{"id":217,"date":"2010-07-12T19:43:27","date_gmt":"2010-07-12T18:43:27","guid":{"rendered":"https:\/\/blogs.bmj.com\/bjsm\/?p=217"},"modified":"2010-09-07T22:53:25","modified_gmt":"2010-09-07T21:53:25","slug":"e-letter-are-there-risk-factors-in-alpine-skiing","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bjsm\/2010\/07\/12\/e-letter-are-there-risk-factors-in-alpine-skiing\/","title":{"rendered":"E-letter: Are there risk factors in alpine skiing?"},"content":{"rendered":"

This E-letter is in response to Are there risk factors in alpine skiing? A controlled\u00a0multicentre survey of 1278 skiers<\/strong>. Abstract<\/a> | Full article<\/a><\/span><\/em><\/p>\n

\n

We read with interest the article from Hasler et al. (2009) “Are there risk\u00a0factors in alpine skiing? A controlled multicentre survey of 1278 skiers”.<\/p>\n

In general, the answer is: ‘yes, there are internal (e.g. gender, age,\u00a0fitness, skill level, risk taking) and external (equipment, environment)\u00a0risk factors’ according to comprehensive model for injury causation by Bahr\u00a0and Krosshaug (1). However, we would like to comment on the presented data\u00a0and methods used because some results seem contrary to other studies in\u00a0this research field.<\/p>\n

Firstly, Hasler et al. reported that skiers with new\u00a0equipment have a higher risk of being injured. However, there seems a\u00a0mistake in the presented data because in the abstract the Odds Ratio (OR)\u00a0was 59 with a 95% confidence interval of 0.37-0.93 while in Table 1 the OR\u00a0was 0.59. If the OR of 0.59 was correct, new equipment would decrease\u00a0injury risk. In addition, what means new equipment? Did the authors compare\u00a0carving skiers with traditional skiers as done by Burtscher et al. (2) showing a reduced injury rate since\u00a0the introduction of carving ski? Where is the cut off between new and old\u00a0equipment? In the discussion section, Hasler et al. stated that the results\u00a0might be explained by a mismatch between the abilities of the skier and the\u00a0equipment. Unfortunately, they did not include skill levels in their\u00a0questionnaire. Several studies showed higher injury rates in less skilled\u00a0skiers and snowboarders (3, 4) while more skilled skiers had a higher risk\u00a0to sustain a more severe injury (5).<\/p>\n

Secondly, there seem mistakes concerning the presented data about snow\u00a0conditions. In Figure 3, artificial snow versus old snow and fresh snow\u00a0versus powder snow show OR <1 while in Table 1 the same OR are presented\u00a0vice versa (OR 0.21 for old snow vs. artificial snow and OR 0.31 for old\u00a0snow vs. fresh snow, respectively). It is the same with slush snow versus\u00a0powder snow which is not a snow condition but a skiing condition in Figure\u00a03 and powder snow vs. slush snow in Table 1, respectively. In addition, old\u00a0snow seems to be in contrast to fresh snow. Does fresh snow mean powder\u00a0snow? However, can old snow not be also old artificial snow? Therefore, it\u00a0is not clear which snow condition actually increases or decreases injury\u00a0risk.<\/p>\n

Thirdly, seasonal checking of skiing equipment showed a trend to decrease\u00a0injury risk (OR: 0.46, p = 0.056). In our opinion, seasonal checking of\u00a0skiing equipment includes primarily an adjustment of the bindings. In\u00a0accordance, Burtscher et al. (2) showed that female carving skiers with a\u00a0binding adjustment older than 1 year had a twofold knee injury rate\u00a0compared to those with newly adjusted bindings. The release of a binding is\u00a0primarily important in preventing injuries to the lower extremity.\u00a0Therefore, it would be better to define risk factors with regard to the\u00a0injured body location.<\/p>\n

Fourthly, injured skiers showed a higher readiness for risk taking in this study. In contrast, other studies \u00a0reported that injured skiers did not take\u00a0more risk but were less skilled compared to uninjured skiers (6-8).\u00a0Therefore, it would make sense to include skill level.<\/p>\n

Fifthly, Hasler et al. showed a higher injury risk when skiing under bad\u00a0weather conditions which is well in accordance with the study by Aschauer\u00a0et al. (9). However, poor snow and weather conditions may be misjudged by\u00a0injured skiers because they may look for an explanation as to why the\u00a0injury occurred. In general, self-report to questions might lead to\u00a0underreport or overreport of health-risk behaviours affected by cognitive\u00a0and situational factors (10).<\/p>\n

Sixthly, gender has not been found to be a significant risk factor in this\u00a0study. That might be due to the fact that Hasler et al. did not\u00a0differentiate between injured parts of the body, e.g. females have a higher\u00a0knee injury risk (2) and males have a higher head injury risk (11) compared to the other gender.<\/p>\n

Seventhly, Hasler et al. calculated that injury risk is higher when warming\u00a0up. This result contrasts general preventive recommendations (12) and also\u00a0the findings by Ruedl et al. (13) who demonstrated a twofold injury\u00a0reduction in a cohort of 36.000 participants of 12 ski schools when warming\u00a0up.<\/p>\n

Eighthly, there seems a mistake concerning the presented data about drug\u00a0consumption. Figure 3 shows an OR > 1 for abstinence from drugs while inTable 1 drug consumption was presented vice versa. In \u00a0addition, in Table 1\u00a0an OR of 5.92 was presented while in the discussion the OR was 1.78 for\u00a0drug consumption.<\/p>\n

Since a case control design was used, the amount of exposure to the\u00a0suggested risk factors was unknown which should be taken into account when\u00a0interpreting the results (14). In the study by Hasler et al. the controls\u00a0were interviewed when coming off slopes after skiing. This implies that\u00a0controls skied probably more than 3 hours although other studies showed\u00a0that most injuries to the lower extremity occurred within the first 2 or 3\u00a0hours of skiing (15, 16). A total of 782 patients were recruited over a\u00a0period of 5 and a half month and 496 controls were interviewed in six\u00a0different ski resorts. This means an average of about 83 controls per ski\u00a0resort and an average of 15 uninjured skiers per month, respectively.\u00a0However, Hasler et al. (2009) did not specify when controls have been\u00a0recruited, e.g. every second day. A continuous recruitment of controls seems of utmost importance to compare prospectively potential external risk\u00a0factors like snow, weather and slope conditions.\u00a0In general, a prospective study design concerning internal and external\u00a0risk factors in relation to gender and type of injury should be used.\u00a0However, at least a case-control-design should be applied matching controls\u00a0according to gender, age and skill level.<\/p>\n

Gerhard Ruedl & Martin Burtscher
\nDepartment of Sport Science
\nUniversity of Innsbruck, Austria<\/em><\/p>\n

References<\/strong><\/p>\n

1.\t\t Bahr R, Krosshaug T. Understanding injury mechanisms: a key\u00a0component of preventing injuries in sport. Br J Sports Med 2005; 39:\u00a0324-329.
\n2.\t\t Burtscher M, Gatterer H, Flatz M et al. Effects of modern ski\u00a0equipment on the overall injury rate and the pattern of injury location in\u00a0Alpine skiing. Clin J Sport Med 2008; 18:355-357.
\n3.\t\t Langran M, Selvaraj S. Increased injury risk among first-day\u00a0skiers, snowboarders, and skiboarders. Am J Sports Med 2004;32:96-103.
\n4.\t\t Hagel B. Skiing and snowboarding injuries. Caine DJ, Maffulli\u00a0(eds.): Epidemiology of Pediatric Sports Injuries. Individual Sports. Med\u00a0Sport Sci. Basel. Karger,2005;48:74-119.
\n5.\t\t Goulet C, Hagel BE, Hamel D, et al. Self-reported skill level\u00a0and injury severity in skiers and snowboarders. J Sci Med Sport 2008; doi:\u00a010.1016\/j.jsams.10.002
\n6.\t\t Bouter LM, Knipschild PG, Feij JA, et al. Sensation seeking\u00a0and injury risk in downhill skiing. Person. Individ. Diff. 1988;9:667-73.
\n7.\t\t Cherpitel CJ, Meyers AR, Perrine MW. Alcohol consumption,\u00a0sensation seeking and ski injury: a case-control study. Journal of Studies\u00a0on Alcohol 1998;59:216-21.
\n8.\t\t Goulet C, Regnier G, Valois P, et al. Injuries and risk taking\u00a0in alpine skiing. ASTM STP 1397, Skiing Trauma and Safety: Thirteenth\u00a0Volume, RJ Johnson, P Zucco, JE Shealy (eds.), ASTM International, West\u00a0Conshohocken, PA, 2000:139-46.
\n9.\t\t Aschauer E, Ritter E, Resch H et al. Injuries and injury risk\u00a0in skiing and snowboarding. Unfallchirug 2007; 110: 301 306. (in German)
\n10.\t\t Brenner ND, Billy JOG, Grady WR. Assessment of factors\u00a0affecting the validity of self-reported health-risk behavior among\u00a0adolescents: evidence from the scientific literature. J Adolesc Health\u00a02003;33:436-457.
\n11.\t\t Mueller BA, Cummings P, Rivara FP, et al. Injuries of the\u00a0head, face, and neck in relation to ski helmet use. Epidemiology\u00a02008;19:270-76.
\n12.\t\t Koehle MS, Lloyd-Smith R, Taunton JE. Alpine ski injuries and\u00a0their prevention. Sports Med 2002; 32 (12): 785-793.
\n13.\t\t Ruedl G, Sommersacher R, Woldrich T et al. A structured\u00a0warm-up program to prevent injury in recreational skiers. Senner V,\u00a0Fastenbauer V, Boehm H (eds.): Book of Abstracts of the 18th Congress of\u00a0the International Society for Skiing Safety, Garmisch-Partenkirchen,\u00a0Germany, April 26 to May 02 2009, 77.
\n14.\t\t Vandenbroucke JP, von Elm E, Altman DG et al. Strengthening\u00a0the reporting of observational studies in epidemiology (STROBE):\u00a0explanation and elaboration. Epidemiology 2007;18 (6): 805-835.
\n15.\t\t Ungerholm S, Engkvist O, Gierup J et al. Skiing injuries in\u00a0children and adults: a comparative study from a 8-year period. Int J Sports\u00a016.\t\t Ruedl G, Schranz A, Fink C et al. Are ACL injuries related to\u00a0perceived fatigue in female skiers? ASTM International 2010; 7 (4), Paper\u00a0ID JAI102747<\/p>\n","protected":false},"excerpt":{"rendered":"

This E-letter is in response to Are there risk factors in alpine skiing? A controlled\u00a0multicentre survey of 1278 skiers. Abstract | Full article We read with interest the article from Hasler et al. (2009) “Are there risk\u00a0factors in alpine skiing? A controlled multicentre survey of 1278 skiers”. In general, the answer is: ‘yes, there are […]<\/p>\n

Read More…<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1105],"tags":[1701,253,1399,1703,1702,1704,1519],"class_list":["post-217","post","type-post","status-publish","format-standard","hentry","category-e-letters","tag-alpine","tag-drugs","tag-injury","tag-knee","tag-risk-factors","tag-skier","tag-skiing"],"yoast_head":"\nE-letter: Are there risk factors in alpine skiing? - BJSM blog - social media's leading SEM voice<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bjsm\/2010\/07\/12\/e-letter-are-there-risk-factors-in-alpine-skiing\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"E-letter: Are there risk factors in alpine skiing? - BJSM blog - social media's leading SEM voice\" \/>\n<meta property=\"og:description\" content=\"This E-letter is in response to Are there risk factors in alpine skiing? 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A controlled\u00a0multicentre survey of 1278 skiers. Abstract | Full article We read with interest the article from Hasler et al. (2009) “Are there risk\u00a0factors in alpine skiing? A controlled multicentre survey of 1278 skiers”. 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