Brains
The very components that make skiing so exhilarating also contribute to its high risk of injury. Exceptional speeds, unpredictable terrain, extended airtime, and the sheer forces placed on the body put every skier at risk. Injuries result from falls, collisions, awkward rotations, and countless other scenarios. But which body parts are most vulnerable, and how can this knowledge help us make smarter decisions on the mountain? The rewards of skiing are undeniable, but so are its risks.
Lower Extremity
As the body’s point of contact with the ground—and the system responsible for absorbing and redirecting immense forces—the lower extremities account for roughly 52% of all skiing injuries.
Knees
Knees, which are so vital to skiing, are unfortunately the body part most likely to get injured. This vulnerability is due to the key role they play as well as their complex structure. Of the four ligaments in the knees, which cause between 10-33% of all skiing-related injuries, the MCL and especially the ACL are most likely to be impacted.
ACL injuries most commonly occur through one of three mechanisms:
- Valgus External Rotation
The most frequent mechanism involves the knee collapsing inward while the tibia rotates outward. This often happens when a skier falls forward, and the inside edge of the ski catches the snow, rotating the tibia outward. The MCL and meniscus are often injured alongside the ACL in this scenario. - The Phantom Foot Mechanism
This occurs when a skier loses balance and sits into the backseat while placing weight on the downhill ski. With the hips below the knees and the torso and arms rotating away, the stiff boot and sharp ski edge act as a lever, forcing the knee inward and placing excessive strain on the ACL. - Boot-Induced Injury
This mechanism results from a backseat landing with straight legs. As the skier falls backward, the boot drives into the lower leg, pushing the tibia forward relative to the femur and tearing the ACL.
The next most common lower-extremity injury is a tibia-fibula fracture, also known as a boottop fracture. Historically caused by bindings failing to release, these injuries, while they still occur, have decreased significantly with modern equipment and proper release mechanisms. Today, boottop fractures most often occur when a ski edge catches and forces the leg to twist beyond the bone’s capacity, or from high-energy impacts with the boottop as the fulcrum.
Upper Extremity
Although skiing relies heavily on the lower body and core, 14% of skiing injuries involve the upper extremities. Falls caught with the arms commonly injure the shoulders and wrists, but the thumb is actually the most frequently injured upper-extremity structure.
Skier’s Thumb (UCL Injury)
The second most common ski injury overall, skier’s thumb, occurs when a pole is caught during a fall, forcing the thumb away from the palm and injuring the ulnar collateral ligament. It is often underreported because many skiers continue to function despite the injury, masking its true prevalence.
Other upper-extremity injuries typically result from falling onto an outstretched arm. The type of injury depends on the direction of the fall, how the body rotates, and which part of the arm takes the impact. Impacts directed onto the lower arm and hand are likely to produce different injuries than impacts against the upper arm. A fall onto an outstretched hand often results in wrist sprains or fractures of the radius or ulna. When force is transmitted higher up, injuries to the humerus, shoulder, or clavicle may occur. Shoulders are particularly vulnerable due to their complexity, with rotator cuff tears and dislocations commonly resulting from bracing against a fall. Clavicle and proximal (closer to the center of the body) humerus fractures require significant force and typically occur during high-speed falls or collisions.
Head and Neck
Head and neck injuries are often the most severe and account for about 13% of all ski injuries. Although some injuries involve superficial cuts or bruises, the most concerning are those to the brain and spine.
Direct impacts to the head or neck are the third most common mechanism of injury and often the most catastrophic. The brain, suspended in fluid without muscular protection, is particularly vulnerable. Concussions, caused by the brain striking the inside of the skull, are the most common injury in this category.
Helmet use and technological improvements have reduced the overall rate of head injuries. However, despite higher helmet adoption to around 80% of skiers in 2016-17, fatalities from head impacts have remained steady. This suggests that while helmets do reduce risk against less severe head injuries, the tragic results of large forces applied to the head remain the same with or without a helmet.Â
This information should not just be a collection of grim statistics to commiserate upon—it can become a guide to injury prevention. Understanding which body parts are most vulnerable and how injuries occur allows us to make informed changes to our habits and training. For the common knee injuries, the knowledge that increased glute strength helps prevent valgus collapse of the knees, or to refrain from attempts to regain balance in the backseat, could both protect against a season-ending injury. Knowing that helmets should be worn and do help against many collisions, but cannot protect against extreme forces, should help inform our more risky decisions. These adjustments may seem small, but they can prevent a season-ending or even life-altering injury.
