive interventions targeting equipment, rules and regulations, course design and snow preparation were the most prevalent in the literature. Furthermore, various contextual factors in the current literature have been found, including gender, competition level, countries and federations, and time periods within a season.

CONCLUSIONS

We provided an in-depth and comprehensive overview of the current state-of-the-art in the alpine ski racing context. We know a lot about little and little about a lot across all the areas associated with injury prevention in such context. The limitations in the literature yield a road map for designing future injury prevention studies to address the key gaps identified. A more comprehensive context-driven approach throughout all stages of injury prevention would benefit the ultimate implementation of effective preventive strategies.

Lumbar Multifidus Morphology in Youth Competitive Alpine Skiers and Associated Sex, Age, Biological Maturation, Trunk Stability, and Back Complaints

BACKGROUND

The lumbar multifidus (LMF), as a dynamic stabilizer of the lumbar spine, may play an important role in the prevention of overuse-related back complaints.

HYPOTHESIS

LMF morphology is associated with trunk stability and differs between symptomatic and asymptomatic skiers.

STUDY DESIGN

Cohort study.

LEVEL OF EVIDENCE

Level 3.

METHODS

A total of 85 youth skiers (28 females, mean age, 14.7 ± 0.7 years; 57 males, mean age, 14.9 ± 0.5 years) underwent anthropometric assessments, an estimation of biological maturation, a magnetic resonance imaging- and ultrasound-based examination of LMF morphology, and a biomechanical quantification of deadbug bridging stabilization performance. Athletes were categorized as symptomatic if they had registered at least 1 significant overuse-related back complaint episode in the 12 months before the main examination.

RESULTS

Male skiers showed a greater LMF size (ie, anatomical cross-sectional area [ACSA]) than female skiers, except for vertebral body L5, where no difference was found (8.8 ± 1.8 cm2 vs 8.3 ± 1.4 cm2, P = 0.18). Conversely, female skiers displayed longer fascicles than male skiers (5.8 ± 0.8 cm vs 5.4 ± 0.8 cm, P = 0.03). Skiers aged under 16 years (U16) skiers had greater values for LMF size and fascicle length than U15 skiers. Maturity offset was associated with L5 LMF size (R2 = 0.060, P = 0.01), fascicle length (R2 = 0.038, P = 0.04), and muscle thickness (R2 = 0.064, P = 0.02). L5 LMF size was associated with trunk stability (R2 = 0.068, P = 0.01). Asymptomatic skiers showed on average a 12.8% greater value for L5 LMF size compared with symptomatic skiers (P = 0.04).

CONCLUSION

There are sex- and age-related differences in LMF morphology in youth competitive alpine skiers. Moreover, the ACSA at the level of the lumbar vertebral body L5 undergoes changes during biological maturation, shows a small, but significant association with trunk stability, and differs between symptomatic and asymptomatic skiers with back complaints.

CLINICAL RELEVANCE

The observed association of muscle structure (ie, L5 LMF ACSA) with functional aspects (ie, trunk stabilization capacity) and clinical representation (ie, overuse-related back complaints) further highlights the important role of the multifidus muscle for training and injury prevention in youth competitive alpine skiers around the growth spurt.

More than just a side effect: Dynamic knee valgus and deadbug bridging performance in youth soccer players and alpine skiers have similar absolute values and asymmetry magnitudes but differ in terms of the direction of laterality

From a preventative perspective, leg axis and core stabilization capacities are important for soccer players and alpine skiers; however, due to different sport-specific demands, the role of laterality clearly differs and may result in functional long-term adaptations. The aims of this study are 1) to determine whether there are differences in leg axis and core stability between youth soccer players and alpine skiers and 2) between dominant and non-dominant sides, and 3) to explore the outcomes of applying common sport-specific asymmetry thresholds to these two distinct cohorts. Twenty-one highly trained/national-level soccer players (16.1 years, 95% CI: 15.6, 16.5) and 61 alpine skiers (15.7 years, 95% CI: 15.6, 15.8) participated in this study. Using a marker-based 3D motion capture system, dynamic knee valgus was quantified as the medial knee displacement (MKD) during drop jump landings, and core stability was quantified as the vertical displacement during deadbug bridging exercise (DBBdisplacement). For the analysis of sports and side differences, a repeated-measures multivariate analysis of variance was used. For the interpretation of laterality, coefficients of variation (CV) and common asymmetry thresholds were applied. There were no differences in MKD or DBBdisplacement between soccer players and skiers or between the dominant and non-dominant sides, but there was an interaction effect side*sports for both variables (MKD: p = 0.040, η2p = 0.052; DBBdisplacement: p = 0.025, η2p = 0.061). On average, MKD was larger on the non-dominant side and DBBdisplacement laterality on the dominant side in soccer players, whereas this pattern was reversed in alpine skiers. Despite similar absolute values and asymmetry magnitudes of dynamic knee valgus and deadbug bridging performance in youth soccer players and alpine skiers, the effect on the direction of laterality was opposite even though much less pronounced. This may imply that sport-specific demands and potential laterality advantages should be considered when dealing with asymmetries in athletes.

Swiss-Ski Power Test Results in Youth Competitive Alpine Skiers Are Associated With Biological Maturation and Skiing Performance

PURPOSE

To explore reasonable application purposes and potential confounders of the Swiss-Ski Power Test (SSPT) that is, since 2004, annually performed by all youth competitive alpine skiers of the under-16-years age category in Switzerland.

METHODS

Preseason SSPT results (8 individual tests on anaerobic and aerobic capacity, muscle strength, and speed and coordination) of 144 skiers (57 female and 87 male) age 14.5 (0.7) years were analyzed along with anthropometry and biological age. Skiing performance was quantified as the actual performance points according to the Swiss national ranking. After the SSPT tests, skiers were prospectively monitored over 12 months using the Oslo Trauma Research Center questionnaire. Data were analyzed using multivariate analysis of variance, Pearson correlations, and multiple linear/binary logistic regression models.

RESULTS

Biological maturation and SSPT results differed between sexes and age (P < .05). For males, SSPT results in the subdisciplines Swiss Cross, 1-leg 5-hop, and standing long jump were correlated to maturity offset, while for females only the obstacle run was related. High box jump and Swiss Cross scores were associated with skiing performance (P < .05). However, none of the SSPT subdisciplines was related to traumatic and overuse injuries (P < .05).

CONCLUSIONS

The SSPT is a broadly implementable and cost-effective field test providing a general fitness profile of youth skiers. Around the growth spurt, differences in biological maturation should be considered. While SSPT results showed association with skiing performance, the test in its current form is limited for identifying injury-relevant physical deficiencies. Consequently, more specific tests may be required.

Deadbug Bridging Performance in 6- to 15-Year-Old Competitive Alpine Skiers-A Cross-Sectional Study

In competitive alpine skiing, a superior antirotation and rear-chain stabilization capacity is essential to constantly remain in dynamic equilibrium while skiing and to counteract the ski-specific adverse loading patterns of the back. As such, skiers' trunk stabilization performance during deadbug bridging (DBB) exercises has been shown to be associated with both skiing performance and overuse complaints of the lower back in skiers under 16 years of age (U16). However, to date, little is known about the corresponding stabilization abilities in younger skiers, i.e., 6- to 15-year-old skiers. As part of a biomechanical field experiment during a national off-snow fitness competition, a total of 101 youth competitive alpine skiers were tested with respect to their trunk stabilization performance during DDB exercise. The maximum contralateral displacement of the pelvic drop during leg lift (DBBdisplacement) was quantified using reflective markers and a motion capture system (Vicon, Oxford, UK). Potential age group and sex differences in DBBdisplacement were assessed using analysis of variance (ANOVA) at p < 0.05. Within each subgroup, the associations of DBBdisplacement with age, anthropometrics and maturity offset were analysed using Pearson's correlation (p < 0.05). Female skiers under 15 years of age (U15) showed better DBB performance than male U15 skiers, while there was no sex difference at the under 10-year (U10) level. In female U10 skiers, DBBdisplacement was moderately associated with body height, while in all other subgroups, no confounding associations with anthropometrics or biological maturation were found. Biomechanically quantifying DBB performance may be considered a feasible and nonconfounded screening test approach in young skiers older than 6 years. Body height may represent a confounding bias in exclusively the U10 female skier cohort and, therefore, should be considered when interpreting the test results. In summary, this study provided sport-specific normative reference data that may be of equal interest to both researchers and sport practitioners.

Perceptions of experts on key injury risk factors in alpine ski racing as a function of stakeholder role and associated level of competition

Objectives

(1) To update experts' priorities of perceived key injury risk factors in alpine ski racing based on a framework and list derived 10 years ago, (2) to identify additionally emerging risk factors since then and (3) to compile a list with countermeasure suggestions.

Methods

A sample of 532 expert stakeholders (athletes, coaches, team medical staff, Ski Racing Suppliers (SRS) and International Ski Federation (FIS) representatives) from the World Cup (WC), European Cup (EC) and FIS-race level participated in a cross-sectional online survey. Experts were asked to name those risk factors with the highest believed impact on injury risk and rank them according to their current priority from a predefined list. In addition, experts were encouraged to name additional (not listed) risk factors and to suggest countermeasures.

Results

Regardless of stakeholder role and competition level, snow-related factors appeared to have the highest perceived priority. However, WC athletes' and coaches' perceptions were also related to equipment, while at the EC and FIS-race level fatigue and physical fitness-related factors were considered important. Athletes' perceptions were largely in agreement with SRS (ie, snow-related and equipment-related factors). At the same time, while coaches, team medical staff and FIS representatives additionally emphasised fatigue and physical fitness-related factors.

Conclusion

Experts' perceptions on key injury risk factors in alpine ski racing depend on the stakeholder role and differ between the competition levels. Thus, to develop effective prevention measures and to successfully implement them, all relevant stakeholders should be given a voice, and prevention efforts should be targeted to the specific level.

Thigh muscle activation patterns and dynamic knee valgus at peak ground reaction force during drop jump landings: Reliability, youth competitive alpine skiing-specific reference values and relation to knee overuse complaints

OBJECTIVES

(1) To evaluate the reliability of quantifying thigh muscle activation patterns and dynamic knee valgus during drop jump landings, (2) to provide reference values for female and male youth alpine skiers, and (3) to study their associations with age, anthropometrics, biological maturation and knee overuse complaints.

DESIGN

Cross-sectional biomechanical experiment including questionnaires.

METHODS

One hundred fourteen skiers of the under 16 category (main experiment) and twelve healthy participants (reliability experiment) volunteered. Quadriceps-to-hamstring-activation ratio and medial knee displacementat peak ground reaction force during drop jump landings were measured using marker-based motion analysis, force plates and electromyography. Additionally, age, anthropometrics, biological maturation and knee overuse complaints were assessed.

RESULTS

There were good test-retest reliabilities and moderate standardized typical errors for both quadriceps-to-hamstring-activation ratio (intraclass correlation coefficient(3,1) = 0.84 [95% confidence interval: 0.69, 0.94]; standardized typical errors = 0.43 [0.35, 0.56]) and medial knee displacement (intraclass correlation coefficient(3,1) = 0.87 [0.74, 0.95]; standardized typical errors = 0.39 [0.32, 0.50]). Male skiers had a significantly higher quadriceps-to-hamstring-activation ratio (3.9 ± 2.0 vs. 2.9 ± 1.4, p = 0.011), whilst medial knee displacement was comparable to females (12 mm ± 11 mm vs. 13 mm ± 9 mm; p = 0.419). In male skiers, medial knee displacement correlated with anthropometrics and maturity offset; in female skiers, quadriceps-to-hamstring-activation ratio and medial knee displacement were associated with knee overuse complaints (p < 0.05).

CONCLUSIONS

Female and male youth skiers use different thigh muscle activation strategies, but show comparable dynamic knee valgus motions during drop jump landings. In females, a combination of increased relative quadriceps activity and medial knee displacement may favour knee overuse complaints.