An Orthopaedic Surgeon’s Guide to the Top Five Winter Sports Injuries

With the winter ski season almost around the corner, A& E departments across Europe will be preparing for the large increase in patients presenting with injuries sustained on the slopes. Whether you are a seasoned pro or a newbie, avoiding injury can either make (or break) your winter getaway.

Orthopaedic Surgeon, Richard Sinnerton, who practices at Prime Health Surrey and the London Upper Limb Unit, is well accustomed to treating patients who have fallen victim to the winter sports curse and here he shares his guide to the top winter sports injuries and provides expert advice on how to avoid them:

“A bit like waiting to hear the first cuckoo of spring, when winter rolls in orthopaedic surgeons try to spot the first skiing injury of the season” says Richard. “They can usually be spotted in the waiting room wearing a rather complex sling, sporting a Day-Glo coloured plaster cast or leaning on a very swanky crutch: all much grander than their NHS equivalents!

For skiers sitting at Geneva airport for the flight home or trying to get some sleep on the ski-train, it often looks as if every second person has some sort of ski or snowboarding injury. In fact, the injury rate isn’t nearly as high as it is perceived to be, but winter sports such as skiing and snowboarding are physical sports and there are dangers associated with them.

So here is a rundown of the top five injuries from the slopes and a few tips on how to prevent them:

  1. Top of the list, and accounting for over 30% of the total, is damage done to the knee. And the most common of those is a sprain or tear of the Medial Collateral Ligament (MCL). This is the one on the inside of the knee and is strained, sprained or torn when the leg is pushed outwards sideways away from the thigh such as when a snowplough becomes the splits. Thankfully most of these are sprains that may not even stop you on the slopes but, the severe tears may need surgery.It is much more ‘exclusive’ to have an Anterior Cruciate Ligament (ACL) tear. This is the ligament that sits inside the knee and links the shinbone (tibia) to the thighbone (femur). It can be ruptured in a twisting fall such as when the tails of the skis catch or when you try to get up from a fall and your skis are still moving. If you hear a ‘pop’ or ‘rip’ and the knee rapidly swells-up, then the chances are you’ve joined the group of elite winter holidaymakers who have ‘done’ their ACL and surgery is beckoning!TOP TIP – While an ACL tear is often unavoidable, preparing your body physically in the lead up to your holiday, may reduce your risk of injury. Ideally at least six weeks before you head off to the powder, get to the gym and ask a Personal Trainer to prepare a programme in readiness for the slopes. The programme should work on core strength, balance and flexibility.


  2. In at number two are head and face injuries which are responsible for up to 20% of all ski injuries and a much higher percentage in children. Luckily, the vast majority of these are minor cuts, scratches and concussions with serious or fatal head injuries remaining rare. Every year we see more and more people wearing helmets and it will not be long before they are a compulsory safety accessory.TOP TIP – Snow isn’t always soft! Head to your local winter sportswear stockist and get fitted for a helmet by an expert. 
  3. For skiers the third most common area of injury is the shoulder but, for the snowboarders out there, this is in fact the number one most common injury. The chart-toppers for the shoulder are dislocations, Acromioclavicular joint (ACJ) disruptions and clavicle fractures. Which one you get depends on which way you fall and which way the energy of the impact is transmitted up the arm.In a dislocation, the ball is wrenched out of the socket and often makes you feel sick with pain. Once this has been put back in joint – hopefully with suitable pain relief and sedation (don’t let your buddy who saw it done on a Netflix series give you many useful tips!) – then, I’m afraid your skiing may be over. If you are over 40 then there is a good chance that this will be a one-off event but if you are under 25 years old the reverse holds true and you are probably better served by having an operation to re-stabilise the joint because it is likely to dislocate again.Next bit in is the ACJ where the outside end of the collarbone joins onto the top of the shoulder blade (the little bumpy bit on the top!) Like the MCL this can be bruised, sprained or completely torn. If it’s the first two then you may be able to ski for the rest of the week but if it’s what we orthopaedic surgeons term a Grade 3 or Grade 5 injury, then you will be strapped up and sitting next to your pal with the dislocation!The most frequently broken bone is the clavicle or collarbone. The Europeans will wrap you up in a figure of 8 bandages that can either feel very comfortable or very uncomfortable but won’t affect the end result of the bone healing. Most of these breaks will heal uneventfully but do take a lot longer than the six weeks the casualty doctor will tell you. Recent evidence suggests that more of these ought to be fixed to prevent future problems and, if your x-ray reveals the ends of the bone are crossed or overlapping then seek out or befriend your local shoulder surgeon because it may well need pinning to get it back out to the right length.

    TOP TIP – Warm up, not just with Gluwein, and don’t ski while tired. Not just limited to the gym, stretching or warming up before you onto the piste could make the difference between making the après-ski that day, or having to swing by the local hospital. Stretching is important because big muscles can cause short tendons (think of all the bodybuilders who can’t get their arms or legs straight) and that increases the chance of a tear.


  4. Still there at number four is the thumb and specifically the Ulnar Collateral Ligament (UCL) which runs on the inside of the thumb at the knuckle. If the thumb gets pulled or pushed outwards then it can go ‘ping’ resulting in a wobbly, unstable joint and a very weak grip. This used to be known as ‘game-keepers’ thumb but as modern sports have moved from the grouse moor to the piste it is now ‘skiers-thumb’. You are at high risk of this injury on the dry-ski slopes where the thumb can catch in the gaps in the carpet and, when you get to do the real thing, the danger lies in the ski-pole strap. If this is round the wrist – where you would expect it to be – then it stops the pole being pulled free of the hand in a fall and instead it forces the thumb out and can damage the UCL.Be particularly careful of the thumb injury that doesn’t seem to hurt but does wobble because that’s the worst one. Don’t be fooled by thinking ‘if it doesn’t hurt it can’t be serious’ because it is, and you may need surgery to reattach it.TOP TIP – Consider investing in protective wrist guards as they can help protect you in case of a fall.

So, now you know the worst, is there anything else you can do to prevent these injuries?

Here is my summary of a few specific things you can do before you head off to the snow.

  • Don’t use the wrist straps on your poles. You can always find your pole again (ignore this advice if you are in deep powder) but if the UCL is gone you won’t be able to hold it!
  • Do consider wearing a helmet but don’t think you can get away with more because of it, you can’t.
  • Don’t lie about your weight. Sounds a strange one (and might not be as dangerous as if you lie about it when bungee-jumping) but release tensions in bindings are weight-related and must be correct.
    Ski on carvers. These are shorter and the risk of the tails crossing and causing an ACL tearing fall is diminished. Don’t forget though if you do fall, don’t try and get up when the skis are still moving, or you might hear that fateful ‘pop’!

No, I didn’t forget the fifth most common area to be injured skiing – you can take your pick between the wallet or the liver.”

What to do if you experience a winter sports injury

Seek out professional help for winter sports injury treatments Should you sustain a sporting injury when out on the slopes, then time is of the essence.

Once you have returned home don’t try to limp on and ignore the pain from your injury. Doing so can hamper your healing and negatively affect your future sporting performance if you don’t take the appropriate action as quickly as possible.

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