American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

Skiing and Snowboarding

David E. Clark, MD, MPH, FACS

Skiing and snowboarding are increasingly popular winter sports in the United States and other parts of the world with sufficient snow. Reports from trauma centers in these areas allow definite conclusions about mechanisms of injury and potential preventive measures.

As with any physical activity, maintenance of physical conditioning, flexibility, and general health are important prerequisites for these sports. Furthermore, all outdoor activities in winter may be complicated by hypothermia, frostbite, or other cold injuries, especially in back country or deep powder conditions. Such injuries can be minimized by wearing proper clothing, drinking warm nonalcoholic beverages, avoiding fatigue, and notifying others of planned travel away from inhabited areas.

Downhill (Alpine) Skiing

The classic injuries among downhill skiers, involving the ankle and knee, are becoming less frequent.1 Up to 27 percent of reported injuries now involve the head or face2,3 and are potentially more severe, accounting for 50 percent–88 percent of downhill skiing fatalities.2 Male skiers are more likely to suffer head injuries and tend to be injured by striking trees or other fixed objects, especially in the afternoon. Alcohol intoxication is rare in fatal cases, but most victims of fatal head injuries were not wearing helmets.

Fatal head injury could be minimized if the skier avoids situations where control might be lost, especially when the skier is fatigued. Helmet use among those who ski at high speeds likely would reduce the risk of death from accidental impacts, although some disagreement exists. Safety instruction has been shown to be generally effective in reducing injury, and especially should be part of youth group activities, where peer pressure may otherwise lead to more risky behavior.1,3 Improvements in the proper fit of skis, boots, bindings, and poles should continue to reduce the incidence of extremity injuries; ensuring proper fit is especially important in growing children.1,4


This relatively new variation of alpine skiing is rapidly gaining in popularity. Participants are younger than the typical downhill skier4,5 and even more predominantly male.2 Novice snowboarders are at particularly high risk for injuries.4,6 In general, injuries from snowboarding tend to be more frequent but less severe than those from downhill skiing and more often involve fractures or other injuries to the upper extremity.2,5,6 Injuries to the spleen and spine are also more common.1,5

Improving instruction on safe snowboarding and avoiding icy or hard-packed snow conditions might reduce the incidence of injury among beginners. As with downhill skiing, speed and jumps should be recognized as inherently more dangerous, and helmet use may be protective in high-speed impacts.1,3,6 Gloves with integrated wrist protection may also be helpful.6

Cross-Country (Nordic) Skiing

In the absence of continuous gravitational acceleration, cross-country skiing entails considerably lower risk than downhill skiing or snowboarding. Nevertheless, a novice might lose control even on short downhill sections. Ski pole injuries to the thumb during falls are notorious among cross-country skiers (as well as downhill skiers). Knee injuries are also common.7

Proper equipment and instruction, including proper falling techniques (drop the poles!), should reduce the incidence of injury. These and the general considerations about winter sports previously mentioned are especially important for inexperienced or less athletic individuals, for whom cross-country skiing is otherwise an excellent activity for physical fitness.


  1. Koehle MS, Lloyd-Smith R, Taunton JE. Alpine ski injuries and their prevention. Sports Med. 2002;32:785–793.
  2. Levy AS, Hawkes AP, Hemminger LM, et al. An analysis of head injuries among skiers and snowboarders. J Trauma. 2002;53:695–704.
  3. Macnab AJ, Cadman R: Demographics of alpine skiing and snowboarding injury: Lessons for prevention programs. Inj Prev 2:286–289, 1996
  4. Hackam DJ, Kreller M, Pearl RH. Snow-related recreational injuries in children: Assessment of morbidity and management strategies. J Pediatr Surg. 1999;34:65–69.
  5. Sacco DE, Sartorelli DH, Vane DW. Evaluation of alpine skiing and snowboarding injury in a northeastern state. J Trauma. 1998;44:654–659.
  6. Machold W, Kwasny O, Gaessler P, et al. Risk of injury through snowboarding. J Trauma. 2000;48:1109–1114.
  7. Smith M, Matheson GO, Meeuwisse WH. Injuries in cross-country skiing: A critical appraisal of the literature. Sports Med. 1996;21:239–250.