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Bonell Monsonís O, Spörri J, Warsen M, Bolling C, Gouttebarge V, Verhagen E. We know a lot about little and little about a lot: A contextualized scoping review on injury prevention in alpine ski racing. Scand J Med Sci Sports 2024; 34:e14533. [PMID: 37955281 DOI: 10.1111/sms.14533] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 09/19/2023] [Accepted: 10/25/2023] [Indexed: 11/14/2023]
Abstract
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.
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Affiliation(s)
- Oriol Bonell Monsonís
- Amsterdam Collaboration on Health and Safety in Sports, Department of Public and Occupational Health, Amsterdam Movement Sciences, Amsterdam UMC, University Medical Centers - Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health and Sports, Amsterdam, The Netherlands
| | - Jörg Spörri
- Sports Medical Research Group, Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- University Centre for Prevention and Sports Medicine, Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Marit Warsen
- Amsterdam Collaboration on Health and Safety in Sports, Department of Public and Occupational Health, Amsterdam Movement Sciences, Amsterdam UMC, University Medical Centers - Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Caroline Bolling
- Amsterdam Collaboration on Health and Safety in Sports, Department of Public and Occupational Health, Amsterdam Movement Sciences, Amsterdam UMC, University Medical Centers - Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam UMC Location University of Amsterdam, Orthopedic Surgery and Sports Medicine, Amsterdam, The Netherlands
| | - Vincent Gouttebarge
- Amsterdam Movement Sciences, Musculoskeletal Health and Sports, Amsterdam, The Netherlands
- Amsterdam UMC Location University of Amsterdam, Orthopedic Surgery and Sports Medicine, Amsterdam, The Netherlands
- Section Sports Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Evert Verhagen
- Amsterdam Collaboration on Health and Safety in Sports, Department of Public and Occupational Health, Amsterdam Movement Sciences, Amsterdam UMC, University Medical Centers - Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health and Sports, Amsterdam, The Netherlands
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Lasshofer M, Seifert J, Wörndle AM, Stöggl T. Heel riser height and slope gradient influence the kinematics and kinetics of ski mountaineering—A laboratory study. Front Sports Act Living 2022; 4:886025. [PMID: 36060627 PMCID: PMC9433713 DOI: 10.3389/fspor.2022.886025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 07/29/2022] [Indexed: 11/13/2022] Open
Abstract
In ski mountaineering, equipment and its interaction with the exercising human plays an important role. The binding, as the crucial connection between boot and ski, must ensure safe fixation during downhill skiing and a free moving heel when walking uphill. Uphill, the binding offers the possibility to adopt the height of the heel (riser height) to personal preferences and the steepness of the ascent. This possible adjustment and its influence on various biomechanical parameters are the focus of this work. For this study, 19 male leisure ski mountaineers were tested on a treadmill, ascending at a fixed submaximal speed (3.9 ± 0.4 km·h−1) at 8, 16, and 24% gradient and with three heel riser heights, low (0 cm), medium (3.0 cm) and high (5.3 cm). The applied biomechanical measurement systems included a 3D motion capture system in sagittal plane, pressure insoles, a with strain gauges instrumented pole, spirometry and a comfort scale. Step length and step frequency were influenced by the riser height and the gradient (p ≤ 0.001). The high riser height decreased the step length by 5% compared to the low riser height over all tested gradients, while steps were 9.2% longer at the 24% gradient compared to the 8% gradient over all three riser heights. The high riser height revealed a force impulse of the pole 13% lower than using the low riser height (p < 0.001). Additionally, the high riser height reduced the range of motion of the knee joint and the ankle joint compared to the low riser height (p < 0.001). Therefore, advantageous settings can be derived, with the low riser height creating proper range of motion for ankle, knee and hip joint and higher propulsion via the pole at 8%, while higher riser heights like the medium setting do so at steeper gradients. These findings are in line with the conducted comfort scale. We would not recommend the highest riser height for the analyzed gradients in this study, but it might be an appropriate choice for higher gradients.
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Affiliation(s)
- Michael Lasshofer
- Department of Sport and Exercise Science, University of Salzburg, Hallein, Austria
- *Correspondence: Michael Lasshofer
| | - John Seifert
- Department of Sport and Exercise Science, University of Salzburg, Hallein, Austria
- Department of Health & Human Development, Montana State University, Bozeman, MT, United States
| | - Anna-Maria Wörndle
- Department of Sport and Exercise Science, University of Salzburg, Hallein, Austria
| | - Thomas Stöggl
- Department of Sport and Exercise Science, University of Salzburg, Hallein, Austria
- Red Bull Athlete Performance Center, Salzburg, Austria
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Kiers K, Kröll J, Mitterbauer G, Scherr J, Spörri J. Perceptions of experts on key injury risk factors in alpine ski racing as a function of stakeholder role and associated level of competition. BMJ Open Sport Exerc Med 2021; 7:e001111. [PMID: 34603741 PMCID: PMC8449969 DOI: 10.1136/bmjsem-2021-001111] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2021] [Indexed: 11/04/2022] Open
Abstract
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.
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Affiliation(s)
- Kirsten Kiers
- Sports Medical Research Group, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.,University Centre for Prevention and Sports Medicine, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Josef Kröll
- Department of Sport Science and Kinesiology, University of Salzburg, Salzburg, Austria
| | - Gerald Mitterbauer
- Department of Sport Science and Kinesiology, University of Salzburg, Salzburg, Austria
| | - Johannes Scherr
- Sports Medical Research Group, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.,University Centre for Prevention and Sports Medicine, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Jörg Spörri
- Sports Medical Research Group, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.,University Centre for Prevention and Sports Medicine, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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Ogrin J, Šarabon N, Madsen MK, Kersting U, Holmberg HC, Supej M. Asymmetries in Ground Reaction Forces During Turns by Elite Slalom Alpine Skiers Are Not Related to Asymmetries in Muscular Strength. Front Physiol 2021; 12:577698. [PMID: 33859567 PMCID: PMC8042208 DOI: 10.3389/fphys.2021.577698] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 03/12/2021] [Indexed: 12/24/2022] Open
Abstract
The ground reaction forces (GRF) associated with competitive alpine skiing, which are relatively large, might be asymmetric during left and right turns due to asymmetries in the strength of the legs and torso and the present investigation was designed to evaluate this possibility. While skiing a symmetrical, 20-gate slalom course, the asymmetries of 9 elite alpine skiers were calculated on the basis of measurements provided by inertial motion units (IMU), a Global Navigation Satellite System and pressure insoles. In addition, specialized dynamometers were utilized to assess potential asymmetry in the strength of their legs and torso in the laboratory. In total, seven variables related to GRF were assessed on-snow and eight related to strength of the legs and torso in the laboratory. The asymmetries in these parameters between left and right turns on snow were expressed in terms of the symmetry (SI) and Jaccard indices (JI), while the asymmetries between the left and right sides of the body in the case of the laboratory measurements were expressed as the SIs. The three hypotheses to be tested were examined using multivariable regression models. Our findings resulted in rejection of all three hypotheses: The asymmetries in total GRF (H1), as well as in the GRF acting on the inside and outside legs (H2) and on the rear- and forefeet GRF (H3) during left and right turns were not associated with asymmetries in parameters related to muscular strength. Nevertheless, this group of elite slalom skiers exhibited significant asymmetry between their right and left legs with respect to MVC during ankle flexion (0.53 ± 0.06 versus 0.60 ± 0.07 Nm/kg, respectively) and hip extension (2.68 ± 0.39 versus 2.17 ± 0.26 Nm/kg), as well as with respect to the GRFs on the inside leg while skiing (66.8 ± 7.39 versus 76.0 ± 10.0 %BW). As indicated by the JI values, there were also large asymmetries related to GRF as measured by pressure insoles (range: 42.7–56.0%). In conclusion, inter-limb asymmetries in GRFs during elite alpine skiing are not related to corresponding asymmetries in muscular strength. Although our elite athletes exhibited relatively small inter-limb asymmetries in strength, their asymmetries in GRF on-snow were relatively large.
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Affiliation(s)
- Jan Ogrin
- Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia
| | - Nejc Šarabon
- Faculty of Health Sciences, University of Primorska, Izola, Slovenia.,S2P, Science to Practice, Ltd., Laboratory for Motor Control and Motor Behavior, Ljubljana, Slovenia
| | - Mads Kjær Madsen
- Department of Health Science and Technology, Sport Sciences - Performance and Technology, Aalborg University, Aalborg, Denmark
| | - Uwe Kersting
- Department of Health Science and Technology, Sport Sciences - Performance and Technology, Aalborg University, Aalborg, Denmark.,Institute of Biomechanics and Orthopedics, German Sport University Cologne, Cologne, Germany
| | - Hans-Christer Holmberg
- Department of Physiology and Pharmacology, Biomedicum C5, Karolinska Institute, Stockholm, Sweden.,China Institute of Sport and Health Science, Beijing Sport University, Beijing, China
| | - Matej Supej
- Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia.,Swedish Winter Sports Research Centre, Mid Sweden University, Östersund, Sweden
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Barth M, Platzer HP, Giger A, Nachbauer W, Schröcksnadel P. Acute on-snow severe injury events in elite alpine ski racing from 1997 to 2019: the Injury Surveillance System of the Austrian Ski Federation. Br J Sports Med 2020; 55:bjsports-2020-102752. [PMID: 33023882 DOI: 10.1136/bjsports-2020-102752] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVES The study aimed to (1) determine the incidence and gender-specific risk ratio of acute on-snow severe injury events (SIE) in elite alpine ski racing, (2) examine the development of SIE over 22 seasons, and (3) analyse SIE with respect to the severely injured body parts and structures. METHODS Data recorded in the Austrian Ski Federation's Injury Surveillance System over 22 seasons were analysed. The Austrian Ski Team consists of four groups: Team National (n=477), Team A (n=444), Team B (n=696) and Team C (n=608). Team National and Team A comprised World Cup, Team B European Cup and Team C junior alpine ski racers. Simple and multiple Poisson regressions were calculated. RESULTS The SIE incidence was 15.7 (95% CI 14.2 to 17.5) per 100 skier seasons. ACL injury events accounted for 70.8% of severe knee injury events and 48.6% of SIE. The incidence of severe ACL injury events was 7.6 (95% CI 6.6 to 8.9). Female World Cup alpine ski racers had a 1.65 times (95% CI 1.02 to 2.69) higher risk of severe ACL injury events than their male counterparts. CONCLUSION The incidence of acute on-snow SIE in World Cup alpine ski racing was higher than previously reported. Despite various prevention efforts, the average seasonal incidence of SIE in World and European Cup alpine ski racers has grown from approximately 11 in 1997 to 23 in 2019; thus with roughly one more injured athlete every second season.
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Affiliation(s)
- Michael Barth
- Department of Sport Science, University of Innsbruck, Innsbruck, Tyrol, Austria
- Department of Business & Society, University of Applied Sciences Kufstein Tirol-FH Kufstein, Kufstein, Tyrol, Austria
- Department of Sports Science, Saarland University, Saarbrücken, Saarland, Germany
| | - Hans-Peter Platzer
- Department of Sport Science, University of Innsbruck, Innsbruck, Tyrol, Austria
| | - Anton Giger
- Austrian Ski Federation, Innsbruck, Tyrol, Austria
| | - Werner Nachbauer
- Department of Sport Science, University of Innsbruck, Innsbruck, Tyrol, Austria
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Transmissibility of whole-body vibrations and injury risk in alpine skiing. J Sci Med Sport 2019; 22 Suppl 1:S71-S77. [PMID: 30885614 DOI: 10.1016/j.jsams.2019.02.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 01/31/2019] [Accepted: 02/21/2019] [Indexed: 01/10/2023]
Abstract
OBJECTIVES Whole body vibrations in alpine skiing are a potential cause for frequent overuse and acute injuries. Therefore, the aim of the study was to investigate the transmissibility of vibrations from the skis to lower back and head. Attention was addressed to distinguish shocks and transient vibrations from long-lasting vibrations. DESIGN Whole body vibrations were analysed in snow-plough swinging, basic swinging, short swinging and carved turns performed by eight highly skilled skiers. METHODS Power spectrum densities (PSD), running root-mean-square accelerations (RMS) and transmissibilities were estimated and analysed from 7 accelerometers positioned on skis, pelvis and head. RESULTS In the measurements frequency range, vibrations were effectively transmitted from the skis to the pelvis and to the head, with the highest transmissibility occurring at frequencies below 6Hz. The highest transmissibility was observed for short swinging. The running RMS was cyclically increasing and decreasing with turning and shocks. Also, transient vibrations exhibited similar PSDs with considerably higher densities compared to overall PSDs. CONCLUSIONS All form of alpine skiing were associated with random, periodic and transient vibrations. Skiing involving skidding was associated with higher vibration levels, higher transmissibilities and more pronounced shocks and transient vibrations compared to carving turns. Frequent skiers should preferably use carving instead of skidding techniques to decrease the risk for low back pain and loss of control.
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Abstract
Alpine ski racing is known to be a sport with a high risk of injury and a high proportion of time-loss injuries. In recent years, substantial research efforts with regard to injury epidemiology, injury etiology, potential prevention measures, and measures’ evaluation have been undertaken. Therefore, the aims of this review of the literature were (i) to provide a comprehensive overview of what is known about the aforementioned four steps of injury prevention research in the context of alpine ski racing; and (ii) to derive potential perspectives for future research. In total, 38 injury risk factors were previously reported in literature; however, a direct relation to injury risk was proven for only five factors: insufficient core strength/core strength imbalance, sex (depending on type of injury), high skill level, unfavorable genetic predisposition, and the combination of highly shaped, short and wide skis. Moreover, only one prevention measure (i.e. the combination of less-shaped and longer skis with reduced profile width) has demonstrated a positive impact on injury risk. Thus, current knowledge deficits are mainly related to verifying the evidence of widely discussed injury risk factors and assessing the effectiveness of reasonable prevention ideas. Nevertheless, the existing knowledge should be proactively communicated and systematically implemented by sport federations and sport practitioners.
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Supej M, Ogrin J, Holmberg HC. Whole-Body Vibrations Associated With Alpine Skiing: A Risk Factor for Low Back Pain? Front Physiol 2018; 9:204. [PMID: 29593563 PMCID: PMC5854839 DOI: 10.3389/fphys.2018.00204] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 02/23/2018] [Indexed: 12/17/2022] Open
Abstract
Alpine skiing, both recreational and competitive, is associated with high rates of injury. Numerous studies have shown that occupational exposure to whole-body vibrations is strongly related to lower back pain and some suggest that, in particular, vibrations of lower frequencies could lead to overuse injuries of the back in connection with alpine ski racing. However, it is not yet known which forms of skiing involve stronger vibrations and whether these exceed safety thresholds set by existing standards and directives. Therefore, this study was designed to examine whole-body vibrations connected with different types of skiing and the associated potential risk of developing low back pain. Eight highly skilled ski instructors, all former competitive ski racers and equipped with five accelerometers and a Global Satellite Navigation System to measure vibrations and speed, respectively, performed six different forms of skiing: straight running, plowing, snow-plow swinging, basic swinging, short swinging, and carved turns. To estimate exposure to periodic, random and transient vibrations the power spectrum density (PSD) and standard ISO 2631-1:1997 parameters [i.e., the weighted root-mean-square acceleration (RMS), crest factor, maximum transient vibration value and the fourth-power vibration dose value (VDV)] were calculated. Ground reaction forces were estimated from data provided by accelerometers attached to the pelvis. The major novel findings were that all of the forms of skiing tested produced whole-body vibrations, with highest PSD values of 1.5–8 Hz. Intensified PSD between 8.5 and 35 Hz was observed only when skidding was involved. The RMS values for 10 min of short swinging or carved turns, as well as all 10-min equivalent VDV values exceeded the limits set by European Directive 2002/44/EC for health and safety. Thus, whole-body vibrations, particularly in connection with high ground reaction forces, contribute to a high risk for low back pain among active alpine skiers.
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Affiliation(s)
- Matej Supej
- Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia
| | - Jan Ogrin
- Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia
| | - Hans-Christer Holmberg
- School of Sport Sciences, UiT Arctic University of Norway, Tromsø, Norway.,School of Kinesiology, University of British Columbia, Vancouver, BC, Canada.,Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
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