المتخصصون في المجالات الطبية

March 10, 2023

In this Q&A, Kristi M. Colbenson, M.D., an emergency medicine and sports medicine specialist at Mayo Clinic in Minnesota, offers winter sports safety tips as well as information on how to promote safety tips with patients and community members. She also provides input on treating winter sports injuries. Dr. Colbenson has an extensive sports background professionally and personally. She is a U.S. Ski & Snowboard team physician and has served as a high school, college and semiprofessional sports team physician. As a Carleton College undergraduate, Dr. Colbenson was an All-American in outdoor track and field and all-conference in basketball.

What are the most common winter sports injuries?

Most common are:

• Musculoskeletal injury, especially shoulder, wrist and knee.
• Head injury.
• Thoracic and abdominal trauma.
• Cold weather exposure.

What is most dangerous in winter sports?

The high velocity of many winter sports combined with unpredictable winter terrain creates a perfect storm for significant injury.

When you participate in high-risk sports, acknowledge that. Be ready to handle stimuli at high speed.

Any tips to avoid trauma?

Here are some safety tips:

• Prepare adequately. Prepare your body prior to engaging in winter sports with strength training in the off-season and a good warmup in-season. Familiarize yourself with your equipment.
• Start below your skill level. It's important to work up to your top performance. Start with what's easy. Build up to where you want to perform.
• Safety gear. If using helmets, wrist guards or other protective gear feels like a hassle, it's worthwhile to wear safety gear to prevent injury.
• Take appropriate classes. Learning a sport solo or with a friend's tips may not provide necessary knowledge and skills.
• Be defensive, especially when skiing or snowboarding. Keep alert for others crashing or already injured. You don't want to become part of their trauma.
• Understand the conditions. Be well informed about the conditions and terrain. Wear appropriate weather gear. Is the ice thick enough? Obstacles in your path? Is it icy? Storm expected?
• If wondering about a last run, reconsider. After hours of your sport, you may wonder about taking one last run or loop. If you're questioning, don't do it. You've likely got mental and physical fatigue. You're at higher risk.

Any suggestions for treatment of winter sports injuries?

Always fall back on your Advanced Trauma Life Support training. Specific suggestions include:

• Know the trauma ABCDEs. It helps to know the procedures you'll follow before a high-stress trauma.
• Get head injury training. Become educated in concussion and head injury diagnosis. Familiarize yourself with the Pediatric Emergency Care Applied Research Network rules and the Canadian CT head rule.
• Prepare for musculoskeletal injury examination. Know how to perform a musculoskeletal exam. Be aware these may not be the first injuries you need to address.
• Consider hidden injuries. Some injuries aren't obvious, such as thoracic spine injury or small pneumothorax.
• Be algorithmic and don't get distracted. Be alert for distractions, such as extremities facing the wrong direction. Despite appearance, they may not be the most urgent issues. You don't want to miss a life-threatening injury. The best trauma surgeons I've worked with stay on their procedures and don't get distracted.
• Familiarize yourself with gear. It's good to practice winter sports gear removal before trauma arises. In our emergency department, we practice things like taking off ski boots with underlying trauma and helmets without causing further neck injury or damaging the cervical spine. Know any equipment that might come into the trauma center. Worst case, if you can't remove a helmet, it can go through a CT scan.

How do you address traumatic injury pain?

IV or IM pain medications are your best options. Don't forget about pain-dose ketamine as a great option for musculoskeletal pain.

Have you experienced poor behavior with injured patients?

Yes. Traumatic brain injury or concussed athletes can present with significant agitation. However, don't forget that brain underperfusion or insufficient oxygenation and ventilation also alter mental status. Hypothermia also may alter mental status.

If the patient is agitated or altered, first think about underlying causes. Then consider treatment with pain-dose ketamine or benzodiazepines.

The worst thing for a patient exhibiting unruly behavior post-injury is applying restraints.

Do you counsel patients about winter sports safety issues?

Yes. It's important to raise safety issues, especially if the patient wasn't using protective gear when injured. It's our professional duty to address this.

You might say to the patient, "For the future, if you'd worn wrist guards, they would've prevented this injury."

What's critical to document with a minor head trauma?

Document that you've completed the following:

• Say, "I'm concerned you have a concussion."
• Tell the patient, "You need to see a specialist before you return to sports."
• Perform a smooth pursuit vision test and videotape it. Show the patient any abnormalities in their vestibulo-ocular reflex.
• Conduct the Balance Evaluation Systems Test (BESTest) for useful posture and balance information. The test clarifies if patients aren't at functional baseline.

How can we improve as health care providers for these injuries?

We often do poorly at assessing for concussion and explaining what it is. We need to provide information about what is needed to heal and avoid second injury syndrome. If patients are athletes and return to sports before they return to their baselines, they may suffer long-term effects.

How should health care providers spread winter sports safety tips locally?

Social media is great for disseminating these messages. Resorts also employ significant education and prevention efforts now. Local club leaders — such as at school ski clubs — also can spread the word.

For more information

Nakhjavan-Shahraki B. Pediatric Emergency Care Applied Research Network (PECARN) prediction rules in identifying high risk children with mild traumatic brain injury. European Journal of Trauma and Emergency Surgery. 2017;43:755.

Stiell IG. The Canadian CT head rule for patients with minor head injury. The Lancet. 2001;357:1391.

Horak FB. BESTest: Balance Evaluation Systems Test.

Grasse KL, et al. Analysis of a naturally occurring asymmetry in vertical smooth pursuit eye movements in a monkey. Journal of Neurophysiology. 1992:67;164.

Refer a patient to Mayo Clinic.