CHAPTER 80 • CROSS-COUNTRY SKI INJURIES 477- Stiffer bindings and rigid boot construction with
heel-ski fixation devices in skating equipment may
increase the risk of ankle and knee injuries.
- The biomechanics of the new technique are also sug-
gested in the changing injury patterns.
1.The skating stride places significantly greater
demands on the hip adductors and external rotators
(Renstrom and Johnson, 1989).
- A greater emphasis on upper body strength in the
double poling action has been implicated in
increasing upper extremity overuse injuries
(Dorsen, 1986).
Comparison of Techniques
- Initial reports suggested greater incidence of injury in
the skating technique; however this remains unsub-
stantiated. - In one recent report of injuries occurring during a long
distance event where the skating technique was the
dominant style used, the injury rate was found to be
higher than reported for similar races in the preskating
period (Butcher and Brannen, 1998).
INJURYDISTRIBUTION
- Studies describing the distribution of musculoskeletal
injuries in mass participation events demonstrated that
lower extremity injuries are somewhat more common
than upper extremity injuries (55% vs. 35%) (Sherry
and Asquith, 1987).
The Distribution of Injuries
- Sprains/twists 40.4%, fractures 27.4%, contusions
16.4%, lacerations 9.3%, dislocations 5.8%, and other
0.7% - The most frequently encountered acute orthopedic
complaints include thumb ulnar collateral ligament
strain, knee medial collateral ligament sprain, and
plantar fascia strain. - The most common overuse injuries include sacroiliitis,
1st metatarsophalangeal(MTP) DJD/synovitis, lateral
ankle pain, and wrist tendinitis.
MEDICAL PROBLEMS
- Common medical illnesses reported include exhaus-
tion/dehydration, cold injury, gastrointestinal (GI)
symptoms, photokeratitis, and bronchospasm.
COMMON MEDICAL CONDITIONS
EXERCISEINDUCEDASTHMA
- Incidence:Exercise induced asthma(EIA) effects up
to 35% of winter sports athletes with the highest inci-
dence found in cross-country skiers (Sue-Chu, Larsson,
and Bjermer, 1996; Larsson et al, 1993; Rundell et al,
2000). One study reported 50% of elite cross-country
skiers with EIA (Rundell et al, 2000).- Pathophysiology: EIA refers to an inflammatory
mediated bronchial response precipitated by exercise.
Exercise is a common trigger of symptoms in athletes
with classic asthma. There does appear to be a sepa-
rate population of athletes who exhibit symptoms only
with extreme exercise. Etiologic factors are low
humidity and temperature of the inspired air and
extreme minute volume.
•Typically, the athlete with true exercise induced
asthma will develop symptoms only in relatively
extreme circumstances. The likelihood of developing
symptoms increases with exercise involving a higher
minute volume and cold dry conditions. - History:It is common for these athletes to exhibit
symptoms intermittently. The usual symptoms include
shortness of breath with exercise that is out of propor-
tion to effort, burning chest pain, post exercise cough,
and wheezing. - Other red flags include a history of childhood asthma,
frequent upper respiratory illnesses, and a chronic
cough. - Physical examination: When symptomatic may
demonstrate wheezing otherwise is typically normal. - Diagnostic testing:The majority of testing protocols
use running as the exercise challenge with pre- and
postexercise pulmonary function test change as the
measured variable, and as such have significant limi-
tations when evaluating the cross country skier (see
Chapter 23). (Rundell et al, 2000; Eggleston, 1984;
Mannix, Manfredi, and Farber, 1999; Garcia de la
Rubia et al, 1998; Randolph, Fraser, and Matasavage,
1997; Ogston and Butcher, 2002; Carlsen, Engh, and
Mork, 2000; Anderson and Daviskas, 2000; de
Bisschop et al, 1999) - Treatment: With classic asthma, the mainstay of
therapy is inhaled corticosteroid with inhaled bron-
chodilator used for symptom management. These ath-
letes should be identified and treated appropriately.
•With EIA, the main goal is prevention of airway irrita-
tion and bronchospasm through preexercise adminis-
tration of medications. Typically a stepped approach
is undertaken.
Preventive Medications Include the Following- Short acting beta agonists (albuterol, pirbuterol), are
usually effective and have the advantage of low cost,
ease of use, and high compliance. - Long acting beta agonists (salmeterol)
- Leukotriene inhibitors (montelukast sodium) should
be reserved as a second line and should always be
used with a beta-agonist as a rescue medication.