Wednesday, December 8

Snowboarding injuries

From 1993 to 1996, the number of people who took up snowboarding more than doubled. And the legion of new "boarders" on the slopes continues to increase. In the 1990s, snowboarding has not only grown exponentially, it has risen above the label of "sport" to become a cultural phenomenon, with its own particular fashion and jargon.

Unfortunately, the downside of all this interest is an increase in snowboarding injuries. "The sheer increase in the volume of snowboarders out there on the mountain is in direct correlation to the increase of people we see in our clinic," says Dr. Andrew Parker, team physician of the NHL's Colorado Avalanche and a member of the Association of Professional Team Physicians. "More snowboarders simply equals more injuries."

Join Dr. Parker as he discusses the types of injuries he usually sees and what snowboarders can do so that injuries don't keep them from "riding" all winter long.

Has there been an increase in snowboarding injuries in the last few years?

Dr. Parker: Unquestionably. Obviously this is due to the increase in the number of snowboarders over the last few years. It's the sheer volume of people on the mountain -- more people, more injuries. I don't think it's an issue in terms of there being so many people snowboarding that it's people injuring people; I think it's more of the fact that if you have more people, there are going to be more injuries.

I also don't think there is much to the claim by skiers that snowboarders are out of control and cause more injuries. If skiing had a sudden boom in popularity, you would see more skiing injuries as well. It's simple numbers.

What are the most common injuries?

Dr. Parker: It's interesting. If you think about how you fall when you ski, you have a really long lever-arm in the form of a ski attached to your foot. So we see a lot of knee injuries, people tearing the anterior cruciate ligaments (ACLs), for example. In snowboarding, your feet are pretty much strapped in to the board and aren't going anywhere, so we tend to see many more upper-extremity injuries than we see in skiing -- shoulder, elbow, wrist and hand injuries.

When snowboarders fall, they land on their hands, their shoulder, their rear-end or their head. One of those is going to take the brunt of the force as opposed to the typical skiing injury where there are going to be torque-type injuries on your knees and lower extremities.

Specific injuries include distal radius fractures -- wrist fractures. There are also wrist sprains and elbow contusions and dislocations. A lot of contusions and rotator cuff injuries in the shoulder. Broken collarbones. Concussions and other head and neck injuries.

What are the treatments for snowboarding injuries?

Q: I am 23 and I tore my ACL when I was 14. My doctor said I was too young to have the reconstructive surgery because I wasn't finished growing. I never had reconstructive surgery (but did have arthroscopic surgery) and continued to play high school and college football and baseball.

Now that I am not quite as active, I have a problem with stiffness and I also have pains when I walk up the stairs. I run fine with no pain, but I can tell that my knee is weaker than the other and I find myself guarding it. Do I need to have the reconstructive surgery now even though I can still play competitive sports with only some stiffness and occational pain? Or do I just need arthroscopic surgery again?
-- Jon Otto, Houston, Tex.

A: From Dr. Charles Burke, team physician for the Pittsburgh Penguins:
"I would recommend a repeat orthopedic exam. The problem with 'living with' an ACL-deficient knee is additional and ongoing damage to your knee. This can include torn cartilage (meniscus) and development of arthritis. Continuing to play sports could accelerate these problems. I am concerned about your symptoms of pain and stiffness. If you also are developing swelling, this indicates further problems."

Do you have a question for a team physician? Click here to ask. And check out more "Ask the Pro Doc" answers to users' questions.

Dr. Parker: In the same way with any other sport, the activity doesn't dictate the treatment -- the injury does. For wrist fractures, the relative young age of snowboarders may dictate a more aggressive form of treatment than you might normally see. In a general orthopedic practice, the greatest number of these injuries usually occurs in the elderly population. You tend to be less aggressive from the standpoint of surgical treatment with an older patient. Most of these people have their fractures lined up or reduced appropriately and then put in a cast or splint. In the younger population, while the fractures are usually not as bad because the bones are not as soft, if a break is comparatively significant, it will probably be treated more aggressively. This means either with open induction/internal fixation, which means making an incision, lining the bones up and holding them with screws or pins or placing something called an external fixator, which is a frame that goes outside the wrist connected to the bones through the skin.

Shoulder injuries are usually treated more conservatively with strengthening programs for the rotator cuff, anti-inflammatories for the contusions and swelling and rest for the general healing process. But again, the actual injury determines the aggressiveness of the treatment.

Can snowboarders do anything to prevent injuries?

Dr. Parker: You don't have to be an aggressive snowboarder to get injured just as you don't have to be an aggressive skier to sustain a significant knee injury. However, if you are going to put yourself in fairly dangerous situations by "boarding" in the trees or going off a lot of jumps and doing a lot of tricks, I think helmets are worth considering in those situations.

There is also probably much to be learned from the rollerblading phenomenon. You see rollerbladers with wrist guards and elbow guards to protect them from the pavement, but a mountain can be just as unforgiving. These pads would seem to be an inexpensive way for someone to protect the upper extremities, especially for the beginner who will fall a lot. The restrictive properties of these pads will help prevent injuries.

It's also important to remember that just because both are done on a mountain in the snow, snowboarding is quite different than skiing. I think people may think that just because they are good skiers, they will be good snowboarders and that is not the case. So take some lessons from a qualified teacher or someone who has done this a lot is a good idea for the beginning snowboarder to help prevent some of the injuries that we see.

Dr. Andrew Parker, a member of the Association of Professional Team Physicians (PTP), is currently team physician for the Colorado Avalanche of the NHL. He is a member of the American Academy of Orthopaedic Surgeons and is also a consulting physician for the Denver Nuggets. Dr. Parker received his undergraduate degree from Occidental College in Los Angeles and his medical degree from Northwestern University in Chicago. He also completed his residency in Orthopedic Surgery at Northwestern University Medical School and was a Knee and Sports Medicine Fellow at Louisiana State University.

The information, including opinions and recommendations, contained in this website is for educational purposes only. Such information is not intended to be a substitute for professional medical advice, diagnosis or treatment. No one should act upon any information provided in this website without first seeking medical advice from a qualified medical physician.

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