January 2010

In the Moment: Olympic Sports

by Jordana Bieze Foster

Spotlight on skier safety

Injury ‘avalanche’ prompts concerns

When the torch is lit to kick off the Winter Olympics in Vancouver next month, the Canadian ski team will be missing no fewer than six of its best Alpine skiers, downed by five anterior cruciate ligament tears and one broken leg. All six were injured between the last week in November and the first week in January.

Lower extremity injuries are nothing new in the sport of skiing. But the recent spate of injuries, sustained so close to the Olympics and with the host country’s team hit particularly hard, has drawn international attention to the issue of ski safety. Even as outspoken Italian skiing legend Alberto Tomba was calling on skiers to strike, International Ski Federation (FIS) officials met with athletes and coaches in mid-December to discuss the extent of the problem and possible solutions.

“Safety of the athletes is and remains the FIS’s foremost concern,” FIS president Gian Franco Kasper said in a December press release.

The FIS Injury Surveillance System is now in its fourth season under the direction of Roald Bahr, MD, PhD, chair of the Oslo Sports Trauma Research Centre, but ISS-generated injury data are only now beginning to be published in the medical literature.

In the December issue of the British Journal of Sports Medicine, Bahr and colleagues reported 191 acute injuries in 521 World Cup alpine skiers during the 2006-7 and 2007-8 competitive seasons, with 45% of those taking place during competitions.

Although the BJSM article states that the risk of injury was higher than previously reported, Bahr said in a January interview published on the FIS website that there has been no change in injury rate or injury pattern since the ISS project began in 2006.

“Whether the ‘avalanche’ of serious knee injuries we have experienced at the beginning of the 2009-2010 season reflects a true increase, or if the many injuries we have witnessed during the first few weeks is just coincidental, we do not know until we have the full data after the season,” he said.

In the BJSM article, injuries most often occured in the knee, accounting for 36% of the total, and more than half of the knee injuries were severe (primarily anterior cruciate ligament injuries). For this reason, Bahr said, the next phase of ISS research will focus specifically on serious knee injuries in alpine skiing.

One key issue to consider is the mechanism that leads to ACL injury in alpine skiers. Because most ski boot bindings are best equipped to release when excessive force is detected during a forward fall, much of the research to date has focused on the “phantom foot” effect of a backward fall (so called because the downhill ski produces a force as if an imaginary foot were pushing on its tail). But an Austrian study published in the November issue of Knee Surgery, Sports Traumatology and Arthroscopy found that ACL injuries sustained by female skiers occurred significantly more often during a forward twisting fall (51%) than a backward twisting fall (29%). That study included only users of “carving skis,” which describes essentially all skis made since the early 1990s; the authors suggested that the injury mechanisms associated with the modern skis may differ from those previously reported.

Interestingly, neither the December ACL injury to France’s Jean-Baptiste Grange nor the late-November meniscal injury to Denise Karbon of Italy were associated with a fall; both skiers finished their runs.

Course conditions have been suggested as a contributing factor. The ISS is also considering equipment rules changes regarding skis, ski bindings, and – taking a page from swimming’s rule book – racing suits.

Average rehab after hip labral repair could fit in NHL offseason window

Professional hockey players who undergo arthroscopic labral repair following the Stanley Cup playoffs in June have a good chance of being back on the ice by the start of the next season in October, according to outcomes data published in January by the surgeon who pioneered the procedure.

Mark J. Philippon, MD, and colleagues at the Steadman Philippon Research Institute in Vail, CO, reported on 28 National Hockey League players who underwent unilateral arthroscopic labral repair and treatment for femoroacetabular impingement between March 2005 and December 2007. Patients included nine defensemen, 12 offensive players, and seven goalies.

The average time to return to skating was 3.4 months post-surgery. The average Modified Harris Hip Score, reflecting pain and function, improved from 70 (range 57-100) pre-surgery to 95 (range 74-100) an average of 24 months after surgery. Satisfaction ranged from 5 to 10 points out of 10, with 10 being the median score. Two players were re-injured and required additional hip arthroscopy.

The results were published in the January issue of the American Journal of Sports Medicine.

‘Double-push’ cross country skiing outpaces conventional techniques

A cross-country skiing technique borrowed from inline skating is significantly faster than conventional techniques for hill climbing as well as on flat ground, according to research from the University of Salzburg in Austria.

Conventional Nordic skiing techniques alternate a left leg push with a right leg push. By comparison, the “double-push” technique involves two consecutive pushes—one inward, one outward—with each leg. The new approach isn’t yet widely used in competition, but the Salzburg research suggests perhaps it should be.

In a September 2008 study published in the Journal of Sports Science, the investigators found that 13 elite skiers completed a 100-meter sprint 2.9% faster with the double-push technique than the conventional V2 technique (one double-pole push for each leg push, alternating left and right legs).

And in the January issue of Medicine & Science in Sports & Exercise, the same group found that six elite skiers navigated a 60-meter uphill sprint 4.3% faster with the double-push technique than with the V2 or V1 (one double-pole push for each left-right leg push cycle).

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