Wintersport Injury Prevention

NSBSA Sport Injury Prevention Tips … Dec 2012

Dehydration – Too little water is a problem…….

Proper hydration before, during and after a run is critical in all weather. Skiers and boarders, instructors and participants can lose a great deal of water through sweat in warm weather and failure to properly replace these fluid levels can lead to dehydration. Drink water or replacement drinks before your activity or teaching, and  drink periodically throughout the morning and afternoon. There are a number of hydration packs available which make carrying your own water on runs quite easy and comfortable.  A few small sips of water or replacement drink every hour or less, is better than waiting until you feel thirsty to take a drink. This is because once you feel thirsty; you have already started to become dehydrated. Runners drink 16 ounces of water or replacement drink for each pound they loose during the course of the run.

Consider using sports replacement drinks instead of water when working out in warm weather. This can help to prevent hyponetremia which can develop when an athlete drinks too much water and the blood becomes diluted. Sport enthusiasts lose a great deal of salt through sweat and not replacing this salt can be damaging . For example marathon runners who only drink water during the race put themselves at risk because they are not replacing the salt that the body needs. However, drinking sports replacement drinks which contain electrolytes can help the body to avoid becoming depleted of sodium.

Mild to moderate dehydration is likely to cause:

• Excessive thirst

• Sleepiness or tiredness — Children are likely to be less active than usual • Dry mouth

• Decreased urine output — dark urine

• Few or no tears when crying

• Muscle weakness

• Headache

• Dizziness or light-headedness

Severe dehydration, a medical emergency, can cause:

  • Extreme thirst
  • •• Irritability and confusion in adults
  • •• Very dry mouth, skin and mucous membranes
  • •• Lack of sweating
  • •• Little or no urination — any urine that is produced will be dark yellow or amber
  •  Sunken eyes, Pale Skin
  • •• Skin that lacks elasticity and doesn’t “bounce back” when pinched into a fold
  • •• Low blood pressure
  • •• Rapid heart beat
  • •• Fever
  • •• In the most serious cases, delirium or unconsciousness.

Treating Dehydration in Athletes of All Ages

For exercise-related dehydration, cool water is your best bet. There’s no need for salt tablets — too much salt can lead to hypernatremic dehydration, a condition in which your body not only is short of water but also carries an excess of sodium. Some people prefer sports drinks containing electrolytes and a carbohydrate solution, but they’re not essential unless you’re exercising strenuously for an hour or more.

Treating Severe Dehydration

Children and adults who are severely dehydrated should be treated in a hospital emergency room where they can receive salts and fluids through an IV rather than by mouth. Intravenous hydration provides the body with water and essential nutrients much more quickly than oral solutions do — something that’s essential in life-threatening situations.


Preventing dehydration sounds easy enough: consume lots of fluids and foods high in water such as fruits and vegetables Unfortunately, determining appropriate water intake isn’t an exact science, especially because so much depends on your age, physical condition, activity level, locale and participants own unique physiology.

Some general guidelines exist, however. The most familiar is probably the 8 by 8 rule — that is, drink at least eight 8-ounce glasses of water a day. A better idea may be the replacement plan. Most adults lose about 2.5 liters of water a day through breathing, sweating and elimination. Food accounts for about 20 percent of your fluid intake, so consuming 2 liters of water a day (a little more than 8 cups) in addition to your normal diet should replace what you lose. On the other hand, the Institute of Medicine recommends more — 13 cups of liquids a day for men and about 9 cups for women.

Perhaps the best overall recommendation is to make a conscious effort to keep yourself hydrated and to make water your beverage of choice. That might mean drinking water with every meal and between each meal; taking water breaks instead of coffee or tea breaks; and substituting sparkling water for alcohol.

These guidelines take into account special circumstances such as strenuous exercise, heat and humidity, pregnancy, breast-feeding, and illness. In those cases, you may need to drink much more.

Hyponatremia – Too much water

Long distance, marathon and triathlon runners are most at risk, because the longer they run the more they sweat, and the more likely they are to consume too much water without taking in enough sodium.  Sodium (salt and chloride) is an essential electrolyte  which allows water to permeate the cell walls so that water can be redistributed throughout the body, allowing muscles to work and organs to function.  Most people don’t get into trouble with a morning workout or a three to five-mile run.  However, consuming too much water and not enough electrolytes,  could hurt the body. Often participants may need to use the facilities, but if not able to, and if  the body can’t use the water , the reverse can occur, dehydration while you’re virtually drowning your body.  Untreated, this can lead to collapse, convulsions, and even death according to the experts.

The symptoms of hyponatremia include muscle weakness, fatique, sweating, bloating, a feeling of fullness in the stomach, nausea, incoherence and disorientation, irritability, and headache. You may be unable to take in any more water, and also unable to urinate. It’s important to review the symptoms and signs. if you have the symptoms of hyponatremia, chances are good that you’ll either be unable to communicate that, or unable to know you’re in trouble.   When the amount of sodium in fluids outside cells drops, water moves into the cells to balance the levels. This causes the cells to swell with too much water. Although most cells can handle this swelling, brain cells cannot, because the skull bones confine them. Brain swelling causes most of the symptoms of hyponatremia.   In hyponatremia, the imbalance of water to salt is caused by one of three conditions:

  • Euvolemic hyponatremia — total body water increases, but the body’s sodium content stays the same
  • Hypervolemic hyponatremia — both sodium and water content in the body increase, but the water gain is greater
  • Hypovolemic hyponatremia — water and sodium are both lost from the body, but the sodium loss is greater

Hyponatremia is the most common electrolyte disorder in the United States. engine/6/6_1/1179.shtml

Skiing and Boarding with Asthma

Research shows that gradual running is much easier on asthmatic lungs than intense, all out speed. This is true both when learning to run, or any sport, and also when practicing. Short, intense bursts of speed can  leave the asthmatic runner or athlete desperaVolunteer Locallytely gasping for air, so longer, slower, endurance runs are easier on the lungs.

* Cold, dry weather  is harder on the lungs than warmer, moist conditions. If the lungs are kept moist and warm, then an attack is much less likely, since dryer and colder conditions are triggers.

* In cold weather, using a scarf or higher collar, to protect your nose and throat may help.

* Some participants are on medications. Pay close attention to their requirements to minimize the possibility of an outbreak. Getting careless due to inattention or the excitement of an event may result in unpleasant consequences.

* Fitness is very important. Many participants are not physically fit for the environments they are about to be a part of.  Regular aerobic exercise, in particular, will help to develop the lungs, heart and circulatory system.

Beginners yoga and gentle stretching, with concentration on the breath can greatly help asthmatics to stay fit and avoid attacks induced by running, and extreme exercise. With yoga, every movement is coordinated with the breath and this discipline will greatly help when actually running on the track. You can learn to coordinate your running steps with your breath in a mindful way that reduces the likelihood of an asthma attack. In addition, yoga greatly relaxes the body and reduces stress. Often the fear of an asthma attack is exactly the trigger that brings on a real one. There are Olympic runners that compete successfully even though they have asthma.

*   Paying attention to the participants needs as well as your own  can be helpful as asthma is a debilitating disease in all climates, and particularly cold climates. Asthma that might be only an annoyance to a non-athlete can be the difference between success or failure in an athlete.

Skiing and Boarding with Autism            The use of a voluneteerhelmet may not be appreciated, by this individual…. but if everyone wears an adjustable one….Life is Good…..Look at videos …. Patience and Modeling Safety are key.  Participants are encouraged to ski with a buddy when not in class. Go Have Fun Safely…….

Collegiate Gatherings   All levels of skiing and ability, especially collegiate, as expressed by the USAA is at higher risk for injury and death…..  A time for meeting up every so many runs is helpful, stay within bounds, and keep  earbuds or exterior media volume on low or off.  Listen to the sounds of the outdoors…..Make Your Own Echo’s Safely……Respect The Outdoors….Stay Injury Free  …Hold off on the alcohol, you don’t drink and drive,  don’t drink and ski… use common sense….moderation is key….

Clothing and Gear      Dressing comfortably is also important for skiers and boarders who continue to work out even when it is very warm. Clothing worn by instructors, coaches in all conditions should be layered, and should be constructed of fabrics which are both lightweight and breathable. This will help to keep the instructor cooler. Investing in clothing constructed of fabrics that wick moisture away from the skin can also help to keep the runner more comfortable in warm weather. Note : cotton underlayers hold moisture longer and are heavier than lighter wicking fabrics. New fabric combinations result in better core temperature.

Exposure to the sun is also a concern in alpine environments. Snow blindness, and eye fatigue or injury can occur from excessive sun, especially in the outback situation. We highly recommend goggles  for blocking sun as well as sunglasses for the same.  A high SPF for the skin (sun protection factor) is also a must on snow, and in the outdoors all year round.  Wearing a breathable, adjustable helmet, provides safety, and warmth.  But in some cases can contribute to overheating and excessive warmth in warmer weather. When wearing helmets, make sure the participants get to take off their helmet when indoors resting between runs.

All participants are encouraged to wear a sunscreen to protect the skin in outdoor alpine environments. There are several brands of sunscreen available designed specifically for use by runners and other athletes. These sunscreens are less likely to drip into the eyes and cause stinging than other types of sunscreen.

Common Injuries

*       Despite your best injury prevention efforts, you may find yourself dealing with some aches and pains. Injuries take a few weeks to develop., or they may take only a few seconds to occur. But in many cases, most ski and board injuries are preventable.

Knee  and Leg Injuries

Pulled Hamstring

A pulled hamstring is a common sports injury, seen most commonly in sprinters. A pulled hamstring is a injury to the muscle called a hamstring strain. Treatment of a pulled hamstring is important for a speedy recovery.

Patellofemoral Syndrome

Also called “Runner’s Knee,” problems associated with the patella, or kneecap, are common in runners. The term runner’s knee may refer to several common injuries such as chondromalacia, patellar tendonitis, or generalized knee pain.

Dislocating Kneecap                                                                                                                                                A dislocating kneecap causes acute symptoms during the dislocation, but can also lead to chronic knee pain. Patients who have a dislocating kneecap may improve with some specific physical therapy strengthening exercises.

Plica Syndrome

Plica syndrome occurs when there is irritation of the lining of the knee joint. Part of the lining of the knee joint is more prominent in some individuals, and can form a so-called plica shelf. If this tissue becomes inflamed, it can cause knee pain.

Iliotibial Band Syndrome

The iliotibial band (IT band) is a thick, fibrous band that spans from the hip to the shin; it lends stability to the knee joint, and is attached to muscles of the thigh. ITBS is caused when the band becomes inflamed and tender. It may snap or tear with severe stress do to an improper twist or fall, or sever with over exertion for extended periods of time, such as terrain park type pipe and stunt practices. Trying a skill improperly , landing incorrectly, or over turning,  over setting the mark for a skill level…

Shin Splints     Shin splints, like runner’s knee, is a term that describes a set of symptoms, not an actual diagnosis. Shin splint pain can be due to problems with the muscles, bone, or the attachment of the muscle to the bone.

Stress Fractures, Broken bones   Stress fractures are common in alpine environments, with skiers and boarders alike. They occur when a participant pushes themselves beyond their limits, in the terrain park, and on the slopes. They can be avoided. Stress fractures are usually seen in long distance runners, and much more commonly in women than in men. These injuries are usually seen in endurance athletes with deficient nutrition or eating disorders.                                                                                           

Exercise Induced Compartment Syndrome    Exercise induced compartment syndrome is a condition that causes pain over the front of the leg with activity. Patients with exercise induced compartment syndrome may require surgery, to relieve their symptoms.

Ankle ,Wrist and Thumb  Injuries

Ankle and Wrist Sprains and Ruptured Ligaments   Ankle  and wrist sprains are common injuries. Early recognition and treatment will help speed recovery . When in doubt, one must wrap the injured tendons with a supportive bandage that will keep that area supported throughout the day. If the ski boot fit is too large, use two pair of thick socks, and try a comfortable foot insert for support.  Avoid using the hands needlessly without proper gloves and gear . Thumb injuries are common. If the snow surface is extremely hard or icy, pole gently..for balance.. and timing…Improper  pole use, or unexpected hard surface jambs with the hand, thumb or ski pole or strap can cause the thumb ligaments to sprain, rupture, or tear rendering the thumb unusable for gripping. Surgery is often recommended to repair this injury. …Snowboarding can cause a variety of wrist and arm sprains and tearing. When landing or slowing yourself down, understand your hands are not always ready for the pressure they are about to receive…Be Gentle

Achilles Tendonitis   Achilles tendonitis is a painful condition of the tendon in the back of the ankle. Left untreated, Achilles tendonitis can lead to an increased risk of Achilles tendon rupture. Bad fitting boots can cause this injury.

Foot Injuries

Plantar Fasciitis   Plantar fasciitis is a syndrome of heel pain due to inflammation of the thick ligament of the base of the foot. A tight, inflamed plantar fascia can cause pain when walking or running, and lead to the formation of a heel spur. Sometimes your participants will have this before they even try an alpine activity. If someone is in pain before they ski and board, make a note of it, ask how your group is feeling, and make sure they do not overexert themselves under your watch…

Overpronation     Pronation is a normal movement of the foot through the gait cycle. When this motion becomes excessive, over pronation can cause a variety of problems by altering the normal mechanics of the gait cycle. Inserts to control excess foot motion in a boot can be helpful for over pronators. Ski boots and boarding boots can help this problem, as well as worsen it. Improper boot fitting brings with it a host of other muscle fatigue , and uncomfortable , sometimes painful experience on the slopes.

Foot and Arch Pain  Arch pain is a common foot complaint. Arch pain, also sometimes called a strain, is an inflammation under the arch of the foot. Treatment of arch pain often consists of adaptive footwear and inserts. You and your participants should use inserts in boots that are not fit specifically. Make sure all rental boots are properly fitting before taking a participant out to have fun. Children are not always fit properly before getting off to their first lesson. This causes tremendous pain in the boot. If they do not fit well, have the parents exchange ASAP for a better fitting boot, and join a different lesson, or get in on the one they are missing if it is not too late, and OK’d with the instructor.

Hip & Thigh Injuries

Hip Bursitis   Inflammation of the bursa over the outside of the hip joint, so-called trochanteric bursitis, can cause pain with hip movement. Treatment of hip bursitis is often effective, but the condition, as with other injuries, has a tendency to come back and sometimes becomes a persistent problem.

Snapping Hip Syndrome  Snapping hip syndrome is a word used to describe three distinct hip problems. The first is when the IT band snaps over the outside of the thigh. The second occurs when the deep hip flexor snaps over the front of the hip joint. Finally, tears of the cartilage, or labrum, around the hip socket can cause a snapping sensation.

Preventing Common Injuries and Dislocations of Joints and Other Body Parts

While this information should probably be first, many athletes, runners included, fail to take proper steps to avoid injury. Even with the most attentive preventative athlete, however, injury may still occur–such is the nature of the sport. Taking a few moments to check on a participants comfort level  will decrease chances of developing a serious problem:                                    – 5 –

Hyperthermia  is elevated body temperature due to failed thermoregulation that occurs when a body produces or absorbs more heat than it dissipates. Extreme temperature elevation then becomes a medical emergency requiring immediate treatment to prevent disability or death.   Common causes include heat stroke and adverse reactions to drugs. The former is an acute hyperthermia caused by exposure to excessive heat, or combination of heat and humidity, that overwhelms the heat-regulating mechanisms of the body causing uncontrollable elevation of body temperature.

Hypothermia   is caused by the lowering of the body temperature resulting in the constriction of blood vessels, sending less blood to the cells. The skin becomes pale in color, there may be loss of judgment , mumbling, grumbling, shivering, lips turn color, loss of fine motor skills, cannot zipper their coats, individuals cannot put on their  gloves, small muscles loose control, making it hard to regain inner warmth. Walking and other skiing and boarding activities are impaired, stumbling may occur,  muscles become uncontrollable. Participant stops talking, blood cells go into a hibernation at 86 degrees F .  Some causes include;  not enough layers, wet fabrics, excessive sweating, wind, drafts, excessive time waiting for a lift to start,  no hat or head gear,  excessive exposure to snow machines, long time standing in extreme cold, or wet environments,  exterior cold and icing, as well as not so cold exterior temperatures. A wet, damp environment can cause a gradual grouping of symptoms ;If caught too late, the pulse will slow, and participant may feel sleepy and curl up to sleep.  At this point core circulation is threatened. CPR will not help and can hurt causing excessive toxic waste into the extremities. Best to make participant go inside well before this stage occurs, and drink warm fluids.  Must build a fire inside their belly. They must get all of their wet garments off, and dry them out.


Due to loss of circulation, and extreme cold weather, extremities are inclined to go numb, fingers, toes, cheeks tend to discolor. There is little to no feeling in limbs, lack of coordination, painful movement. When warming up the extremities,  do so with a gentle warm breathe, warm dry clothes, gentle movement , not too hurried and no touching of these areas until the  skin starts to turn normal in color . Then you may gently rub and warm the skin to correct temps. There may be burning sensations, or pain…May reoccur quicker , more easily in future.

Watch others, be aware. If there is one person cold, there are usually others cold as well.  Injury prevention is a  serious issue for those who exercise regularly, especially those who are in training for a particular race or event. In these cases injury prevention is not only important because it helps avoid a painful injury and potentially long recovery period but it is also critical because an injury can disrupt the training schedule and result in not being properly prepared for an event.  Injury prevention awareness and properly fitted clothing can go a long way towards injury prevention, serious injury and death.

High Altitude Euphoria, Vertigo and Inner Ear Imbalance

High Altitude euphoria is something to watch for. Lack of oxygen can be debilitating as well as exhilirating. A lack of equilibrium can cause nausea.

Proper Fitting of  Cross Training / Running  Shoes

One of the most important pieces of equipment for sport enthusiasts are their running shoes. Running shoes should fit properly, not be overly worn and should also ideally be designed to accommodate the runner’s style of running. Additionally, running shoes should be replaced regularly to prevent injuries which may result from the running shoe being overly worn out. A good recommendation for how often to replace a pair of running shoes is every 300-500 miles. Some runners keep a detailed training log with a section for accumulated miles since the runner started wearing a new pair of running shoes. Good foot support is encouraged for dryland training.

Skiing in The Trees,  Out of Bounds,  Behind Snow Guns and Snow Machines  Can  Kill  You

Know your limitations, don’t try to ski or snowboard behind snow making equipment, or machinery, as this can cause serious injury and death…. Be visible….Dirt and gravel, grass and tree stumps are not forgiving.  Even skilled amateurs and professionals will tell you skiing off piste is  dangerous and often impossible. It’s a tough ending to endure when there is no snow to support the activity. . When going into backcountry, bring properly packed  backpacks, be prepared, take a wilderness first aid course.

Brain Injury and Prevention

We promote the program  Lids on Kids designed to educate children and young adults on the importance and protection  of the brain while skiing and boarding.  We believe the clashes and collisions caused from boarders and skiers colliding is real and preventable. When a  participant of either activity cannot slow down, turn or stop, and both parties fall, a head can get hit by a ski or board, resulting in serious brain injury, parapalegic injury,  and death. Well fitting, adjustable helmets go a long way in protecting the participants from serious head injuries and should not be underestimated by any age or skill level. .

Stretching and Muscle Alignment for Skiers and Boarders

Stretching regularly can also help to avoid injuries. Teaching your participants to stretch safely is key. One worthwhile recommendation for stretching is to gently stretch before, during and after a run.  Gentle stretching before, even during  a run stretches cold muscles which are not as pliable as muscles which have been warmed up . Head, neck and arm circles, arm stretches, upper body stretches, and lifting of the feet in the boots, on the skiis, or board is helpful.  It is also a good idea to cool down or gently stretch after you have completed your run. This helps the muscles properly relax and will aid in the recovery process . This is important because the muscles can tighten considerably during the course of the run. Gentle stretching afterwards will help to prevent a long term shortening of the muscles.

Finally, we can help to prevent injuries by taking care to avoid doing too much mileage too quickly. An individual who has not been running, or working out at all and attempts to immediately start skiing or boarding is likely to experience a number of different injuries. Those who have not been working out regularly are advised to start out with a couple of stretches on the snow before they continue to go down the hill.. Even experienced skiers and boarders can cause injuries by attempting to increase their mileage, and skill level too quickly. You should aim to increase the skill levels as gradual as possible and try to avoid injuries commonly associated with overtraining such as shin splints and stress fractures.

NSBSA References  

Charlottesville Womens 4 Miler Training Program Manual ,  SOLO Wilderness Training Program

  1. Skorecki K, Ausiello D. Disorders of sodium and water homeostasis. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 117.
  2. Verbalis JG, Berl T. Disorders of water balance. In: Brenner BM, ed. Brenner and Rector’s The Kidney. 8th ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 13.    Review Date: 5/29/2011.   Reviewed by: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc A.D.A.M., DisclaimerCopyright © 2012, A.D.A.M., Inc.


The National Ski and Board Safety Association    300 Preston Ave.  Charlottesville, VA 22902

Office Phone 434 293 3262
  Cell 434 987 2074  Volunteers Needed…Give ED Sara Greenfield a Call

Website Designers and Social Media Volunteers Needed,    Nonprofit  Donations Graciously Accepted


– 7 –


One Response

  1. Dick Bolt
    Dick Bolt / 3-2-2013 / ·

    I am a retired System Safety Engineer living in Far Western MD working on lake, boating, park & ski safety!

Leave a Reply