Domhnall MacAuley: Apres Ski and A&E

Domhnall MacauleyHeading for the slopes? Sunshine, blue skies and an exhilarating holiday. Cant wait! You don’t need any gloomy doom sayer spoiling your excitement. But, as you board your flight, look around at your fellow passengers- mostly fairly well off, youngish and middle aged, setting off for a well earned winter break. Not as fit as they used to be, playing sport for, perhaps, an hour or so each week, they expect to spend the next six consecutive days skiing for up to five hours each day with late nights and early mornings and little recovery. A recipe for muscle fatigue, aches and pains, and overuse injury not to mention the potential for serious trauma.

Top level alpine skiing is breathtaking but, so far this year, at least seven high profile athletes have been badly injured – enough to end their Olympic hopes. This month’s British Journal of Sports Medicine describes 191 injuries in 521 World Cup skiers with an injury rate of 9.8 injuries per 1000 World Cup/ World Ski Championship runs- a staggeringly high level. But, you wouldn’t expect this in recreational skiers.

Another piece in the same issue of the journal gives us some insight: Swiss researchers, looking at injuries coming to their trauma centres, created three categories- high level athletic skiers where fast and aggressive skiing lead to injury from small mistakes. Good skiers, where poor visibility and over ambitious skiing was a problem. And, the less experienced, where the highest risk was the combination of icy slopes and not wearing a helmet. Alcohol did not seem to be a major factor in this Swiss study. They suggest that this may be because, in Switzerland, skiers tend to drive to the slopes and the drink driving laws are punitive

But, one week holiday skiers have a lot to pack into their annual escape. And, drink plays a big part. This year, however, you will see a series of advertisements in British Airports advising you of the hazards of alcohol and skiing. Drink seems to have become an integral part of our ski culture and people tend to start early; apres ski might follow morning coffee. Later in the day, people who would never dream of drinking and driving, hurtle down slopes with abandon. Barely in control with tired muscles struggling to maintain coordination on a rutted icy evening piste- its like riding a motorbike through a playground after half a bottle of wine. Apres ski and A&E. Sounds like a theme for a new reality TV programme. One to avoid.

 Domhnall MacAuley is primary care editor, BMJ