Sports Medicine: Just the Facts

CHAPTER 82 • FIGURE SKATING 489

spent on the ice. Over the past 5 to 10 years, however,

attention has been placed on optimizing ankle strength

in off-ice programs. In the elite athlete, weakness in

the ankle stabilizing structures is much less common.

Lower Leg

• Posterior medial tibial syndrome, peroneal tendinitis,
  and/or fibular stress syndrome may develop at the level
  of the top of the boot. These syndromes are typically
  attributed to weakness of the tibialis posterior and per-
  oneal muscles. They can also be due to relative inflexi-
  bility of the gastroc–soleus complex. Continued training
  with such symptoms can culminate in tibial and/or fibu-
  lar stress fractures. Treatment and prevention include
  optimizing flexibility in the gastroc-soleus complex,
  strengthening of the ankle inverters and averters, evalu-
  ation of the boot, and the skater’s position within the
  boot. Orthoses, blade mounting, and padding of the top
  of the boot may be beneficial.

Knee

• Anterior knee pain is one of the most frequent prob-
  lems and typically occurs in the “landing leg.” The eti-
  ologies are multiple and include relative hip
  weakness, quadriceps weakness, inadequate flexibil-
  ity of the hip and thigh musculature (Smith, Stroud,
  and McQueen, 1991), patella shape, and tracking
  issues. Skaters may also experience patellar compres-
  sion injuries from falling but rarely experience patel-
  lar fracture.


• Infrapatellar and patellar tendinosis are seen in elite
  skaters and are often very difficult to treat because of
  the lengthy competitive season. The authors have used
  prolotherapy with good results.


• Meniscus and ligament injuries are relatively rare in
  figure skaters, likely due to the lack of fixation of the
  blade in the ice. Jumps are typically landed as the ath-
  lete is skating backward and cocontraction of the
  quadriceps and hamstring muscles is necessary for
  control of the landing.

CORE, HIP, ANDPELVIS

• Athletes are presenting with an increasing rate of
  groin, hip flexor, adductor complex, and external and
  internal oblique injuries. These types of injuries are
  some of the most common injuries sustained by the
  most elite athletes. An estimated 25% of national
  team members from the United States and Canada
  have been affected by hip flexor injuries in recent
  years.


• The increase in these types of injuries is attributed to
  the focus on triple and quadruple revolution. The
  mechanisms are multifaceted. Skaters perform
  upwards of 45–60 practice jumps daily. They often
  have tight hip flexors and asymmetrically strong hip

flexors. Additionally, skaters can have relatively weak

or asymmetrically strong core musculature and hip

stabilizers. Combined, these issues increase the poten-

tial for overuse injury.

•Avulsion fractures of the ischium, lesser tuberosity, and

crest of the ilium have increasingly been reported in sin-

gles and pairs skaters, as well as synchronized skaters.

These occur during early phases of growth spurts, and

have markedly increased in athletes who perform the

more difficult double, triple, and quadruple axel jumps.

These injuries are slow to heal and often recur. Proactive

evaluation of the athlete for hip strength asymmetry,

flexibility, and endurance can be preventive.

Additionally, it is important to ensure that an athlete has

adequate strength to initiating training for such jumps.

SPINE

• Many skating moves and jump landings require an
  arched or hyperextended back, placing the posterior
  elements of the lumbar spine at increased stress and
  causing potential for lumbar strain, facet pain, poste-
  rior iliac crest injury, spondylolysis, and spondylolis-
  thesis. The rigidity of the boot and restricted plantar
  flexion of the ankle limits adequate knee flexion,
  therefore the athlete is unable to maintain normal
  alignment of the spine with jump landings.


• Spondylolysis is often missed by clinicians, and a high
  level of suspicion is important to diagnose this injury
  in skaters. A young skater with persistent back pain
  should be evaluated with X-rays, followed by a single
  photon emission computed tomography(SPECT) bone
  scan or computed tomography(CT) of the area.


• Appropriate therapy includes strengthening of the
  core musculature to provide control of the trunk and
  pelvis and to assist in maintaining the alignment of the
  body during jumps, spins, and lifts, as well as
  strengthening of the ankle-supporting musculature to
  permit the use of a more flexible boot, which accom-
  modates greater dorsiflexion during landing.

UPPEREXTREMITIES

• Upper body strength is essential to both jumping and
  spinning, and pair elements. Many elite skaters have
  inadequate shoulder stabilizers.


• Synchronized skaters are at increased risk of shoulder
  and wrist injuries as they often hold onto each other
  throughout their programs.

MEDICAL CONCERNS

EXERCISE-INDUCEDBRONCHOSPASM

• The incidence of exercise-induced bronchospasm
  (EIB) ranges from 33 to 50% in elite skaters in the